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Prescription for the NHS

12 May 2023

James Newcome reflects on his time as lead bishop on health and social care


Junior doctors and nurses in the NHS are among those in the headlines recently

Junior doctors and nurses in the NHS are among those in the headlines recently

FOR the past 12 years, I have had the huge privilege of serving as Lead Bishop for Health and Social Care. When asked (as I often am) what the Church has to do with either, I point to both our calling to care for the whole person — body, mind, and spirit — and the part that the Church has played throughout history in establishing hospitals and hospices, and caring for the elderly.

It has been fascinating. And, for someone who never even took biology O level, highly educational. It has involved me in debates in the House of Lords, especially on medical ethics; visits to numerous hospitals and care homes; training sessions with bishops’ advisers and hospital chaplains; membership of two select committees (Long Term Sustainability of the NHS and Adult Social Care); regular meetings with health ministers and senior NHS staff; and, most recently, co-chairing the Archbishops’ Commission for Re-imagining Care.

During these years, the NHS and social care have rarely been out of the news, and the current round of pay disputes and strikes by nurses and junior doctors has further raised their media profile. So, I welcome this opportunity to reflect a little on some of the lessons that I have learned, and some of the (rather tentative) suggestions that I would like to make about the way forward.

MY FIRST observation has to do with the extraordinary dedication, commitment, and skill of the vast majority of health and care workers. For most, this work really is vocational, and — not least during Covid — their efforts have been exemplary and sacrificial (and that includes hospital and GP chaplains).

But the pressures that they face are enormous; and that frequently boils down to staff shortages. Recruitment and retention are ongoing problems: more than 125,000 vacancies are currently reported in the NHS.

In September 2022, the Government’s “Our Plan for Patients” promised to train more doctors, dentists, nurses, and care staff; but, as with many other visionary White Papers (including the Care Act 2014, and “People at the Heart of Care”), the reality is rather different from the aspiration.

Many health and care staff are exhausted and demoralised, and we are all familiar with the daily litany of extended waiting times: for standard operations; for attention in A & E; for ambulance arrivals; and for consultations with GPs (especially face to face). As for NHS dentists, they are increasingly becoming an endangered species — as hard to find nowadays as local branches of banks, or village post offices.

The Bishop of Carlisle, the Rt Revd James Newcombe

Meanwhile, the issues confronting NHS staff grow ever greater and more complex. As a population, we are ageing, with multiple morbidities. At the same time, our young people are manifesting mental-health issues on an unprecedented scale, prompted perhaps by a range of causes which must include social media.

Then there are the complicated ethical concerns with which medics have to wrestle daily. For instance, should you offer someone an incredibly expensive cancer drug, which may lengthen their life by a few months, when your budget has limits — and when that money could have paid for dozens of life-enhancing operations, such as hip-replacements?

And what about “assisted dying” and palliative care? Or treating people who smoke or are obese? (Obesity, which is developing at an alarming rate, costs the nation up to £13 billion every year.)

These are not straightforward questions, and have no simple answers, but they are a significant cause of stress in an already over-stretched workforce.

So, too, is the short-termism evident in so much of the planning that takes place in this arena — largely for political reasons, and because of a fixation with the next election. This was a key finding of the Lords Select Committee on the Long-Term Sustainability of the NHS; and, although we would have preferred a 20-year perspective, we were delighted to see the emergence of an NHS ten-year plan.

Health care easily becomes a political football, and, when it does, everyone is affected, staff and patients alike. This has a particular application to the vexed issue of funding, which is never enough. Almost every government wants to retain the fundamental principle of NHS care, which is that it should be free for everyone at the point of need. But few politicians are brave (or foolhardy, as some would see it) enough to spell out the implications of that for our taxes.

THEN, of course, there is the whole operation of the integration of health and social care, which has recently come to the fore with reports of several thousand patients’ remaining in hospital beds because they had nowhere else to go. The Department of Health has now become the Department of Health and Social Care, which is an important change; but nobody could claim that full integration has taken place.

Nor could they claim, though some have tried, that social care has been “fixed”. The recent Select Committee on this subject found that it has been historically largely invisible, and that the current system was complex, fragmented, and difficult to navigate. It highlighted the plight of unpaid carers, of whom there are several million in this country, including children. Significant numbers of them are at financial, physical, or emotional breaking-point; even “paid” carers are frequently undervalued, poorly trained, and badly remunerated.

In social care, workforce issues are even more pronounced than in the NHS. Indeed, in the first three months of 2022, about 2.2 million hours of home care were undelivered, owing to lack of staff. Funding is inadequate — and now, even the “social care levy” on National Insurance has been cut. As in the NHS, there are thousands of dedicated and wonderful carers; but the system is not in a good place.

SO, WHAT can be done?

Obviously, I don’t have all the answers to such a huge and challenging question, which affects every one of us. But everything that I have seen, heard, and experienced over the past 12 years prompts the following suggestions.

First, develop further long-term thinking and planning. Some of that, particularly with regard to the workforce, is in preparation. Further work is, I know, being done on issues such as digitalisation (and the digitising of data) and the use of technology and AI. But long-termism is, to some extent, a frame of mind, and that has yet to be firmly embedded.

Second, improve integration. Big steps are already being taken in that direction — not only with the Department’s change of title, but also with the creation of integrated care systems and integrated care boards around the country (building on the original Sustainability and Transformation Partnerships).

The integration of health and social care is extraordinarily difficult to achieve, and won’t happen overnight. But, as we are frequently being reminded, it is vital for the future of both.

Third, prevention — which, as we all know, is better than care. Public Health is central to this debate, and its budget needs to be restored as we look to turn the NHS into a “wellness” rather than an “illness” service.

Social prescribing has had an important part to play in promoting healthier lifestyles. So, too, does recognising the fact that poor health (mental as well as physical — and they need parity of esteem) is not just a consequence of disease. It is affected by many other factors, from good housing to environmental access, from family life to isolation and loneliness — which provides a good opportunity to mention the important part played by parish nurses, Anna chaplains, and GP chaplains (among many others).

Fourth, there needs to be a greater recognition of the spiritual dimension of health, and the vital job of hospital chaplains, and others, who provide spiritual care and support.

ALL of this requires a change of attitude, which has been highlighted by the Archbishops’ Commission on Re-imagining Care. At present, those who are elderly and disabled are often regarded as a burden. How can we begin to see them as a blessing? And how can our culture’s obsession with independence and autonomy be replaced by an awareness of our mutual interdependence and need of each other?

The Commission is calling for a “national care covenant” which will rebalance rights and responsibilities, with a strong emphasis on our responsibility, both as individuals and members of various communities, as well as a clear mandate for universal care.

It goes almost without saying that adequate funding is essential (especially in the light of recent announcements), and numerous reports have been produced that all point out that, if we want a world-class health service (which the NHS is still reckoned to be), and social care that is universally available, we have to pay for it; but that is another article (or several).

Many other good recommendations have been made in recent years, including the value of “co-production” (collaborative working between those who need care and support, carers, and others, to develop better care plans); the appointment of a Commissioner for Care and Support (who would champion carers and potential changes to the care system); and the creation of an Office for Health and Care Sustainability (which would act rather like the office for budget responsibility and advise the Government of the time on long-term policies).

Some, me included, have called for a Royal Commission to gain cross-party support for substantial change. I do hope that the Church will continue to contribute to this very important debate, knowing that the God who made every one of us in his image is deeply concerned with our physical, mental, and spiritual wholeness.

The Rt Revd James Newcome is the Bishop of Carlisle.

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