Historically, many service institutions -- hospitals, health clinics, universities -- were launched by faith communities and designed to carry out missions of mercy and bless their neighbors. But now, in the hyper-bureaucratized West, it can seem as if those founding days are over.
Dr. Laura Neilson demonstrates otherwise.
Ten years ago, she and her husband, Chris, were serving as church planters with the Salvation Army in Oldham, a town in Greater Manchester, one of the poorest places in the U.K.
Neilson, then a medical student, was frustrated at the poor health care her neighbors and fellow church members were receiving.
She organized a community effort to get a new health clinic approved by the National Health Service for the local area. Although the U.K. has universal free health care, there are gaps in the levels of access and service -- particularly for primary care -- between the rich and the poor.
When the NHS plans called for the clinic to be built by a for-profit company without interest in improving the neighborhood, she objected.
“Someone is going to make money from providing bad service to the poor?” she said.
The NHS manager dismissed her, saying, “Why don’t you do something about it?”
So she did. Neilson -- then 25, with a new baby -- went home, Googled “how to set up a company” and went on to found the nonprofit Hope Citadel Healthcare in 2010.
The general practice, or GP, is based on “focused care,” the philosophy of treating the whole person and addressing underlying issues that might affect the person’s health, such as poverty or homelessness.
Hope Citadel offers food pantries, choirs, and groups for mothers and toddlers, along with counseling services, extended doctors’ appointments, and in-house referrals.
The company has grown to include nine health centers in Greater Manchester, employing 120 people and seeing 33,000 walk-in patients per year.
Neilson and Hope Citadel have won national awards, been featured in national media and become sought out as an alternative voice in British health care. They have consistently shown better outcomes than other approaches, reducing emergency-room visits by those in its care by some 40%.
John Patterson, Neilson’s medical director, says simply, “We are a redemptive company.”
Faith & Leadership contributor Jason Byassee spoke with Neilson about her approach to health care and entrepreneurship, and how they are informed by her Christian faith. The following is an edited transcript.
Faith & Leadership: Tell me more about “focused care.”
Laura Neilson: We take on poverty and clinical and social complexity and people who can’t engage the system -- they either anger it or it angers them -- but we can do quite a lot with them.
My motivation comes from my personal faith: Jesus Christ goes to the margins. In health care, what does that look like? Here it’s inner-city deprivation. It’s interesting to start to apply things that are common in faith communities, systematize them and apply them outside.
Our GP practices look like “normal” ones on one level, but they feel very different. We talk a lot about understanding people’s stories and not just their diagnoses. And we talk about compassion and the power of hope.
There is a long heritage in medicine, which we’ve lost the last 50 years, in abiding and compassion. Before decent drugs were available, doctors were kind and compassionate. They held you when your baby died. We’ve lost that along the way.
Once you’ve heard someone’s story and sat troubled with them, like Mary pondering in her heart, you ask, “What can we do?” That could mean writing letters to housing people, advocating, or walking with a woman until she decides to leave her abusive husband and make a plan to leave.
When I was a junior doctor, I asked a gastroenterologist if he’d ever seen anyone give up alcohol: “No. Never.” Well, I’d seen it quite a lot, mainly through the church. I realized the stories you hear determine the ones you will live out.
The model works even if you don’t understand the faith or the ethics; the foundations of it are teachable, and it catches. Then it can grow wider. Some of our best work is with people of no faith or who are fascinated by it.
We started with a food bank and clothes-giving scheme, including uniforms for school kids. We have run choirs and gardening and walking groups and toddler groups. That’s not normal NHS work at all, but now it’s proliferating.
F&L: How did your faith influence how you designed the clinic?
LN: I’ve always been interested in the question of how you live your faith out in nonchurch settings. We are called to lead in a way that helps bring in the kingdom of God. We see that more often outside the church than inside sometimes.
Hope Citadel coined the description “focused care.” We see patients who are clinically and socially and mentally complex cases, who have been turned out of other practices. They typically go to A&E [the emergency room] to see a doctor, where the medical models are all linear.
Some focused-care work is provided by the sorts of wise women we have in church, who now wear an NHS badge and do what they do with their pastoral skills in a medical setting. They get people entered into systems properly, into housing where they’re not evicted. That model has grown and is now practiced in some 50 practices around Manchester.
F&L: How has your foundation in faith helped or hindered your medical work?
LN: When we formed the company, we had mostly older, evangelical men who wanted us to have a statement of faith and an ethical stance up front.
I felt we should not. If you ask doctors about, say, abortion, euthanasia or contraception, you’ll get a massive range of views, and it will only be divisive.
So I talk about the kingdom theologically -- the closest translation is to justice and inequality -- and people of no faith can get onto that.
I encourage our doctors not to pray with patients, not because it doesn’t work, but because there is a power imbalance in the room. So we pray behind the scenes. We work with other organizations that are not faith-based. People will then bump into faith rather than be forced into it.
I’m not evangelical enough for some. They think I’ve watered down faith, because I duck those sorts of questions. I find that offensive. I keep talking about poverty and justice and systematic injustice and forgotten areas and peoples, and try to connect with Christians on that instead of on the culture wars.
On the other side, people will meet me, and after a few hours, they’ll say, “You’re really quite normal, aren’t you?” There is such prejudice around Christianity in England in general.
A lot of our staff do have strong faith and live it out. Others have their own faith or no faith but get the social justice. We never say we’re a Christian company. We’re not.
That came to a head at an early decision point where we interviewed two doctors. One was a Christian and not the best doctor. One was a non-Christian but a good doctor and kind. That was a defining moment. You don’t get a job here because of a badge of faith.
I am surprised by how many Christians I meet who say, “Fantastic, I’d love to work with you” that often then say, “This is too tough for me.”
We pay well, but you can earn more as a doctor elsewhere. Probably 70% we meet end up taking jobs in middle-class areas for more money. That’s disappointing -- to hear, “I would love to help the poor, but I really need a five-bedroom house. Why waste your life making less money than you could?” I always think, “Well, I wasted my life, too, then.”
Amidst a national shortage of GPs generally, I see our staff as God’s provision. We couldn’t have grown this quickly or filled loads of recruitment holes without God’s favor.
F&L: What sort of external validation has Hope Citadel received, and what has that meant to your work?
LN: The Care Quality Commission of the NHS gives a rating of “outstanding” to only 4% of surgeries [doctors’ offices] in Britain, and three of our offices have won them. Such a validation, through a very robust process in its external judgment, gave us a barometer we didn’t have before. I won an award from a national journal of health care management, a “rising star” award.
We have become a benchmark for what’s possible in deprived areas, so we get visited by departments of health, who are quite surprised. Most think health innovation comes from London, but the proper backwater of Manchester, in this little deprived area, we’re getting better outcomes than in wealthier areas.
They ignored us for a few years, but in the last two or three years, more people are open to finding out why we’re getting these outcomes and what can be learned.
F&L: How hard was it to start an institution from scratch?
LN: I was self-taught. If I’d thought it through, I wouldn’t have done it. We moved to Oldham to plant a church and improve an area and help bring the kingdom. For me, having a youth group and a pool table were not enough.
I had started as a medical student and realized that the health care in our area was not very good. So I launched a community campaign to get a GP-led practice in the estate. I got angry at the health care system and had a real sense of injustice.
A for-profit health scheme would have seen a company take money out of our area and not build community. That initial negative emotion gave me a lot of motivation. I didn’t have a vision of what we could do; I just knew that I didn’t want that to happen.
So I literally sat down, age 25, with a tiny baby, halfway through medical school, and Googled “how to set up a company.”
I had to write a tender to bid for NHS funding. In four weeks, I wrote 50 essays back to back: what we would do with recruitment and medicine and so on. I tackled them like I would an academic essay, like a real geek, and scored the highest mark in the country.
I prayed at 2 a.m. that God would give me the words, and what came out was quite good. It turned out to be prophetic.
Then it was quite fun. When we won the contract, it was like being on “The Apprentice,” employing people for the first time, opening buildings, developing a new skill every week for two years.
There are lots of upside-down things about this story. I started it before I was qualified; I was a third-year medical student. I’m still not qualified as a GP, so this has been a meandering way of doing things, a bit bonkers even.
But we’re the only organization to get three “outstanding” assessments by the NHS assessment standards. That’s a watershed moment. To get this kind of proper badge of quality, and to show these shifts in outcomes, is incredible.
