The NHS, a case of bad theology?

"The NHS is the closest thing the English have to a religion"

(Nigel Lawson) 

The other week the wife and I headed to the Land of My Fathers to watch Wales v Italy at the Principality Stadium. It seemed obvious that Wales would win that game of rugby, but Italy didn't read the script. They snatched victory with a brilliant try in the closing minutes of the match. Before the game we went for a wander around Cardiff city centre. At the Cardiff Castle end of Queen Street stands a statue of Nye Bevan, the Labour heath secretary who set up the National Health Service in 1948. If Lawson was right, the religion of the English was founded by a Welshman. 

I was reminded of the words of Mrs Thatcher's Chancellor on reading a column by Matthew Syed (@matthewsyed) in The Sunday Times, We must challenge our leaders when they lazily deify the NHS. In the article the author reflected on the Ockenden report into failings at the Shrewsbury and Telford Hospital NHS Trust. The report detailed 1,592 incidents of poor care between 2000 and 2019. At least 201 babies and nine mothers might have survived if they had been given better medical treatment. 

Syed argued, "the problem within the NHS is not institutional but theological. In short, we have deified this organisation for so long that it is no longer amenable to rational reform." Because the NHS has been accorded almost divine status. its actions are deemed almost beyond criticism. Those who do complain about poor practice are all too often shunned rather than listened to so that lessons might be learned. Syed's prescription was to target the 'theology' of NHS-worship, "its time to secularise the NHS". If the problem with the NHS is one of bad theology, however, the solution is not no theology, but good theology. 

Porcelain gods

Last Friday we went to see Paul Weller in concert at the Guildhall in Portsmouth. One of the songs he performed was Porcelain Gods from the album Stanley Road. Weller knew what it was to be a 'pop idol'. His band, The Jam often topped the charts in the late 1970s and early 80s and attracted a loyal following of young mods. Weller blindsided fans, not to mention fellow band members Bruce Foxton and Rick Buckler by splitting The Jam in 1982. He went on to form the highly successful  Style Council, but by 1989 his creative juices seemed to have run out.  His record label rejected his latest offering and the Style Council were no more. Weller was the rock god who fell to earth, not knowing whether he could resurrect his career and start again. That is the background to Porcelain Gods. Weller sang,

How disappointed I was
To turn out after all
Just a porcelain God
That shatters when it falls

The song is a recognition that the singer was all too human and breakable, a 'porcelain god'. Any worship offered to Weller the pop idol is therefore misplaced. And so it is with any human individual or institution. Those who 'clapped for carers' during the pandemic might be excused for feeling similarly disillusioned when they read the shocking findings of the Ockenden report. For all the undoubted good it does, the NHS is not a fitting object of worship and should not be treated as such. There is only one who is worthy of worship, that is God our Creator. He is perfect in his being and flawless in his ways. That is true of no one else, not even the NHS. Criticism of the health service is not sacrilege. It is the necessary prelude to much-needed reform.  

Good pessimism 

Another theological problem highlighted by Syed is a kind of Pelagian attitude that shapes how the NHS views itself. Healing the sick is a definite good, but that does not mean everyone involved in the world of medicine is morally perfect, or that every aspect of the NHS deserves to be championed as 'world class', when clearly it is not. Witness the damning Ockenden report. The fact is that NHS managers and medical practitioners are not exempt from the effects of 'original sin'. We are all morally flawed. Donning a stethoscope is no cure for that. 

Syed thinks that secularism is the answer, but one of the most distasteful things about Christianity according to 'Enlightenment' thinkers was the very idea of 'original sin'. David Hume and others rejected the Bible's pessimistic view of human nature. They believed that human beings were capable of discovering the truth by reason alone and on that basis decide for ourselves what is right and wrong. It was a kind of secularised Pelagianism. Pelagius taught that it was possible for human beings to achieve moral perfection by their own efforts. Augustine of Hippo argued strenuously against Pelagius. According to Augustine, his views constituted a denial of the seriousness of sin and the need of salvation by the grace of God. 

Augustine-style pessimism about human nature is both realistic and healthy. It protects us from thinking our own actions are always beyond criticism and that it is only others who are capable of doing wrong. As Alexander Solzhenitsyn wrote, "The line separating good and evil passes not through states, nor between classes, nor between political parties either – but right through every human heart." Given that is the case, robust systems of oversight and accountability need to be put in place as a safeguard against wrongdoing. The institutional Pelagianism of the NHS militates against that, which is why whistle-blowers are often ostracised and patient concerns are all too frequently ignored. According to the Ockenden report, “There was a tendency of the trust to blame mothers for their poor outcomes, in some cases even for their own deaths.” Tragic.  

Secularise the NHS?

Secularising the NHS won't necessarily help matters. But good theology may be of some service in  pointing us to the one true and living God who is Father, Son and Holy Spirit. He is no 'porcelain god' who cannot bear the weight of our worship. Theology also bears witness to the unique worth and value of human life, created in the image of God. That is why the sick should be cared for, rather than discarded. The 'Golden Rule' laid down by Jesus is the foundation of medical ethics. We should care for others as we would like to be cared for, “So whatever you wish that others would do to you, do also to them" (Matthew 7:12). But regarding NHS staff as 'Angels' who are incapable of getting things badly wrong is a denial of reality. Strong Augustinian antibodies are needed to destroy the virus of institutional Pelagianism.