Prescribing Jesus

Is it appropriate for a doctor to offer Christianity as part of the treatment?

There's something wearying about the seemingly endless procession of "religious discrimination" cases coming before courts and employment tribunals. But the case of Dr Richard Scott, currently being heard by the General Medical Council, is a remarkable one. The accusation against the Margate GP is that he inappropriately discussed religion with a patient, a "vulnerable" and depressed 24-year-old. To be more specific, having first gained the patient's consent to broach the topic, he explained that Christianity might be of greater benefit than the religion (unspecified) to which the patient currently adheres. Becoming a Christian, it was implied, might help him get better.

Paul Ozin, for the GMC, said that the patient -- said to have been suicidal and to have had "lifestyle issues" at the time of the consultation -- was left "very upset" and felt Scott "had belittled his own faith". Scott contends that he did nothing wrong. He was merely exercising his "professional judgement", as allowed by GMC guidelines.

These professional guidelines seem quite straightforward. Here are the two relevant paragraphs:

19. You should not normally discuss your personal beliefs with patients unless those beliefs are directly relevant to the patient's care. You must not impose your beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views. Equally, you must not put pressure on patients to discuss or justify their beliefs (or the absence of them).

33. You must not express to your patients your personal beliefs, including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress.

Here's where things begin to get interesting. While the guidelines seem to envisage that any discussion of religion in a clinical setting should be a rare occurrence, Scott would appear to have been taking the opportunity to evangelise to his patients on an almost daily basis. In an interview earlier this year, he stated that he had raised the subject of Christianity with "literally thousands" of his patients. Not only that, he often encouraged them to attend evangelical Alpha Courses at his local church -- and that, out of every ten he asked, eight took up the offer and two "had their lives changed as a result".

Scott can at least not be accused of springing Christianity on his patients without due warning. He belongs to a Christian-oriented practice, the Bethesda Medical Centre in Margate. Until recently, the official NHS website carried a profile of the surgery, which stated:

The six partners are all practising Christians from a variety of Churches and their faith guides the way in which they view their work and responsibilities to the patients and employees. The partners feel that the offer of talking to you on spiritual matters is of great benefit. If you do not wish this, that is your right and will not affect your medical care. Please tell the doctor (or drop a note to the practice manager) if you do not wish to speak on matters of faith.

All this is, as I say, quite remarkable. This isn't the case of a doctor being persecuted by grim-faced secularists, because he once dared to mention his faith during a consultation. This is a doctor who, together with his colleagues, openly offers God as part of his normal treatment: a doctor who expects patients to opt out of being preached at whenever they go to the surgery with a sore throat or in need of a blood test.

The hearing is only taking place because Scott refused the GMC's decision to reprimand him over the incident. Backed by the Christian Legal Centre -- which is usually to be found at the heart of such cases -- he is insisting on his right to offer Jesus on the NHS.

I dug up an article written by Scott in 2002 for the magazine of the Medical Christian Fellowship, in which he was quite open about his motivation:

Evangelism is a job for all Christians, at all times and in all places, and Christian GPs are in a unique position to reach the lost in their local area. Sharing the gospel with patients is not an abuse of trust because God himself gives us the authority and salvation is their greatest need. We need to allow time for consultations in which the gospel might reasonably be introduced . . .

The article says nothing about the GMC guidelines but a great deal about the Bible. Scott writes that his "own particular focus is on depressed patients and anyone wearing a cross", the latter being "often lapsed Christians who carry much guilt and welcome the chance to discuss their faith". He mentions the "Christian notice board in the waiting room" and tells a story about a six-year-old boy who was encouraged by one of his posters to "profess his belief in Christ".

Scott is clear that Christian doctors have a special mission to save their patients from hell.

People are dying for the lack of the gospel message; eternal separation from God in hell is their future.

We are in a position second to none to reach the lost in our local area. We certainly have a greater access to non-Christians in a congenial environment than most full-time ministers . . . Our territory, our peculiar mission field, is our patients.

Far from Scott being the latest victim of a politically-correct secular tyranny, it would appear that, for many years now, the Bethesda Medical Centre has been able to function as part surgery, part evangelical outreach centre. This is an extraordinary state of affairs, even in a National Health Service that continues to fund homeopathy.

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We're racing towards another private debt crisis - so why did no one see it coming?

The Office for Budget Responsibility failed to foresee the rise in household debt. 

This is a call for a public inquiry on the current situation regarding private debt.

For almost a decade now, since 2007, we have been living a lie. And that lie is preparing to wreak havoc on our economy. If we do not create some kind of impartial forum to discuss what is actually happening, the results might well prove disastrous. 

The lie I am referring to is the idea that the financial crisis of 2008, and subsequent “Great Recession,” were caused by profligate government spending and subsequent public debt. The exact opposite is in fact the case. The crash happened because of dangerously high levels of private debt (a mortgage crisis specifically). And - this is the part we are not supposed to talk about—there is an inverse relation between public and private debt levels.

If the public sector reduces its debt, overall private sector debt goes up. That's what happened in the years leading up to 2008. Now austerity is making it happening again. And if we don't do something about it, the results will, inevitably, be another catastrophe.

The winners and losers of debt

These graphs show the relationship between public and private debt. They are both forecasts from the Office for Budget Responsibility, produced in 2015 and 2017. 

This is what the OBR was projecting what would happen around now back in 2015:

This year the OBR completely changed its forecast. This is how it now projects things are likely to turn out:

First, notice how both diagrams are symmetrical. What happens on top (that part of the economy that is in surplus) precisely mirrors what happens in the bottom (that part of the economy that is in deficit). This is called an “accounting identity.”

As in any ledger sheet, credits and debits have to match. The easiest way to understand this is to imagine there are just two actors, government, and the private sector. If the government borrows £100, and spends it, then the government has a debt of £100. But by spending, it has injected £100 more pounds into the private economy. In other words, -£100 for the government, +£100 for everyone else in the diagram. 

Similarly, if the government taxes someone for £100 , then the government is £100 richer but there’s £100 subtracted from the private economy (+£100 for government, -£100 for everybody else on the diagram).

So what implications does this kind of bookkeeping have for the overall economy? It means that if the government goes into surplus, then everyone else has to go into debt.

We tend to think of money as if it is a bunch of poker chips already lying around, but that’s not how it really works. Money has to be created. And money is created when banks make loans. Either the government borrows money and injects it into the economy, or private citizens borrow money from banks. Those banks don’t take the money from people’s savings or anywhere else, they just make it up. Anyone can write an IOU. But only banks are allowed to issue IOUs that the government will accept in payment for taxes. (In other words, there actually is a magic money tree. But only banks are allowed to use it.)

There are other factors. The UK has a huge trade deficit (blue), and that means the government (yellow) also has to run a deficit (print money, or more accurately, get banks to do it) to inject into the economy to pay for all those Chinese trainers, American iPads, and German cars. The total amount of money can also fluctuate. But the real point here is, the less the government is in debt, the more everyone else must be. Austerity measures will necessarily lead to rising levels of private debt. And this is exactly what has happened.

Now, if this seems to have very little to do with the way politicians talk about such matters, there's a simple reason: most politicians don’t actually know any of this. A recent survey showed 90 per cent of MPs don't even understand where money comes from (they think it's issued by the Royal Mint). In reality, debt is money. If no one owed anyone anything at all there would be no money and the economy would grind to a halt.

But of course debt has to be owed to someone. These charts show who owes what to whom.

The crisis in private debt

Bearing all this in mind, let's look at those diagrams again - keeping our eye particularly on the dark blue that represents household debt. In the first, 2015 version, the OBR duly noted that there was a substantial build-up of household debt in the years leading up to the crash of 2008. This is significant because it was the first time in British history that total household debts were higher than total household savings, and therefore the household sector itself was in deficit territory. (Corporations, at the same time, were raking in enormous profits.) But it also predicted this wouldn't happen again.

True, the OBR observed, austerity and the reduction of government deficits meant private debt levels would have to go up. However, the OBR economists insisted this wouldn't be a problem because the burden would fall not on households but on corporations. Business-friendly Tory policies would, they insisted, inspire a boom in corporate expansion, which would mean frenzied corporate borrowing (that huge red bulge below the line in the first diagram, which was supposed to eventually replace government deficits entirely). Ordinary households would have little or nothing to worry about.

This was total fantasy. No such frenzied boom took place.

In the second diagram, two years later, the OBR is forced to acknowledge this. Corporations are just raking in the profits and sitting on them. The household sector, on the other hand, is a rolling catastrophe. Austerity has meant falling wages, less government spending on social services (or anything else), and higher de facto taxes. This puts the squeeze on household budgets and people are forced to borrow. As a result, not only are households in overall deficit for the second time in British history, the situation is actually worse than it was in the years leading up to 2008.

And remember: it was a mortgage crisis that set off the 2008 crash, which almost destroyed the world economy and plunged millions into penury. Not a crisis in public debt. A crisis in private debt.

An inquiry

In 2015, around the time the original OBR predictions came out, I wrote an essay in the Guardian predicting that austerity and budget-balancing would create a disastrous crisis in private debt. Now it's so clearly, unmistakably, happening that even the OBR cannot deny it.

I believe the time has come for there be a public investigation - a formal public inquiry, in fact - into how this could be allowed to happen. After the 2008 crash, at least the economists in Treasury and the Bank of England could plausibly claim they hadn't completely understood the relation between private debt and financial instability. Now they simply have no excuse.

What on earth is an institution called the “Office for Budget Responsibility” credulously imagining corporate borrowing binges in order to suggest the government will balance the budget to no ill effects? How responsible is that? Even the second chart is extremely odd. Up to 2017, the top and bottom of the diagram are exact mirrors of one another, as they ought to be. However, in the projected future after 2017, the section below the line is much smaller than the section above, apparently seriously understating the amount both of future government, and future private, debt. In other words, the numbers don't add up.

The OBR told the New Statesman ​that it was not aware of any errors in its 2015 forecast for corporate sector net lending, and that the forecast was based on the available data. It said the forecast for business investment has been revised down because of the uncertainty created by Brexit. 

Still, if the “Office of Budget Responsibility” was true to its name, it should be sounding off the alarm bells right about now. So far all we've got is one mention of private debt and a mild warning about the rise of personal debt from the Bank of England, which did not however connect the problem to austerity, and one fairly strong statement from a maverick columnist in the Daily Mail. Otherwise, silence. 

The only plausible explanation is that institutions like the Treasury, OBR, and to a degree as well the Bank of England can't, by definition, warn against the dangers of austerity, however alarming the situation, because they have been set up the way they have in order to justify austerity. It's important to emphasise that most professional economists have never supported Conservative policies in this regard. The policy was adopted because it was convenient to politicians; institutions were set up in order to support it; economists were hired in order to come up with arguments for austerity, rather than to judge whether it would be a good idea. At present, this situation has led us to the brink of disaster.

The last time there was a financial crash, the Queen famously asked: why was no one able to foresee this? We now have the tools. Perhaps the most important task for a public inquiry will be to finally ask: what is the real purpose of the institutions that are supposed to foresee such matters, to what degree have they been politicised, and what would it take to turn them back into institutions that can at least inform us if we're staring into the lights of an oncoming train?