Reform votes: what really matters in the end

Two votes, three decades apart.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A grand dinner table set for a meal sits within a large room with paintings on the wall.

The dining room of the Garrick Club.

I was this week one of several hundred members of the Garrick Club, with many more attending online, crammed into a central London conference room to vote on whether women could be admitted as members for the first time since our founding in 1831.

We Garrick members rather fancy ourselves as a secret society – and it was a rich irony that our vote was held in the same block as the Freemasons’ Hall in Great Queen Street.

Actually, I rather like the tradition that what’s said and done in the Garrick stays in the Garrick. So this isn’t about our club’s internal wrangling and politics, beyond the now widespread news that women were voted as eligible for membership by a majority of 60 per cent.

Rather than go further into that, I want to compare it with another well-fought fight for women’s inclusion: The admission of the female gender to the priesthood of the Church of England, more or less exactly 30 years ago in 1994.

Much of what was going on in the Church then was being rehearsed again in London WC2 this week. You might call it long overdue dismantlements of patriarchal institutions, even if neither the Church nor our club would self-identify as such. No case could continue to be sustained for all-male preferment in our Church or in our club.

To their great credit, the vote was won for reform by those who decided to work together, without rancour or resentment, in preference to further division and bitterness.

There are two observations I would make of the Church precedent that may be of some comfort to my fellow club members, who may feel that nothing will ever be quite the same again. The first of these is quite a quick point. After a couple of weeks of women’s priesthood, almost everyone in the Church wondered what all the fuss had been about. Ordained women became a natural part of the priestly fabric of the Church really that quickly.

Yes, provision had to be made for those who in conscience couldn’t accept women’s ordained ministry, so the process was not without its pain. But three decades on, women priests (and subsequently and inevitably bishops) are so much part of the weave of that fabric that most church congregations feel they’ve always been there.

The second point I would make is that I know anecdotally of very many traditionalists opposed to women’s ordination who, at the General Synod, either voted for women or abstained when the result became inevitable. To have fought a last-ditch, hopeless defence could only have lastingly damaged the Church’s reputation and ministry.

To their great credit, the vote was won for reform by those who decided to work together, without rancour or resentment, in preference to further division and bitterness. My feeling is that a tranche of Garrickian votes were cast for similar reasons.

These were women at the top of their game. It’s just taken a couple of millennia for our churches and clubs to catch up.

The comparison of a gentleman’s club and gentleman’s church is an imperfect one. Members of a church could be male or female; only the clergy were strictly male. There were profound theological and ecclesiological arguments (though I don’t share them) made against the prospect of women priests by Anglo-Catholics, which aren’t available to fans of men-only clubs.

But the similarities between the institutions are founded on the principles of patriarchy nevertheless. The idea that men, in private circumstances, can behave and associate in the pretence that they are still in charge of everything, as they were in the nineteenth century, both at church and in clubland.

This doesn’t matter much when it comes to the likes of all-boy or all-girl sports teams – though it’s a delight to see Woodlanders Football Club, Lioness-cubs to a girl, beat the boys to win their cup.

It begins to matter very much indeed when the senior figures of professions and public institutions seek to associate only with their male colleagues. That’s as true of a boss who takes only the boys in the office to a rugby match at Twickenham as it is of gentlemen’s clubs. It may be patriarchy-lite, but it is rooted in the same hegemony that gave the Church its patriarchs.

It’s an irony as rich as the location of this week’s Garrick vote that the gospel is far from patriarchal in its narratives, even though the language of Father and Son so ostensibly is. The Nazarene, scandalously for his day, freely associates with women. The Jesus movement is radical in gender equality in a manner that its Church has failed down the centuries to emulate.

Jesus gives full messianic attention to a despised and shamed Samaritan woman; he saves an adulterous woman (code for prostitute) from stoning; he stops to address a bleeding woman who just wants to touch him; as the risen Christ, he gives a woman, Mary of Magdala, the greatest apostolic mission in history to tell his dispersed disciples what she has witnessed.

Little wonder women appear so prominently in the Acts of the Apostles. These were women at the top of their game. It’s just taken a couple of millennia for our churches and clubs to catch up.

Article

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.