Presidential Address

Diocesan Synod: 6 October 2007

Not checked against delivery

Over the past few months I have chaired a couple of public meetings for the West Hertfordshire Primary Care Trust (PCT) and the East and North Hertfordshire PCT. The meetings were concerned with the changing provisions of healthcare and went out under the banner 'Delivering quality healthcare for Hertfordshire'. My job was simply to be the neutral chairman; but of course, when it comes to healthcare, emotions run high so there were times when the meetings became a little feisty, and being chairman was a touch demanding.

In essence the proposed changes are these:

1. PCTs, and GPs in particular, should deliver more local healthcare and should do so as effectively as possible. They should also be more involved in preventative strategies, for example dispensing statins to help bring down the rate of cardiovascular disease.

2. There should be two 'high tech', state of the art hospitals for Hertfordshire, both of them consultant led, providing high quality acute services. Rather than having specialisation in small local general hospitals, these specialisations should be grouped together in the two main hospitals.

3. It follows that in W Herts and in E and N Herts there are decisions to be made about which of the current hospitals becomes the main specialist unit, that is, the major acute hospital - and what follows from that are questions about how the remaining hospitals are to function. In W Herts, for example, it would seem that Watford will be the major acute hospital and either St Albans or Hemel will be the elective care surgical centre. There will be seven Urgent Care Centres in Hertfordshire.

4. The work of paramedics will become of increased importance; if journey times to hospital take longer because of traffic congestion, when urgent intervention is of the essence, the paramedics of the Ambulance Service will be frontline. They and the hospitals will develop new ways of working together for the good of acutely ill patients.

There are, of course, many other details in the proposed changes but, in broad brushstrokes, those four areas I have outlined are the key to understanding them. It is not for me to go into detail about what I may think about these proposals. They represent not only a local pattern but are part of a national reorganisation.

Let me recap:

1. GPs are the platform on which everything else is built.

2. It is claimed that major acute hospitals will be more effective than current provision and their importance will increase, though patient stays in them may be very brief.

3. Smaller local hospitals will lose their Accident and Emergency departments and some may become places either for non urgent elective surgery and/or places of recuperation following major medical intervention in the specialised units.

Now, why is all of this in a diocesan synod address? Well, partly because healthcare across Herts and Beds is changing rapidly and the changes affect us all, but partly also to illustrate a much bigger point. The meetings I have chaired have been labelled 'consultations' - and so they have been. The experts, be they senior NHS managers or clinicians, have made a presentation and then there has followed lively questioning and comment from the floor. The problem lies with the word consultation. The NHS personnel have been entirely courageous and very clear in explaining the plans they are proposing, and they have listened attentively to the views put forward. They see the exercise as consultative. Members of the audience, meanwhile, have worked on the assumption that 'consultation' implies everyone starting with a blank sheet of paper and designing a health service from first principles - and when, as is necessary in the NHS (and in similar public bodies), the planners have had to produce a new scheme constrained by money, politics, professional boundary lines, etc, at the same time as continuing to provide healthcare, then a clash of expectations is inevitable. The clash is not between two opposites, what is right and what is wrong, but between two competing 'goods'. In this case it is 'good' to have the best healthcare available as close as possible to the patient, whilst the 'good' of providing the best healthcare may require that care to be given in a place where specialists are available, that is, at some distance from the patient's home.

In the meetings I have chaired, everyone - managers at the 'top table' and the audience - want what is best. That's why the debates become so passionate. But there seems to be an assumption that

a) the managers are not human

b) they are concealing things

c) they don't really care

d) they don't understand.

In my experience, none of those things is true. And this is where I come to the heart of the problem. The primary assumption appears to be that 'they' are not to be trusted - and this 'they' refers not only to the NHS, it refers to anyone in public life: council officials at district or county level, teachers and governors, clergy and diocesan office staff, bishops ... I am not naive enough to think that all people in public life are perfect, nor do I think that we should not be accountable, but when relationships in the structures of governance in our nation and in the Church are constructed on the basis that 'they' are guilty until we have proved them innocent, the results, I think, are increasingly troublesome. Civic trust, if I can call it that, is essential for the wellbeing of a civic society. Where it does not exist, a kind of angry, mistrustful, unhappiness results.

But it is even more complex than that - and again I use the NHS only as an example. The speed of technological and scientific change which the NHS has to contend with is breathtaking. You have no sooner planned for your new specialist unit in cardiovascular care, than a new drug is discovered which transforms life expectancy - and all that planning, all that expenditure, appears to have been thoughtless. Change in all organisations is the only constant and it is very, very difficult to manage and to lead - and threatens trust. How can we begin to restore trust in civic life?

1. By trying to ensure that those in positions of leadership really do try to work out of an ethic based on the common good.

2. By expressing appreciation for those who work in the NHS and in public services, so that young people may catch a vision of a society where service and self-giving are given high status and may themselves want to work for the common good.

3. By recognising that the most complex problems in civic life require difficult decisions to be made, that is, those where the decision is to give priority to one good, rather than another good - and that to make those kinds of decisions requires wisdom and the willingness to make mistakes and the courage to acknowledge when mistakes have been made.

4. By trying to resist the growth in the spirit of fear, which seems to characterise many of our public services and institutions, and replace it with Christ-like courage and love.

5. By trying to show, within our churches and communities, a way of human interaction which is based on an awareness of sin and weakness in all of us, but a sin and weakness overcome by the gift of Christ's own life and death, and based also on a desire, daily, to offer our lives to God to be used by Him for the furtherance of His kingdom.

6. Finally, by recognising that within our churches we are living with realities - not 'virtual' communities, not cyber 'love-ins' - but living with the gifts and complexities of real human relationships and finding that through patience and grace and humility, new ways of being human do emerge.

In a confused and sometimes fearful country, our churches are signals of God's love, signals of God's reality, signals of new forms of community. None of our churches are perfect - of course not - but I see in many of our parishes, in many of our churches, signs of the love and compassion and power of Jesus Christ at work, and for that we ought to give the most profound and heartfelt thanks.

Simply by being God's Church, by being at prayer, by being in fellowship, by being together, by being open to the Holy Spirit, by being forgiving, by being places of reconciliation - by being all of those things and more, we are offering a challenge to the world and a challenge to each other to persevere in living by faith, in hope and love, so that trust may grow. So thank you for who you are and for all you do, up and down the diocese, to be God's people. You are signs of His love and signs of His promise - signs, by God's grace, of what true humanity and true community are all about.