It is hard to care when the cash is not there

16 November 2011

Hospital nursing staff have been accused of neglecting patients. But funding is often the problem, says Robert Thompson

RECENT reports about care in the NHS have uncovered many examples of bad practice in our hospitals. These findings have generated much discussion about kindness and em­pathy in the health-care system and about the “value” of the vulnerable, especially older people, in contem-­porary society.

Joan Bakewell, speaking on the Today programme on Radio 4 last month, identified the secularisation of society as the source of this shift in attitude. Her reductionist analysis, however, fails to take account of the Church’s all too chequered history when it comes to issues of care.

The current highlighting of in­stances of child-abuse in the Roman Catholic education system demon­strates that Churches have not simply been in the business of living out Jesus’s ethics of care. Similarly, the mess around the management of the Occupy London demonstration outside St Paul’s Cathedral has shown how the Church is often perceived to be a morally ambiguous contributor to issues that affect our national life.

If Christians are to contribute to these national debates in any mean­ingful way, we need to do so with extreme care. In the first place, we need, at the very least, to address both their individual and their social and political aspects. Second, we need to highlight the connections be­tween issues of NHS provision and our banking system. Third, we too easily forget that the Church’s re­sponse to these issues has ecclesiological significance for the govern­ance of its own life.

The report of the Care Quality Commission (CQC), the NHS regu­lator, on the treatment of older people in hospital, found, after 100 spot checks, that one fifth of patients in the NHS trusts that it visited were going hungry and unwashed.

Dame Jo Williams, who chairs the CQC, said that the delivery of care was seen to be “a task that needed to be completed”. She recommended that those respon­sible for staff training “need to look long and hard at why the focus has become the unit of work rather than the person who needs to be looked after”. Her comments highlighted the in­dividual responsibility of nurses, at the expense of addressing their structural context.


Having worked in the NHS as a chaplain for more than ten years, I feel it a great shame that much media attention focused on these words. In my experience, the over­whelming majority of nurses and other health-care professionals are dedicated, caring individuals, whose practice is not characterised by simple box-ticking. Rather, it is often Christlike and self-sacrificial, fre­quently in difficult circumstances.

The nurses that I know often work additional unpaid hours, miss meal breaks, and work on wards with very poor nursing-to-patient ratios. Add to this the damaging shift pat­terns, the need to respond to fre­quent organisational change, the pay (which is much less than other, less well educated and trained public-sector workers), and the current threat to pensions — and you have a cocktail for a highly stressed work­force.

Care is not a bottomless resource. Rather, it needs the right environ­ment in which to grow. Caring ser­vices require investment in caring: it is misplaced to single out nurses.

More structural criticism often focuses on bad management. But this is also too easy. Boards and man­agers are also responding to frequent organisational change, which means that their focus is on the financial position of a trust. My own trust, for instance, is now in a public battle to keep its paediatric cardiac services. We are in competition with other NHS providers in London to secure contracts and income.

This is where the connections be­tween the provisions of care and financial resources in our society are located. The gradual marketisation and privatisation of health care will be exacerbated by the new Health and Social Care Bill. While some degree of competition may well make NHS trusts more effective, there is a real question-mark over the quality of care that can be given by businesses that aim simply to make profits.

Under such market forces, it is the care of the most vulnerable which will be most affected. This was demon­strated by the damning report on care in the Southern Cross group, and its subsequent damaging collapse.

Older people and those suffering from mental-health issues often pres­ent multiple problems, which are expensive to treat and do not neces­sarily lead to a “positive out­come”, let alone a positive return on a balance sheet. They may well be worse off under the private than under the public sector.

YET, if Christian contributions to these debates are not to be dismissed as hypocritical, then we also need to look at how we govern our own common life. We need to connect the issues of care and the financial re­sourcing of the Church’s ministry. The Church cannot speak out effec­tively about the excesses of under-regulated forms of capitalism, unless it forms a community that cares for its members in its own common life, and offers a countercultural location to rampant self-interest.


At the very least, this means that we need to be extremely careful that the forms of Christian faith that we live out and teach are not in them­selves individualised, privatised, and depoliticised. It also means that we need to cultivate a greater apprecia­tion of those involved in ministry in the poorest areas of our country.

In the NHS, the burden of blame is falling on the hardest-working, least powerful workers, those who minis­ter to patients in the midst of staff shortages and financial strin­gency.

Of course, every neglected patient is a scandal; but, before the Church joins in the feelings of outrage, it needs to consider how it would fare under similar scrutiny. We cannot contribute to a caring society if, by our structural in­difference, we starve those in front-line minis­try of the atten­tion and re­sources that they need.

The Revd Robert Thompson is Chaplain of the Royal Brompton Hospital, London.

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