How much should we blame God for NHS shortcomings?

 I was watching Talking Pictures TV on Sunday (8th May); around 4.45pm they showed a short film, made, I think, in 1960, about schools for the deaf. It was an interesting film, made in a bygone era, but one which might still have some relevance today. 

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My stepmother, Margaret, was a working State Registered Nurse when that film was made. She had done her training soon after leaving school in the late forties, and, after a year or two as a nursery nurse at an industrial laundry, she worked in hospitals in central London until the late seventies, when she moved to an occupational health role, before retiring at the end of 1991. 

Margaret had grown up when things were very different to now; all respectable people attended church. She was an active Sunday School attendee, and continued - on the face of it - to uphold ‘Christian’ values, but did, when the mask slipped, have some attitudes that, at least today, would be considered cruel, or unacceptable.

One such was towards the less fortunate in society, and I was reminded of this when watching the film about the deaf boys and girls. I can recall more than one occasion, after Margaret had encountered a disabled child, or we’d seen one on television (perhaps in a film like the one I mentioned), she would ask, rhetorically, ‘what was the mother up to in the time before that child was born?’ - clearly leading the conversation onto the topic of the dangers of promiscuity and how the mother should have behaved more responsibly. This was, of course, without any detailed knowledge of what had caused the disability, and possibly as much a statement of religious belief as much as medical knowledge.

She was also quite vocal about the evils of alcohol; hypocritically, sometimes, for the port and lemon would flow freely whenever she got together with some of her old nursing friends; they would enjoy a cackle about their times in training, and the various patients they’d had to deal with, their various conditions, and failings. 

In later life she continued in the fold of non-conformist christianity, first at the URC church in Woodford, where she and my father lived, and then at, I believe, a Methodist church in Worcestershire, when they retired to the Severn Valley. They even bought each other their own hymn books, and she would, as she used to say, ‘enjoy a good sing’. No doubt many of the congregation at both churches shared some of, and indeed reinforced, her - indeed, their - beliefs regarding alcohol, promiscuous behaviour and the general degeneracy of younger generations. By then, of course, she was not greatly involved in patient care, so her opinions would have had little effect on others.

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Over the past fifteen years or so, I have witnessed similar attitudes among some staff at hospitals, obviously affecting the way they treat patients. Not among all staff, I should make very clear, but among enough to make it acceptable, in some areas, for staff to speak in a very cruel and judgemental way, and, no doubt, to affect the quality of work and diagnoses  they deliver - even, for example, the content of their notes might be phrased to state what they believe they see, rather than what they actually see. One example was at a hospital in Leeds, where Viv had been taken after a seizure - she had been epileptic in childhood and her seizures started to recur around the age of 50, as is not uncommon. She hadn’t had a great deal of alcohol in the preceding days, and had been taken there by ambulance. I arrived a while later to help as much as I could. She’d been undressed by staff; I asked where her clothes were, for - even if they had been cut off - there might have been something of importance in her pockets. ‘We’ve burnt them’, a porter, yes, A PORTER, told me. ‘SHE’S JUST A BLOODY ALKY’, he added at the top of his voice, loud enough for all the gathered throng in A & E that evening to hear. How he came to conclude that I don’t know, but something must have been said among the staff before I arrived, and he felt free to announce it.

Alcohol problems were the first diagnosis among clinicians regarding Viv’s seizures at that time, it took a while before other issues - including a brain tumour and effects of childhood (prescribed) used of phenobarbital - were picked up; it was also not until we moved south, two years after that incident, that Viv was even offered drugs to control the seizures. 

There was a subsequent situation when a consultant neurologist - at least someone vaguely qualified, I suppose -  seemingly diagnosed alcohol as the cause of her neurological problems, when in fact, at the time, it was hydrocephalus - a life threatening but easily addressed problem; a scan had shown hydrocephalus eight weeks previously (we later learned) and the radiographer had commented on it in the associated notes, but these were ignored by said consultant. Viv suffered for a year before the hydrocephalus was properly diagnosed and treated. 

Were either of these problems due to clinicians, and others in a hospital setting, having preconceived views on the cause of Viv’s condition, and consequently reducing the effort they were prepared to expend on investigating her symptoms, I wonder? It would seem so: it's hard to believe both examples of poor patient care were unconnected to their perception of the cause of her condition. (I should have complained about the incident with the porter; I did about the consultant, matters are ongoing.)

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To understand these sorts of attitudes amongst health staff one has to look back to the pre-war world, when there was no NHS. Hospitals and medical care then were either expensive, or provided by charitable organisations, often with strong links to nonconformist christianity. The Salvation Army ran one for pregnant women in Clapton, London for instance, which eventually became part of Barts. Guy’s Hospital, in London, was, I understand, originally established as a hospital to treat "incurables" discharged from St Thomas' Hospital. The patronising language and appalling treatment of the mentally ill a century or so ago is, of course, legendary.

The Nuffield Trust records that, prior to the creation of the NHS, ‘the professional attitude to working-class patients was frequently robust, and sometimes downright rude, but this was accepted with tolerance’. Other than (at least some) members of the ‘working class’ being less tolerant of poor care in ‘our’ NHS, has this changed in the intervening 75-odd years?

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Consider a number of the known NHS scandals in recent years - Shipman, Belfast, Mid Staffordshire, Gosport, Shrewsbury. One thing in common in all of them seems to be that the perpetrators all felt they were doing the right thing, sometimes in difficult circumstances. In spite of all of their medical or nursing training, they seemed to believe they were justified in carrying out what was, in fact, abuse on vulnerable patients - often with fatal consequences. In some cases it is possible that the abuse was a consequence of poor management; I’m not sure if any of the inquiries into these scandals have ever dug deep enough to look into the characters and attitudes of the abusers, or those who failed to provide proper management and governance, and as to where the sense of the validity of such abuse might have originated. It's surely an important question, because the attitudes and character of our hospital managers, doctors, nurses and indeed all staff involved in healthcare are as important to our wellbeing as the relevant technical skills that they learn during their training. Are some doctors - and others in the NHS - still robust, or rude, when dealing with patients they consider to be ‘working class’? 

Harold Shipman was, I believe, raised as a devout Methodist; the inquiry into the Shrewsbury scandal concluded, among other things, ‘the trust .. had a tendency to blame mothers for poor outcomes - in some cases for their own deaths’. Neither of these facts instil confidence that all are treated properly within ‘our’ NHS.

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The Hippocratic Oath, written 2,500 years ago, includes the line: "I will use treatments for the benefit of the ill in accordance with my ability and my judgement, but from what is to their harm and injustice I will keep them." This sums it up nicely; no matter how good the medical knowledge or capabilities of a doctor, if their judgement is flawed, they will not perform optimally, and their patients will suffer.

Nurses, on the other hand, may swear the Nightingale pledge (or a version of it): ‘"I solemnly pledge myself before God and in the presence of this assembly: to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavour to aid the physician in his work and devote myself to the welfare of those committed to my care."  There’s an awful lot of subjectivity around this wording, and the bits about ‘passing my life in purity’, and abstaining, well, they're right up the street of nonconformists. Might patients be treated differently according to their class, wealth, perceived intelligence, or cause of illness? 

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So, to return to the title: how much is God to blame for some of the worst errors, and negligence, that has been seen in ‘our’ NHS?

It's a bit like an often misunderstood biblical quote - that, supposedly, money is the root of all evil, which is actually ‘the love of money is the root of all evil’ (1 Timothy 6:10). It's not God himself (or herself, or itself) that is to blame, for, as any self-respecting atheist will tell you, there is no God; the fault arises with the obsessive worship and adherence to ill-thought through beliefs that run through some religions (including modern ones, such as mask-wearing) that may give rise to incidents that can have the most appalling consequences, and not just in a health setting; one only has to recall the events of September 11, 2001 to realise that there are plenty of reasons why facts, rather than beliefs, should lead decisions, and why all people should be treated equally, irrespective of background, habits, beliefs, perceived faults, education history, race, sex, or disability.

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I was very fond of Margaret, and it's not easy to write this about her; I don’t see her attitudes as necessarily being a failing of hers, but of the institutions - church and hospitals - that caused such attitudes to become ingrained in her psyche. We, humanity, should learn that such attitudes were mistakes, and take steps to ensure they will never cause harm again.

Until that happens, we should be aware of the possibility that they might arise, and take steps to ensure they do as little damage as possible - in the NHS, and elsewhere.