A prophet in springtime

A visit to a spring, surrounded by marks of belonging, prompts Andrew Rumsey to consider the purpose of property.

Andrew Rumsey

Andrew Rumsey is the Bishop of Ramsbury. He is also an author whose writing centres on themes of place and local identity.

An oak tree stands over a field and fence, behind which, in the distance, rises a man made hill with a flat top.

Swallowhead Spring with Silbury Hill in the distance.

Jim Champion, CC BY-SA 2.0, via Wikimedia Commons.

After weeks of winter the land awaits its consolation. Unfurling woes roll out so regularly that media feeds read like lament, a psalmody of untethered sorrow. The temptation is to withdraw into immediacy, of course, and purely field the incoming as if sat in a gaming chair of perpetual reaction, spotting and batting away the next insurgent.

When we cry for strategy perhaps what we really mean is prophecy – strategy being inorganic, mechanistic, hardly adequate for the times. After all, how do you map a scene that is constantly changing? Our present panic seeks good words from the world to come, where no one but God has been. But in an age that sniggers away divine possibility the Lord is afforded the past tense alone. We shall, I suspect, come to regret being so confident of our own purposelessness.

What if our absent-minded land were a place of promise, and we had simply forgotten?

What characterizes this world is a kind of dogged amnesia: collapsing past and future into a monotonous present. ‘There is no remembrance of former things; neither shall there be any remembrance of things that are to come with those that shall come after’. Like the rivers, he suggests, that run into the sea before their ascension and condensation start the cycle again. But what if repetition is not our destiny, and we inhabit instead an ecology that is radically open? What if our absent-minded land were a place of promise, and we had simply forgotten?

What is clear, however, is the enduring need to mark territories where meaning or identity has been found: our arrow-hearted initials notched into the bark.

Prophecy returns to the origins of things in order to seek and sketch what is to come. So, after its overflow last week, I am drawn to revisit Swallowhead Spring, near Avebury in Wiltshire, where the River Kennet rises and begins to drain down into the Thames. Like many such sites round here, the signage indicates conflicting claims on this landscape. A ‘Pagan Britain’ sticker has been slapped upon an anti-littering notice and the trees are frilly with ribbons and dangling dream catchers, the symbolism of which escapes me. What is clear, however, is the enduring need to mark territories where meaning or identity has been found: our arrow-hearted initials notched into the bark. Lovers and villagers would apparently come to Swallowhead Spring for Good Friday picnics, before shinning up the then-accessible Silbury Hill. When I last visited in October, it was just a dry basin with a slightly sludgy brook, but now I can hardly approach for the cataract.

Back home, a bubble-wrapped book has arrived, being the proceedings of the 1941 Malvern Conference: a source I am exploring for clues to the current and future condition of the beleaguered English Church. Under the shroud of total war, Archbishop William Temple gathered an eclectic range of prelates, poets and politicians to devise a route by which the Church might offer a lead to society in the new world that would, at some point, emerge. It is immediately striking in its erudition and reach, addressing the fundamental concern that ‘the true end of man’ had lately been obscured by the pursuit of wealth.

The purpose of work, and education, therefore, needed recovering – but with personality, not product, at its heart. Progress was, however, almost derailed by a Christian Socialist attack on private property, which T. S. Eliot, among other conservative delegates, rebuffed. Hard, perhaps, to imagine the same debate stirring such feeling today, although any consideration of social justice surely must. As H. G. Wells once observed, from the earliest times society was a mitigation of ownership – the mutual recognition that co-operation needed to override competitive possession if humanity was to flourish. The matter was finessed at Malvern in fine Anglican style, with the following resolution:

It is a traditional doctrine of Christendom that property is necessary to fulness of personal life; all citizens should be enabled to hold such property as contributes to moral independence and spiritual freedom without impairing that of others; but where the rights of property conflict with the establishment of social justice or the general social welfare, those rights should be overridden, modified, or, if need be, abolished.

This was synthesis, not fudge, I choose to think – and helpful in reaching a similar conclusion lately, while trying to locate my true north, politically speaking. The conservative in me tends towards continuity, local institutions and the Parable of the Talents, in its acknowledgement of unequal gift and yield; the radical abhors squandered privilege and exploitation of the poor for personal gain. Naboth’s vineyard may be the place, therefore, given that I am firmly in favour of covenantal ownership, which either serves the common good or is reckoned to be in deficit.

The conservative fallacy is to recycle the sins and sinecures of our forebears and call it tradition; the equivalent on the Left is to be perpetually uprooting and call it liberty. Amid their own peculiar failings, the Christian has – somehow – both to belong and not belong, to possess all and yet nothing, in search of a country that is forever ahead.

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.