Letter from Burnley: the shifting sands of the cost of living crisis

With a worsening crisis affecting his community, Alex Frost reflects on the growing struggle and the impact on its people.

Alex Frost

Alex Frost is a vicar in Burnley, Lancashire, and an advocate for the local community.

Two older men lean agains the wall of a football club's entrance, next to thin open doorways.

Burnley football club turnstiles.

Have you ever watched one of those retrospective television programmes, that takes us back to the 1980's or 1990's? They usually include clips of Wham or Oasis or Yuppies with massive mobile phones.

I don't know about you but the label 'The cost-of-living' is one that I suspect might take its own place in one of those shows twenty or so years from now. And I do wonder if things will be better or worse than they are presently.

You might that hope which ever political government of the day is in power in 2044, the cost of living crisis and poverty will have significantly shifted from where they presently are.

In my own town, Burnley in Lancashire, the shifting sands of such matters are starkly evident, and things seem to be getting worse rather than better. The evidence of a cost of living crisis has shifted matters from financial insecurity to many other areas. For example, within the cost of living crisis sits another crisis that appears to be getting more concerning as the months go by and we drop into the harshest months of the year.

He cites places of refuge as dangerous, violent, volatile places that are not in keeping with his desire to live a quiet and normal life that befits a gentleman in his late fifties.

That crisis is one of extremely worrying mental health issues with adults and some very young children in our community. On a personal level, there is nothing more painful than taking a funeral service for a young person who has taken their own life, which happened to me in recent months. Alongside such sadnesses, there are almost daily examples of individuals, many of whom are young mothers pouring their hearts out on social media with woes of poor mental health with seemingly nowhere to turn. In my own borough the mental support provision within the NHS is at breaking point with long delays for mental health counselling and support. Thank goodness then for the voluntary sector who help me to help others on a regular basis. After the pandemic of COVID in Burnley, where a recent Joseph Rowntree Foundation poverty report suggested 38 oer cent of children in Burnley live in poverty, we are in a battle to keep our most vulnerable people mentally well and with an optimistic outlook for a brighter future.

And then there is the matter of homelessness. Who'd have thought we'd be living in a time when people are now being evicted from a tent? And what about those who lived outside for many years - what are we to do for them? There is a chap in Burnley, who by choice is living rough behind our corporation cemetery because the accommodation offered to him would place him in a hostel where addiction and violence is commonplace. The only blessing to be taken from it is that he has found a warm spot and he is relatively safe against the winter elements that are coming our way during the winter. But the saddest thing about this gentleman is that it is a preferable option to what is offered were he to use the provision available. He cites places of refuge as dangerous, violent, volatile places that are not in keeping with his desire to live a quiet and normal life that befits a gentleman in his late fifties.

Watching young mums literally gathering up the crumbs from our food provisions at church is a chastening and humiliating experience for them and those who serve them.

And as the sands shift, what about our young people? In the school where I am a governor, 58 per cent of our children are on free school meals, and many come from broken homes and difficult circumstances. What encouragement can we give them to ensure their young lives are ones of opportunity, fun and learning? What can we do to ensure the struggles of the children's parents don't bring their own development to an uncertain and worrying future? Some parents in the grip of a cost-of-living crisis lose their filter on vocabulary and so every worry, concern, disappointment and crisis is shared. Shared with little boys and girls who shouldn't be constantly subjected to a world that is always churning out negative scenarios on their innocent and immature minds.

And what about the national celebration of a food bank and community kitchens and all they do for the poor people of our parishes? Three cheers for the voluntary sector who take the strain of a failing social security system that gives food with one hand but potentially snatches self-worth with the other. Watching young mums literally gathering up the crumbs from our food provisions at church is a chastening and humiliating experience for them and those who serve them. I hate foodbanks, not because of the good they clearly do, but, because they normalise and hold up a failing social security system in our country today.

As we approach Christmas and a new year, I wonder how the shifting sand of the cost-of-living crisis might influence, our cultural horizon? Is it idealistic, romantic or downright stupid to think we might change the great and mighty to think differently in their approach to poverty? I am keen football fan, and you might be familiar with the term 'He/She talks a good game' and after many years following Burnley Football Club I have witnessed on many occasions when Managers have talked a good game but sadly failed to deliver on the field of play. And I think that is true of the majority of our politicians of all parties. They can talk a good game but often fail to impress us because the substance doesn't match the sentences.

I am convinced through many years of dealing with abject poverty, that people in difficulty respond better to compassion over criticism, understanding over instruction, reality over rhetoric. So many people in my context don't want to be in poverty. They would prefer not to struggle, and they would recognise they need help. The shifting sands of surviving should encourage society to prioritise people before pedestrianisations of town centres, and hope over HS2 railway lines. As the sands of our landscape continue to shift, it surely must be the priority of the church, the government, and for people to stop people from sinking in a swell of poverty and hardship. When it does that, perhaps the church can demonstrate to the society, its role and its mission still has much to offer in 2024 and beyond.

Article

Care

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.