Health, Happiness and the NHS

Our Lady of Consolation
Our Lady of Consolation, icon, since c. 1450 at Cambrai, Flanders

Today is the feast of Our Lady of Consolation and the 70th birthday of the National Health Service. I owe an enormous debt to both and make no apologies for an intensely personal post.

Many years ago, before I became a nun, I was doing some research in Ourense, Galicia, where the canon-archivist was very keen to show the enigmatic Inglesa his pride and joy: a statue of Our Lady of Consolation that had been much beloved of English seamen. I had so far acculturated to Spanish ways that I actually dropped to my knees and prayed — for England, of course, but even more, with all the egocentricity of youth, for myself and future path in life. I did not know that it would lead me to an English Benedictine monastery under the patronage of that self-same Lady of Consolation, nor that one of my kinswomen had been a member of the community back in the eighteenth century. But it did, and I think that the emphasis on compassion, on strengthening, the choice of dedication gave the community has been a marker in many monastic lives. Here at Howton Grove, where we are under the patronage of the Blessed Trinity, we continue the tradition, I hope, albeit in a different form from that of the seventeenth century when Cambrai was established.

It seems to me very suitable that the NHS should have begun on the feast of Our Lady of Consolation, though I doubt whether its first architect would have been so appreciative of the link! During the last seventy years the NHS has undergone many transformations and will doubtless undergo many more, but one thing it has done superbly well, especially for the poor. It has taken away the worry of ‘how will I afford treatment?’ I myself have two rare diseases, one of them a rare and aggressive form of cancer that has been kept at bay far longer than I have any right to expect by a treatment programme entirely funded by the NHS. The community couldn’t afford the treatment I’ve had; we couldn’t even afford the insurance premiums for the treatment I’ve had. So, yes, I am just one more person who owes her life to the NHS, but there is a little more to it than that.

I began by referencing Our Lady of Consolation for a reason. I haven’t much time for those who moan and groan about the NHS being underfunded or who are scathing about its poor outcomes in some areas because I happen to believe that we are each of us chiefly responsible for our own health. It is up to us to adopt as healthy a life-style as we can and I don’t expect the NHS to make good any defects in my own ‘self-care’, as it were. The NHS is flawed, as any large organisation will be flawed; but that isn’t the point. The existence of the NHS has freed us from an anxiety about ourselves that can be quite crippling. The question we must therefore ask is, what do we do with that freedom? Are we givers of comfort and encouragement or merely consumers thereof? There are times when my own illness makes me look inward and feel very sorry for myself, but I hope there are more times when it forces me to look outwards at the sufferings of others. When I can do nothing else, when I am too sick to write or respond to requests, I can try to pray — and somehow, in ways I can’t explain, I think that does achieve something. Despite all the sadness, anger and division in the world, despite all the moral, physical, mental and spiritual sickness that exists, there is a way of spreading health and happiness. It is called prayer, and it costs . . . everything.

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NICE and a Not Nice Proposal

A proposal by the Department of Health that ‘wider societal benefit’ should be taken into account when considering whether the NHS should pay for a drug is being challenged by NICE, the National Institute for Health and Care Excellence. At first sight, it is a difficult question. When there are limited resources, we have to accept that we may not always be able to do all that we wish. If the cost of my cancer treatment has to be balanced against your transplant surgery or their psychiatric care, we know that one or other of us may come out the loser — not because of any ill-will, but because there isn’t enough money to do everything. We assume that deciding how to allocate resources will be done as fairly and as compassionately as possible, mainly on medical grounds, to produce the greatest good for the greatest number. Only now there is the suggestion that much more attention should be paid to how ‘productive’ in economic terms an individual is considered to be; and that introduces something new into the mix, something I myself find a little sinister.

The economic productivity of an individual can be measured in various ways. For the Government, the tax revenue to be gained from a highly paid, middle-aged executive is obviously much greater than that from someone who is elderly or unemployed. The potential long-term benefit from a young, highly-paid individual is even greater. But is that the only way in which ‘societal benefit’ should be measured? The elderly, unemployed woman may not be contributing much to HMRC, but she may be providing childcare for her grandchildren, contributing a lot to the local community through charity and volunteer work and enhancing life for countless others. How do we weigh that against pounds and pence in the Exchequer? Again, what about the person whose life, on the surface, is a bit of a mess, do they have less value than any other human being simply because they are not contributing anything that society as a whole values?

It is at this point that the Department of Health’s proposal begins to look very disturbing. I have a personal interest in the matter because, as a nun, my economic worth to the country is minimal (although I do work to help support the community and its charitable outreach, financially as well as practically). It could well be that in any allocation of resources, I would fail to tick any of the required boxes. That certainly brings home to me how radical a change in attitude this seemingly reasonable proposal of the Department of Health could bring about, one that will  affect more than healthcare. Many people take their notions of right and wrong from legislation. If we have a two-tier health service, may we not end up having a two-tier conception of human dignity and worth — in other words, first and second class citizens?

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Something the Chancellor Forgot?

Unlike many in Britain today, I have no strong feelings about the Budget. That doesn’t mean I am indifferent — far from it — but when I look at the situation in Greece or Portugal, or even nearer home in Ireland, I think we are comparatively lucky. However, taking both the Budget and recent decisions to change the nature of the NHS and other familiar elements of our welfare system into account, I can’t help noting that there is one glaring anomaly.

There was nothing I could see in yesterday’s budget to help or encourage the voluntary sector. No matter how successful business in Britain may be, no matter how much surplus wealth may (eventually) be created, the voluntary sector (charity to you and me), can never plug all the gaps in our state welfare system. Indeed, major donors will not be getting the tax relief they have in the past for substantial donations to charity unless they have super-sized incomes (if you give £2M to charity, you now need to be earning £8M, or have I done my sums wrong?). There may be a vague hope that the strong impulse towards charitable giving among Jews and Christians, for example, will help make up for that lack, but with the constant nibbling away at organized religion and the demonstrable falling away in giving across all sectors of society, one may question that.

As one who is very conscious of the needs of some of the most forgotten people in society, the elderly blind and visually impaired among them, I suppose I am entitled to a gloomy view. It won’t stop us doing all we can, but there comes a point where we can do no more. Many charities this morning are probably wondering which services they will need to cut during the coming year. Maybe our Lenten alsmgiving needs to be a whole-year programme? What do you think?

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