In the ‘The Compassionate Society’, an episode of the television series Yes Minister, a conversation about misspending in the National Health Service takes place between the Minister for Administrative Affairs, Jim Hacker, and the Permanent Secretary, Sir Humphrey Appleby:
Jim Hacker: This money is voted solely, Humphrey, to make sick people better.
Sir Humphrey: No, no, no, no, no, Minister. It is to make everybody better. Better for having shown the extent of their care and compassion. You see, Minister, when money is allocated to the health or social services, Parliament and the country feel cleansed, purified, absolved: it is a sacrifice…
Jim Hacker: Load of claptrap.
Sir Humphrey: And when a sacrifice is made, nobody asks the priest what happened to the ritual offering after the ceremony.
Although Jim Hacker and Sir Humphrey were talking about money, the conclusions of recent inquiries have pulled back the curtain on what, or rather, who the sacrificial offerings really are. For some time, we didn’t want to know. In one big national in-joke, we broadcast to the world images of spinning hospital beds and dancing nurses. Now the shame has been exposed and we are appalled. The Neuberger review found that misapplication of the Liverpool Care Pathway, intended to help healthcare teams provide comfort and the best possible care for dying patients in the last few days of their life, led to patients enduring poor care and suffering considerable distress for prolonged periods prior to their deaths. The Keogh report estimated that there have been thousands more deaths than expected in a number of NHS Trusts, with severe staff shortages, and poor patient care and hygiene.
I did my clinical training in NHS hospitals and I would have been working in the NHS now, had I not pursued ordination after qualifying. Much of the care I saw, including palliative care, was excellent. Many of my friends are working in the NHS now and are highly competent and compassionate doctors. As a Reformed Christian, I believe in common grace. Despite the Fall, we are not as bad as we could be and there is much good in the world – including in the NHS. This is the gift of God. In Jesus Christ, all things hold together (Colossians i.17).
Without for one moment denying individual responsibility, it is possible for the systems within which individuals work to be broken and lead to individuals behaving in harmful ways that they otherwise wouldn’t. To use the language of logic, broken systems are a necessary but not sufficient cause. This was brought home to me recently in a book on poverty alleviation called When Helping Hurts by two Reformed authors, Steve Corbett and Brian Fikkert. They describe the Fall in terms of the harm done to four basic relationships – our relationship to God, ourselves, others, and the rest of the creation. Moreover, since these four relationships are the foundation for all human activity, the effects of the Fall are also manifested in the economic, social, religious, and political systems that human beings create over time. People affect systems, and these systems in turn affect people. The blame lies with people and the blame lies with systems. This includes the NHS.
Jeremy Hunt and Andrew Burnham are going to debate for some time to come who is to blame, what is wrong with the system – why problems weren’t reported, why warnings weren’t heeded – and what needs to change. For my part, I hope this prompts us to look back beyond the past sixty years into the history of the Bible and the Christian tradition of the patristic, mediæval and Reformation eras to see how God’s people in the past cared for the sick and the dying. Although the model of healthcare we follow does make a difference, I also hope this will cause us to question the extent to which the provision of healthcare can ever be morally neutral, because the problem actually lies much deeper. Ours is not a culture that actually values life. Recent revelations have focused on the end of life, but we can also see this at the beginning of life. While newly published figures indicate that the total number of abortions dropped slightly in 2012, the killing of 185,122 unborn children is still hardly the picture of a culture of life, and the number of repeated abortions has reached a record high, with some women ending the lives of nine more more unborn children. The reason life is not valued at its beginning or at its end takes us back to those four foundational relationships. Our relationships with others are broken, leaving us with what Corbett and Fikkert call a ‘poverty of community’. This manifests itself in self-centredness and the exploitation and abuse of others, whether by taking their lives before they are born, or failing adequately to care for them at the end of their life. One person has described ours as not so much a culture of death, but as a ‘culture of me’.
Ours is a culture of Cain, who slew his brother Abel because he couldn’t bear the thought that God had regard for Abel’s offering and not his own (Genesis iv.1-10). The voice of Abel’s blood cried out to God from the ground, and the blood of our aborted children and those patients who died prematurely and in distress because of the treatment they received cries out to God from our hospital floors. But there is another sacrificial victim, God’s own Son, Jesus Christ, who gave himself on the cross. His blood speaks a better word that that of Abel (Hebrews xii.24). It can speak forgiveness for those who have had abortions. It can speak forgiveness for those who were complicit in the poor treatment of the sick and dying in our hospitals. It can speak forgiveness for all who are part of this ‘culture of me’. It can speak forgiveness for you and me.