AT THE Bromley by Bow Centre, in east London, patients sit beside their doctors during their consultations, and the desks are curved so that both can read the computer screen together. The message that this is intended to send is: health is a partnership.
"It may seem a small thing, but in the NHS it's pretty big," says the Revd Andrew Mawson - now Lord Mawson, in recognition of his service to community regeneration. He is one of the founders of the healthy-living centre. "We are seeing doctors and patients in relationship. . . It's to show that, as a patient, you own your own health. We see ourselves as gate-openers not gatekeepers. [We're] about asking, what is health? Well, it certainly isn't just tablets."
Healthy-living centres offer a holistic approach to medicine, and Bromley by Bow Centre has taken it further than most. More than 2000 people walk through its doors every week. Some are wanting to see a GP, or get advice on healthy living; some are families seeking support, or attending the nursery; others are in need of benefits, work, or in debt; others, still, are taking part in art clubs or other activities.
It is an ambitious network of interconnected community enterprises, alive and thriving in Tower Hamlets - one of most deprived boroughs in England. But the most surprising fact about the centre lies not in its success today, but in its origins. Only 30 years ago, it was a 200-seater church that welcomed just a dozen regular worshippers.
Lord Mawson was the United Reformed Church minister who arrived there in the mid-'80s, at the time of the Church of England's report Faith in the City. He agreed to take on the church for two years, to see if he could help turn it around.
"The church was becoming aware that, unless something happened, it would be closing in two or three years. People in the church started saying: 'Let's give the building away, and see what happens.' So, when someone [asked] about setting up a dance school in the church hall, we decided not to do the usual church thing and let her rent the space, but to work with her to make it a success. It wasn't long before 150 children started coming."
The dance school was later joined by a nursery, a café, and art studios and workshops, followed by innovative community initiatives in the areas of family support, social welfare, and learning.
THE catalyst behind the centre's launch in 1997 as the the first healthy-living centre in the UK, complete with GP surgery and more, came about because the church - by now home to several enterprises and community programmes - became involved in the life, and then death from cancer, of Jean Vialls. Ms Vialls, in her mid-thirties, was failed by the medical and social services that were supposed to support her, because they did not communicate with each other.
"The healthy-living centre began with a partnership with local GPs, who were saying at the time that 50 per cent of patients that they saw didn't have a medical problem, but an unemployment, or a housing, social, education, or lifestyle-related problem. But when I suggested that we were going to build an integrated health-care centre, you'd have thought I'd suggested building nuclear weapons."
A protracted battle with the NHS followed, which ended when the Conservative Health Minister of the day, Brian Mawhinney, visited the centre, and wrote an order to give Lord Mawson's team a budget, and three members of staff, to get the healthy-living centre going.
Today, besides the reception for the health centre, there are a housing desk and education facilities, too. "It is part of what is called 'social prescribing', which we have pioneered," Lord Mawson says. "If a patient comes into the surgery but needs welfare advice, or access to education, then that person is referred within the centre to the area that can meet their needs."
Symbolic of this different approach is the fact that there are no NHS signs, although the doctors are NHS doctors. "There are no NHS signs, because it's a health service, not an illness service," Lord Mawson says.
OVER the years, the centre has evolved, grown, and changed. "We've had to learn hard lessons. We've evolved things as the centre has changed: we are about opportunities. If you fundamentally believe that humans are created creatures, then you believe that humans don't just receive, but give, too," Lord Mawson says.
"We have to start with what is a human being, made in the image of God. When people with all sorts of conditions embrace their passion, they get healthier. Education and health are connected. When people get jobs and work and have education, it changes the nature of the world, and a healthier nation begins to grow."
One of the successful projects pioneered in the healthy-living centre brought art and medicine together to help children and their parents understand asthma. "We ran a major project, as the numbers presenting with asthma were rising, and if you were a parent with a child with asthma, we could see it could be frightening.
"We got a doctor and a nurse, who is an artist, together with parents and patients, and started to use art to understand what is happening in the body. It was about having fun together, breaking down barriers, but also understanding the science of asthma.
"The project mixed health and science and education, and a whole new way of training doctors, too. And one of the works of art created in the project is now on the wall of the Department of Health."
THE Bromley by Bow Centre has gone from strength to strength, but many other healthy-living centres that received Lottery Funding in the late 1990s have already shut. Now that funding stream is closed.
Lord Mawson blames idealism and lack of focus for the failure of some. "A lot of the centres that began to open were projects that were unsustainable. In the long run, they just weren't business-focused. People were developing fitness centres and complementary health programmes, and the NHS should have been encouraging GPs to commission services.
"There were 250-plus of these centres across the country, but the brand was not focused in the way it should have been. If you were doing it, and applying for money as part of something already up and running, that was fine, but it takes a while to develop a new project and make it sustainable, and, by then, the funding had moved on.
"The Lottery Fund was a great example of what sounds like a good idea, but with no sense of sustainability. Politicians move on to the next big thing, and the community is let down. Politicians never go the full cycle, but in the Church we are around for the long haul."
Lord Mawson is now involved in a social-enterprise project, One Church, 100 Uses, which started in his own Church, the URC, but is now working in other denominations, too. The project helps churches to engage with sources of funding and build strategic partnerships to serve their communities.
"The Church can do more with health," he says. "It needs to develop local partnerships, to reach out to a whole range of people, not be a club. If the Church becomes isolated, it becomes unstable, and not healthy itself. Churches need to embrace enterprise. Didn't the Church use to do that? Look at monasteries: they were always very entrepreneurial. It is not a new idea."
LORD MAWSON is also involved in two other projects that marry health and Christian spirituality. One is working with a Baptist church on the Isle of Dogs, which has formed a partnership to open a Free School and a health centre.
Another is a development in Tower Hamlets, the St Paul's Way Transformation project, which is building new schools, housing, and health and children's centres. The diocese of London is in partnership with the NHS, and housing, community, and other associations to deliver the project alongside Lord Mawson's company, Andrew Mawson Partnerships.
"Small churches can be great catalysts if they develop partnerships with others around them, like doctors," he says. "We need to embrace entrepreneurs and business. It is about being intensely practical, not recycling poverty by being well-meaning. Churches need to stop fearing business and enterprise, and build relationships. We are interested in how the Word became flesh: we need to put this into practice."
But although the Bromley by Bow Centre has thrived and developed, the church has stayed small. The 2000 who use the centre have not become worshippers at the church.
"That was never the intention," Lord Mawson, who no longer leads the church, says. "We were very clear that we weren't about converting people. It is about the Word becoming flesh, being known by what you do. It was only when we built that first nursery that parents believed we kept our promises.
"We want to build a strong community and create trust, and not be a group of people trying to get other people to join our club."