It will come as no surprise to those of you who are sitting in this congregation today to know that the National Health Service is one of the most talked about institutions in this country. The trouble is we are all involved in some way or other, either as patients, relatives of patients, staff, managers, or administrators. It is a soft and easy target to criticise – you don’t have to be an expert to have an opinion about its state and there is so much to talk about – waiting lists, cleanliness, shortage of beds, outpatients department, patients on trolleys, food and until recently in Wales parking as well. Yet opinion polls show that in spite of all this, it is the country’s pride and joy and a service such as this commemorating the NHS’ 60th anniversary, the inception of the new Abertawe Bro Morgannwg University National Health Trust – the largest in Wales, and a thanksgiving service for the dedication and care of the nursing profession gives us time to reflect and to remember.
Of course, there are problems with the National Health Service. There always will be problems with a national institution but remembering and reflecting help us to put these things into perspective. It was in 1942, in the middle of the Second World War, that the Beveridge Report had a vision of a new society which would make public provision for the health of the nation and the care of the sick. The miracle of 1948 was that the National Health Service was founded at all. It is so easy to forget that after the Second World War, Britain was exhausted economically. She’d had to sell more than a thousand million pounds of overseas investment to fund the war. I know that today that doesn’t sound like very much, but then it really was. One thousand five hundred million pounds worth of damage had been done to factories and homes. 15.9 million tonnes of shipping had been sunk. It was against a background of financial stringency that the welfare state was created. Moreover, it wasn’t without controversy when it was set up. The cost was expected to be great and most doctors believed that it would reduce their fees and freedom. They didn’t want to stop being self employed professionals for under the National Health Service Act, they became civil servants working in a system of nationalised health care provision. The BMA therefore strongly opposed the setting up of the Health Service. 90% of doctors threatened to resign rather than join it. So the background was economic hardship and entrenched opposition. It took enormous courage and determination on the part of Aneurin Bevan, Clement Attlee and Stafford Cripps to set it up.
And let’s also remember that District nurses were employed by District Nurses Nursing Associations and they had to raise funds for their own salaries. They held bazaars in order to make sure that they were paid properly. Remembering all that puts our problems in their proper perspective. It certainly ought to enable us to give thanks for the tenacity and vision of those who set it up. It was the conviction of the government of the day that the fighting of disease and the restoration of people to good health were crucial. It is a system that is free, for the most part, at the point of delivery. It came into being as a universal and comprehensive producer of free health care. There is nothing like it in any other part of the world. Universal – providing services to everyone regardless of their ability to pay. Comprehensive – providing the full range of health care for all ages “from womb to tomb and for all health needs from teeth to toes” as someone put it, and affordable, that is, it does not demand inordinate levels of taxation or any other form of payment.
And it’s also worth remembering that it came into being against a background of other welfare measures because it was realised that you couldn’t separate health from other social problems such as poverty, unemployment and housing. So the National Health Act was part of this wider package of reforms bringing in unemployment benefit, old age pensions, widows pensions and death grants. As the catechism of the Roman Catholic church says about health “Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good. Concern for the health of its citizens also requires that society helps in the attainment of living conditions that allow them to grow and reach maturity – with such things as food and clothing, housing, health care, basic education, employment and social systems”.
Now in fact the setting up of the National Health Service, like so much else in this country and we tend to forget it, owes a great deal to biblical insights. Why do I say that?
- Both the Bible and the National Health Service are concerned with healing and wholeness.
- In both, there is enormous stress on the importance of caring for others not just for ourselves.
- The founding of the Health Service, against a whole raft of other welfare reforms, reflects the biblical insight that life in an integrated whole.
Let me talk briefly on those 3 things.
Health and healing are central to the biblical view of things. The God of the Old Testament is the God who is at work for the salvation, wholeness and restoration of human beings within a restored creation and it is full of stories about healing. In the New Testament, Jesus again and again restores people to health – the sick, the blind, lepers and the deranged. His manifesto at the opening of his ministry in Nazareth was that he had come to make the lame walk, the blind see, and to bring liberty to captives. Healing the sick is part of restoring people to wholeness and salvation and healing in the New Testament are seen as different aspects of the same divine activity.
Fel y mae’r geiriau yn y Gymraeg yn awgrymu, mae cysylltiad agos rhwng iachâd ac iachawdwriaeth. Yn y Testament Newydd mae iachâd ac iachawdwriaeth yn rhan o’r un weithred dduwiol.
Jesus exhorted his disciples to heal the sick and the Christian faith has never lost sight of its broad concern with health and the fighting of disease. For when people are diseased they are less than the people that God means them to be. That’s why doctors and nurses, as well as a raft of other professions, are deemed to have a vocation. Fighting disease, restoring people to health is seen as part of God’s purpose. God is interested in us as total human beings – our minds, our bodies as well as our souls. We forget how many life threatening diseases have been cured as a result of the National Health Service – diphtheria, whooping cough, smallpox, tuberculosis – all killer diseases in the 1950’s and 60’s.
But true healing doesn’t stop with the curing of physical ailments. You will remember the story of the paralytic led down through the roof when Jesus sees that somehow there is something more than physical illness afflicting him. The malaise went deeper than that and He forgave the man’s sins before telling him to get up and walk. That is not to say that sickness is the result of sin but that salvation is a many faceted thing. To be made whole requires healing of body and mind and spirit and it is excellent that the ministry of Chaplains is an integral part of the life of any hospital.
The National Health Service was founded on another biblical insight, respect for the dignity and unique value of every human being. That’s why the Health Service is a comprehensive service and a national one. It does not depend, thank God, on how wealthy we are or on our status. It’s worth remembering that before the founding of the National Health Service, the very poor wouldn’t dare call the doctor, until they had to, simply because they couldn’t afford to pay him and then it was often too late. Pregnant women were 5 times more likely to die giving birth in Wales than in more affluent parts of the country. People couldn’t afford to go to hospital because they were charged so they went to work houses just for basic palliative care. Terrible diseases, therefore, decimated the population which relied for the most part on home cures and old recipes.
Florence Nightingale, when she saw the terrible conditions of the military hospitals of the Crimea, protested not just at the loss of life, but at the affront to human dignity of such places. She is regarded as the founder of modern nursing because she believed passionately that everyone deserved care and respect as they were nursed, whoever they were, officer or solider, likely to recover or not – because for her all were made in the image of God. It is possible to offer nursing care and to treat people just as objects. True nursing is about offering respect and dignity to those being ministered to.
Now it is easy to forget in the National Health Service which is a large complex technologically dependent organisation, that at the end of the day it is patients who are important, that the personal supportive response to human need and to a particular person at a particular moment is the thing that counts. That’s what the story of the Good Samaritan brings out. You could, of course, argue that there was need to look at the whole problem of policing that Jerusalem/Jericho road and that therefore you couldn’t deal just with one person in need. It was a structural problem. True enough but at that particular moment it was one man in need whom the Samaritan dealt with and so too when it comes to a complex organisation such as this, it is this particular person in this particular place who needs your attention and that’s what the caring professions are all about.
Health care has to recognise the importance of the personal in a world of targets, accountability and value for money, all of which are important. It is also worth remembering that people who have serious health problems require expensive treatment that they would never be able to provide for themselves. But even people who are rich and have private health insurance do not rely on it for chronic or long term illnesses. BUPA has no hospitals for cancer or for schizophrenia. One of the glories of the NHS is that it is paid for from taxes so that we all contribute according to our needs and according to our means. That’s the essence of the meaning of the word “society”. It’s not a collection of individuals but a community for mutual care. The NHS is a great leveller.
Someone writing about all this recently said “that the National Health Service is based on the principles of solidarity and subsidiarity. Solidarity means that we are all responsible for one another. The NHS is funded by those who can most afford it -to provide for those who most need it and subsidiarity that decisions should be taken as close to the grass roots as possible”. As Professor Marcus Longley put it “high tech medicine is very popular with the latest heroic treatments and gee whiz surgery. What really makes the difference for most people is the low tech human element – the little kindnesses, understandings and extra effort which NHS staff makes every day for their patients”. In other words, the system has to be kept human – in the way we deal with patients but also in the way we deal with staff. For if staff are not treated with dignity, they might treat others with less than the dignity they deserve.
Because of under-funding, decisions have to be made on priorities. Hugh technological advances continue to be made and have really gathered pace in recent years and treatment is available for more and more conditions previously regarded as untreatable. The assumption may arise that if something is technically possible, it will be available, whatever the cost. With finite resources, does that mean that this is done at the expense of other less urgent treatments?
There are examples of a small number of people receiving very expensive treatment and so denying a large number of people less expensive but no less important treatment. How is this claim to be measured against that claim? Whose life is to be given priority? There is no doubt that those with longer term needs such as the mentally ill and those with problems of ageing have a difficult time pleading their cause against the powerful advocates of high technological care for those with life-threatening conditions.
But in a civilised society, we need to ring-fence provision for the aged and the mentally ill, the people who are the most marginalised in our society. And it is certain that we need fuller public discussion of these issues.
The plight of the mentally ill, arguably the most vulnerable in our society, needs urgent attention. There has been a substantial shift of care of the mentally ill, and indeed the elderly, from hospital to the community. The aim is still care but there has not been an adequate shift in resources. They have suffered more than most.
There is need for politicians, people of faith, health and social-care professionals, community leaders and health and social care managers to develop just solutions to ethical dilemmas we face in the health service and to try to prioritise.
The third point I made at the beginning was that health and disease cannot be divorced from issues of social justice, education, the environment, housing, transport and access to welfare services. The Black Report, which was rejected by the Thatcher Government in the 80’s argued that suffering and disease were greater among poorer people than among those who lived in rural areas. A recent Rowntree Report points out what ought to be obvious – that unskilled workers and their children are twice as likely to die prematurely than professional people. A huge variety of diseases are caused neither by germs nor by viruses and are cured neither by drugs nor surgery, because they have to do with other factors in society.
Social factors are responsible for many illnesses – living in poverty, poor housing, working long hours – all lead to illness. We have to tackle root causes not just symptoms. There would be less strain on our health service if the roots of some of our social problems were addressed.
The gap between the rich and poor in Wales is the biggest for 50 years. Some of Wales’ poorest households are so deprived that families cannot afford two decent meals a day. There are parents who go without food for days so that children can eat, and pensioners who live in one room all winter because their houses are so cold. All of that inevitably affects their health.
Of course, we must also make sure that we look after our own health in terms of healthy diets, exercise and not smoking so that we do not put undue stress on the health service. Prevention and cure go together.
People of faith stand alongside you who work in the Health Service in wanting healing and wholeness, in stressing the importance of every individual and in making sure that health is seen in the context of other issues such as justice, education and welfare.
So today we give thanks to God for our Health Service and for the inauguration of this new Trust and pledge ourselves anew to make sure that it is the best that we can make it and that it serves the requirements of all who need it with both humanity and dignity.