The latest report from the Care Quality Commission is a shocking indictment of standards of care for elderly people in parts of the National Health Service. As important is the revelation of how widespread the problems seem to be, affecting 55 of the 100 hospitals visited. Elderly people were found to be deprived of food, water and their dignity. No “ifs or buts” this is unacceptable. Having worked in an NHS body that suffered a similar breakdown in care and management I can well understand the impact on patients and their relatives and also on staff on wards or other services unaffected by the report’s findings.
This week has also seen debate in the House of Lords on the Health and Social Care Bill which was given a second reading. This seeks to implement a series of major changes to the way the NHS is run, offer patient choice, use competition between providers within a balanced regulatory system that promotes integrated care, transfers public health responsibility to local authorities and establishes Health and Wellbeing Boards. And this from a Secretary of State who said in opposition there would no top-down reforms of NHS structure.
What should be a Unitarian perspective on these changes to the NHS? As with any issue of faith and public issues it is best to see if the General Assembly has any stated position. If not, or if the position is out-dated, are there any general principles upon which we can draw? In this case we have the former.
In 1944 the General Assembly Annual Meetings approved a Resolution urging the Government to accept “without reservation” the principles embodied in the Beveridge Report on “Social Insurance and Allied Services” published in 1942. Beveridge identified the five “Giant Evils”; squalor, ignorance, want, idleness and disease, and went on to propose widespread reform to the system of social welfare to address these. Highly popular with the public, the report formed the basis for the post-war reforms, what became known as the Welfare State, which included the expansion of National Insurance and the creation of the National Health Service.
In 1989 an emergency Resolution was approved expressing concerns about changes to the Health Services arising from the Conservative Government’s NHS White paper “Working for Patients” without proper consultation or trials and urging the Government to reconsider the proposals which it was believed could lead to poorer quality of care and reduced choice for patients and be determined by cost rather than clinical need. The Government was urged to give priority to fully tax funded provision under the NHS of local hospitals and community health services which should be accessible to local residents, especially children and older people. The White paper was, however, implemented and laid the basis for the provider-purchaser split (in England but no longer in Scotland or Wales) and facilitated the introduction of non-NHS providers of services and greater “commercialisation”.
In 2000 the General Assembly “strongly” affirmed its commitment to the principle of a NHS free of charge to patients at the point of delivery and called upon the Government and the Scottish Executive to provide sufficient resources from general taxation to ensure the NHS was adequately funded to meet the health needs of modern society. The Budget Statement of March 2000 was welcomed.
A group of top doctors and health specialists has warned that the current reforms will do "irreparable harm" to the health service:
"The Bill will do irreparable harm to the NHS, to individual patients and to society as a whole. It ushers in a significantly heightened degree of commercialisation and marketisation that will fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively and efficiently to communicable disease outbreaks and other public health emergencies … It is our professional judgment that the Health and Social Care Bill will erode the NHS's ethical and co-operative foundations and that it will not deliver efficiency, quality, fairness or choice."
The letter includes signatories from across a wide spectrum of public health practice, including more than 40 directors of public health and some 100 leading public health academics.
The NHS Confederation’s Chief Executive, Mike Farrar said: "There is support for some of the principles in the Bill but at a practical level it has few enthusiasts and we need the Lords to help give the reforms a fighting chance of success. They still need to sort out some of the fundamentals - the accountability of all the key players in the system must be crystal clear, not least of the Secretary of State. And we also need peers to get beneath the surface of the legislation and give us the practical tools we need to tackle the major problems we face.”
In summary the position of the General Assembly has been to support the principle of a state funded and provided national health service provided free to patients. This undoubtedly reflects the Unitarian commitment to the inherent dignity of all individuals; including the needs for health, income and shelter, and an appreciation of our wider responsibility for community. Of course, no specific set of internal organisational arrangements for the NHS should be accorded “approval”; these must change as the environment changes. Indeed, involvement of community based and mutual organisations, such as co-operatives, could be seen as being closer to service users. As a former chair of a medium-sized community mental health organisation for young people I saw the value of being able to develop ground-breaking services that met real needs of marginal communities free from the pressures of the “standard” NHS body.
Today we face rising demand from a growing and ageing population, increased expectations from patients accompanied by increased costs of new drugs and technologies. However, the claims of solidarity that underpin a Unitarian perspective need to be safeguarded in any changes; protecting what is valued and ensuring that the poor performance exposed by the Care Quality Commission is addressed at every level of the NHS. High quality health care for all is a sign of a compassionate and responsible society.