The fact that the NHS featured as such a central part of the London 2012 Olympic Games should tell us all how much we love the NHS. Over the past two years, it seems to me that the currency attributable to loving the NHS has become increasingly important in British health politics. At times, particularly when opposing views have been most polarised, it has felt as though how much you love the NHS has become the discriminating factor.
At one level, the NHS it is an estate of buildings, a menu of services and a collaborative of people. But in order to understand its very essence, it seems appropriate to turn to the NHS Constitution.
The NHS belongs to the people.
It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.
So if this is what we love, then what does it mean to love the NHS?
A search of the internet reveals a breadth of perspective with proposals for between three and ten different types of love. Top of the search engine list was Wikipedia’s description of C.S. Lewis’s book The Four Loves. This book explores four types of love that exist, based on the four Greek words for love. So, rather than looking at how much we love the NHS, I wonder whether considering how we love it might shed some more light on this very British love affair?
The first type of love is affection. Traditionally, familiarity breeds contempt, but in love, it breeds fondness. This allows us to love the NHS, despite its imperfections, because we have grown up with it. After all, nothing is perfect and by international comparisons, the NHS is a high performing health system. Yet affection demands love, irrespective of the consequences of just those same imperfections. While this perhaps protects us from losing all that we value about the NHS, is there a danger that it can blind us to poor quality, unresponsiveness and waste?
The second type of love is friendship. In this context, love for the NHS is based on the strong bond we have with it. We share the most joyous and painful moments of our lives with the NHS. It brings comfort in times of distress. Friendship is a plural type of love, and additional friends add value in most situations. Having more than one friend supports wellbeing even when we have a best friend. After all, don’t individuals find value outside of the NHS in healthy lifestyles, self-management, over-the-counter remedies, complementary therapies and private medicine?
The third type of love is romance. This centres around our need for deep emotional connection. The uncertainty of ill health often results in fear and anxiety. At such times, our emotional attachment to the perceived certainty provided by the NHS can act as a powerful healer. What makes us feel good must surely be good for us. When we are aware that the NHS has let us down, it can result in a deep emotional pain. Romance can be so powerful that even in the presence of evidence that a particular intervention is not good for us, we have an even greater fear of the insecurity that change intended for the good can bring. At its most extreme, might this result in the NHS equivalent to Romeo and Juliet’s unhappy ending, where we lose everything we love?
The fourth type of love is unconditional love, or charity. It is a love that puts the needs of others above the needs of self. It is not blind to imperfection, but acknowledges it and still loves. It gives of itself in an attempt to help others improve. Applied to the NHS, it rises above the interest of self, profession and organisation. Yet it could also be a tough love if applied to health inequality. Might unconditional love put populations of people ahead of individual patients in its pursuit of better and more equitable outcomes?
The British love affair with our NHS brings strength and weakness. As with all strengths, we should seek to build on them and with all weaknesses, seek to strengthen them. As we continue in our efforts to improve the NHS together, how can we ensure that our love for it neither blinds us to the change required, nor renders others blind and stifles debate? But instead, that it results in us securing all that we value in creating an NHS that truly belongs to the people for generations to come?