Sermon preached by The Bishop of Gloucester, The Right Reverend Michael Perham, Chairman of the Hospital Chaplaincies’ Council
2 July 2008 at :00 am
Your new National Health Service begins on 5th July. What is it? How do you get it? It will provide you with all medical, dental, and nursing care. Everyone - rich or poor, man, woman or child - can use it or any part of it. There are no charges, except for any special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.
Thus spoke the Central Office of Information for the Ministry of Health in 1948 and it is worth hearing again that concise statement of what was intended and of what has, to a very great extent, been delivered over 60 years.
A sixtieth anniversary, a diamond jubilee, is not necessarily something that catches the headlines, even in a world where we look back with nostalgia at countless centenaries and anniversaries. But the sixtieth anniversary of the Health Service, far from being overlooked, is providing the moment for some fresh thinking and new direction, much of it coming from Her Majesty’s Government itself, and that must be good. But before we explore the future, we do well to pause, reflect and give thanks. It would be a pity if we passed over the opportunity to celebrate amazing achievements and wonderful service.
For me there are four compelling reasons to celebrate, to rejoice, to be immensely thankful.
The first is that the National Health Service happened at all. It was a brave and visionary social revolution emerging, surprisingly, out of a world of post-war austerity. It was opposed by most of the professionals who would have to work within it. Its background was economic hardship and entrenched opposition. Yet it came into being, promoted by courageous politicians, and it was not very long before it was the pride and joy of the nation and the envy of the world. Give thanks!
The second is that it has continued to evolve, responding to radical change - not so much radical change imposed by politicians and administrators (though, of course, there has been that), but radical change brought about by medical advance and by new insights within the medical profession.
- In 1948 a cateract operation meant a week of total immobility with the patient’s head supported by sandbags. This eye surgery is now over within 20 minutes and most patients out of hospital the same day.
- In 1958 hip replacements were so unusual that the surgeon who invented them asked patients to agree to return them post-mortem. The NHS now carries out a thousand of these replacements every week.
- In 1968 the first UK heart transplant patient survived only 46 days. The procedure is now routine enough for two dozen to be carried out in the same period.
In that same year, the hospice movement had only just begun. It’s only forty years old. And, as each decade has gone by, there have been more developments - in 1978 test tube babies, in 1988 the breast-screening programme, in 1998 NHS Direct, now handling more than half a million calls a month, now in 2008 recommendations that, in the words of its author, Lord Darzi, ”are about giving patients more clout”. That must be right.
For the ongoing evolution and the increasing medical sophistication, give thanks!
The third reason to rejoice is the huge satisfaction and pride that the people of this country still have in the Health Service. Politicians, challenging one another, rightly always want to get it better. Newspapers sometimes run horror stories of things that go wrong. Some people have a raw deal. This week’s BBC poll on the NHS found that 82% of people were still proud of the NHS and half of those still saw it as the envy of the world. I’d give a lot for a vote of confidence like that. Give thanks!
The fourth reason to celebrate? Simply this - and it’s hugely important. The Health Service work-force deserves honour and praise. Health care “professional” - I use the word in its widest meaning, doctors of many kinds, nurses of many kinds, administrators of many kinds, support workers of many kinds, chaplains of many faiths - continue to be people of dedication, continue to exercise care and compassion towards their patients. “Honour physicians for their services . . the skill of physicians makes them distinguished,” says the writer of Ecclesiasticus, and we need to widen that honouring of those who care for the sick and work for health to include the entire profession. For the people of the NHS, give thanks!
That profound sense of thankfulness needs to be set against the inevitable difficulties that have been encountered as the NHS has tried to respond to change over the years. Nor will the difficulties vanish away, however much we try to anticipate change. The growing number of older people presents an immense challenge. Longevity brings problems of its own.
The story from St Mark’s Gospel that we have heard this afternoon is not without a hint of humour. It would be a way of solving a bed shortage in the local hospital to have your friends make a hole in the hospital roof and lower you in on a stretcher! I’m not recommending it, though it does demonstrate strong faith and real determination. In some ways it is a very modern story. It is rooted in the community and the agenda has been set by local people who make a decision. The needs of the person are reflected in the actions taken. But the principal interest in the story lies in the dialogue and the scribes. There is a conversation in which the two parties are talking a different language and are not therefore understanding one another. Some are looking for a physical cure to the paralysis. Jesus, with his talk of forgiveness, is on another plane. It’s a highly dangerous area with which to engage, because some dreadful things have been said by religious people identifying sickness with sin. But what Jesus is getting at, and it is something the medical profession knows but sometimes can ignore, is that we are whole persons - physical, mental, social, spiritual beings - and you cannot treat one part of us without reference to the other parts. You cannot bring health to the one part without seeking it for the whole person. I guess something of that lies in the desire that people have articulated, as we have been hearing this week, to be recognised as persons, not as numbers. We are, each one of us, wonderfully unique beings, of body, mind and spirit, created, as people of faith would say, in the image of God, and of infinite value for that alone.
The great ambition of the National Health Service must surely be to become just that, a national health service, rather than what the pressures make it a national cure service, coming to our rescue when health collapses. We shall only have real health in the nation when we recover the sense that we are whole persons and where we give attention to our physical, mental, social and spiritual needs. That is a task laid upon the whole community. We cannot ask government all that for us. We cannot require it of the NHS alone. It is a task for us all. But within the Health Service it means ensuring that every specialist profession has a broad view, a desire to bring health and healing to the whole person, and sees their own contribution within a collaborative process in which others will play a part and where the uniqueness of the individual is taken with real seriousness. This will be true in the spectrum of services offered and not least in the challenging world of mental health issues.
It also means giving honour, and, to be honest, resources, to those who, alongside the specialist professionals, hold the broader brief. In terms of recognising the social needs of the patient, it may mean new partnerships with social care. In terms of the spiritual needs it will mean honouring the chaplaincy team or the spiritual care team, recognising its professionalism, protecting it from cuts that can obliterate a small department. Chaplaincy is another part of the Health Service that has grown significantly since the establishment of trusts in its professionalism. It is as much a changing world as every other part of service. Chaplains and spiritual care advisers have needed to become much more professional. They have learned how to exercise spiritual care for people of many faiths and to engage with the spirituality of those who have no religious faith or affiliation. Spiritual needs are present throughout our lives, but especially when ill health knocks our self-confidence. It isn’t simply at the stage of palliative care and preparation for dying that we need those who will help us to reflect on the deep questions of life and personhood. And it isn’t just Christians and members of the other world faiths who may need the ministry of the chaplain. The Health Service needs to protect and extend its provision for spiritual care if we are to have a wholeness of approach.
There is one more word that is a commonplace part of our language that comes from the Judaeo-Christian tradition that I think we need to take seriously. Again it’s much wider than the NHS, but has its implications here. It is the word “vocation”. I want to see priests and ministers working in the NHS because they experience a vocation to work alongside those who are ill or who carry the burden of supporting a sick relative. I want them to know that to be their calling, whether for a life-time or just for a particular period. I want them to be thoroughly professional, but I don’t believe a profession and a vocation are mutually exclusive.
But the word “vocation” is not just for the religious. I think we hear less than we did about the work of doctors and nurses and others in the health service as vocational. I think we have fallen into a mistaken view that to be one of these is just to do another job. The Christian tradition, that has been so formative in our culture, teaches us that there isn’t such a thing as “just another job”. Every man, every woman, has a calling, a destiny to try to fulfil, some unique of loving God, their neighbour and themselves by dedicated service in fulfilment of their vocation.
There is much that a future NHS will need that is beyond the knowledge of a bishop! There is probably much that is beyond the imagination of most of us. Our forebears in 1948, for all their vision, cannot have pictured the advances and the changes that we have seen. But I think I do know that, if the National Health Service is to continue to serve, it will need to hold on to two timeless truths.
- The human person is a wonderful combination of the physical, the mental, the social and the spiritual, a divine design beyond compare.
- To heal the sick and to make people healthy is a vocation, a collaboration with the God form whom all health and wholeness comes.