Article
Care
Comment
Economics
Ethics
4 min read

NHS: How far do we go to feed the sacred system?

Balancing safeguards and economic expediencies after the assisted dying vote.

Callum is a pastor, based on a barge, in London's Docklands.

A patient eye view of six surgeons looking down.
National Cancer Institute via Unsplash.

“Die cheaply, protect the NHS” It sounds extreme, but it could become an unspoken policy. With MPs voting on 29th November to advance the assisted dying bill, Britain stands at a crossroads. Framed as a compassionate choice for the terminally ill, the bill raises profound ethical, societal, and economic concerns. In a nation where the NHS holds near-sacred status, this legislation risks leading us to a grim reality: lives sacrificed to sustain an overstretched healthcare system. 

The passage of this legislation demands vigilance. To avoid human lives being sacrificed at the altar of an insatiable healthcare system, we must confront the potential dangers of assisted dying becoming an economic expedient cloaked in compassion. 

The NHS has been part of British identity since its founding, offering universal care, free at the point of use. To be clear, this is a good thing—extraordinary levels of medical care are accessible to all, regardless of income. When my wife needed medical intervention while in labour, the NHS ensured we were not left with an unpayable bill. 

Yet the NHS is more than a healthcare system; it has become a cultural icon. During the COVID-19 pandemic, it was elevated to near-religious status with weekly clapping, rainbow posters, and public declarations of loyalty. To criticise or call for reform often invites accusations of cruelty or inhumanity. A 2020 Ipsos MORI poll found that 74 per cent of Britons cited the NHS as a source of pride, more than any other institution. 

However, the NHS’s demands continue to grow: waiting lists stretch ever longer, staff are overworked and underpaid, and funding is perpetually under strain. Like any idol, it demands sacrifices to sustain its appetite. In this context, the introduction of assisted dying legislation raises troubling questions about how far society might go to feed this sacred system. 

Supporters of the Assisted Dying Bill argue that it will remain limited to exceptional cases, governed by strict safeguards. However, international evidence suggests otherwise. 

In Belgium, the number of euthanasia cases rose by 267 per cent in less than a decade, with 2,656 cases in 2019 compared to 954 in 2010. Increasingly, these cases involve patients with psychiatric disorders or non-terminal illnesses. Canada has seen similar trends since legalising medical assistance in dying (MAiD) in 2016. By 2021, over 10,000 people had opted for MAiD, with eligibility expanding to include individuals with disabilities, mental health conditions, and even financial hardships. 

The argument for safeguards is hardly reassuring, history shows they are often eroded over time. In Belgium and Canada, assisted dying has evolved from a last resort for the terminally ill to an option offered to the vulnerable and struggling. This raises an urgent question: how do we ensure Britain doesn’t follow this trajectory? 

The NHS is under immense strain. With limited resources and growing demand, the temptation to frame assisted dying as an economic solution is real. While supporters present the legislation as compassionate, the potential for financial incentives to influence its application cannot be ignored. 

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation.

Consider a scenario: you are diagnosed with a complex, long-term, ultimately terminal illness. Option one involves intricate surgery, a lengthy hospital stay, and gruelling physiotherapy. The risks are high, the recovery tough, life not significantly lengthened, and the costs significant. Opting for this could be perceived as selfish—haven’t you heard how overstretched the NHS is? Don’t you care about real emergencies? Option two offers a "dignified" exit: assisted dying. It spares NHS resources and relieves your family of the burden of prolonged care. What starts as a choice may soon feel like an obligation for the vulnerable, elderly, or disabled—those who might already feel they are a financial or emotional burden. 

This economic argument is unspoken but undeniable. When a system is stretched to breaking point, compassion risks becoming a convenient cloak for expedience. 

The Assisted Dying Bill marks a critical moment for Britain. If passed into law, as now seems inevitable, it could redefine not only how we view healthcare but how we value life itself. To prevent this legislation from becoming a slippery slope, we must remain vigilant against the erosion of safeguards and the pressure of economic incentives. 

At the same time, we must reassess our relationship with the NHS. It must no longer occupy a place of unquestioning reverence. Instead, we should view it with a balance of admiration and accountability. Reforming the NHS isn’t about dismantling it but ensuring it serves its true purpose: to protect life, not demand it. 

Healthcare systems exist to uphold human dignity, not reduce life to an economic equation. If we continue to treat the NHS as sacred, the costs—moral, spiritual, and human—will become unbearable. 

This moment requires courage: the courage to confront economic realities without compromising our moral foundations. As a society, we must advocate for policies that prioritise care, defend the vulnerable, and resist the reduction of life to an equation. Sacrifices will always be necessary in a healthcare system, but they must be sacrifices of commitment to care, not lives surrendered to convenience. 

The path forward demands thoughtful reform and a collective reimagining of our values. If we value dignity and compassion, we must ensure that they remain more than rhetoric—they must be the principles that guide our every decision. 

Explainer
Change
Community
Migration
Politics
9 min read

The facts and our feelings both puncture the small boats-fuelled immigration argument

From stats to sociology, how to be better informed on the issue

Roger is a Baptist minister, author and Senior Research Fellow at Spurgeon’s College in London. 

A people sumggler steers an overcrowded small boat.
A people smuggler steers a small boat, 2021.
x.com/ukhomeoffice.

Late in the evening of May 20, over 80 refugees clambered aboard the small boat that was to bring them to England. They had not gone far when French rescue services were summoned with the boat still located off the Pas de Calais. An eight-year-old boy and a 40-year-old woman were pronounced dead by the medical team and taken to Calais. Both were believed to be Turkish nationals, with their deaths presumed to have been caused by a combination of crushing and suffocation. The small boat continued its journey without them, though 10 others were also evacuated. 

This story is deeply shocking.  

What is also profoundly disturbing is that, while we may not be aware of the details of this particular case, the story is still familiar to us. According to the University of Oxford’s Migration Observatory there were 73 deaths crossing the Channel in 2024. 

It was almost 30 years ago, in the wake of the UK’s 1996 Immigration & Nationality act that I first became aware of the issues surrounding refugees and asylum seekers. Our church in Croydon was only a short walk from the Home Office’s Immigration and Nationality Directorate based at Lunar House, and it seemed to make sense to begin a drop-in centre. The Croydon Refugee Day Centre has continued its work ever since. 

From the beginning it was hard to miss the fact that asylum was a hot-button issue. The reactions it triggered were intense. I also quickly discovered that nothing was straight-forward. Weaponised politics, the labyrinthine complexity and glacial slowness of our state bureaucracy along with the internecine nature of the charitable sector made collaborating with others frustrating and problematic to say the least. 

Over the years I’ve learned two important lessons with regard to immigration and asylum. First, what grabs the headlines is not necessarily the most important issue. Indeed, it can deflect attention, action and resources from what is of primary significance. Then, second, complex issues are rarely solved by simple, straight-forward, 'silver bullet’ solutions. As the American satirist H. L. Mencken observed: 

“Every complex problem has a solution which is simple, direct, plausible—and wrong.” 

So, with the issue unlikely to go away in the foreseeable future, these are some of the things I believe we need to understand and have an eye to. 

Immigration: don’t get confused 

When the Office for National Statistics reported in May that the total of long-term immigrants to the UK in 2024 was 948,000, that really does seem like a very big number. And it is. But it includes everyone coming to the UK who is changing the normal place where they live. It includes those who’ve come to study here (30 per cent) and those who’ve got a UK-based job (33 per cent).  

The foreign students on full fees raise vital revenue for the universities and subsidise the fees for home students, and those coming to work here make a significant contribution to the economy. Not to mention the legacy of ‘soft’ influence when both return home having had positive experiences of life in the UK. 

Incidentally, and a little out of left field, the immigration figure also includes Brits returning home from living abroad. In 2024 they accounted for 60,000 individuals, or 6.3 per cent of the total. 

Asylum seekers and refugees only make up 15 per cent of the overall number (including the Homes for Ukraine scheme), with those claiming asylum from the small boats only 5 per cent. 

The small boats: don’t get distracted 

Perhaps the main reason for the small boats featuring so prominently in the immigration narrative is the compelling nature of the images the news media can use. Include criminal gangs and the jeopardy of life and death and the result is a heady mix. 

But here’s the thing, the Migration Observatory report that: 

“Between 2018 and 2024, the asylum grant rate for people who arrived by small boat was 68%.” 

Allow that to sink in for a moment: almost seven out of ten of those who arrive by small boat have a legitimate reason to seek asylum in the UK. The real villains here are the criminal gangs, not the passengers they transport. 

Things could look very different if there were safe pathways for these asylum seekers to follow. On these figures the bottom would be blown out of the business model of the criminal gangs that operate the small boats, and they would swiftly move on. Especially if accompanied with the speedy removal of those who have no right to remain in the UK. This would act as a significant disincentive to those who would have previously made an unsuccessful attempt. 

This has to be the way to tackle the presenting problem of the small boats, especially when the ‘push and pull’ influences are given proper consideration.  

‘Push’ and ‘pull’: don’t be misled 

‘Push’ issues are those that cause the migrants to leave their home. Iran, Iraq and Afghanistan have consistently been the most common sources for asylum seekers over the last 30 years. and this tells its own story. Together they underscore that the key ‘push’ factor is people seeking to escape persecution, conflict or danger. 

‘Pull’ influences are why a particular country is the preferred destination. Extensive research has established in the case of the UK the ability to speak English, the presence of family already here and the “general impression that the UK is a good place to live" are far and away the strongest influences. Disproving the popularly advocated myth that it is about the black economy or sponging off the benefits system.  

The right to work: don’t be fooled 

The total cost of the asylum system in the UK was an eye-watering £5.4b in 2023-24, a figure that is largely driven by a backlog in processing applications. On average this took 413 days in 2023-24 with the year-end backlog standing at 91,000. For the 38,000 of those awaiting a response in hotel accommodation, this comes at a cost of £41,000 per person, per year.  

Thankfully the number awaiting a decision is decreasing, but because asylum seekers are not allowed to work until they’ve been waiting for over a year, they cannot contribute to their own support. In France they are allowed to work after six months and in Italy after only 60 days. 

It is, perhaps, a sobering thought that those who have shown the initiative, resilience and tenacity to attempt a passage to a new life, not even deterred by the threat of death, might be the kind of asset to the country and its economy that we need. 

The world we live in: don’t close your eyes 

We cannot uninvent the fact that we live in a globalised world. The preponderance of international supply chains and the fact that 54 per cent of Brits travel abroad on holiday only underlines how ingrained it is in our everyday lives. We are all interconnected to a degree that we cannot possibly comprehend.According to the World Health Organisation, the origin of COVID-19 in Wuhan, China in December 2019 led to between 8-9 million deaths worldwide; the container ship Ever Given, stuck in the Suez Canal in March 2021 cost the global economy $9.6 billion per day; and the Russian invasion of Ukraine in 2022 had a catastrophic effect on grain and fertilizer prices in sub-Saharan Africa. 

All that to one side, migration to these shores has been part and parcel of our history since before we had a history. From the Romans, Anglo-Saxons, Vikings and Normans, to more recent arrivals from the Caribbean, South Asia, Poland and Hong Kong this is an integral and ongoing part of the story of the British Isles. It is what has made us British. 

The politics of migration: don’t be seduced 

In these febrile political times, many will be quick to jump on the bandwagon of blaming the immigrants for everything that is wrong. The narrative is a seductive one that makes a visceral connection with listeners. Where the substance of argument is missing emotive language will do the heavy lifting on its own, so look out for speech like this: 

  • Crisis or emergency language: out-of-control, unprecedented, overwhelmed 
  • Metaphors of flooding or invasion: tidal, swamped, relentless 
  • Threatening or dangerous terms: illegal, criminal, extremist 
  • Dehumanising or reductive language: waves, swarms, hordes 
  • Economic or social burden framing: unsustainable, overstretched (services), job-stealing 
  • Warnings of loss: losing our culture and traditions, no-go areas 

It’s the sociologist Zygmunt Bauman, commenting on life in the city, who coined the terms ‘mixophobia’ and ‘mixophilia’ to describe some of the dynamics he observed. But I think they can extend to the whole of society, not just our cities. Indeed, with Bauman I think we can even experience both feelings within ourselves at the same. We experience the fear of ‘mixophobia’ – of being involved with strangers – in our  

“… reaction to the mind-boggling, spine-chilling and nerve-breaking variety of human types and lifestyles that [we] meet and rub elbows and shoulders [with] in the streets” 

“Mixophilia”, by contrast, is the joy of being in a different and stimulating environment. 

“The same kaleidoscope-like twinkle and glimmer of the urban scenery, … never short of novelty and surprise, [that] constitutes its difficult-to-resist charm and seductive power.” 

Born a Polish Jew in 1925, Bauman’s family fled to Russia in 1939. As Professor of Sociology at the University of Leeds t He maintained that the holocaust was not the breakdown of modern civilisation, but rather the product of it. 

Twenty years ago, he predicted that Europe would be faced with a battle between “two contending facts of the matter”. On one side would be the life-saving role played by immigrants in a fast-aging Europe. On the other, “the power-abetted and power-assisted rise in xenophobic sentiments eagerly recycled into electoral votes”. 

For Bauman “mixophobic paranoia” feeds upon itself and acts as a self-fulfilling prophecy. It may temporarily reduce the pain that those afflicted by it feel, but ultimately only makes the condition worse. Rather, “mixophobia” is the symptom of their anxiety, not the cause – acting on it is like “removing the rash while mistaking it for the cure of the illness”. 

If there is to be any hope for him, it is in the cohabitation and interaction with strangers that the future lies. 

So, there it is. As shocking and disturbing as the stories and images of the small boats are, it is not really about the small boats. Sitting beneath the phenomena is the age-old issue of migration, with the sharp and divisive edges of its present-day expression. 

In the late 1990s I was proud of the churches in Croydon rallying together to establish the Refugee Day Centre. In the years that followed it was often groups of churches who took the lead in their own towns and cities as asylum seekers were dispersed around the country. 

It was a practical way to “love our neighbour as ourselves”. In the rallying cry of the Victorian Christian social reformers, “The Fatherhood of God means the brotherhood of man.” 

As the historian Tom Holland has observed it is because Western values are deeply rooted in the Christian tradition that human dignity and the sanctity of life are deeply prized virtues that animate our best intentions and our understanding of what is good. 

In his mid-80s, Bauman wrote: 

“For more than forty years of my life in Leeds I have watched from my window as children returned home from the nearby secondary school. Children seldom walk alone; they prefer walking in groups of friends. That habit has not changed. And yet what I see from my window has changed over the years. Forty years ago, almost every group was ‘single colour’; nowadays, almost none of them are …”