This week: James Newcome, Bishop of Carlisle
Why he matters: He has been the Church of England’s lead on health and social care matters for a decade, attempting to bring “a voice of moderation” to a range of ethical debates. As a member of the House of Lords, he regularly speaks on NHS-related issues and was a member of its recent inquiry into the long-term sustainability of the NHS.
“There was so much in the NHS long-term plan that was really good and very useful”, says Bishop Newcome, “but one thing that was completely lacking was any reference to the spiritual dimension of care.”
This was surprising he adds, because the spiritual dimension is embraced by the NHS’ “purpose” to care for the whole person, but also expected as “the culture of today is very suspicious of anything that might be termed religious”.
The bishop reflects that the current myriad different definitions and interpretations of spirituality make “policy makers and others rather frightened of using the term in case they tread on people’s toes and upset somebody. It’s easier just to leave it out altogether.”
He also says the caution can often stem from a belief that religion and spirituality are the same things.
“We’re always at pains to point out that religion and spirituality are different. Spirituality is a much broader category, and everybody has spiritual needs, whether they would refer to them in those terms or not.”
The sidelining of religion and spirituality in policy has had a knock-on impact on its role at a local level. Bishop Newcome says that despite good evidence that catering to an individual’s spiritual needs can improve health outcomes even in those without a religious faith, hospital chaplains proved a “soft target” when cuts had to be made.
The Church of England led a fight back against the trend and the bishop says he has received far less alarmed and/or alarming messages from chaplains lately.
Part of the resilience of these services has been, he suggests, the way they have changed to reflect modern care delivery.
Chaplains, says the bishop, are now “part of the multidisciplinary care team” who provide support, “regardless of whether people are religious or not”, by being there to talk through “fears, worries, hopes and anxieties” of patients and relatives.
Religious healthcare leaders
In common with the rest of the society, healthcare leaders and senior clinicians are a lot less likely to have an active religious faith than in the past.
However, devout believers are represented at all levels in the NHS – including among senior policy makers and trust chief executives.
Does the bishop think that faith influences the decisions they make and the way they make them?
“Whether it’s always consciously part of their decision-making process is [difficult to tell]. Unconsciously it’s absolutely bound to be, because it’s part of the way in which their whole worldview is determined, and their mindset is established.”
Religious healthcare leaders tend to be different in three particular ways he continues, the first being that their job is likely to be a way to express their faith.
Perhaps more significantly, Bishop Newcome agrees with HSJ’s suggestion that religious healthcare leaders may be more prone to reflection as a result of their rituals of worship.
“If they were struggling with a decision, they would almost certainly be bringing that into the daily prayers… and asking for some kind of sense of the right way forward, and that right way forward would be, generally speaking, something that is going to contribute best to the common good.”
If prayer should fail, then the third distinguishing characteristic is that they would seek counsel from a “religious advisor”.
Yet despite the continuing role of hospital chaplains and the presence of devout healthcare leaders, Bishop Newcome acknowledges that religious faith has less of a sway over healthcare than it used to.
What, if anything, has the NHS lost because of that asks HSJ.
“One of the things it may have lost is a constant reminder of how the NHS came into being in the first place”, says the bishop, “[in particular] how hospitals and hospices have their roots… in the church.”
Even now, he adds, “If you obliterated Christianity in this country the voluntary sector would collapse.”
Along with the lack of understanding of the NHS’ roots and religion’s role in healthcare, the bishop laments the reduced influence of the church as “something that is non-party political, is devoted to the good of everybody regardless of whether they come to church or not, and has a series of criteria which are not determined by self-interest or the latest fad, but has something solid in the background to rest upon, which in the case of Christian church would be the principle of serving one’s fellow human beings.”
The morality of NHS funding
The debate about NHS funding has many dimensions, but one that is often missing is morality. Does the bishop consider paying tax a “moral good”?
“If paying tax to fund the NHS means I’m doing something that I may or may not benefit from myself, but it’s going to benefit all my fellow citizens, then I think that’s a moral good.”
He then hastens to add: “If one goes back to the Old Testament times people gave money [to] provide care of one kind or another [to the weak]. It was regarded as the thing you did because you were part of the community. And that [expectation] got transformed into the welfare state.”
So much for how the NHS remains financially sustainable, what about how it should spend its money? Where, for example, should the balance lie between funding cutting-edge therapies and levelling up existing care to acceptable standards.
“I think it’s a fascinating question to which there is no straight forward answer”, says the bishop. “My feeling is that obviously we’ve got to go on researching, had we not done so, many of the things that we now take for granted would not be happening. But there is a balance here and some of the things we might like to do in terms of research may have to go a bit more slowly in order that we don’t ignore the basic needs of the majority.
“While one would love to have our cake and eat it, I don’t think that’s possible. There are some areas, particularly ones where you’re not necessarily talking about a cure, but about just lengthening a person’s life a little bit, where, if I was asked my advice, would say [you should] soft pedal that one in the interests of the vast majority [who could benefit more widely through the money saved].”
Suffering is no longer part of the agenda
The bishop says that the church’s support for a tax-funded healthcare system is not unconditional. Part of the deal must be that people also “take some responsibility for their own health”.
The bishop is worried about the “dependency culture that’s arisen [in which] people automatically expect somebody else to sort everything out for them”.
This he believes is reflected in people’s views of the NHS which is “quite self-absorbed and self-centered. It is incredibly focused on what this institution is going to give me. It lacks any transcendent dimension, it’s all about how long you are going to live and how fit I’m going to be. All of which are important, but there is more to life than that. And that takes us right back to the whole spirituality debate and the fact that in fact, without some extra perspective on all of this, it becomes a little pointless.”
This “dependency culture” also raises other concerns associated with the unprecedented faith placed in medical science, he says.
“If you really think doctors can do anything nowadays, you’re going to get very disappointed. There is also the danger of going in the direction of the States. I was talking to a friend who’s a doctor [in the USA] recently and not only is his insurance policy massively expensive, but he’s really quite frightened of being sued by one of his patients if he doesn’t get something right, or even if he does get it right, but it doesn’t produce the desired outcome. In our society, we have unrealistic expectations and what we hope for is not even necessarily always the right thing to hope for.
“There is an assumption now that life will be without any kind of difficulties. The whole idea of suffering is not part of our agenda any longer. And so, if somebody isn’t stopping [your] suffering, they’re not doing their job properly. I think there’s quite a dangerous position to be in.”
Coming up: Health secretary (and would be PM) on the NHS in 2050 and Department of Health and Social Care permanent secretary Sir Chris Wormald.
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