The Catholic Bishops’ General Election advice called on Catholics to support a “robust National Health Service on which we can all rely”. This is something of an about-turn. When the NHS was formed, the then Catholic Archbishop of Westminster, Cardinal Bernard Griffin, fought for and obtained exemptions from nationalisation for the small number of Catholic hospitals. He argued that it would be a ‘sad day for England when charity becomes the affair of the state’. The number of Catholic hospitals remains tiny and any significant expansion is currently out of the question.

Nigel Lawson once described the NHS as the nearest thing we have to a national religion; and it seems to have become an item of faith in the English and Welsh ‘branch’ of the universal Church. But, before joining the adulation, it is worth just pausing for a moment and considering that no Catholic country has adopted a model where only the state both finances and provides healthcare. Indeed, not only have no Catholic countries copied the British model, only Canada and Iceland in the whole developed world have done so.

Catholic social teaching is pretty clear that all should have healthcare as one of the basic goods necessary for a dignified living. Vatican II document, Gaudium et spes, stated: “The demands of the common good…are strictly connected to respect for and the integral promotion of the person and his fundamental rights [These include] the provision of essential services to all, some of which are at the same time human rights: food, housing, work, education and access to culture, transportation, basic health care…”. But, how healthcare is provided and financed should be a matter of prudent judgement and we should consider the other principles of Catholic social teaching in thinking about this matter.

In general, the Church has maintained that the promotion of the common good requires a large degree of economic freedom and that families have the right to plan their own economy. This should be underpinned by a strong ethical culture in which families choose what is good. Civil society, Church institutions and many other organisations within society can aid the family in this regard, especially in the provision of complex services such as healthcare or education.

The role of the state is to ensure provision of essential goods where, for some reason, they are not otherwise provided and to help and support families and other institutions rather than displace their role. The Church has articulated this vision very clearly in the field of education. Parental rights, and the rights of the Church and civil society to educate children are upheld very strongly. It has to be said that there is less discussion of these issues in the case of healthcare, but this area is no less important.

In the UK, we are not used to the idea that the provision of healthcare can involve choices. As my father used to say to me as a child at meal times, “you get what you’re given”. But there are very real choices that can be made. We spend 10 per cent of national income on healthcare and this is not just a case of procuring a fixed set of services that cannot be varied. For example, choices can, in principle, be made, between large, specialised hospitals that might provide better treatment at the technical level and small, local hospitals that might provide a more caring and intimate atmosphere. We can choose between invasive treatments to add a few months to life expectation and better care for the dying. The list of trade-offs is never ending. It might be tempting to think we can have the best of everything, but we can’t. In the NHS, these choices are made at the political level. In most countries, at least to some extent, they are made by families when choosing how they are going to be insured.

More profoundly, there are important moral choices involved in the provision of healthcare. We may prefer that abortion is banned by law, but, if it is legal, we surely should be able to choose a healthcare provider which applies Christian virtues and values to care at the beginning and end of life and in relation to so-called sexual and reproductive services. This is possible, but not in the UK. In Germany, for example, many hospitals are owned by religious groups.

Most continental countries have social insurance systems through which families can choose between insurers that use different models of health provision and the state’s role is supportive and to help pay the premiums for the less-well-off.

Of course, the assumption is that, if we did not have the NHS, we would not have healthcare. Visions of a distorted version of outcomes in the US are conjured up where – it is alleged – people are left untreated on the streets. This is a straw man. Nobody, on either side of the debate, wishes to move to a US-style system. There are, though, plenty of healthcare systems around the world which provide families with greater autonomy whilst ensuring that healthcare is available for all. All EU countries, with the exception of Belgium and Luxembourg have close to 100 per cent healthcare coverage but do not have a system like the NHS. These systems also tend to have much better outcomes, and the suggestion that this is due to higher levels of spending is not generally true. We do die younger because of the NHS.

It is probably the case that British Christians cling on to the NHS on the ground that it promotes equality. There are certainly more important values in Catholic social teaching than equal outcomes but, even here, the NHS has no great story to tell. There tends to be equality of opportunity to access healthcare services – and that is why the NHS tends to do well in the much-quoted Commonwealth Fund study. However, the NHS is only about average when it comes to equality of out-turn as measured by life expectancy across different income groups and so on. On the other hand, the decentralised social insurance systems of Germany, Holland and Switzerland are three of the best in the developed world.

In Centesimus annus, Pope Saint John Paul II talked about how the state had taken over the functions of society, especially in the case of welfare. One hundred years earlier, Pope Leo XIII had talked about the importance of societies of mutual aid that were developing in the industrialised world and how the state should not interfere with them. They were right.

Our Bishops would also have been right to argue that access to healthcare for all should be an election issue. But, there are many ways in which this can be achieved, and the preservation of the NHS itself is not a defining issue for Catholics. Civil society, the Church, mutual societies and other forms of non-state organisations could play a key role in the provision of healthcare. This would enable all families to have more freedom about this sensitive and intimate issue, and also allow Catholics to make choices that were in accordance with their consciences.

This article was first published in the Catholic Universe.