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BOOTH PHILIPPhilip Booth is Editorial and Programme Director at the Institute of Economic Affairs and Professor of Insurance and Risk Management at Cass Business School.

Nigel Lawson
once said that the NHS is the closest thing the English have to a religion. Of
course, we also have the established church. And, indeed, the established
church seems to see the NHS as part of its theology. Last week, Archbishop
Welby, at his enthronement, said: “Slaves
were freed, Factory Acts passed, and the NHS and social care established
through Christ-liberated courage.” In their response to the Mid Staffordshire NHS
scandal the local bishops of Lichfield and Stafford said: "We
have now seen what many of us suspected – that the marketisation of the health
service has gone too far…This Christian basis has been weakened in recent years
and covering the bottom line has become all important."

This is a
totally inappropriate response to the deaths of 1,200 people in a state-run
health system. It is quite extraordinary to blame the scandal on the marketisation of
healthcare in the UK. Indeed, by almost every measure, the UK has amongst the
least marketised health systems in the world (along with Iceland and Canada).
For example, 4 per cent of UK hospitals are not publicly owned compared with 26
per cent in Spain, 51 per cent in Germany and 34 per cent in France. Many of
these non-state hospitals in other countries are operating within
state-financed health systems which Anglican bishops would describe as
“marketised” state systems (though there is generally a much higher level of
private insured funding too). If the Bishops were right, surely France and
Germany should be experiencing a Mid Staffs scandal each week.

If
you look at mortality amenable to healthcare, the UK has amongst the worst
records in the EU, some way behind countries with more marketised health
systems. It is worth noting, however, that the figures of mortality amenable to
healthcare fell more rapidly in the UK than in any other OECD country apart
from Ireland during the period 1997-2007 – this is the period when the UK
government began to introduce some limited marketisation (though not, I
believe, in Mid Staffs hospital). But, of course, if the NHS is your religion,
then evidence is not relevant to the debate – for some, the NHS is an article
of faith.


Indeed, calling the
NHS a creation of Christ-inspired courage is stretching things beyond
credulity. Beveridge was, it appears, a Christian though also a eugenicist. He
was also a friend of Archbishop William Temple who was certainly a supporter of
the welfare state. But Beveridge did not propose the NHS as we see it today but
probably favoured state-finance and state direction in a mixed system of
provision. He did not propose that all the charitable hospitals, mutual aid
societies and so on should be nationalised by the state as happened in
practice. He almost certainly had in mind something much closer to the
marketised models criticised by the bishops and closer to the non-NHS models
used in many Christian Democrat countries such as Germany.

Indeed, perhaps we
should think more seriously about Christian objections to the NHS, such as:

  • Was it
    appropriate for the state to sweep away charitable, mutual and commercial
    provision where this met people’s needs?
  • Is it more noble
    for health care to be provided and funded via a bureaucracy and compulsory
    taxation or by commercial, reciprocal and charitable endeavour?
  • Is it appropriate
    for the state to be providing healthcare for all rather than ensuring that
    all can have healthcare by supporting families, charities and the
    community in obtaining healthcare from a plurality of sources?
  • Is coercive state
    finance and provision a higher value than personal concern motivated by
    charity?

Beveridge would
probably have answered “no” to those questions – as might Attlee. The person
who answered “yes” and created the NHS as we know it was Bevan – an atheist. A
man about whom George Brown wrote: “He
had a burning faith in whatever seemed good to him at the time but, outside
politics, had no personal faith at all.”

Certainly, the Catholic Church took a
different view from that of Bevan. Cardinal Griffin managed to negotiate an
opt-out from nationalisation of the Catholic hospitals arguing: “it will be a
sad day for England when charity becomes the affair of the state.”

Our Anglican bishops
should open their eyes and see that there is a big wide world out there. They
ought to have a grander vision of the Christian role in healthcare than a
policy of nationalisation and bureaucratisation. If not, why not go the whole
hog and add support for the NHS into the 39 articles of the Church of England?
Perhaps in Article 37, between: The Bishop of Rome hath no jurisdiction in this
Realm of England” and “The Laws of the Realm may punish Christian men with
death, for heinous and grievous offences” we could add: “Voluntary and private
healthcare, being an alien, papist concept should have no place in this land”.
Then article 39 could be shortened by the removal of:
every man ought, of such things as he possesseth, liberally
to give alms to the poor, according to his ability”
, given that the Church of
England seems to think that such generosity should be replaced by coercion and
that the community should be replaced by the state.

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