A Christian Perspective on the state of the NHS

shadowAs we anticipate another strike day by junior doctors, Dr John Pike, a GP in the Bristol area and regular reader of this blog, offers these reflections on the current state of the Health Service.

Aneurin Bevan, the founder of the NHS, once stated: “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.” And so the principle of the NHS was established: universal healthcare; free at the point of delivery; paid for through taxation. Emergency care is provided by GPs and hospitals 365/24/7. There is a strong biblical mandate for all this, as we see below.

However, in recent years we have witnessed what some regard as a creeping privatisation of the NHS. This has included an increasing role for the private sector in providing healthcare and there have been cases where companies which cherry picked services which they thought would be profitable later pulled out when this did not materialise, leaving the NHS to pick up huge debts. There have been inequalities in provision and the postcode lottery, funding problems and allegations of personal financial gain for some closely involved with commissioning. Patients have suffered through long waits for emergency and outpatient treatment.

Staff are unhappy as well. The NHS has always depended on the goodwill of the 1.3 million people who work for it, the largest employer in Europe. Everyday, all employees work in very stressful circumstances, beyond contracted hours, to ensure that patients get the best care that can be provided within limited resources. Increasingly, overworked staff feel unvalued, not properly remunerated for their work and skills, and being expected to perform to the highest standard in an unsafe, overstretched and inadequately funded environment.

Junior Doctors

The Secretary of State for Health, Jeremy Hunt, recently announced that he would impose a new contract on Junior Doctors in an attempt to enforce the seven day routine NHS that was promised in the Conservatives’ General Election manifesto. This was based on claims, since disputed, that more patients die in hospitals at weekends. Junior doctors, and many consultants and GPs, feel an imposed contract would ultimately harm patient care, through doctors being over-tired and working with low morale, that it would amount to a pay cut for more work and would provide an extra intolerable level of stress in excess of that which juniors already face. It has been questioned whether the NHS can afford a routine seven-day NHS when even a basic service is under-funded. The strikes have already harmed patient care and a mutually agreeable resolution is necessary but seems as remote as ever. There are early signs that many juniors will move abroad if the contract is imposed.

General Practitioners

In recent years, spiralling workload, rapidly rising costs of medical indemnity insurance (especially for those doctors providing care out of hours), and increasing levels of bureaucracy and of clinical governance have led to worsening levels of stress and morale for family doctors and adverse effects on quality of care. Funding for General Practice as a percentage of the NHS budget fell from around 10.5% in 2004/2005 to around 7% now, forcing practices to make redundancies. Some practices around the country became no longer financially viable and were forced to close. There has been a recruitment and retention crisis, with doctors retiring early, training vacancies unfilled and GPs moving abroad or leaving medicine. Patients have inevitably suffered.

Can scripture help inform our thinking on how we should respond to the issues this raises?

Both the Old and New Testaments give accounts of healings. These include the healing of King Hezekiah by God (2 Kings 20:1-11), the healing of Naaman from leprosy by Elisha (2 Kings 5:1-27) and the many healings by Jesus. These include the ritually unclean (a haemorrhaging woman, Mat 9:20-22/Mk 5:25-34/Lk 8:), outcasts (lepers, Mat 8:2-4/Mk 1:40-44/Lk 5:12-14, Lk. 17:11-19), those with evil spirits and seizures (Mat 4:23-25, Mat 8:14-17/ Mk 1:29-34/Lk. 4:38-41, Mat 8:28-34/Mk 5:1-20/Lk 8:26-39, Mat. 17:14-23/Mk 9:14-32/Lk 9:37-45, Mk 1:21-28/Luke 4:31-37), the slave of a Roman Centurion, an employee of an unwelcome occupying power (Mat 8:5-13/Lk 7:1-10/? Jn 4:46-54), someone in the party arresting Jesus (Lk 22:51), foreigners (Mat. 15:21-28/Mk 7:24-30), various people with physical disabilities (Mat 9:2-8/Mk 2:3-12/Lk 5:18-26, Lk 13:10-17, Jn 5:1-18) and the deaf, blind and mute (Mat. 9:27-34, 15:29-31Mk 7:31, Mat 20:29-34/Mk 10:46-52/Lk 18:35-43, Mk 8:22-26, John 9:1-7). Even the dead are raised to life (Mat 9:18-19, 23-26/Mk 5:21-24, 35-43 /Lk 8:40-42, 49-56, Lk 7:11-16, Jn 11:1-44, Acts 20:7-12). Many of these healings occurred on the Sabbath, something which irritated the Pharisees.

In Acts 2:43-45, we read:

Everyone was filled with awe at the many wonders and signs performed by the apostles. All the believers were together and had everything in common. They sold property and possessions to give to anyone who had need.

This particular text does not specifically mention healing, but a miraculous healing is recorded in the following chapter, the healing of a lame beggar by the temple gate called Beautiful (Acts 3:1-16). There are further examples of healing in Acts 5:12-16, but there is also an example of healing denied (2 Cor. 12:7-10).

Scripture also records the importance of rest.

What do we learn from scripture about the care of the sick? All this scripture can teach us much that is pertinent to the problems the NHS now faces:

  1. Healing is God’s gracious provision to us. Healing occurs at his discretion and through his power.
  2. The biblical witness does not recognise the concept of people profiting from healthcare. Indeed, judgement follows swiftly for Gehazi when he tries to extract money and clothing from Naaman as reward for the healing, contrary to Elisha’s own clear instructions. The punishment is that Gehazi and his descendants forever receive the leprosy that had been taken away from Naaman.
  3. In that same story, a captured young servant girl plays a crucial role in ensuring that Naaman receives healing. God can use anyone to ensure that people receive the care they need.
  4. Healthcare is a universal right and, in his lavish grace, God may give healing to anyone that asks for it in faith, including (or even especially) to those on the very margins of society. It is for us today to ensure that we facilitate this.
  5. Receiving healing from God is usually dependent on those being healed accepting their responsibilities.

Today, many others must accept their responsibilities in resolving the current crisis.

The Government

The government has to provide the healthcare service within finite resources. Romans 13:1-7 provides the key text on respecting the governing authorities, which have all been established by God. However, when government policy is at odds with scripture, we as Christians should be prepared to be vocal about what is right, in this case, the provision of healthcare without desire to make profit, for all. So far as is possible, the original aim of the NHS, for healthcare to be provided free at the point of delivery should continue, so that everyone, including those of limited means, have access to the care they need. Government should maintain an environment where those providing the treatment are properly remunerated for their work, feel respected and assisted in providing care to the best of their ability in a safe manner, free from unnecessary stress and with adequate time for rest and for other obligations, including time with families and study. Maintaining staff morale and improving recruitment and retention will be vital if patients are to continue to receive the best care.

Healthcare Providers

The scripture above raises the question of whether we, as Christians, can support private companies operating in the healthcare sector with a view to making a profit. Nuffield Health is a private organisation with a not-for-profit status, which is is a guarantee that any operating surpluses are reinvested back into the business, for the improvement of services, rather than being removed from the organisation as dividends. This is a good example of how the private sector can operate within Christian ethical principles.

The percentage of the GDP spent on public healthcare in the UK is about 7%, which is less than at least 15 other well-developed countries. The NHS provides exceptional value for money and the model is very well regarded by other countries. It should be possible for the fifth wealthiest nation in the world to continue to maintain this service and the wellbeing of those who work in it.

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20 thoughts on “A Christian Perspective on the state of the NHS”

  1. I am grateful for Dr Pike’s insights. However, his interpretation of scripture is selective and it seems to me to be a step too far to assert that private healthcare is inconsistent with Biblical teaching. I see no justification for such a sweeping claim.

    It is also extraordinary to assert that ‘government policy is at odds with scripture’ in this area. Many Christians would disagree. The point about Biblical healings is that they were effective and enabled those who were healed to achieve their God-given potential. The key issue for healthcare in the UK is which type of system (state-controlled, private, or a mix of the two) will deliver the same effective outputs which enable people to live life in all its fulness. And the simple fact is that healthcare in the UK falls well behind equivalent provision in Europe on almost every measure. The Euro Health Consumer Index for 2015 put the UK in 14th place out of 35 and noted that ‘the UK healthcare system has never made it into the top 10 of the EHCI, mainly due to poor accessibility (together with Poland and Sweden the worst among European healthcare systems) and an autocratic top-down management culture’. In other words, it is state control which is dragging us down! Is there really a scriptural justification for poor healthcare? I speak as someone who lost both parents to NHS incompetence and bureaucracy, so forgive me if I feel quite strongly on this.

    As for arguing that ‘the biblical witness does not recognise the concept of people profiting from healthcare’, this is simply not a defensible position. Who provided the rehab healthcare to the mugged man in the Good Samaritan story in Luke 10:25-37? Not the Good Samaritan but the innkeeper who was paid for his efforts.

    I fear that Dr Pike’s interpretation of scripture has been coloured by professional self-interest and a roseate view of the NHS which seems to be shared by many in this country but which is simply not borne out by this nation’s actual health indicators.

  2. Jeremy. Thank you for engaging. First, can I say I do not object to people being paid (and having their expenses reimbursed) for providing healthcare services. On the contrary, I make it clear that they should be properly remunerated. Secondly, I do not object to private healthcare per se. I gave the example of Nuffield Health, a private organisation that reinvests the profits in the business. Thirdly, I do not object to market forces. Indeed, part of the current crisis is due to the government ignoring market forces and the fact that many are leaving or not joining the profession because pay, terms and conditions are so poor. What I object to very strongly is basically greed, people trying to make money (lots of it in many cases) out of other people’s misfortune or through conflicts of interest. To use one of Anthony Thiselton’s aphorisms (used in a different context), it is “the exploitation of people, whether through business practice or general aims in life”, a “general grasping beyond ordained boundaries in the face of what God assigns as the self’s due”. Such was the case in the Naaman story and it is condemned very strongly in many places in scripture. I observed in the article that the UK invests a lower percentage of GDP in healthcare than at least 15 other developed countries. I agree with you that one of the biggest problems is “an autocratic top-down management culture”. Before the 2010 GE, David Cameron promised that there would be no top-down reorganisation of the NHS. What we had in reality was the biggest top-down reorganisation of the NHS since its’ inception. It cost many billions of pounds which, in my view, was designed to allow Cameron’s richest friends make a lot of money out of the NHS. As for my claims about cherry picking and failures of the private sector, have a look at what happened to Hinchingbrooke Hospital, to take just one high profile example. The NHS provides an excellent healthcare service to everyone in this country. It is not perfect but it is a lot better than the system in the USA which, I understand, led to 700,000 people going broke because of medical bills. Most people in this country cannot afford private cover. I don’t object to people who can afford it using private healthcare insurance (I do myself because, as a self-employed locum GP, I am dependent on speedy treatment in the event of illness, preferably at the Nuffield), but I strongly believe in the founding principles of the NHS for those who cannot afford private cover. I agree with you that it should be better funded so that everyone can get top-quality healthcare. No doctor or nurse can perform to the best of their abilities in a system that is over-stretched and under-funded, and I am sorry to hear about your parents in that regard. I know because I work in the NHS every day and I have also seen what it has done to my colleagues, including my wife, who had to leave work as a locum GP because of intolerable stress and ill-health. Many other colleagues in Bristol who I know have had to do the same. Best wishes. John

  3. This is all a bit simplistic.
    the evidence (such as it is) is that patients admitted at weekends have a higher mortality within the next 30 days, not at weekends, as you state witout clarification.
    The UK is not alone in this finding . it is unlikley to be due to a single factor

    You dont answer the question of what should doctors do if they believe the actions of the Government will make matters worse for staff and patients?

    Successive Governments over the past few years believe (in general) that competition will drive up standards and drive down costs.
    And involving the private sector, with a much more focused view on costs , will get better value for money.
    You can agree with that, or not.

    So what should doctors do when faced with a Secretary of State who they believe is either at best misguided, or at worst spinning deliberate half-truths and misrepresentations to achieve badly thought out ends that wont benefit staff or patients ?

    • Dear grumpyolddoc, I suspect I would agree with many of your views, but all that is completely beyond the scope of the article. I was asked to write about a Christian perspective on the NHS, not an article about junior doctors only. The junior doctors strike action, which I wholeheartedly support, is only one symptom of a much deeper problem of disastrous government interference in a great national treasure at every level. I tried to allude to all these problems with single words or phrases, given the word limit of 1400 words, which I exceeded anyway. It is not for me to tell the junior doctors what to do. Many will have slightly different views on this. If I were a Junior now, I would be getting my certificate of good standing from the GMC today. If I were a medical student, I would be considering a medical career abroad ASAP. If I were finishing A levels, I would not pursue medical training in this country because the government may enforce mandatory working in the NHS for some years after obtaining a British medical degree. As it is, I am a 54 year old GP who will be retiring as soon as I financially can afford to do so. My wife was forced to leave general practice through ill health/stress and now works in holistic care. I don’t know where you are in that list yourself. If you are a Junior, I fully support you in your strike action, however long it takes, and I wish you well in whatever you decide to do next. This Tory government is, in every respect, the worst government I can ever remember. Their treatment of the NHS is a disgrace and what I think about them in other respects is not fit to type on a Christian blog.

  4. I think it’s a bit sweeping to say we learn from scripture that healthcare is a universal right. What I pick up from scripture is that doctors are generally useless (or were at that time), sick people should trust God rather than medical professionals (implied in 2 Chronicles 16:12), and supernatural healing is the norm. God has graciously allowed the medical profession to improve since then.

    • I have to agree about healthcare as a “universal human right”. Nothing in scripture to suggest as much.

      Also a shame that the old Acts 2 passage is trotted out as if it is some sort of instant proof of the good of collectivism (as it so often is). Nothing at all mentioned about the voluntary nature of those believers holding everything in common.

      • Hang on, can we reflect on this? Scripture tells us three things:

        1. Health is a gift from God
        2. God gives gifts to all, regardless of merit
        3. God institutes the ‘powers that be’ with the intention that they will enact his just will.

        So if healthcare is not available freely to all, on the basis of need rather than merit, on what basis do you think that healthcare should be made available to people?

        The most prevalent global alternative is that healthcare is available most to those with most money. Could you offer a rationale for that, or suggest an alternative basis for making healthcare available?

        • You’re making 2 plus 2 equal about 400 there Ian.

          Healthcare is not available “freely to all”. In this country, it’s fee at the point of access – or “free at the point of abuse”, as it is becoming known!

          Health is a gift to some, which God seems to see fit to withhold from others, just like any other gift. But using your first two premises to insist that it is the secular state’s role to equalise the gifts God has given people…?! A happy, loving family is a gift from God also. So do we forcibly redistribute children to equalise this gift? Your child gets sent to a care home every other month whilst you look after an orphan?

          The broader problems with positive human rights (“the right to healthcare”) are manifold, not least the question of who is obliged to provide such services, and at what degree of coercion. But there is also the issue of the differing values people put on healthcare. I may wish to use my money in other ways and take the risk of only being able to afford minimal care in the future; others may wish to pay a premium for regular check-ups, the most comprehensive plans etc.

          “Healthcare” is now massively complex and non-homogenous. To talk of “denying healthcare to the poor” or “only those who can afford it receiving healthcare” is inevitably like a red rag to a bull for those who care about the less fortunate (all of us, I hope). But we’re not talking about having your life saved with an emergency appendicectomy here. There’s a whole spectrum of monitoring, preventative treatments and so on that can be undertaken – I don’t see why those with the means shouldn’t be able to easily pay for more advanced or quicker treatment, particularly given that when those technologies develop, they inevitably become available more cheaply to others.

          To insist that a whole country, with different abilities to pay, different priorities, different values placed on preventative measures etc. all lumps in together to get one standard level of pretty average care seems outdated.

  5. From a christian perspective, how much should we reinforce the view that we have a responsibility to look after our own bodies? If we deliberately abuse them how much should the NHS be expected to help with the finite resources available?.

  6. We all have to do our part,since it is God who sets up kingdoms/governments.And,if any system would not comply with God I think it would bring displeasure to Him and dishonor to a nation. .To make gain or profit off the poor does not bring honor to my brother,to my company or to God.I had 121,000 patient members at my hospital in the 23 years I served as chaplain.Each gave what they could afford and some had nothing to give at all.I served there needs without regard to how they could pay me or not.The chaplains at my hospital were not on salary until 2007.Prior to that we lived on donations from our members.When I served the patient his med/chart did not state if he was rich or poor.I treated them all with the same value.Colossians 3:10 makes very clear ref to when we deal with our fellow man we are to use the (renewed) part of our mind which is [ Christ in us]in accordance with (this image) we have been created by.Thats how God made us to be.We are to be servants of on another.When we get that right it will be like a form of heaven on earth.

  7. I’m not sure there is, or is intended to be, a Biblical endorsement of either state or private provision of health care. Both can work and are appropriate in differing circumstances. But I hope it’s not taken wrongly if I suggest that our God is principled but also pragmatic (eg Luke 9.50, Luke 20.25), and thus if something serves a good purpose and is not in opposition to Him, then we may use it.

    In times past, private individuals or organisations were mostly all that were appropriate to assist someone who was sick or in physical or mental distress. Today our population size and our integrated and highly technical systems for living together have necessitated a far greater measure of state involvement in many areas of life, and health is no exception. While many of us strongly resent and resist unnecessary state involvement in the lives of individuals, the idea of a well run NHS seems eminently sensible, almost certainly the best value for money and also the fairest way of ensuring that all have access to help when their need is genuine. Densely packed and highly mobile populations (such as ours) would be extremely vulnerable to epidemics and transmission of all manner of dangerous pathogens if, by virtue of poverty, a proportion of the population were left untreated when sick.

    About 25 years ago a customer in whose house I was working solemnly informed me that the NHS was ‘bust’ and we would have to ‘get real’ and change to an insurance system for funding it. Unsurprisingly he turned out to be a retired insurance salesman! The theory that if everything is done for profit people magically become super efficient and therefore provide a much better service at a reduced overall cost has surely long since been tested to destruction.

    But whatever system is chosen for healthcare it needs to be well led, valued and supported. In the case of our NHS that means our government has to own up to its responsibility for organisational excellence, clinical standards and research, and justice for staff and patients alike. The cynicism displayed by politicians who have used and continue to use it as a political football or a means of financial gain for their friends is certainly morally repugnant and falls well short of anything which could claim a Biblical endorsement. If we accept that the principle of an NHS works for our situation (which most of us do) we have the responsibility to support it, to support its staff and hold our politicians to account when they abuse it.

  8. They have closed all the cottage hospitals and all the converlecence homes these dealt with non emergency and minor injuries, as well as dealing with the after recovery care. Both of these were early indicators of more serious problems.. what concerns me about the current strikes is although it is entirely right that the junior doctors should be heard, and although it is entirely right that the NHS should be adequately staffed and not abused, the government will blame those who fight for rights as being to blame for the backlog of operations and delays in patient care.
    However in the current government’s case there is a very significant issue they are overlooking, that is that they want to leave Europe, Europe and other countries pay for hospital care, yet they want to leave Europe David Cameron rejects the way the system works whilst at the same time wanting to adopt parts of their system..Either we stand out as Britain or we don’t our health service is one thing which sets us apart from other countries.

  9. Dr Pike has set out some views about health policy that deserve consideration in political debate. But the timing of this is odd, because the dominant issue in the NHS this week is an industrial dispute, not an election. I support another party, but I respect the fact that the Conservatives won an election on the promise of weekend working. Today we need to look at Scripture to see whether it’s ever right to stand up against misguided leaders (Calvin thought it might be, see the last chapter of the Institutes) and whether workers have any rights (there are many passages supporting paying people justly).

    • ‘…I respect the fact that the Conservatives won an election on the promise of weekend working…’

      I don’t think the inclusion of a policy in a manifesto, along with very many other items and then only giving people the option to vote for the whole lot or none of them (in a once in 5 years ‘first past the post’ voting system), can convey any moral authority for governments to pursue that policy. Such manipulation of an ancient (and always unsatisfactory) system is indefensible if you are claiming a democratic mandate.

    • I don’t support the government in this at all, even though it was in their manifesto. Before the GE 2010, Cameron promised there would be no top-down reorganisation of the NHS, yet that is precisely what they did. Stating you will do something in a manifesto doesn’t give it moral integrity. Treating junior doctors in this disgraceful way and forcing your will on people like this on the basis of totally unscientific and discredited claims about death rates related to weekend admissions doesn’t have any moral legitimacy, especially if they will be working far harder (when the workload is already excessive) for less pay.

  10. Fascinating series of responses to Dr Pike’s piece but somehow trying to apply ‘biblical principles’ doesn’t really work, and using healing ‘miracles’ from the Gosples is even less use when discussing the current NHS. Neither, it seems to me get us very far in discussing why we have an NHS or why it’s worth defending. Instead, we might recall that the NHS was conceived and founded within a society which could speak about society – and do so in a language of interconnectedness and corporate identity that itself drew on deep Christian roots. It was this that people such as William Temple were able to use to speak meaningfully of a national health service. In other words, people recognised that they belonged together in wider groups than families and on a deeper basis than self interest. Temple was a leading advocate of the NHS and he worked from a social ethic of mutuallity and responsibility for one another in a single society. In short, it embodies a Christian social ethic without using that language in public. The NHS is a part of, and an expression of, a wider (and at root Christian) social ethic which could be looked to in the 1940s but which successive governments over the past 35 years have undermined. That the NHS enjoys such support and is served by such dedicated staff is a testament to Temple’s original vision. This is, I think, a more secure basis for a defence of the NHS than biblical principles or healing miracles draawn from a very different context, because it resonates with those of other faiths and none and it is vital that the NHS is supported as widely as possible. It also ensures that care which does not lead to healing is still valued as highly as any other aspect of the NHS.

  11. just a quick question for you…….in light of the COV-19 outbreak do you think it will be compulsory for all health care workers to be vaccinated with all the available vaccines we have in the UK? I am thinking of a Nursing degree but I am concerned regarding the view at the moment of the flu vaccine being possibly a sackable offence if not taken. I am very uncomfortable being forced to have a vaccine to work in the NHS – looking towards the future with a possible vaccine for this outbreak.


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