Many people will be celebrating the birth of the NHS, 60 years ago tomorrow. Most of the population will have no alternative experience with which to compare the service, but, for older people, it remains something of a post-war miracle.
Writing in 1960, Donald Soper reflected that the NHS “has meant a new life to those always on the edge of poverty and want, who no longer need fear illness and physical disability as the final and irreparable blow to their hopes and happiness”.
Despite huge social change over the past 60 years, the rise of consumerism and a greater plurality of values, people are still reluctant to see the quality of health care linked to personal wealth. We want the NHS to continue — but we also want it to be better, fairer, and faster.
The remarkable achievement of turning the nation’s co-ordination for war into a state infrastructure for health should not be forgotten. The creation of the NHS was a hard-fought and divisive process. The formal decision of the British Medical Association to back the scheme came only at the eleventh hour. Even among those in favour, there were concerns that something of the local identity and compassion of hospitals would be lost in the transition to government control.
In the accounts of the time, there are statements that now sound naïve and optimistic. Aneurin Bevan, writing in the British Medical Journal assured doctors: “My job is to give you all the facilities, resources, apparatus, and help I can, and then to leave you alone as professional men and women to use your skill and judgement without hindrance.”
Within days of the NHS’s coming into existence, the new board of the United Leeds Hospitals gasped under the weight of central co-ordination: ten ministry circulars arrived after the agenda had been distributed. The chairman complained: “I have got more now than I can read.”
For many before 1948, the decision to see a doctor was an act of last resort. A man in his 80s told me how his father, suffering from rheumatoid arthritis, “must have spent an absolute fortune because a man used to come down monthly collecting money on behalf of the doctor. The difference between my childhood and then getting older financially has just been absolutely enormous.”
Even without the NHS, health care in Britain would have changed. But the aspiration of a service to care for everyone equally to the best of its ability remains a radical commitment. As one A & E nurse put it to me: “I just love the fact that anyone can walk through those doors and get treated: it doesn’t matter who they are.”
For Barbara Castle, the NHS was “the nearest thing to the embodiment of the Good Samaritan that we have in respect of our public policy”. Yet, in the 21st century, such generous intentions are not always seen as good economics, and there are those who suspect that what we receive without direct cost we value less. The argument about the existence of the NHS has moved a long way since 1948, but it continues to produce fierce debate about how it should provide health care.
At times, there has been an inevitable struggle between the focus on a short-term clinical outcome and the care of each patient as a person. The cuts experienced by many chaplaincy departments in 2006 were a sign of this tension, as financial pressures and a target-driven culture threatened to squeeze out less tangible contributions to well-being.
Recently, however, there are encouraging signs that the qualities epitomised by chaplaincy might receive greater recognition. In a recent speech, the Secretary of State for Health said that he wanted to see compassion and empathy prioritised, alongside all the other measures of nursing performance.
It appears that there is a fresh awareness of something chaplains and nurses have always known: that, while adverse health events can be described in general, they are experienced in particular.
In the case of a woman who had endured repeated miscarriages, becoming pregnant again raised both hopes and fears. Her story was heard by those caring for her, and progress was monitored with great sensitivity.
When the mother expressed her thanks after a successful birth, the obstetrician told her: “Because this is the most important thing in your world, it’s important to me.” Each patient has a unique story, and the best care is provided when these personal worlds are honoured.
Churches and faith communities can do much to foster the values that underpin the health service. The NHS is seen as being there for all, required to provide care equally on the basis of a patient’s needs, and to do so in the conviction that co-ordinated planning is best. These values have been criticised throughout the history of the NHS, on the grounds that they weaken individual effort and suffocate innovation.
It has always surprised me that the annual meetings of hospitals are often so poorly attended. But there is evidence that this is beginning to change. More and more NHS organisations are achieving Foundation status, which includes the requirement to have a register of members — local people, staff, and patients.
The members have a voice on policy-making bodies through their election of governors, and this is one way concerned individuals — including Christians — can inform the core values of their hospitals. This is catching on in some places; in Preston, for example, the Trust has about 20,000 members.
Nigel Lawson once remarked that the NHS was “the closest thing the English have to a religion”. Certainly there are those who show a faith-like passion for its provision, and a consequent energy for its preservation. If mission involves a desire to understand the hopes and fears of each generation, then the NHS is an institution that requires the Church’s attention. This is a 60-year-old with a story that reveals the values of a nation.
The Revd Dr Chris Swift is Head of Chaplaincy at the Leeds Teaching Hospitals NHS Trust.