Opinion - A 21st Century NHS
How should we approach the NHS as Christians going forward into the 21st Century? A Doctor takes us through some of his thoughts...
The NHS is not coping with the 21stcentury. Increasingly we see reports of faltering care and missed targets. Where is it all going wrong? It would be difficult to argue that the issue lies with the staff, who frequently go above and beyond their duty of care. Investment in health and social care, while a political football, does vary and has been intermittently increased and cut by various governments over the last 20 years. Ultimately though, it’s difficult to argue that there’s a lack of investment when 30% of the government budget is spent on healthcare(1).
Unfortunately, there are deeper issues which aren’t fixed simply by increasing budgets.
An ageing population
The NHS was founded in 1948 as one of the major reforms to UK society to come out of the Second World War and was designed to provide a service free at the point of care, funded by taxation, with all eligible. Life expectancy in 1951 in England and Wales was for men 66.4 years and women 71.5 years. In 2011 this figure was 79.0 years for men and 82.8 years for women. (2) Neither the pension system, nor the health and social care system, was originally designed to take this dramatic increase in life expectancy into account.
A population which lives longer with more chronic diseases
Advances in medicine mean many diseases such as diabetes, heart disease, chronic lung disease, dementia, strokes, and certain types of cancer have much better prognoses than they previously did. Although many of these diseases remain uncurable, they are managed as a chronic health condition, often allowing sufferers to lead relatively normal lives. This is not always the case however, and as we age the effects and exacerbations of such diseases begin to become more frequent and more significant. While a wonderful blessing that many people no longer suffer as they did thanks to such advances, our health system is struggling to cope with managing the complications of chronic disease in a greater proportion of the population, for a longer period of time, than when it was instigated. This problem is only going to worsen. (3)
The change of the family unit in society
In a secular society, this is the least touted reason for the increased burden the welfare system faces. It is increasingly common that the elderly are relying on the state to support them in their later years, through home helps, medication prompts, and personal care. As a society in the last 100 years this is a huge shift; only a few generations ago it would have been seen as the family responsibility to look after infirm relatives. We see that the “traditional” family unit in the UK is becoming increasingly rare and that the shift is to the state or private firms to look after our old and infirm. I am not arguing that care homes, or state-run personal care for the elderly, is wrong or immoral (there are many reasons why this may be entirely appropriate), only that it places further responsibility on an already strained system.
Where does Christ come in?
I’ll start by saying that I don’t have a solution or the word count to discuss these issues in depth!
Up until this point, I have avoided bringing Christianity into the discussion. Although on the surface the problems facing the NHS seem entirely secular, the attempt at solutions should not be. Increasingly, a Christ centred voice is likely to be required as issues such as assisted suicide and the fair distribution of health resources become more prominent. Clearly, the Bible does not give a blueprint for a 21stcentury healthcare system, but there are areas we can apply and some principles to consider.
Genesis 1:27 and Matthew 14:34: All human beings bear the image of God, and the need for Christ-like compassion
This principle must be at the forefront of any decisions made about healthcare or the legal ethics that is so often interlinked. It can be all to easy to boil healthcare and resource allocation down into numbers and figures but we must remember that each person is an eternal soul, bearing the likeness of the Creator. As a healthcare professional this is something that I have to bear in mind and re-teach myself on a daily basis – it is far easier to have sympathy on the elderly lady than the drug addict. It is far easier to question why we’re “wasting resources” on the “undeserving” than spending money on causes that seem more worthwhile. When it comes to making decisions or discussing resources in healthcare, we need compassion tempered with Godly wisdom. The decisions that are made are not easy: is it better to spend money to extend the life of 100 people by 1 year or 1 person by 2 years?
It goes further than this though. When we consider the elderly and the dying, we need to take a step away from views that see the vulnerable as a burden or the gift of life as pointless. As a doctor, I am not arguing for the preservation of life at all costs. Indeed, there are times where it is good and right that we ease suffering in the active and acute process of dying, and there are times we need to judge that this process is occurring and that to attempt to prevent it is wrong. I do however, have grave concerns surrounding the possibility of agents of the state (doctors) being given the power to actively end life in someone who’s death is not imminent, regardless of safeguards.
Matthew 25: “I was sick and you looked after me”
On a final note, perhaps we should also bear in mind that the Bible is clear that healthcare is not solely the responsibility of the state (some would argue that healthcare is not evena responsibility of the state). As Christians we are all called to look after the sick and infirm. Clearly there is a role that only modern medicine can fill in caring for the sick and vulnerable, but there is also a role only the Church can fill in caring for the sick, the vulnerable, and the lonely and displaying Christ’s love and compassion to a 21stcentury society.
- Kingston et al, The Lancet Public Health. August 2018. Forecasting the care needs of the older population in England over the next 20 years: estimates from the Population Ageing and Care Simulation (PACSim) modelling study. Available from: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30118-X/fulltext