On 5th July 2018 Lord Darzi of Denham led a debate to mark the 70th anniversary of the NHS, “That this House takes note of the creation of the National Health Service in 1948, and the case for integration of health, mental health, social and community care to equip the National Health Service for the next 70 years.” The Bishop of Carlisle, Rt Revd James Newcome, who is the lead bishop for healthcare, spoke in the debate:
The Lord Bishop of Carlisle: My Lords, I too am most grateful to the noble Lord, Lord Darzi, for securing this timely debate. On the one hand, I am grateful because it is an opportunity to recall and be thankful for the establishment of the NHS in 1948 as one part of a comprehensive vision of social welfare—which, incidentally, owed much to the insight and energy of Archbishop William Temple and other Christian thinkers and activists. Temple and Beveridge were close friends, and much of the post-World War II vision that led to the creation of the welfare state by Bevan and others emerged from church-led consultations.
On the other hand, I am grateful for the clear emphasis in this debate on integration. Our word “health” comes from an Old English word meaning “wholeness”, and the Old Norse version of that word meant “holy” or “sacred”. From the start, when churches and monasteries founded our first hospitals, healthcare has been understood holistically. There is a real sense in which our National Health Service should include caring for all aspects of well-being in all our people. Certainly, in the Select Committee report on the long-term sustainability of the NHS the word “integration” appeared several times.
In the brief time available, I will suggest two aspects of healthcare that fall into the community care category, and which, like mental health and social care, urgently need integrating with other parts of the NHS. The first and most obvious is public health. Here I declare an interest as an associate of the Faculty of Public Health. Other noble Lords have raised this and I am sure others will. I will not, therefore, dwell on it, but from a purely financial point of view money spent on prevention bears obvious dividends: it is never wasted. From a well-being angle, furthermore, prevention has always been better than cure and always will be, especially in relation to our consumption of food and alcohol and our commitment to taking exercise.
The second aspect is spiritual well-being. The World Health Organization understands spirituality as,
“an integrating component, holding together the physical, psychological and social components of a person’s life”.
It is often perceived as concerned with meaning and purpose. For those nearing the end of life, this is commonly associated with a need for forgiveness, reconciliation and affirmation of worth.
Delivery of spiritual care is the responsibility of all professionals in the multidisciplinary healthcare team. This debate, however, provides the opportunity to affirm the vital role of healthcare chaplains, who minister to the spiritual needs of those from all religions and none.
Underlying all this is a significant question of responsibility. Who is responsible for making all this integration happen? We ourselves have an obvious responsibility, as every citizen does, when it comes to prevention but with regard to the integration of physical and mental health with social and community care, do we look primarily to NHS England, regional STPs, local trusts or Parliament to take a lead? I would be most grateful for the Minister’s view on this. There is also the question of consultation. The foundation of the NHS followed a comprehensive and inclusive debate in UK society. Are there any plans for a similar process of inclusive debate, in which all voices are heard and all concerns addressed, as we look forward to the next 70 years of our invaluable National Health Service?
Lord Lexden (Con): It is an immense pleasure to follow my favourite Bishop. Fortunately, none of the others are here to learn that I care for them less….
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con):….It is also important to acknowledge the point made by the right reverend Prelate the Bishop of Carlisle that it was also an expression of Christian purpose, something that Nye Bevan himself acknowledged. As the noble Lord, Lord Hennessy, said, it was the nationalisation of altruism. It is also, as the noble Lord, Lord Bird, reminded us, part of our national effort to end poverty; that is what is at stake.
The NHS plan will be led and developed by clinicians and patients. I promise the right reverend Prelate the Bishop of Carlisle that it will be inclusive. It is based on six key principles: focusing on the prevention of ill health; significantly improving access to good mental health; driving forward the integration of health and social care; spreading best practice and eliminating variations; embracing the opportunities of technology; and building the workforce we need for the future.
The right reverend Prelate the Bishop of Carlisle pointed out quite rightly that, first and foremost, we must continue to focus on prevention, not least because, as the noble Baroness, Lady Jolly, pointed out, unhealthy behaviours are associated with a significant number of early deaths in the UK. Each year there are around 80,000 deaths related to smoking, a point alluded to by the noble Lord, Lord Faulkner; 30,000 deaths related to obesity; and 7,000 deaths related to excessive alcohol consumption. This must change.