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Steve Fouch

Happy Birthday NHS: Let’s not let a national good become a national god

Steve Fouch is CMF Connections Manager, and formerly worked in community nursing, HIV & AIDS and palliative care. He serves on the International and European regional boards of Nurses Christian Fellowship International.
The views expressed do not necessarily reflect those of CMF.

Today (5 July 2018) marks seventy years since the world’s first, free-at-the-point of delivery, universal access, national healthcare system was launched. Britain’s National Health Service (NHS) has become so much a part of the fabric of British life and culture in those seven decades that it is regularly cited in surveys of the British public as the one thing that they are most proud of about the country.

If you live in the UK and didn’t know any of this, it is likely because you have neither read a newspaper, surfed the web or watched television for the last few weeks. If you don’t live in the UK, you may wonder what all the fuss is about.

At the height of the Second World War, British Civil Servant Sir William Beveridge produced a report arguing for a nationalised insurance service for welfare and healthcare that would be accessible to all on the basis of need rather than ability to pay. The principle of caring for those not able to pay for themselves was not new, and indeed a slew of charitable (often church-run) hospitals had been doing this in Britain and most of Europe since the Middle Ages. But it was the idea that this would be delivered by the state in setting up a national health service, funded out of general taxation, with no means testing that was so radical at the time.

However, it would not be until 1948, three years after the end of WW2 with a nation still in a painful process of rebuilding itself after six years of brutal conflict, that the NHS would finally be launched. Overnight charitable and for-profit hospitals were nationalised, with only local family doctors (General Practitioners or GPs as they are now known) remaining semi-independent as contracted private providers and the first port of call for those seeking treatment.

Doctors resisted this radical change initially, fearing a loss of private income. Many church hospitals and Christian doctors also had anxieties about the impact on their freedom to practise in the name of Christ. However, the public were and remain deeply attached to the idea that all citizens, regardless of class and wealth could now get world class healthcare. In time the professions all came around to the idea. Today the medical profession and the churches remain some of the NHS’s staunchest defenders.

Indeed, that principle of making healthcare universally accessible to all has become globalised. The UN Sustainable Development Goals (SDGs) have enshrined the goal of each country moving towards Universal Health Coverage (UHC) as one of the fundamentals to achieving sustainable health for all people everywhere at all ages. And the British Government has been busy exporting the NHS model (especially its GP led primary care model) to countries as diverse as the United Arab Emirates and the People’s Republic of China!

However, since the day that it started, the demand has outstripped the resources of the NHS. Initially this was because those who had lived with ailments untreated because of cost could now freely seek treatment. In time it became apparent that this initial surge in demand was not going to go away, and if anything was increasing.

Over the decades, the NHS has also become a victim of its own success. As maternal, infant and child mortality rates plummeted, the population began to grow. As public medicine developed, so population-wide preventative measures reduced disease incidence across the nation and across all social classes. As care for the diseases of old-age improved, and social care for the elderly became part of the wider welfare provision, so life expectancies began to rise.

That growing and increasingly elderly population now need more long term social and medical care than ever before. As child birth grew safer and fewer children died young, so birth rates began to drop. The paradox of wealthy nations is that there are fewer and fewer young, working people to fund the care needs of the elderly.

Furthermore, the costs of new medicines and medical technologies has continued to escalate. As a result of all of these pressures, the NHS now finds that its costs are spiralling upwards as funding either stagnates or shrinks.

While it is a broadly efficient system, and offers the best palliative care on earth, the NHS has poorer outcomes for many major diseases than many other developed nations. It can be bureaucratic, uncaring and incompetent. The Francis Report showed how readily a caring institution can lose its focus and priorities, to deadly effect. The NHS is not the best healthcare system on earth, much as we like to think that it is. This deep national faith in the NHS can become resistant to reform and change.

However, ask anyone in Britain about the NHS today, and they will readily recognise its problems and limitations. They may even have horror stories to share about when care went wrong for a friend or family member. But they will also tend to express an admiration for the institution and a belief in its founding principles. As Nigel Lawson once said, the NHS is ‘the nearest thing the English have to a religion’. That could be said of the Scots, Welsh and Irish too! Any British politician who seeks to ignore or challenge this, risks their political career. This too can make real reform very difficult.

Is it also a sad reflection on our national priorities? Healthcare free at the point of need to all regardless of means is a good, godly principle that many Christians would endorse. In a modern, industrialised country, probably only the state is big enough to coordinate such a service. But in the process the volunteerism, charitable instincts and spiritual motivation of many who would care for the sick can be pushed to one side. When the NHS was set up, it embraced church-run services, and hospitals and did not interfere overly much in their ethos and organisation. That has changed, and today faith is pretty much banished from the workplace and spiritual needs are poorly, if ever, addressed for many patients.

Furthermore, in a culture that has abandoned Christianity, the hope of staving off death and suffering has replaced trust in Christ and the resurrection. Our focus has become distorted, seeking to postpone death rather than embracing life in all its fullness. Or, when suffering becomes too much, embracing death through assisted suicide rather than finding hope. Have we turned a national good into a national god?

We continue to support the NHS, but not uncritically, especially if it is to survive as a healthcare system for the next seventy years!

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