lion&lamb: Back Issue

Introduction: Political Compassion?
Derek Poole

Silly Games with Flags
Alwyn Thomson

From the Director
David Porter

Church and Society
Lesley Carroll

Education
Mike Wardlow

Social Development
Doug Garrett

Environment
Tom Clarke

Wilson on Suffering
Alan Wilson

Finance and Personnel
Stephen Roper

Enterprise, Trade and Investment
Lawson McDonald

Faith and Practice - Esmond Birnie
Megan Halteman

Higher and Further Education
John Gillespie

Health and Social Services
Brian Coulter

Agriculture
Jack Patterson

Culture, Arts and Leisure
David Boyd

The Essential IVP Reference Collection

Embodying Forgiveness
ECONI Conference

Not of This World?
New Book

Summer School 2001

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DEPARTMENT OF HEALTH AND SOCIAL SERVICES AND PUBLIC SAFETY
The Health and Social Services and Public Safety Portfolio in our Northern Ireland Assembly is rumoured to have represented the one Ministerial Office which local political parties wanted least. Whatever the truth is, by common consent Health and Social Services was believed to be something of a poisoned chalice. It was likely to test any new Minister to the extreme with its highly contentious agenda including unresolved proposed closures of small hospitals, and a growing and worrying mismatch between service demands and available funding.

Health and Social Services are rarely out of the news, with arguments about configuration of services and the state of the Service. It is their propensity to illustrate both the best and worst of human behaviour and values, though, which so often places them in the spotlight. It is in the context of the Health Service that countless acts of selfless love and care to the highly vulnerable are acted out daily by nurses, doctors, social workers and the vast array of staff who make up the UK’s largest workforce. At the same time, and always guaranteed to attract media attention, the deceitfulness and wickedness which Jeremiah observed as part of our fallen humanity emerges from the same Health Service which produces such good. The conduct of disgraced GP Dr Harold Shipman, the Bristol heart babies’ scandal, which was said to have been nurtured by a ‘culture of arrogance’ and recently the abuse of power in Liverpool’s Alder Hey Hospital pathology services have contributed to the erosion of public confidence.

Christianity and Health and Social Services intriguingly have a key requirement in common. This has become clear as government ministers and Health Service managers struggle to respond appropriately to the crises of confidence engendered by incidents such as the Alder Hey organs scandal. They have concluded that public trust is at the very heart of the Health Service. When Minister de Brún agreed in February 2001 to set up a locaIinquiry into body organ removal and retention practices she informed the Assembly that this was necessary to restore public trust.

This shared core requirement between Christianity and the Health Service emerged in a more general sense following recent findings from research commissioned by the Adam Smith Institute. Dr Shirley McIver commenting on these findings argued that they appear to support the view that ‘young people have lost faith in the ability of the NHS to satisfy their needs.’ This research found low expectations of the future survival of the Welfare State and that ‘more people believed in the survival of the monarchy than free NHS services.’

Axiomatically a fundamental pre-requisite to public confidence in the Health Service is that its staff must demonstrate they are worthy of such trust. This can no longer be assumed with the progressive and, I believe, unstoppable shift in balance of power from professional to patient. Furthermore it is made more difficult to achieve by the growing gulf between public expectations and the ability of the Welfare State as presently organised and resourced to deliver. In the UK spending on health care compares unfavourably with most of our European neighbours. In Northern Ireland too, per capita expenditure is acknowledged as substantially and increasingly less than in the other devolved regions. This combination of damage to public confidence and substantive under-resourcing has caused Tony Blair nationally and Bairbre de Brún locally to affirm that they are resolved to modernise the 1940’s institution which we know as the Health Service.

The organisation of the NHS since the 1940s was influenced by Christian charitable virtues to meet the needs of the destitute and to provide for the most vulnerable. The Welfare State was considered by many to be the ‘cheapest mode of maximum insurance’ for all citizens against calamities such as personal ill health. Through funding from national insurance payments paid by taxpayers the NHS represented a universal prudent safeguard. The problem is that modest demands anticipated in the 1940s have been replaced by a costly, growing menu of services and treatment possibilities reflecting advances in medical science, improved longevity, and changing personal family and societal values and expectations. This is illustrated powerfully by the following trends locally reported by Directors of Social Services.

Poverty - one child in every four dependent upon social benefits;

Alcohol Abuse - 22% males, 8% females drinking above sensible limits;

Family breakdown - 5,000 separations/divorces per annum 27% of marriages ending in divorce;

Domestic violence - 14,000 incidents annually, with children present in 93% of such incidents;

Lone Parent Families - 26% of families with dependent children;

Emergence from Conflict - a new pattern of violence now emerging, such as drug wars, which are being tackled by Health and Social Services staff.

Few would argue that the NHS was conceived when the moral climate and the prevailing ethic of the 1940s limited demands likely to be made upon it. Harry Blamires, one time student and later friend of C S Lewis at Oxford, illustrates the dilemma faced by the emergence of the post-Christian mind and associated values upon the NHS when he contrasts the ever-advancing treatment of infertile couples through new forms of in-vitro fertilisation with the daily destruction of ‘foetuses’ for other women within the same Service. The net result he says is ‘a health service that engineers artificial birth here and artificial death there. The Christian is bound to feel that men and women are trying to be God’.

What then can the christian’s response be to a Health Service that despite enjoying persistent public support as an institution faces a crisis of confidence? Is there a distinctive contribution which christians can make to a service where the underpinning values and shared meanings of its past have been infected by wider post-modern confusion, rendering it liable to accusations of being uncaring and to prevailing uncertainty.

The fact that there are large numbers of christians employed in the Health Service should afford one of the best opportunities for practical application of salt and light, for demonstration of christian relevance. Trust or confidence is a feature not of structures or systems but of human interaction. It is a pivotal part of human behaviour and relationships. It follows that if we want to restore public confidence the focus for change in the NHS should be upon its enormous workforce and not so much upon endless restructuring solutions. Meanwhile what of that proportionately large if overall minority of christians working in the Service? How can we communicate our faith to those who have abandoned belief in a meta-narrative, absolute truth or in exclusivity, yet who so often long for greater certainty? I find appealing what Ravi Zacharias has to say.

We, as christians, make a staggering claim. We lay claim to truth that is exclusive … We proclaim one way to God - Jesus the Way, the Truth and the Life. When we lay claim to truth in such radical terms, it is imperative that such truth be undergirded by love. If it is not undergirded by love, it makes the possessor of that truth obnoxious and the dogma repulsive.

Health and Social Services provide the perfect context to practise, patiently but pro-actively, christian love to patients and clients and reach out in love to colleagues who are sceptical. We must with a heightened consciousness pursue iniatives in uncontrived, authentic christian love in the Health and Social Services workplace.

Individual christians can also impact positively upon the Service through pursuit and practice of excellence, or what Vaughan Roberts calls ‘wholeheartedness in a broken world that can’t be bothered.’ In In Search of Excellence, one of the top selling management texts of the 80’s, the authors observed, “For us one of the main clues to corporate excellence has come to be just such incidents of unusual effort on the part of apparently ordinary individual employees.” This should motivate ‘ordinary’ christians in the Health Service to believe that, through wholeheartedness, christian values can be extra-ordinarily asserted in a culture that is otherwise indifferent. To do so is to live out the biblical mandate: ‘Whatever you do, work at it with all your heart, as working for the Lord, not for men…’. (Col.3: 23). Thereby the self-styled ‘centres of excellence’, as our large teaching hospitals like to be known, are forced to give way as excellence is potently relocated not in an institution but in the ordinary individual.

Collectively too, christians can make distinctive contributions to the Service. The example of Jesus, who ‘went about … teaching and preaching and went about doing good and healing’, provides the perfect harmonious model for witness and social action. 18th and 19th century evangelicals displayed a passion for witness and social service which flowed from their understanding of God as Creator and Law-giver, Lord and Judge, and of people as uniquely valued, made in the image of God and loved by Him. They viewed christian engagement with the world as expressing the love of God in Christ through collective practical social service and opposition to injustice. Similarly today christians can collectively contribute to the health and well-being of people. This is especially true for those who are most vulnerable, who churches can support both directly and indirectly. They can provide organised christian alternatives to the marginalized eg single parents, homeless persons, people with learning disabilities. It is time for churches so to re-engage with society. Steve Chalke (Oasis Trust) recently challenged what he calls ‘institutional secularism’ i.e. ‘where christian love, belief and charity is ostracised and discriminated against’. The christian can offer holistic care addressing not merely presenting problems but the whole person. The Health and Social Services, with their necessary remit for the most vulnerable and with their increasingly limited capacity to fully and satisfactorily meet the needs of such, present christians with opportunity for new forms of engagement, which challenge institutional secularism.

Brian Coulter is Chief Executive of the Fold Group, is a former Assistant Director of Social Services and current Chair of the Eastern Health and Social Services Council. He attends ChristChurch, Belfast.