NHS 70th Anniversary
‘The Diocese of Sodor and Man joins with the General Synod of the Church of England in rejoicing at the 70th anniversary of the National Health Service and in committing itself to prayerful and practical support to the NHS’.
An anniversary reflection...
July 5, 1948 was a great day in British history. It was the day on which Aneurin Bevan, the Health Secretary announced the creation of the National Health Service. The NHS was one of the great triumphs of post-war British life. It is remarkable that out of the trauma of the Second World War, such a vision could emerge of universal health care, free at the point of delivery. At the same time it is perhaps an illustration of the fact that out of suffering and trouble, great ideas and visions can be born.
It was perhaps another surprise to all of us when the opening ceremony of the 2012 Olympics, Danny Boyle chose the NHS, as one of the key factors of British life to be celebrated at that moment when 1 billion people around the world was watching. It was an inspired choice, and one that in the UK at least received enthusiastic approval. Americans of course found it much more perplexing. It has been one of the points of real cultural difference - we can never quite understand their preference for the system of health insurance, and they can never quite get our love for the NHS. It remains a remarkable achievement. It employs more than 1.5 million people, putting it in the top five of the world’s largest workforces, together with the US Department of Defence, McDonalds, Walmart and the Chinese People’s Liberation Army.
The NHS was of course one of the pillars of the welfare state that emerged after the Second World War, inspired not least by the vision of William Temple who in 1941 published a book “Citizen and Churchman” in which he contrasted the ‘welfare-state’ with the fascist ‘power-state’ and defined its role in supporting the vulnerable. A year later, In 1942, now as Archbishop of Canterbury, he addressed the Industrial Christian Fellowship at the Royal Albert Hall, where 10,000 people turned up to support demands for post-war central planning of employment, housing and social security. Temple himself believed this was a full expression of Christian ethics in public and political life.
The NHS emerged out of many different strands, one of which was a Christian commitment, articulated by William Temple and others, to health care. In particular, the Christian belief that each human being is a creation of the one true God, an object of his love, and for whom Christ died, is a solid grounding for the worth and value of each individual, and therefore for the principle that no matter what your background, wealth or income, health is something fundamental to human life, and therefore needs to be available indiscriminately across society.
The welfare state in general, and the NHS in particular, was widely welcomed by the church at the time, and remains valued by the church today. And the church continues to play a vital role in the NHS, especially through the excellent work of hospital Chaplains, who play a vital role in caring for the whole person. Yet at the same time, there is a sense that when the NHS was created, the state effectively took over many of the functions that the church used to perform in society. Charity to the poor was replaced by the benefit system, education became the preserve of the state, and health care - long understood as a Christian imperative, with the long history of Christian hospitals provision going back to the very earliest days of the church, was taken over by the NHS.
It has left the church with a bit of a problem - what is the church to do, when many of its traditional functions been taken over by the state? Does it just revert to more ‘spiritual’ activities such as worship, evangelism or Bible study? Or should it give its attention to the gaps in the social welfare provision, aiming to provide what the state cannot? This was perhaps part of the idea behind David Cameron’s Big Society, but it was also the source of the critique of that idea. The suspicion was that the Big Society was simply a means of cutting public services, while relying on local bodies such as churches to fill the gap.
The NHS, like much of the welfare state, faces significant challenges right now. We all know that the NHS is expensive. When it was launched in 1948, it had a budget of £437m (roughly £15 billion at today's value). For 2015/16, the overall NHS budget was around £116.4 billion, funding which comes directly from taxation. The NHS is struggling with issues created by underfunding, so perhaps it might turn back to the church to fill the gaps?
A recent brief analysis of the relationship between the church and the future of welfare, by Sam Wells, Russell Rook and David Barclay, pointed out that William Beveridge’s original vision began with deficits not assets. He wanted to address the five evils of Want, Idleness, Ignorance, Disease and Squalor. The difficulty of this approach is that it focuses upon what human beings lack, rather than what they are. People are not just recipients of charity, or assistance from the state, but are persons made in the image of God. in other words the role of the church is to focus not so much on what people lack, but what contributes to enabling people to live a fully and satisfyingly human life, flourishing in every way.
They argue that the goal of the church should be to aim at people’s flourishing, not just the relief of Want; fulfilment rather than just abolishing Idleness; inspiration not just abolishing Ignorance, being a blessing rather than just abolishing disease, and offering hope rather than merely abolishing squalor. True, the church does have the responsibility of holding the state to account for addressing these five great evils, but it is to go beyond simply being a critic of the state, and recognise that even when these five evils have been addressed, there is still something more to being human than filling these deficits. As a result the church is to ‘work actively and tirelessly to model and cultivate the goods.”
This is a helpful analysis, because it takes the church beyond nostalgia for the days when it was the main provider of things such as healthcare, but also points to complimentary and positive future relationship between the church and the NHS, something I want to explore in the remainder of this lecture.
The Christian church has always understood human nature as multifaceted. When asked about the greatest commandment Jesus replied: “‘Hear, O Israel: the Lord our God, the Lord is one; you shall love the Lord your God with all your heart, and with all your soul, and with all your mind, and with all your strength.’ The second is this, ‘You shall love your neighbour as yourself.’ There is no other commandment greater than these.” (Mark 12.29-31). Implicit in this statement is a very basic anthropology - while it may be hard to identify each of these terms with our modern understanding of human life, it embraces emotional, psychological, intellectual and physical dimensions. It also suggests that true human flourishing means not just the absence of disease or sickness, but positive relations of love towards God and towards other people. It is an essentially social vision of human life flourishing in ongoing and deepening relationship with our Creator, and in profound self-giving mutual love towards those placed around us.
This fully rounded vision of human life for St Augustine was grounded in the Trinitarian life of God. As he analysed the internal life of humans, he saw the complex interplay of memory, understanding and will, or, when thinking about vision, he reflected on the thing we look at, our perception of that thing in our eyes, and the mental attention required to focus upon it. He saw in all of these vestigia trinitatis - traces of the Trinitarian life of God.
This offers a vision of human life that requires more than just physical health. This complexity in human life corresponds to the rich inner life of God himself.
All this is to suggest that we are not just bodies to be healed. We are certainly not less than this - and any Christian understanding of healing must include the physical, but it also has to go beyond this to a sense of what it means for human beings to flourish, which involves not just physical health, but also restored relationships to God and to other people in community.
It also points us in a direction for the place of Christian healing in the age of the NHS.
Medical and Miraculous Healing
The Christian church has long had a concern for bodily and not just spiritual health, from the early care that the church gave to victims of plague and disease in its early years to the long tradition of hospital care in missionary contexts across the world. There are three theological foundations for a Christian commitment to healthcare – the foundational doctrines of Creation, Incarnation and bodily Resurrection, which all point to a concern for the material, the physical dimension of reality. For Christians this physical Creation is not an unfortunate accident, but was declared GOOD right from its very inception. That creation was reaffirmed in the Incarnation, when God took on human flesh – bones, sinews, brain, hands feet – entering the world in the person of Jesus Christ, the Son of God. The Resurrection removes any doubt that Christianity is committed to creation and its ultimate renewal – the Resurrection appearances involved a body – a renewed one as we shall, see but a body nonetheless, as a sign of the renewal, not the rejection or surpassing of the physical Creation. Christianity is in many ways not a very spiritual religion. It does take the life of the spirit, the inner life of people very seriously but refuses to divorce that from bodily wellbeing and is very well aware of the links between the two.
Christians have always had a commitment to traditional methods of healthcare, and a recognition that medical treatment through doctors and those who studied human anatomy and disease were part of the divine economy of care for the world. In the year 260 A.D., when one of the great epidemics was devastating the Roman world, a time in which it is estimated 5000 people a day were dying in the city of Rome itself, Christians were known for their efforts of care and nursing the sick. The Christian Bishop of Alexandria, Dionysius, wrote:
‘most of our brother Christians showed unbounded love and loyalty, never sparing themselves and thinking only of one another. Heedless of danger, they took charge of the sick, attending to their every need and ministering to them in Christ, and with them departed this life serenely happy; for they were infected by others with the disease, drawing on themselves the sickness of their neighbours and cheerfully accepting their pains. Many in nursing and curing others, transferred their death to themselves and died in their stead…’
Medical knowledge did not extend to understandings of germs and bacteria, and so this was a world incapable of dealing with communicable diseases. Nonetheless, Christians seemed to do what they could, offering food and water for instance, to enhance the possibilities of survival, even if it meant increasing the likelihood of catching the disease. The Christian response was so markedly different from that of the surrounding society, that a century later, stung by the attraction and power of this witness that was drawing people to Christian faith, the apostate Emperor Julian launched a campaign to try to start pagan charities, that would match the Christians’ efforts.
Such heroic devotion to the sick won many admirers, and quite a number of early Christian conversion stories testify to the attraction and power of such a witness. At the same time however, alongside this practical assistance and care for the sick, Christians also prayed for more direct forms of healing. In the early Christian centuries, stories abound of miraculous supernatural healing, unexplained and unaided by normal medical processes. Throughout Christian history, testimonies and stories proliferate, not just in less sophisticated societies, but even in our own, of Christian healing in answer to prayer. Of course such stories are contested, but however far we might be committed to a thoroughgoing materialism, it is hard to argue against the sheer volume of such stories, and at least the possibility that on occasion, seemingly in answer to prayer, medical healing is accelerated, disease is removed, and a measure of at least temporary healing takes place.
A Theology of Miracles
I want at this point to turn to a historical and theological account of a Christian understanding of miracles. On the shores of the Sea of Galilee, where Jesus conducted most of his public ministry, there stood the Roman city of Tiberias. It is one mysterious aspect of the Gospels that this, the largest city on the lake, is never mentioned within the Gospels. It seems that Jesus never went there, perhaps because of its association with Roman imperial power. Tiberias was well-known for its healing springs, which drew people from miles around, coming in search of healing. It is an intriguing suggestion that the reason why so many sick people were drawn to Jesus was that they had come to Tiberias, had not found healing in its healing springs, and therefore came to this charismatic preacher to see if he could help. And Jesus did heal many.
It is remarkable that out of all the great religious leaders of the world, Jesus seems to have been the only one whose primary mode of action during his public life was healing the sick. While there are miracle stories associated with Muhammad, such as his night journey from Mecca to Jerusalem, and then to heaven and back, they are very limited, and do not extend to healing miracles, perhaps out of a desire not to overshadow the primary miracle in Islam, which is of course the giving of the Qu’ran itself. Gautama the Buddha is said to have possessed various superhuman powers and abilities, notably various kinds of telepathy, divine vision and so on, but he refused to perform miracles, including miracles of healing, saying instead "...I dislike, reject and despise them.”
Reading the gospels however, it is remarkable how much of them is taken up with an account of Jesus’ miraculous behaviour, particularly his miracles of healing. Of course he does teach and offer wisdom, he instructs his disciples and the crowds, but rather than the miracles being illustrations of his teaching, it actually seems to be the other way round.
In Luke’s Gospel, Jesus’ opponents accuse him of carrying out exorcisms through evil powers. Jesus replies that this doesn’t make any sense - if evil is fighting against evil, then it is divided kingdom and must soon fall. He then goes on to point out what he really thinks is happening: “If it is by the finger of God that I cast out the demons, then the kingdom of God has come to you.” (Luke 11.20).
The message seems to be this: the kingdom of God is coming. You can see the signs of it all around you. In the space around Jesus, you can see the sick healed, the dead raised, the poor dignified. That is the good news - the ‘good news of the kingdom’, to use the phrase that Jesus himself often seem to use. It is not that Jesus came primarily to teach some new ideas, to offer a new philosophy to explain the way the world is, but instead he came to bring in the kingdom of God. His miracles are not an illustration and addendum to his teaching – it is the other way round. His teachings are in fact a commentary on what is happening in his actions. The teaching explains the significance of what is taking place as he heals the sick, raises the dead, walks on water, predicts the downfall of the Temple and goes to his death. These were the signs that the Kingdom of God was drawing near, that God’s rule had been set up on earth again, and was set to spread. Jesus’ teaching draws out the significance of these actions and helps those who have ears to hear to realize their significance.
However, while much of Jesus is public ministry is taken up with miraculous healing, he did not heal everyone in Palestine in the first century. There is a scene towards the end of Nikos Kazantzakis’ novel, The Last Temptation of Christ, where the sick of Judaea pelt Jesus with their bandages and crutches as he carries the cross towards Golgotha, because he has failed to heal them all. Moreover Jesus’ healing miracles were only ever temporary miracles. All those whom he healed presumably got sick again one day and died. Even Lazarus, whom he was said to have raised from the dead, presumably died again one day, and was not resuscitated a second time.
This relates to a theological problem often encountered with the idea of miraculous healing. If God heals in response to prayer, why don’t we do it all the time? Why doesn’t the Church organise healing prayer teams to wander around the wards of NHS hospitals, seeking to empty the beds - surely that might be a good way to address the problems of NHS funding, and to fill the churches in one fell swoop?
There is a reason however why Jesus did not heal all of those in Palestine, and why miracles are of necessity rare events.
At the risk of simplification, Christians believe three things about God:
- That he made the world with a certain order, and structure of cause and effect, with a moral regularity to it, where actions carry consequences, and responsibilities.
- That this world has now been damaged as a result of a turning away at least part of that creation from its creator, allowing the virus of evil to enter the world, seeking to destroy all that he has created.
- That God still loves the world, and is at work to redeem it, and to rescue it, primarily through the sending of his Son to live, and die and rise again within that world, and the promise that he will one day restore it.
Given all this, what would we expect in terms of God’s interaction with the world?
In one of Douglas Coupland’s novels (Hey, Nosrtadamus!), one of the characters, Lloyd Anway ponders a Christian group that expects frequent miracles: “they talk about miracles all the time, and this, too, baffles me. They’re always asking for miracles, and finding them everywhere. In as much as I am a spiritual man, I do believe in God - I think that he created an order for the world; I believe that, in constantly bombarding him with requests for miracles, we are also asking that he unravel the fabric of the world. A world of continuous miracles would be a cartoon, not a world.”
He has a point. A world of continuous miracles would be a very unpredictable and unreliable world, one where you could never tell the results of certain actions, and in which any kind of moral structure or regularity was absent. A world in which God intervened every time something bad was about to happen, would be a world in which we never learnt the habits and virtues that lead to good and healthy human life, because you can never predict what the results of any particular action would be.
However at the same time, a world without any miracles at all would be a world which God had appeared to abandon to its own devices. It would be the world of Deism - a God who winds up the world like a watch, and allows it then to run its own course. It would naturally lead to the conclusion that whichever God had made this world did not really care about it.
I would suggest that this pattern, of miracles (for example miracles of healing, that cannot be explained by normal medical processes) which are by definition rare, occasional but real, is precisely what we should expect given the Christian understanding of God and creation - by God who creates a world with regular physical and moral order, a world which has become damaged through the fall, and yet a world that God loves, and promises to redeem. This view of miracles preserves the sense of the order of the world, and yet retains the freedom of God to interrupt that order from time to time for a particular purpose.
In John’s gospel, miracles are described as semeia - signs. In other words, their significance does not inhere in themselves, but in what they point to. When a person is healed through prayer, it is of course good for that person, and perhaps an encouragement to the person who offers the prayer, but the significance of the miracle is something much greater. It is a sign, pointing to either the power of God which lies behind this remarkable occurrence, or perhaps more fully, a sign of the day when all sickness will be banished, the dead will be raised.
The point is that Jesus’ miracles of healing always point away from themselves towards something else, defined here as the kingdom of God. This of course, is shorthand for the place, or state, where God’s will is done, on earth as it is in heaven. Jesus proclaimed the kingdom of God, not just as an empty philosophical idea, but as a practical reality.
This kingdom however is more than just physical healing of disease. It is a much bigger idea - a vision of human society not just healed of its problems. It offers a vision of exactly that flourishing, fulfillment, inspiration, blessing and hope that we mentioned earlier. Christians pray for healing, not just to supplement the work of doctors, and certainly not to prove that somehow clergy are more powerful than consultants (!), but as a sign of a much bigger picture of human flourishing - a positive vision of what human life and society is meant to be like.
Resurrection and Rewewal
The greatest miracle of all, of course, is the Resurrection, the overcoming of all the powers of darkness, of sin and death and Satan. It is, in Christian understanding, not just another miracle among many others, but is the one miracle towards which everything else points. The Resurrection indicates a momentous interruption to the normal processes of death and decay. The body of Jesus has been broken, torn, ripped apart by violent beating and crucifixion. The dead body is taken from the cross, and placed in the tomb, ready for burial. Yet at that point something else disrupts the normal course of physical death and decay. Out of the decomposing body, new life emerges. When Mary and the other disciples encounter the risen Jesus, whether in the garden, on the road to Emmaus, or by the lakeside in Galilee, they see a body which is both continuous and discontinuous from the pre-Resurrection body of Christ. Some disciples. Like Mary in the garden, or the couple walking the road to Emmaus, don’t recognise him when they first see him. This body appears to be able to pass through closed doors, not because it is ghostly and insubstantial, but because the walls themselves are not strong or substantial enough to stop him.
Even at the earliest preaching of this staggering claim, it was countered by the assertion that this kind of thing simply does not happen. St Paul addresses exactly this concern in his first letter to the Christians in Corinth, when he takes on someone who asks “how are the dead raised? With what kind of body do they come?” He replies with a powerful image:
What you sow does not come to life unless it dies. And what you sow, you do not sow the body that is to be, but a bare seed, perhaps of wheat or of some other grain. But God gives it a body as he has chosen, and to each kind of seed its own body…. So it is with the resurrection of the dead. What is sown is perishable, what is raised is imperishable. It is sown in dishonor, it is raised in glory. It is sown in weakness, it is raised in power. It is sown a physical body, it is raised a spiritual body. (1 Cor. 15.36-44)
When a gardener plants a bulb in the ground, the bulb begins to decompose. And yet somehow within that decaying bulb, new life germinates, a green shoot appears, and before long, a stem, and then a flower appears above the surface. At first glance, the flower seems to bear no physical resemblance at all to the bulb that was planted, and yet we know that the two are related: one has come from the other. Out of the dying bulb, a new kind of life has emerged. This is an image of what happens in Resurrection – both the Resurrection of Jesus and the future Resurrection of those who are bound to him by faith.
The Resurrection therefore points to the greatest miracle of all – the healing of all creation that will one day come about. The healing miracles of Jesus therefore, and in addition the healing miracles that come about through the church’s prayer, are smaller signs of this great miracle which is yet to come. They too are brief, occasional momentary interruptions to the natural course of things, not to display the power of God, much less the supernatural or psychic powers of the healer, but pointing to the kingdom of God, the kingdom that we pray in the Lord’s Prayer will come one day ‘on earth as it is in heaven’. They are, if you like, divine nudges, reminders that God has not given up on his world, that he has not forgotten us, and that one day all of creation will be healed, just as this person has experienced temporary and momentary healing in the present. They are a sign of a much bigger healing – the healing of all things that Christians believe will one day take place.
So let me draw these reflections to a conclusion. From this discussion of the nature of miracles, and their relation to the natural, created order of the world, I would suggest there are three things that the church does in its healing ministry, especially in a country where healthcare is well-developed, and offered generously and freely as it is through the NHS in Britain.
First, the church should celebrate and seek to defend the NHS. It does so on the basis of two fundamental Christian convictions. The first is the conviction that each individual is of equal value before God, that health is one of the most precious of God’s gifts, and therefore healthcare should be available to all, regardless of ability to pay. This may from time to time mean the church calling government to account to support and defend the NHS.
Second is our belief in Resurrection, telling us that death is not the worst thing that could happen to us, and is the potential gateway to a greater and more substantial life than the one that we experience now. Christians do believe in the possibility of a good death, and therefore can set limits on the offering of care, believing that there does come a point when it is no longer wise or caring to prolong life. Death has been overcome, and therefore is not ultimately to be feared.
Decisions of how much treatment to offer and for whom are of course complex, and difficult to resolve. Because Christians can look death in the eye as a defeated enemy, they do not regard the sustaining of life at any cost as being the ultimate goal, and this perspective provides grounds for limits to the offer of health-care, while seeking to continue to offer the ideal of care available to all regardless of need. There have been a number of high profile recent cases involving children where doctors have taken the view that nothing more can be realistically be done to prolong life and therefore decided to withdraw ongoing attempts to sustain life at all costs – and that is very difficult for parents and carers. Christian faith in Resurrection, and the belief that this life is not the last word, can and does give people – both doctors and carers - strength and a framework for thinking to enable them to make such difficult decisions. Letting go of those who are dying is very difficult, and a belief in a life beyond this one can help people do this.
Third, alongside its commitment to the medical profession, to the NHS and the ideals it embodies, the church also prays for healing. It does so not as a rival, or even a gap filling exercise for the NHS, seeking to heal what doctors can’t. It does so, recognising that every miraculous healing is significant not just for itself, or for the person healed, but as a sign of the kingdom of God, a sign of the resurrection of all things that will one day take place - a sign not just of a healed creation, but a restored and healthy social order.
Christian approaches to healing should not be described as ‘alternative therapy’, as on the one hand Christians see a vital and important place for the more regular natural medical processes of healing, and on the other hand, prayer for miraculous healing is not seen as an alternative, or a rival to such medical care, but an adjunct, or perhaps better an extra dimension to the overall healing which God brings. Both medical healing and prayer for healing are incomplete, but significant signs of the day when all creation shall be healed, and to that end, we should give thanks for both the NHS, and ministries like the Christian Healing Mission, and encourage continued conversation and cooperation between them. They are both gifts of God, given for different purposes, equally of value as signs of God’s care for his world.
Ministries like the Christian Healing Mission, therefore have a vital place in the life of the church and in the life of wider society, because they point to a bigger picture, a grander healing which does not simply include the physical, but also the social, the spiritual, the mental and the emotional.
To end with one more final point: The one thing that neither the NHS nor the Christian healing ministry can provide is certainty. Doctors and nurses do their best, but bodies don’t always heal, and patients die. Christians pray, and sometimes people are healed, but, as we have seen already in this lecture, many times they are not, prayers go unanswered, and healing does not take place. In neither case can certainty be offered. Yet Christian faith does offer something sure and dependable. In the promise of Resurrection, it offers hope. This hope goes beyond physical healing, beyond even death itself, to the trustworthiness of a God who both sustains the world in being from moment to moment, preserving the order and structure of that world, and yet who overcomes all that seeks to destroy that creation, through the power of resurrection.
Christian healing does not stop with prayer for healing, and the expectation that on occasion, God will respond to that prayer with visible and tangible physical change. It goes beyond that to offer something that neither medical practice nor miracle can provide: the certainty that lies with the faithfulness of the God of creation and redemption.
In the marvellous film, the Shawshank Redemption, the main character, played by Morgan Freeman closes the film with the memorable line: “Hope is a good thing. Maybe the best things.” Sickness brings with it uncertainty and fear. While neither the NHS nor the church can offer the absolute certainty of physical healing, the hope that comes from a trust in the God from whom we came and to whom we will return, is perhaps the greatest healing of all.
The Rt Revd Graham Tomlin
Bishop of Kensington
5 July 2018
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