Words made flesh in Bethlehem

Day 4, spent around Bethlehem singing Christmas Carols, and refecting on stories and sites that reflect the mystery of the Incarnation. Stooping to enter the little door (of which Herbert Howells’ famous carol tells) we found ourselves in a forest of scaffolding that makes the repais on Great Missenden Church look like a Sunday School outing. They are fixing the roof for the first time in many hundred years. This time round I was especially struck by the network of caves under the Church of the Nativity, and especially the tiny space where Jerome spent 40 years translating his Vulgate Bible. We also took in the Shepherds’ fields (where Ruth, tradition says, met Boaz), and a remarkable Palestinian Social and Cultural development centre based at the Lutheran Church here (of which more another time, no doubt).











The Word became flesh, and this fact, and his dwelling among us, gave flesh a new value. Life in itself is shot through with Divinity in a new way. So we went to visit the Holy Family Maternity hospital, run by the Sovereign Order of St John of Malta (known in Germany as “Maltesers”). Since 1985 they have administered the old French hospital site, and in it they have delivered almost exactly 50,000 babies. They currently have 63 beds, 18 in ICU, making their hosopital overwhelmingly the largest provider of neonatal care in the area. The ethos and values are Roman Catholic, but they are, of course, entirely non-sectarian in their service provision which is offered on the basis of need, not means to pay.

Dr Jacques Keutigen, medical and centre director, is one of the most inspiring people I have ever met. He and his administrator, Usama Kheilieh, took us therough some amazing facts and figures. In an area where unemployment is currently better than has sometimes been the case but still runs at 27%, with no social security or free health insurance, they manage to sustain an premature mortality rate of under 2% — better, I believe than the UK’s. consider the large hospital in Gaza, where the premature mortality rate is over 35%. Their motto? “The Poorest Deserve the Best.”

One of our party, Sally Raikes, is a midwife and, like many of us was profoundly moved to reflect on the loving excellence Holy Family offer some of the poorest people on earth as they enter the world. She managed to snap this picture of a new mother and baby attending today, that somehow says it all. There is no point in our words of faith if they do not equip us to recognise Christ where he said he would be, in the face of the youngest and least.

The Christmas story indicates a complete revaluation by God of the least, the most vulnerable and obscure, the disreputable and the displaced. What would a community who really embraced that value look like? How much time would you expect it to have for discrimination based on race, gender, age, orientation, or class, all of which seemingly devalue the humanity of perpetrators as much as objects? Where would class based education fit into its life? I do not believe in human rights and equality as some kind of lefty bolt-on. Fundamental equality is a recognition of the wholeness of God’s gift of life itself. No vision of humanity that discounts it can be whole, and I believe in it because I believe in the Incarnation.

As we broke bread together in the hospital’s chapel, there was a very focused, intense mood among us. We have not got this right, and we need to put serious effort into a new kind of life that makes God’s values our own, as intentionally and thoroughly as those who work at the hospital, to ensure that the poorest not only deserve, but receive, the best.

How healthy is your healthcare?

Max the Cat has been to Michelle the vet this week for an eye ulcer — cost £45 (drugs), & £45 for 3 consultations. But why use the same system as a basis for Human healthcare? There’s been all kinds of blogosphere buzz around the US healthcare debate, some of it comparing our own National Health Service.

Like any system it has its ups and downs, its challenges and pitfalls. Amongst its personal ups as I have experienced them over 54 years are Dr MacArthur, our GP when I was 12. He was an old fashioned Scots socialist who refused to take private patients, and got me a hospital bed in 10 minutes at a weekend because I needed it. He saved my life, and would have been insulted to be offered money over and above his pay for doing such a thing.

Stephanie’s birth as an undiagnosed extended breach in a strange hospital (she arrived early and unexpected on Christmas night) was supervised by one of the finest obstetricians in the world, who gave Lucy the choice, then delivered her faultlessly without a C-Section, using an old midwives’ routine called the Burns-Marshall technique. Both these ace bits of effective medical care were delivered with nary a credit card or insurance policy between them, and I would take a lot of persuading that the kind of medical system we use for Max the Cat would have served us any better.

But if you’re comparing healthcare systems across whole populations, the big statistics are the place to begin. Make no mistake, a system which allows people to die earlier and risks more children’s lives, across a whole population is not as effective as one that delivers higher life expectancy and low child mortality. Efficient use of people’s resources is a bonus, given the inherent and spiralling costs of modern healthcare.

So here are the figures, and the comparisons for the UK, France, Singapore and the USA.
No system is free of glitches, failures and compromises, Every system is challenged by spiralling costs, but what works best is surely an empirical, rather than ideological question. It’s unfortunate that the US faces tough basc choices about healthcare at a time politics has been so snarky and partisan. The basic systems of medicaid and medicare was put together at a time there was a higher level of bipartisan respect and public service ethic. All good systems involve public and private elements, but the clever bit is in how they are belnded for the good of all. With any luck something can be done — why should US babies suffer three times the mortality rates of their counterparts in Singapore?

MK NHS Hospitals Trust Good News

Licensing Karen Reeves to Milton Keynes Hospital as colleague to Carole Hough on Friday, felt like a new beginning for the trust, as well as the chaplaincy. Karen brings a strong professional background in hospital and community healthcare, along with a profound commitment to justice, social inclusion and peace. MK is very much the kind of diverse, fast-moving urban environemnt in which she has really flourished.

Milton Keynes has grown continuously and exponentially over 30 years, with a chronic and worsening overhang as money follows people, sometimes several years behind. This makes any social, health, educational planning a nightmare. Hospitals are especially vulnerable, as a burgeoning young population puts an immense load on the whole system. As MK grows into the 10th biggest city in the country, John Prescott's target for 2020, this problem rages on.

The temptation is always to sweat the immediate challenges, whilst ignoring the big unfolding context. MK Hospitals NHS Trust, chaired by Mike Rowlands and, since last summer, Walter Greaves, has worked hard to make the most of the realities, challenges and opportunities of Milton Keynes, short and long term. Where chaplaincy could easily become roadkill, the trust has worked hard to provide proper spiritual care in in very trying circumstances. Karen’s arival is a tanglible sign of that commitment.

After a few years of backs-to-the-wall, through which Carole has, incredibly, managed to cope, Friday’s service was good news. Karen’s arrival, partnership with bereavement services, a good and supportive trust (Thanks to Gill Rodney and, particularly Nicola Lester), means the chaplancy team is now back on track for full out of hours cover, increasing voluntary support, developing its present excellent ecumenical and interfaith character, and a host of other good work. The Creation hanging in the chapel was by sisters from Turvey Abbey — a beautiful piece of work, that looks all the better at a time of great hope, as well as challenge, for the hospital...

Assisted Suicide and the Law

Statutes are crude, basic means of laying out the ground and protecting people’s basic rights. The ways they are interpreted and applied is where the action is. Remember the dangerous dogs act? It was going to stop dogs killing children, a laudable plan, but proved almost impossible to apply in practice. The devil is in the detail. Hard cases make bad laws, and one person's sensible relief is another's death warrant.

To know that in principle the law, whilst not criminalising suicide, protects life pretty absolutely, is surely no bad thing. As long as it is applied with compassion, it is surely better to know you will have to justify, formally and case-by-case, taking a life, rather than saving it. Death is the exception not the norm.

My mother suffered from dementia, which came with extended episodes of depression, over four very difficult years before her death in 1994. We did what I imagine any family would do — sold her house, and used the money to pay for the very best care for her; which towards the end was pretty total. Yet there were, even late on, some moments of comparative lucidity and even flashes of joy. Although in her depression she sometimes asked insistently to be put down, it helped and protected everyone to know that this was not really an option. Her condition was sometimes extremely challenging for her, her carers, and the family, along with me and my power of attorney. To add to the mix a legal right to assisted suicide would have made it a complete and utter bloody nightmare. And imagine what legislation must also cover, circumstances where there was less goodwill in the family, with several hundred thousand pounds riding on a decision to terminate a.s.a.p. More tea, Dr Shipman?

The fact that this is so extraordinarily complicated an area in which to legislate shouldn’t make it entirely impossible, but it involves thin ice, which it wouldn’t be wise to skate over. This is big life and death stuff, which has to stand up and protect the weak in millions of circumstances far less extreme and unusual than those on which the media is majoring just now. We need to pick our rut carefully. We may be in it for a long time.

(National) Healthy Church?

How healthy is the National Health Service? How healthy what some call the National Church? On the Wardman Wire, Simon Sarmiento reports an address to the July NHS Live event by Donald M. Berwick, Professor of Health Policy and Management at the Harvard School of Public Health, President and CEO of the Institute for Healthcare Improvement. He warmly endorsed the vision and principles of the NHS, compared to the fractured, exorbitant and frequently inequitable US equivalent, with its harrowing tales of medical bankruptcy. By way of constructive criticism, Professor Berwick came up with ten points for NHS policymakers, and Simon wondered how they could be cast as discussion starters for the C of E. Some provisional, kneejerk, suggestions:

1. (NHS) Put the patient at the center - at the absolute center of your system of care.
   (C of E) We exist for the common good; the people who don’t come weekly as much as the people who do. 82% of them used a Church in some way last year. How does what we do serve their real needs? How self-serving are we gathered congregations; how realistic and committed about the needs of people out there?
   
   
2. (NHS) Stop restructuring.
   (C of E) There are limits to the benefits of pastoral reorganisation. After forty years of it there are still doubtless anomalies out there, but people need some sense of stability out of which they can work. You can’t solve process problems by structural tinkering.
   
   
3. (NHS) Third (NHS) strengthen the local health care systems - community care systems - as a whole.
   (C of E) Parishes are where most good happens. People used to have a bumper sticker — “This car may not be a Rolls Royce, but its paid for and it’s in front of you.’ After fifty years of being told by clever people that the parish system has no future, it’s still there, and most people value their local church far more than bigger, slicker and more remote specialised units.
   
   
4. (NHS) To help do that, reinvest in general practice and primary care.
   (C of E) Subsidiarity! Bread-and-butter proclamation, celebration, community building, pastoral care, are not distractions, but the core. job. Deaneries, dioceses are enabling systems for what matters on the ground.
   
   
5. (NHS) Please don’t put your faith in market forces.
   (C of E) Money is a good servant and a bad master! We need to be transparent and realistic about resourcing and deployment, applying fair agreed criteria, but not mindlessly Darwinian. Often the parish church is all that’s left, in the country and Urban centres. Beware pure congregationalism and its attendant scourge, suburban captivity!
   
   
6. (NHS) Avoid supply-driven care like the plague.
   (C of E) For whose benefit are we doing this? Ministry is not all about Vicars, but gifted Christians in community, being enabled to do what they are called to do well. Recognise for whose benefit we are really doing this.
   
   
7. (NHS) Develop an integrated approach to the assessment, assurance, and improvement of quality.
   (C of E) Let’s get the act together! We have fine ideals, like the five marks of mission. Changes to clergy discipline and terms and conditions of service, along with other requirements from society (child protection, charity SORPS) are pulling things together pragmatically. We have mission audits and heathy churches, but very quirky and inconsistent means of assessing them across the network.
   
   
8. (NHS) Heal the divide among the professions, the managers, and the government.
   (C of E) Take responsibility for our own feelings and actions. Put the synodical and other stuctures we have to use, rather than being cynical about them. The answer to a crappy meeting is a good meeting, not no meeting.
   
   
9. (NHS) Train your health care workforce for the future, not the past.
   (C of E) We all want training. Do we all want to learn; and if so, for what? How does theological training measure up to real life? The gold standard of theological education is still often sometimes thought to be party biased, Victorian private institutions, in which perfectly sensible people are taught to aspire to ‘have their own church’ one day. They end up having to learn servant ministry on the job, if training institutions let them, and the rest of us, down like that. How sad if conventional colleges spend millions to provide all the potential of community, and then blow it by the kind of behaviour that hits the headlines. The Hind report has begun to restructure learning and training — but what about process and standards?
   
   
10. (NHS) Aim for health.
    (C of E) Aim for personal and corporate spiritual health. Numbers are fine, but what quality of corporate and personal holiness and excellence do people experience? Sometimes very high; and sometimes not. Sometimes both at one. To present everyone mature in Christ is quite a vision, and we need to be focussed and intentional about delivering it.
    

The Brain — Stroke of Genius

As both my parents had strokes towards the ends of their lives, a remarkable TED talk caught my eye. Recently Jill Bolte Taylor, brain scientist, had a stroke which she was able to analyse as it happened. Her story, from this year’s TED event at Monterey, affirms powerfully the concept of the brain as a powerful self-organising structure, along with some fascinating workshop manual information about what Woody Allen called his “second favourite organ.”

Creepy Man, Scary Stuff

Herr Doktor Gunther von Hagens, that is, with a plastinated chum. Catherine, Lucy and I caught a bit of TV last night — Channel 4’s Eat to Save your Life. Jamie Oliver tried to lighten the load with his usual cheeky chappie bit, but the outlook is as as dark as the Doktor’s hat. In a nutshell, and it looks as though we could do with more of those, the food we eat is killing us, from 70% junk sausages to Killer Kebabs. Hydrogenated Meat and no Veg makes Jack a bloated corpse — and the bloated corpse agrees. We gawked at the yellowing sheet of glutinous fat strangulating his heart and squeezing his lungs up into shriveled mangos higher than his tits. His most noticeable feature was a bloody great slab of what looked like foie gras and turned out to be... foie gras. Talk about a notorious evil liver. This guy managed to stay alive whilst morphing his into warm paté. 18 queasy members of the Great British public lurched ’n retched before Doktor Death’s Monitor of Mirth, wondering what was in their wallets.
Who wouldn’t?

The message was obvious and simple. Our friends in the food industry are rendering everything except the squeak, piling it high and selling it cheap, stashing away industrial quantities of salt and covering their tracks with sugar. Get your five a day, stay off the junk food as much as you can, read the label, and you'll make a pretty corpse. And the undertakers will have another ten years’ wait for you.

Food for Thought. But is knowing the truth enough to set you free in itself? Faith without works is dead, as the man said.

Post-Christmas Blair Which? project

Erstwhile Buckinghamshire weekender Tony Blair has joined his wife’s church. Why not? Two years’ sixth form journo harum-scarum on this topic was all bilge, and would have been even if TB were still PM. If Lloyd George, a Baptist, had decided to join the Methodist Church, it would not have mattered a spearmint puff. How much less this man, this century. Christians join other denominations every day. Advertising for a new archdeacon this year, a significant proportion of applicants were originally ordained in the RC Church. So what? Only denominations that take themselves way too seriously, or just don’t understand post-Christendom would be bovvered. So Tony Blair deserves better than crackpot right wing RC’s sounding off like the Judaean People’s Front about how unworthy he is to join them. They should read more Graham Greenes.

But what about Tony Blair the leader? In the season for annual reviews, what’s the historical score? How would a consumer mag rate our recent history? Here’s one Oxonian nerd hot tip — Historians’ verdicts on leaders are usually more positive than those of their detractors / persecutors immediately after they left office. It looked like decline and fall for this erstwhile Blair voter to count no fewer than six “Bliar” Tee shirts in one tube carriage last summer. Does this fate await all England managers and prime minsters? Build ’em up, knock ’em down — they were never as good or bad as the papers said. Paying tribute to Tony Blair’s idealism and charisma sounds almost Blairily insincere.

Historically speaking? Gladstone came from a conservative background but was willing (sometimes too willing?) to play a high radical hand. Gladstone was high minded and immensely hard working, with a knack for catching the moment rhetorically. Enemies accused Gladstone of ruthless demagoguery, of which he was himself utterly unaware. They called Gladstone insincere, when he was in fact only too sincere.

Incredibly, when you consider what both were up against, the Gladstone project in Ireland, like the Blair project there, almost made it home. Gladstone’s government ground into the dust, like Blair’s, amidst recriminations about an overseas fiasco involving Muslims — Sudan for Gladstone, Iraq for Blair.

Blair’s governments blew impressive economic bubbles, delivered a minimum wage, tackled the foothills of child poverty, inspired style iconry and mildly rebalanced a few UK priorities. None of these were quite all they were cracked up to be, but they were hard-earned and amount to considerably more than nothing. Did Blair renew the UK constitutional setup, or did he destroy it? We’ll see. Ditto Education.

Healthcare was a more precarious endeavour. Blair sincerely piled shedloads of cash in, but somehow the returns diminished and the more that went in, the less people appreciated it. Perhaps, and the only way to discover this was to try it, the UK simply maxed out the benefit any market model healthcare system could deliver without as much money leaking out the bottom as was going in the top. Contemplating Debt Mountain and aging assets, historians may wonder at the scale of PFI — a UK public works funding scheme rather like putting your mortgage on your credit card. Tony Blair’s most serious tactical political disaster, although it seemed like a good idea at the time, was announcing his departure in 2005. The UK media being the UK media, he never quite got out of the garage for his third term.

Tony Blair’s Mary Tudor “Calais” would have to be Iraq. This is a real shame, because his leadership over Kosovo and Sierra Leone was courageous, creative and effective. Surely Blair was right to cherish the US/UK relationship. It was just Blair’s bad luck that the US fell into the hands of a foreign policy ingenu and Neocon experimentalist, who mired his country recklessly in a Suez-style adventure that screwed up its prestige in the Middle East. Compare and contrast Annapolis with Camp David, and weep. Afghanistan was dumb. Iraq was dumber. In the story of the American Empire, the Iraq war will probably play a similar part to the Boer War in the tale of its British counterpart, militarily and otherwise.

Possibly Blair did all he could to temper the loonery, but in fact almost a million innocent civilians died, Iraq collapsed into major chaos and became a world terrorist centre, whilst Iran’s star began to rise. UK public trust crumbled after the dodgy dossier. The CIA used to say, you can’t put the toothpaste back in the tube.

Or can you? It remains to be seen what’s next for Tony Blair. He’s certainly made a far more selfless, courageous and principled start to his next career than his predecessors did to theirs. It could even be redemptive. It’s all too easy to judge others who bear burdens we will never have to shoulder. Perhaps it’s time t0 cut him a bit of slack for now, and offer our sincere prayers and good wishes for the future.