Archbishop says health and people come before money and targets

-10/05/06

The Archbish


Archbishop says health and people come before money and targets

-10/05/06

The Archbishop of Canterbury, Dr Rowan Williams, has warned that National Health Service cuts brought about by the competitive system could compromise the quality and centrality of patient care.

The head of the Church of England suggested that “short-term economics” threatened to undermine service delivery, and could put vulnerable people at particular risk.

In a sermon preached at Westminster Abbey for the annual Florence Nightingale Commemoration the Archbishop said that, like Mother Theresa, Florence Nightingale had understood that care and compassion sprang from the understanding of the patient as an individual, entitled to respect and dignity:

He declared: ìBoth [these women] took it for granted that the level of human respect given to any patient is the same whether they are rich or poor, young or old, likely or unlikely to recover, because they stand on the same ground before their creator.î

Invoking the biblical notion of integrated personhood, the Archbishop added: ìThe self is what is ill or hurt or restricted, not simply a set of bodily functions and processes. Healing is therefore about sustaining and restoring that vulnerable sense of who we are. It is about the service of human dignity.î

Dr Williams told representatives of the nursing profession gathered for the service that some management styles and short-term economics could risk compromising the primary duty of the NHS in the UK to care for patients and treat them with due dignity.

There were already concerns, he said, that the budget-driven approach of some Trusts was having a detrimental effect both on staff and their patients:

ìNHS Trusts vary enormously; but there are enough whose style of management seems driven by short-term economics to give real concern. Anecdotes abound of senior and responsible people in hospitals being given ridiculously short notice of economies to be achieved,î declared the Archbishop.

He continued: ìAn appeal to the overall numbers employed in the NHS doesnít deal adequately with the fact of plain local insecurity in this or that particular institution. And we have to ask whether the increased budgetary role of local medical practices in the running of hospitals will do anything to halt this or whether it will accelerate the most worrying trends.î

Said Dr Williams: ìIf nurses and other staff are not treated with dignity, what help do they have in treating patients with dignity? Ö The problems which now face nurses as a profession, problems acutely in the public eye in recent weeks, are not about the successes or failures of particular politicians, but about a culture that has grown up in the NHS over recent decades, in which accountability and accountancy have become seriously confused, and false and destructive models of what counts as meeting targets have distorted a good deal of our practice.î

This, he argued, also made the context of the debate about assisted dying all the more problematic: ìA target-obsessed NHS, managed with an eye to brisk traffic through its beds and reduction of expense, doesnít feel a very good place in which to have a reasoned and balanced discussion of assisted dying.î

The Archbishop went on: ìOnce we let go of the principle that everyone deserves care and respect, we are in uncharted territory; and if there is ever what looks like a short-cut in dealing with the terminally ill or even the outstandingly inconvenient, resource-intensive patient, we have to face the possibility of any number of subtle pressures that may be at work in favour of assisted dying, however little the proponents of this may want it or approve it.î

Dr Williams said that the challenge was not simply about getting enough resources, but rather of keeping sight of what the funding was intended to provide;

He declared: ìAgain and again it seems that the real task for health care in these days is not just to fight the constant battle for proper resourcing, but to hold on to the belief that what needs to be resourced is a system that has to be kept human ñ that is, a system that puts resources at the service of dignity as an intrinsic and vital aspect of health.î

ìIt must be a system that treats its own professionals with dignity and doesnít assume that the only professional skills worth developing are the material ones, or that the only goals that matter are the economic ones.î

The Archbishop of Canterburyís sermon clearly touches on a number of controversial current issues in public life.

The UK governmentís Department of Health rapidly issued a statement in which it said targets helped to save lives. “Last year, the NHS treated more people, faster and better than ever before – and saved more lives than ever before.”

Announced the authority: “Dignity, respect and putting patients at the heart of all decisions are at the centre of all of our policies, so we agree with much of what the Archbishop has said.”

However nurses and doctors and their unions and professional bodies take a more circumspect view of the regimes in which they are required to operate, and they are likely to welcome his warnings.

The normally moderate Royal College of Nursing barracked and booed Labour health secretary Patricia Hewitt at their recent conference, and in spite of the partyís claim to be investing more than ever in health care, concern about its policies is spreading at the grassroots as well as in local communities ñ with local Trusts having to lay off staff to meet targets.

On assisted dying, which comes before parliament on Friday, the Archbishop seemed concerned to make a careful and balanced comment about the context of the debate which both supporters and opponents of the Joffe Bill could reflect on.

Dr Williams has made his opposition to the Bill clear, but he has also expressed compassion for those who face terminal illness and concern for the moral and professional complexities of the issue.

However this week the British Humanist Association launched a stinging attack on what they call scare-mongering by wealthy and unrepresentative Christian groups who oppose the Assisted Dying Bill, pointing out that the majority of Christians are in favour of compassionate change.

The BHA stresses that its ëIn Bad Faithí report is not intended to demean religion, but to point out where specific religious arguments, organizations and resources are being deployed manipulatively.

As to the central theme of the Westminster Abbey service, Florence Nightingale is an iconic figure for both health care and Christianity ñ though black organizations and churches are pushing for much more recognition for Mary Seacole (1805 ñ 1881).

In contrast to Nightingale, Seacole did not come from a wealthy middle-class background and had no formal training. Not only did she suffer from the restrictions placed on women at the time but she was also hindered in her career by the colour of her skin. Despite these prejudices, she established herself as a pioneer of the nursing profession.

Similarly, Mother Theresaís image of selfless love has been tarnished by accusations that her reluctance over modern medical technology, because of a romanticized notion of religious service to the poor, actually led to unnecessary death and suffering. Her supporters strongly deny this.

Declared Dr Williams of the main focus of the event: ìFlorence Nightingale was not an angel, youíll be happy to know. She was a formidably tough, principled and obstinate woman, whose main goal was to create a climate in medical care that was properly professional.î

The Archbishop of Canterbury’s full sermon can be read here.


Archbishop says health and people come before money and targets

-10/05/06

The Archbishop of Canterbury, Dr Rowan Williams, has warned that National Health Service cuts brought about by the competitive system could compromise the quality and centrality of patient care.

The head of the Church of England suggested that “short-term economics” threatened to undermine service delivery, and could put vulnerable people at particular risk.

In a sermon preached at Westminster Abbey for the annual Florence Nightingale Commemoration the Archbishop said that, like Mother Theresa, Florence Nightingale had understood that care and compassion sprang from the understanding of the patient as an individual, entitled to respect and dignity:

He declared: ìBoth [these women] took it for granted that the level of human respect given to any patient is the same whether they are rich or poor, young or old, likely or unlikely to recover, because they stand on the same ground before their creator.î

Invoking the biblical notion of integrated personhood, the Archbishop added: ìThe self is what is ill or hurt or restricted, not simply a set of bodily functions and processes. Healing is therefore about sustaining and restoring that vulnerable sense of who we are. It is about the service of human dignity.î

Dr Williams told representatives of the nursing profession gathered for the service that some management styles and short-term economics could risk compromising the primary duty of the NHS in the UK to care for patients and treat them with due dignity.

There were already concerns, he said, that the budget-driven approach of some Trusts was having a detrimental effect both on staff and their patients:

ìNHS Trusts vary enormously; but there are enough whose style of management seems driven by short-term economics to give real concern. Anecdotes abound of senior and responsible people in hospitals being given ridiculously short notice of economies to be achieved,î declared the Archbishop.

He continued: ìAn appeal to the overall numbers employed in the NHS doesnít deal adequately with the fact of plain local insecurity in this or that particular institution. And we have to ask whether the increased budgetary role of local medical practices in the running of hospitals will do anything to halt this or whether it will accelerate the most worrying trends.î

Said Dr Williams: ìIf nurses and other staff are not treated with dignity, what help do they have in treating patients with dignity? Ö The problems which now face nurses as a profession, problems acutely in the public eye in recent weeks, are not about the successes or failures of particular politicians, but about a culture that has grown up in the NHS over recent decades, in which accountability and accountancy have become seriously confused, and false and destructive models of what counts as meeting targets have distorted a good deal of our practice.î

This, he argued, also made the context of the debate about assisted dying all the more problematic: ìA target-obsessed NHS, managed with an eye to brisk traffic through its beds and reduction of expense, doesnít feel a very good place in which to have a reasoned and balanced discussion of assisted dying.î

The Archbishop went on: ìOnce we let go of the principle that everyone deserves care and respect, we are in uncharted territory; and if there is ever what looks like a short-cut in dealing with the terminally ill or even the outstandingly inconvenient, resource-intensive patient, we have to face the possibility of any number of subtle pressures that may be at work in favour of assisted dying, however little the proponents of this may want it or approve it.î

Dr Williams said that the challenge was not simply about getting enough resources, but rather of keeping sight of what the funding was intended to provide;

He declared: ìAgain and again it seems that the real task for health care in these days is not just to fight the constant battle for proper resourcing, but to hold on to the belief that what needs to be resourced is a system that has to be kept human ñ that is, a system that puts resources at the service of dignity as an intrinsic and vital aspect of health.î

ìIt must be a system that treats its own professionals with dignity and doesnít assume that the only professional skills worth developing are the material ones, or that the only goals that matter are the economic ones.î

The Archbishop of Canterburyís sermon clearly touches on a number of controversial current issues in public life.

The UK governmentís Department of Health rapidly issued a statement in which it said targets helped to save lives. “Last year, the NHS treated more people, faster and better than ever before – and saved more lives than ever before.”

Announced the authority: “Dignity, respect and putting patients at the heart of all decisions are at the centre of all of our policies, so we agree with much of what the Archbishop has said.”

However nurses and doctors and their unions and professional bodies take a more circumspect view of the regimes in which they are required to operate, and they are likely to welcome his warnings.

The normally moderate Royal College of Nursing barracked and booed Labour health secretary Patricia Hewitt at their recent conference, and in spite of the partyís claim to be investing more than ever in health care, concern about its policies is spreading at the grassroots as well as in local communities ñ with local Trusts having to lay off staff to meet targets.

On assisted dying, which comes before parliament on Friday, the Archbishop seemed concerned to make a careful and balanced comment about the context of the debate which both supporters and opponents of the Joffe Bill could reflect on.

Dr Williams has made his opposition to the Bill clear, but he has also expressed compassion for those who face terminal illness and concern for the moral and professional complexities of the issue.

However this week the British Humanist Association launched a stinging attack on what they call scare-mongering by wealthy and unrepresentative Christian groups who oppose the Assisted Dying Bill, pointing out that the majority of Christians are in favour of compassionate change.

The BHA stresses that its ëIn Bad Faithí report is not intended to demean religion, but to point out where specific religious arguments, organizations and resources are being deployed manipulatively.

As to the central theme of the Westminster Abbey service, Florence Nightingale is an iconic figure for both health care and Christianity ñ though black organizations and churches are pushing for much more recognition for Mary Seacole (1805 ñ 1881).

In contrast to Nightingale, Seacole did not come from a wealthy middle-class background and had no formal training. Not only did she suffer from the restrictions placed on women at the time but she was also hindered in her career by the colour of her skin. Despite these prejudices, she established herself as a pioneer of the nursing profession.

Similarly, Mother Theresaís image of selfless love has been tarnished by accusations that her reluctance over modern medical technology, because of a romanticized notion of religious service to the poor, actually led to unnecessary death and suffering. Her supporters strongly deny this.

Declared Dr Williams of the main focus of the event: ìFlorence Nightingale was not an angel, youíll be happy to know. She was a formidably tough, principled and obstinate woman, whose main goal was to create a climate in medical care that was properly professional.î

The Archbishop of Canterbury’s full sermon can be read here.