The NHS: in gratitude on its 70th birthday

Today is the 70th birthday of the National Health Service. Services and celebrations are happening across the nation. We are right to honour this great institution and be profoundly thankful for it.

I'm not one of those with a dramatic life-and-death story to tell about the NHS. I've not troubled my GPs overmuch in my lifetime. Most of my ailments have been small beer compared to what many others have had to face: childhood infections and abrasions, adolescent allergies, the odd broken limb, hypertension, mild atrial fibrillation, psoriasis. I've undergone a vasectomy, a prostate op and keyhole surgery for hernias. I have NHS hearing aids. Too much information? I suspect that for a man coming to the end of his seventh decade, it's pretty standard fare.

The Archers, the NHS and I are almost exact contemporaries. After the war, my mother became a nurse at the old Charing Cross Hospital in central London where I was born. Neither she nor my father were people of faith, but they did instil in me from a very early age a kind of hushed reverence for the NHS. (The Archers had to wait a few more years.) Our GP in north London was an elderly German-Jewish exile called Dr Landstein. I recall him quite clearly from the mid-1950s: kindly, compassionate, wise. Nothing was too much trouble for him. He enjoyed home visits and chats with my mother who like him had also survived the Holocaust. It felt like a family bereavement when he retired. I remember his successor too, Dr Giwelb. He was younger, less priestlike, more professionalised, more "modern", but he too was among the gods of my childhood pantheon (where they were flanked by Miss Bull, my primary school headmistress, and Owen Brannigan who lived three doors away on our street). Between them, they shaped my expectations of healthcare for a lifetime. And they have been abundantly fulfilled in adulthood. I'm thinking especially of two marvellous GPs had in Sheffield and Durham. Perhaps they know who they are.

When I was a parish priest, I was also the official chaplain to the town's infirmary, paid by the NHS. I learned a lot about healthcare in those years, not least when I was involved in the in-service training of doctors, nurses, administrators and support staff. I was proud to be a tiny part of that exemplary hospital, proud to have a role in an institution that was so valued in the community. If I ever entertained doubts about the virtue of universal healthcare (I'm not sure that I did), my experience in that place of truth and love quickly dispelled them.

So I understand why Polly Toynbee writes as she does about the NHS as a kind of surrogate religion. It's simply there, like the good old C of E, a benign institution that we're glad exists to bless our nation and provide for it at times of need, even if we rarely have to trouble it ourselves. For my generation and for everyone younger, it has hatched us, patched us up and dispatched us. We've felt safe and cared for. We've never known anything else. We can't quite understand why the whole world doesn't emulate the NHS, why the United States, for instance, has struggled so hard to provide even the rudimentary ObamaCare for the most needy that is now being unravelled by Donald Trump.

But we know for ourselves how politicised health care has become. No government has dared to tamper with the idea of universal healthcare free at the point of use. It would be a certain vote-loser. And yet the sustainability of the NHS is under threat in a way that would have been inconceivable even a quarter of a century ago. Conservative administrations have been reluctant for decades to say openly that excellence in healthcare requires that we all put our hands in our pockets to pay for it through our taxes. Only now is there a belated acknowledgment of this in the Prime Minister's £20 billion funding commitment. It's a welcome start. But it's nowhere near enough if the NHS is to be stabilised. It's now an urgent case of playing catch-up. Years of chronic underfunding must be put right if the founding vision of the NHS is to be honoured in our day. To achieve this, our leaders have to believe in it. Back to the NHS as a quasi-religion that needs vision and faith if it's to serve us well and flourish.

I recently read Adam Kay's book This is Going to Hurt. He was a junior hospital doctor specialising in obstetrics. He loved his work and showed every sign of going on to a promising career as a consultant. But the pressures on him as a healthcare professional became intense - not because of any failure of his, but because of "the system": impossible working hours, lack of resources, an absence of proper rigorous supervision, the ever-increasing likelihood of making a life-threatening mistake. So he resigned his position and is now a writer. His book is candid about his experience. It is by turns very funny and extremely alarming. We've known for years what GPs and junior hospital doctors have to contend with. But when you read something as personal and vivid as this, you begin to worry. You wonder how on earth the NHS can carry on as a viable institution, let alone have a future.

Like so many other things - the environment, arms sales, ethical trade, reform of our financial structures, the benefits system, Brexit, it comes down to the political will. Do we really want a future in which the founding vision of the NHS continues to play a central part in the welfare of our people? If so, are we willing to pay for it? Our politicians must come clean. And while we're on the subject, that applies to social care for the elderly too. We baby-boomers are getting old. Demographic projections show how our demands on the NHS will put it under ever-increasing strain until our generation has died out. Before that, we are going to need social care that is beyond the means of many people to afford. For those who are "just about managing" or not managing at all, the prospect of ageing is bleak and even terrifying. After a lifetime of looking after others, who will look after them?

Today we celebrate the vision and courage of those pioneers of 70 years ago who believed that the nation should look after its people from cradle to grave. That's not about setting up unhealthy dependencies so much as creating structures of mutual giving and receiving so that those who need care have access to it and need not fear that it will be denied them. It's old-fashioned to speak of "the idea of a Christian society". Yet I profoundly believe in this ideal of a public caring institution which is for all people, and from which no-one is excluded. It's a practical expression of the great commandment to love our neighbour as ourselves. On this NHS birthday, and out of gratitude for all that it represents, I believe we must renew our heartfelt political commitment to it so that our children and grandchildren may benefit as we have done.

But a birthday is for celebrating and being thankful. The NHS is not a perfect institution but I want to say, unhesitatingly, that it is a great one So this is a day to be glad and set our hopes high. As the Archbishop of Canterbury tweeted today, "The NHS is an expression of our deepest shared values. Whatever its challenges, it’s about us living out our concern for solidarity and the common good. It reflects God’s concern for every person without exception. Today let's pray, give thanks and recommit our support. The NHS can be proud of its first seven decades." Indeed.  Floreat!

Lent - 40 Shades of Gratitude

If you follow The Archers you’ll know that Alan the Vicar has put forward a novel idea for the village’s Lenten observance. Let’s give up complaining, he’s proposed, and every time we offend, let’s put a fine in the sin-box and give the proceeds to charity.

I quite like that idea, though it needs a bit of calibration. Does “complaining” only cover what we do publicly, or what we are overheard doing? Does it only cover what we say or write, or should it include what we think as well? Does it only apply to named people or organisations (“The Vicar doesn’t visit enough”; “Bridge Farm yogurts have lost their taste”) or also to the ubiquitous “they” (as in “Why don’t they mend the potholes in our roads?” or “They don’t care that our trains never run on time”)? And when is a negative comment not necessarily a complaint (“Our bins haven’t been emptied this week: that’s going to cause problems, so we’d better phone the Council”)? And are Ambridge folk still allowed to talk about “bad weather” or a “poor wi-fi signal”?

Maybe the casuistry of complaining is too complex. And to rub your nose in negativity doesn’t exactly lift the spirits. That’s the trouble with Lent. It’s not that giving up things isn’t often very good for us - fasting and self-denial are important aspects of a healthy spiritual (and ordinary human) life. But so much depends on our attitude, our motive for undertaking whatever Lenten exercise or discipline we opt for. So I’m much more encouraged by a tweet from one of my favourite Twitter clergy, @sallyhitchener. “This year I'm taking up #GratitudeForLent - 40 days, 40 thank you notes to people to whom I'm grateful, for small or great things. Want to join me?”

I think Sally gets right to the heart of Lent. For a start, she accentuates the positive, always a good antidote to the negativity of complaining. But she isn’t calling for the kind of generalised goodwill clergy are so proficient at while never sacrificing their gift of vagueness. She sets a clear objective that is, as business-speak has it, SMART: Specific, Measurable (she’ll know if she’s achieved it or not), Assignable (clear about whose task this is, in this case hers), Realistic (it can actually be achieved) and Time-related (in this case, 40 days). The Muslim month of Ramadan is characterised by smart objectives for the fast which makes it all the easier to get a handle on (I don’t say easier to observe). I believe a Lenten observance that sets smart goals will be helpful in at least contemplating the journey that lies ahead.

But much more important is the content of Sally’s Lenten resolution. “Gratitude for Lent” - what could be more true to the spirit of Christianity than that? You could say that gratitude is where Christian discipleship begins, as we acknowledge with thankfulness the tender mercy of the God who has loved us in Jesus Christ and called us to be citizens of his kingdom. So to practise gratitude in Lent is to go back to the very foundations of faith. The clue is in the principle of eucharist. That word literally means “Thanksgiving”. So to live eucharistically doesn’t only mean participating in the service of worship at which we celebrate together the great acts of God. At a deeper level, it means cultivating thankfulness as a habit of the heart, training our deepest selves to respond to life in a spirit of gratitude and praise to God our Creator and Redeemer. In Lent, that gratitude is given a paschal shape as we prepare to celebrate the death and resurrection of Jesus, the redemptive event from which our very identity as Christians is derived.

I used the word “training” just now. Training is what the Greek word askesis means. An ascetic is someone who takes their training seriously, reckons that it’s something worth investing in. Yes, the three great disciplines Jesus speaks about in the Sermon on the Mount, prayer, fasting and giving alms, are basic to the classic Christian understanding of askesis. But motivating them all, I think, has to be a sense of thankfulness, the eucharistic acknowledgment that these disciplines are not ends in themselves, but are meant to deepen our engagement with God whose goodness has invited us into the adventure and challenge of discipleship. The ascetic journey is to travel more deeply into God’s heart of love. It both draws on our thankfulness and enhances it as we discover how infinitely indebted we are to the Love that moves the sun and the stars.

So Lent, this annual season of renewal, this springtime of the Christian year, invites us to find new ways of practising the habit of eucharistia. Where do we start? Sally gives us a practical suggestion. Her forty thank you notes will get us thinking about forty ways in which we need to be grateful - to other people, and through them, to God himself. And alongside these forty shades of gratitude, why not pray the General Thanksgiving each day? I don’t know a better way of seeing off our tendency to complaint and negativity. Indeed, I believe we shall discover that thankfulness is truly life-changing because it transfigures our perspective on life. The Thanksgiving Prayer says that we should be grateful above all for thine inestimable love in the redemption of the world by our Lord Jesus Christ. Which is what we look forward to celebrating at Easter. Here's the General Thanksgiving in its original, magnificent form in the 1662 Book of Common Prayer.

Almighty God, Father of all mercies, we thine unworthy servants do give thee most humble and hearty thanks for all thy goodness and loving-kindness to us and to all men. We bless thee for our creation, preservation, and all the blessings of this life; but above all for thine inestimable love in the redemption of the world by our Lord Jesus Christ, for the means of grace, and for the hope of glory. And, we beseech thee, give us that due sense of all thy mercies, that our hearts may be unfeignedly thankful; and that we show forth thy praise, not only with our lips, but in our lives, by giving up our selves to thy service, and by walking before thee in holiness and righteousness all our days; through Jesus Christ our Lord, to whom, with thee and the Holy Ghost be all honour and glory, world without end. Amen.

Brexit and The Archers

Here's a bit of fun stuff for the post-#Brexit blues. Or not. It may depend. You may think I'm trivialising the solemn or solemnising the trivial. 

The Archers was (were?) born the same year as me, in that annus mirabilis 1950. I've been an avid listener since I was a teenager. In the days of our analogue innocence, woe betide anyone who interrupted those hallowed 15 minutes. Nowadays, the BBC iPlayer has loosened the tight grip the 7pm pips used to have on my daily routine (though I'm old enough to remember when it was 6.45pm - perhaps some readers of my generation can recall when the change was made).

Let's not go in for exaggerated claims. I won't say that all I've ever learned in life has been picked up from The Archers. But as a north London suburbanite brought up behind privet hedges and net curtains, I did learn quite a lot about the countryside. To us townies, it was a foreign country. They did things differently there. That was part of my justification for listening to it, or so I told my mother. She was a dyed-in-the-wool Mrs Dale fan. She was disconsolate when it folded. But I don't know how much medical knowledge she or anyone ever distilled from Dr Dale's surgery or his worrisome wife. By contrast, I used to say to her, The Archers was educational. It was far more than entertainment (we didn't call them soaps in those days). You were informed about the realities of farming and how people interacted with the land. You learned. So it was essential listening. And also, a lot of the time, huge fun.

This marriage of informing and entertaining was always the mission of The Archers. It was originally conceived as a way of getting information across to farmers and smallholders about how to increase productivity after the austerities and food-shortages of the war and post-war rationing. There was regular advice from the Ministry of Agriculture, Fisheries and Food who had a role in devising the scripts. You didn't just learn about the daily round and common task of the life in the countryside: good husbandry, farm-management, the vicissitudes of seed-time and harvest and the hazards of unseasonal frosts. Nor was it just about Doris Archer's kitchen, jam-making and beef stews. You picked up a lot about rural poverty, employee relationships, estate management, pesticides and livestock movement not to mention the (sometimes overwrought) dynamics of village life. This daily window on an "everyday story of country folk" had its ups and downs. But you felt you were in the company of people who knew what they were talking about when it came to the landscapes of middle England.

But the programme has never been merely quotidian in its concerns. Some of its big stories have focused on events that have been very much in the headlines: organic farming, foot-and-mouth disease, farm tenancies, road building, badger-culling, flooding and GM crops. The Archers were never afraid of being topical, even controversial. Locals expressed their views forcibly on the village green, in the shop, in the Bull, even in church. The cut-and-thrust was part of the point. The programme didn't need to take sides to acquaint a listening public with the joys and sorrows of a green and pleasant land from which many were increasingly distanced in towns and cities.

Which brings me to my point. Why have The Archers studiously avoided getting drawn into the greatest political decision of our generation, the European Union Referendum? Our friends at Felpersham Cathedral (@Felpercathedral) installed an #EUReferendometer to monitor all mentions of the referendum on the programme. (Discursus: I wonder where did they put it - in a transept? the crypt? the triforium? underneath the high altar? Or did the Dean or a minor canon have to wear it under their cassock and surplice like a heart monitor?)

The Cathedral issued a weekly report on referendum talk in the village. There was little to report: just one significant kick, a conversation between Adam and David about the implications of EU membership for farming. (David was for Remain. Adam, surprisingly, said he would be voting Leave - as a gay man, had he forgotten the progress so energetically promoted by the EU in relation to LGBT equality?) Apart from that, not a single conversation about any substantive referendum themes. Not one!  The referendometer flatlined for the best part of four whole months. There was just a bland exchange or two about how important it was to vote and how the village hall was given its customary role as polling station, but without getting into any issues ("I know better than to ask you which way you're going to vote", or weasel words to that effect).

When it came to the EU debate, Ambridge was the most silent, undisturbed place in Europe. The Bull was untroubled by any argument. There were no sermons in church, no meetings in the village hall. Peggy didn't fall out over it with the vicar. Debbie runs a farm in Hungary, yet she had nothing to say from the perspective of eastern Europe. Brian and Justin are used to thinking big about farming, but they had more pressing things on their mind than the Common Agricultural Policy. Young farmers Pip and Josh bucked the trend of their generation by not being engaged with it at all let alone coming in as fervent Remainers. Even Susan kept her counsel, a phenomenon unheard-of in all the years she has presided over the village shop. A cloud of EU-unknowing hung over the village. The referendum was strictly off-limits. It was the topic - love it or loathe it - that dare not speak its name except (we are guessing) in dark corners out of reach of the microphone. Out of reach of us.

I find this profound silence perplexing. The Archers has a good track record in helping listeners understand how the big news stories affect the countryside and the rural economy. It knows from long experience how to weave them seamlessly and unselfconsciously into fictional drama. I wasn't expecting it to take a position on the EU, but I was 100% sure it would deliver on its past form of squaring up to hot topics like the referendum. I was wrong. More wrong than I could ever have guessed. Its avoidance of the EU debate has been near complete. And, I think, cowardly and disappointing.

I used to belong to the wonderful group called the "Archers Anarchists". Their core belief is that the programme isn't make-believe and its participants aren't actors. The place and the people are real. I'm afraid that after the referendum, Ambridge has become less real than it used to be. The cynics and mockers are right. It's a little bit of an imagined but lost England, a feel-good audio theme park that is untroubled by the messy complexities of national and global politics even when they bear directly on it. If the Archers don't care about rural life enough to engage with a national debate with such momentous consequences for all the Ambridges across the UK, why should we bother to take them seriously any more? 

Ambridge: you have let us down. I doubt you would have changed anyone's mind. I'm not suggesting you should have tried. But had you been a bit more spirited, we would have gone into the polling booth better informed, whether we live in an urban or a rural environment. I'd have thought it would be an unrivalled opportunity for The Archers to come into its own once again, assert its own relevance, get itself noticed. You showed with Helen and Rob that you knew how to handle a difficult story really well and get the nation talking about it. So why duck out of the referendum? Were you under orders from On High? We need to know. 

Ok, let's not get too solemn about it. There's more to life than Ambridge and the referendum. (There really is!) I'm sure the BBC will take this in good part. It comes from a well-wisher. We want Ambridge to flourish as we learn how to inhabit a post-Brexit world. No doubt we'll hear about that from time to time even if it's too late to help us make this biggest political decision of our lifetimes. But we shall keep calm and carry on listening. We're too hooked to do anything else.