Health and Well-Being, and the NHS (The Archbishop of York)
In April 2010, in the wake of the Financial Crisis, I invited a group of academics and practitioners to come together to take stock, not only of the policies by which our society and our economy should be governed, but also of the underlying values and principles of which that society and economy are an expression. We named the group “The Archbishop of York’s Symposium”.
Participants have included economists, financiers, social scientists and theologians who have been engaged in an open discussion on what we feel are the important public policy issues of the day.
At our most recent meeting, just a few days ago in the Summer of 2011, the members of the Symposium met to examine the issue of health and healthcare reform in the UK.
It was an issue that had been on my heart for some time, but even in the week where we sat to discuss the matter, the newspapers were dominated with stories about possible cuts to health provision and rationalisation of services under a modernisation programme.
It is hard to put into words the way that British people feel about the National Health Service (NHS). There is a sense of national pride not only in the hard work and professionalism of the doctors and nurses (and other staff), but also in the institution itself.
When Aneurin Bevan launched the NHS on 5th July 1948, he probably had little idea that 63 years on the foundations he had put in place would be so interwoven into the fabric of our national identity.
The NHS was born out of a long-held belief that good healthcare should be available to all, regardless of wealth.
It was motivated by three core principles:
• That it meet the needs of everyone
• That it be free at the point of delivery
• That it be based on clinical need, not the ability to pay.
I have to say that I am extremely grateful that these principles remain in place to this day.
On 25th May this year, I had been in London listening to President Barak Obama address the Joint Houses of Parliament and had then attended a Service of Thanksgiving for the life and work of the great judge, Lord Bingham of Cornhill. There had been no indication that anything at all was wrong with my health. But later that night I was engulfed by illness and I had to be urgently admitted to hospital.
So what did I do? Did I have to check my medical insurance details, or check that there was enough money in my current account to cover my medical treatment?
No. Because of the system we have in England, I was able to go into the local NHS hospital – St Thomas’ in Westminster – and immediately receive the care that was required to help make me better. The doctors and nurses were brilliant.
It is a principle that enables all UK residents to have peace of mind whether they are in their home city, or on the other side of the country. The NHS will always do its best to care for you, regardless of your personal income or place of residence.
Of course, having a service which is “free at the point of delivery” is not the same as having a service which is “free”. The fact is that we all help pay for the running of the NHS through general taxation.
Whilst it is rarely popular for a public figure to sing the praises of the principles of taxation policy, I am always happy to say that if you want better public services then you have to be prepared to put in the investment to ensure that they are properly funded.
It seems only right to me that those that earn more should therefore contribute more to help nurture the common good. It is not about generosity of the pocket, nor about generosity of spirit, it is about fairness or equity.
However, taxes are only part of the solution – there is a strong argument for making better use of the money already in the system. There is nothing wrong with ensuring investment is targeted but at the same time holistic.
For many years, it seems that our society has perpetuated the myth that the private sector is always more professional and more proficient than the public sector. This has never been my experience of public services, and I think this does a great disservice to the many people who devote their lives to working in the public sector to support others.
We should remember that “private” doesn’t always mean “better”. Look at the mess private Banks and their gambling casinos got us into!
We must never allow health provision in this country to become exclusive. Decent health care should not solely be the preserve of those that can afford to purchase it. I am certainly not persuaded by internal competitive markets when one is treating very ill patients.
Let us as a nation protect the principles of Bevan that allow each man, woman and child access to health care whenever they need it.
Good health isn’t simply a case of what is, or is not, provided by the NHS. A recent survey outlined the determinants of health as follows:
40% is due to behaviour
30% is due to genetic inheritance
15% is due to social environment
5% is due to physical environment
This leaves only 10% to healthcare.
Whilst the NHS has focused on addressing inequalities in recent years, devising formulae to spread finance for healthcare more fairly around the country, we can see that deep-rooted societal inequalities still remain.
For example, Manchester health authority gets three times as much investment per person than the health authority in Surrey – however life expectancy in Surrey is still 7 years longer than in Manchester.
It’s not just a North-South divide. The London Health Observatory recently found when looking at life expectancies that in our capital, you would lose a year of life expectancy for every tube stop on the Jubilee Line journey across London from west to east depending on where you lived.
The sad fact is that in our growing consumerist society, and the beguiling mantra: consumer choice, people want more and more, whilst being prepared to pay less and less. Often vast sums are spent on very ineffective treatment, and, although it may not be popular, we need to listen to the doctors and not just the patients. Doctors took up the vocation to treat patients and not to be managers of budgets or fund-holders. Let us not do to doctors what we have done to teachers: made them managers of budgets with targets to meet.
You can’t have a system where those who shout loudest get most. This is especially seen in areas such as GP provision, or when people say it is “against their human rights” not to have an operation on the NHS.
We need to be careful to not create a greater black hole in public finance out of a misplaced sense of duty. We cannot simply solve all health issues by throwing money at the healthcare system. We must look at the wider societal indicators and tackle problems at their root cause.
As our population becomes increasingly ageing, we need to look at how healthcare provision is funded to ensure it is sustainable.
At the moment, I know that I will be looked after in my old age because there are many hard working young people who are currently paying into the pot. But we need to know that when our young people reach old age that there will be someone to look after them too. We need to instil a renewed sense of solidarity.
Whilst life expectancy is steadily rising, disability-free life is dropping for the average person. Let us strive for an improved quality of life for all, not just an improved quantity of life for all. Let us learn to trust each other and invest for a better future that everyone can be part of, no matter where they are born or what their average income is.
We seem to have lost sight of the essential dignity of the human being. Patient–centred care now translates as individuals who have things “done” to them by others. Can this be right?
We need compassion. Consideration of compassion is illuminating. In a social context, we have lost compassion and human dignity, especially where people are at the end of their life or disabled.
We need to make sure we do not create a health system which is inhuman and unresponsive to individual need.
The problem with targets are that they are not based on need, they are based on numbers. I spent 15 days in St Thomas’s Hospital. What was the target for treating someone with a very acute condition which came on suddenly? What was the permissible budget?
It is not just the patients who suffer because of this behaviour. We should not underestimate the impact of bureaucracy on the morale of those working in the health system.
For example, the surgeon who operated on me recently had worked for three days straight and had major operations all day from 10am before he operated on me at 12.30am! I am told this is not an uncommon occurrence. How do we even begin to say thank you?
How do we build up springs of solidarity so that people feel appreciated and valued? How do we help people to feel that it is a vocation to treat others? How do we get a sense of moral compassion in such a big organisation?
The parable of the Samaritan shows compassion expressed appropriately with dignity, and we need to apply this to the Health Service as it provides for a community of the sick.
We forget though that in this parable, although Jesus is talking about those who give help, He is also talking about those who receive. We need to see our own roles in the same way – if we were the injured man, we would want someone to help – so how do we help build a responsive society?
When the credit crunch happened, we learnt a lot. Mammon’s temple showed that money is a means for exchanging goods – and not the determining factor. We also learnt that we cannot keep borrowing to keep up. Mammon was given a severe pasting but I am afraid he is slowly rebuilding his merciless temple.
We are in a fragile economic position as a country, and whilst the 5 social demons of Beveridge are still here, we should remember that the importance of self worth is also still present.
I grew up as one of thirteen children, but my parents were very good at reading to us and telling us stories. We all felt incredibly valued and loved. In fact it was utter happiness. I believe that we need to have the same attitude towards the children of this nation.
We need wholesome environments – not just money in the pocket to make us happy. As a society we are hesitant about the importance of neighbourliness and valuing others. Raising children is more important than material wealth.
Whilst we may strive to deliver value for money, we cannot allow care to be market-led or commercialised to the point where patients’ safety is put at risk. You cannot compare an NHS hospital to a supermarket.
When my appendix was removed, the doctors felt it necessary to keep me in hospital for two weeks – whilst it may have been cheaper for me to have been treated on a production line in a factory, care and compassion for the patient must be paramount.
We need to recognise that there are no easy answers when we look at the demands on the NHS. All health-care systems have their limitations but in the NHS we have a wonderful institution with fantastic staff who are doing their best to serve and treat us, often in impossible circumstances.
If we accept that healthcare can only touch some of the factors contributing to the overall health of a person, we need to challenge policy-makers over those aspects of funding and social policy that affect those who are suffering or living under the burden of societal injustice. We need a generation of equity.
We need to re-articulate what is needed in our country in this new modern context, and debate how we can work together to best deliver it.
Over the next few days, some of the contributors to my Symposium will make public their own findings about our health system. I found what they had to say both informative and challenging. As our political leaders embark on reforming the NHS via the Health and Social Care Bill, I hope that these observations will help re-ignite a national debate so that we can ensure our institutions deliver what is best for not only the individual, but also for society and the wider country.
Let us re-examine the relationship between the individual, society and the State – and not be afraid to question our own expectations of health care provision.
In the 1940s, the Beveridge Report set out the Christian ethic. The then Archbishop of Canterbury, William Temple, wrote that the dignity of every human being had by law been put into a statute. If this Symposium can manage to help to achieve this aspiration for a new generation, we will have achieved our objective.
It is not wrong to want to re-open the public discourse around the provision of public services. We all want to see a system that is compassionate and responsive. We all want to see investment spent appropriately in order to provide the best care possible to as many people as possible. The challenge is how do we achieve that?
Let us aim high as we set out upon this journey – and let us aim together.
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