John Sentamu: NHS care must not be led by the market; you cannot run a hospital like a superstore

0
Have your say

I HAD been in London listening to President Barack Obama address the Joint Houses of Parliament on May 25, and had then attended a Service of Thanksgiving for the life and work of Lord Bingham.

There had been no indication that anything at all was wrong with my health. But later that night I had to be urgently admitted to hospital.

So what did I do? Did I have to check my medical insurance details, or check that there was enough money in my current account to cover my medical treatment?

No. I was able to go into the local NHS hospital – St Thomas’s in Westminster – and immediately receive the care that was required to help make me better. The doctors and nurses were brilliant.

The founding principle of the NHS enables all UK residents to have peace of mind whether they are in their home city, or on the other side of the country. The NHS will always do its best to care for you, regardless of your personal income or place of residence.

Of course, having a service which is “free at the point of delivery” is not the same as having a service which is “free”. The fact is that we all help pay for the running of the NHS through general taxation.

While it is rarely popular for a public figure to sing the praises of the principles of taxation policy, I am always happy to say that if you want better public services you have to be prepared to put in the funding.

And it seems only right to me that those that earn more should therefore contribute more to help nurture the common good. It is not about generosity, it is about fairness. However, taxes are only part of the solution – there is a strong argument for making better use of the money already in the system. There is nothing wrong with ensuring investment is both targeted and, at the same time, holistic.

For many years, it seems that our society has perpetuated the myth that the private sector is more professional and more proficient than the public sector. I think this does a great disservice to the many people who devote their lives to working in the public sector to support others.

We should remember that “private” doesn’t always mean “better”. Look at the mess private banks and their gambling casinos got us into.

We must never allow health provision in this country to become exclusive. Decent health care should not solely be the preserve of those that can afford to purchase it. I am certainly not persuaded by internal competitive markets when one is treating very ill patients.

While the NHS has focused on addressing inequalities in recent years, devising formulae to spread finance for healthcare more fairly around the country, we can see that deep-rooted societal inequalities still remain.

For example, Manchester health authority gets three times as much investment per person than the health authority in Surrey – however, life expectancy in Surrey is still seven years longer than in Manchester.

It’s not just a North-South divide. The London Health Observatory recently found when looking at life expectancies that in our capital, you would lose a year of life expectancy for every tube stop on the Jubilee Line journey across London from west to east depending on where you lived.

The sad fact is that in our growing consumerist society, and beguiled by the mantra of consumer choice, people want more and more, while being prepared to pay less and less.

Often, vast sums are spent on very ineffective treatment, and, although it may not be popular, we need to listen to the doctors and not just the patients. Doctors took up the vocation to treat patients and not to be managers of budgets or fund-holders. Let us not do to doctors what we have done to teachers: make them managers of budgets with targets to meet.

You can’t have a system where those who shout loudest get most. This is especially seen in areas such as GP provision, or when people say it is “against their human rights” not to have an operation on the NHS.

As our population ages, we need to look at how healthcare provision is funded to ensure it is sustainable.

But we need to be careful not to create a greater black hole in public finance out of a misplaced sense of duty. We cannot simply solve all health issues by throwing money at the healthcare system. We must look at the wider societal indicators and tackle problems at their root cause.

But we also seem to have lost sight of the essential dignity of the human being.

Patient–centred care now translates as individuals who have things “done” to them by others. Can this be right? We have lost compassion, especially where people are at the end of their life or disabled.

So we need to guard against a health system which is inhuman and unresponsive to individual need. The problem with targets are that they are not based on need, they are based on numbers. I spent two weeks in St Thomas’s Hospital. What was the target for treating someone with a very acute condition which came on suddenly? What was the permissible budget?

It is not just the patients who suffer because of this behaviour. We should not underestimate the impact of bureaucracy on the morale of those working in the health system.  The surgeon who operated on me had worked for three days straight and had major operations all day from 10am before he operated on me at 12.30am.

How do we build up springs of solidarity so that people feel appreciated and valued? How do we help people to feel that it is a vocation to treat others? How do we get a sense of moral compassion in such a big organisation?

When the credit crunch happened, we learnt a lot. Mammon’s temple showed that money is a means for exchanging goods – and not the determining factor. We also learnt that we cannot keep borrowing to keep up. Mammon was given a severe pasting but I am afraid he is slowly rebuilding his merciless temple.

We are in a fragile economic position as a country. Yet people need more than money in the pocket to make them happy, and as a society we remain hesitant about the importance of neighbourliness and valuing others. Sometimes, we forget that raising children well is more important than material wealth.

We need to recognise that there are no easy answers when we look at the demands on the NHS. While we may strive to deliver value for money, we cannot allow care to be market-led or commercialised to the point where patient safety is put at risk. You cannot compare an NHS hospital to a supermarket.

If we accept that healthcare can only touch some of the factors contributing to the overall health of a person, we need to challenge policy-makers over those aspects of funding and social policy that affect those who are suffering or living under the burden of societal injustice.

As our political leaders embark on reforming the NHS via the health and social care bill, I would like to see a national debate take place – one that would re-examine the relationship between the individual, society and the State – and not be afraid to question our own expectations of health care provision.

In the 1940s, the Beveridge Report set out the Christian ethic. The then Archbishop of Canterbury, William Temple, wrote that the dignity of every human being had by law been put into a statute.  If we could help to achieve this aspiration for a new generation, we will have achieved our objective.

It is not wrong to want to re-open the public discourse around the provision of public services. We all want to see a system that is compassionate and responsive. We all want to see investment spent appropriately to provide the best care possible to as many people as possible. The challenge is how do we achieve that.

Let us aim high as we set out upon this journey – and let us aim together.

• Dr John Sentamu is the Archbishop of York. His recommendations on health policy stem from a series of symposium meetings. Further details can be found atg www.archbishopofyorksymposium.org