The British Medical Journal is not one of my regular online haunts, admittedly, but I couldn’t resist looking in after spotting this article on the Beeb’s website.

The NHS should provide more faith-based care for Muslims, an expert says.

Muslims are about twice as likely to report poor health and disability than the general population, says Edinburgh University’s Professor Aziz Sheikh.

To give the BMJ its due, it has framed this question as a debate and is promoting articles that argue both for and against this particular proposition, which I’ll get to in a moment, but even without reading both sides of the argument, I can quite easily provide an answer to their question.

Should Muslims have ‘faith-based’ health services? NO.

The NHS has no business providing ‘faith-based’ services at all. What it can, and should, provide are services that make reasonable accommodations of individual’s personal beliefs, where these may have some bearing on their ability to access and make best use of the services that the NHS provides.

I suppose I could be accused of being a tad pedantic here, but I think distinction made above is a particuarly important one.

To call something a ‘faith-based’ service implies a measure of exclusivity and special treatment that is expressly merited by the mere possession of a particular religious belief, irrespective of whether there is a rational justification for providing whatever it might be that distinguishes a ‘faith-based’ service from the same service that is provided for everyone else.

To make a reasonable effort to accommodate the beliefs of particular individual when they access health services so as not to place artificial and unnecessary barriers in the way of their being able to receive the care they require is nothing more than common sense.

As a matter of basic principle, it is the job of health care professional to treat their patient’s clinical needs, not their religious beliefs (unless they’re accessing psychiatric services) and that emphasis needs to be retained in order to ensure that the provision of healthcare, generally, is determined by the right set of priorities. That doesn’t mean to say that NHS should not make reasonable accommodations for certain religious beliefs and practices in situations where to do otherwise would limit the ability of clinicians to deliver an appropriate standard of care, but in terms of hierarchy of priorities, patient care comes first every time and the NHS should avoid doing anything that gives even the appearance of their having compromised on that principle.

Prof. Aziz Sheikh, who writes in favour of ‘faith-based’ services, helpfully provides a ‘shopping list’ of the kinds of services he considers should be provided under this particular banner; one that nicely illustrates the distinction I am making here.

Some of what he suggests is, to my mind, relatively uncontroversial and falls squarely into the category of reasonable accommodations.

For example, he notes that some Muslims may prefer to see a only doctors of the same gender as themselves out of a wish to comply with the Islamic requirement for modesty.

That’s not a particularly unreasonable request in general terms, give or take the availabilty of suitable doctor – it may not always be possible for a hospital to accomodate such a request in some clinical areas, if a female patient needs to see a consultant and the hospital only has male consultants in that particular specialism then unless the patient is happy to be referred to an alternative hospital (which should not, in theory, be a problem under the policy of patient choice) them may have make a compromise on their principles in order to get the care they need.

The one qualification I would make to that view is that I’m not certain of what the actual position of Islam is in relation to modesty in the context of medical care. Do the usual strictures apply in such situations or it the receipt of medical care a situation in which the interpretation of modesty is afforded a little more flexibility. The decision as to whether such an accommodation is reasonably seems to me to depend on the scholarly view of this issue within Islam and, equally, whether that view is being adequately communicated to the faithful in the teachings given in Mosques – its a bit of two-way street as far I can tell in which the NHS and Islam need to inform each other in to arrive at an appropriate outcome for individuals.

Access to adequate prayer and ablution facilities, likewise, seems another matter on which a reasonable accommodation can be reached. Few hospitals, especially in urban areas, are likely to be without Muslim staff, let alone Muslim patients, so its reasonable to consider how the NHS might provide facilities that meet their needs. Access to Muslim ‘chaplains’, which another suggestion in the article, seems another relatively uncontroversial request – okay, so I don’t see that its the responsibilty of the NHS to pay for such services, but then I take the same view of the NHS paying for Christian chaplaincy services as well – but an arrangement with local Mosques to have an Imam ‘on call’ when needed is not an unreasonable thing to be asking for.

Prof Sheikh also notes that adequate information on the content of drugs (i.e. whether they are derived from pigs or alcohol) and whether suitable alternatives are available would be very helpful – nothing unreasonable there at all, in my view – nor is his request for better information for Muslim patients who self-modify their treatment regimes during Ramadan or take part in Hajj, on the relative health-risks that may arise and how to manage them safely. As far as I’m concerned, sound advice and a well-informed patient is a good thing.

Coroner’s services are also raised, as these can cause delays in bodies being releasesd for burial, which is flagged up a training issue, which is fair enough again, within reason – legal processes and requirement do have to be properly observed as well. Prof. Sheikh’s call for this to be backed up with reform is one I’m a touch more uncertain about, if only as I’m not quite sure what reforms he’s looking for – if things can be speeded up without compromising the need to ensure that the cause of death is adequately investigated and established, when necessary, then fair enough. There is a balance to be struck on this issue, but as long as reforms ensure the right balance is arrived at then, again, no particular controversy or problems should result.

None of the suggestions above, however, merit the epithet of ‘faith-based’ services – some (prayer facilties) are not healthcare services at all but ancilliary services provided alongside healthcare is certain settings, others are merely reasonable adjustments that can be made to ‘standard’ services as an when the need arises and in many cases are not even unique to Islam. Religious Jews, for example, have as much interest in knowing whether certain drugs are derives from pigs as Muslims do, and anyone who travels overseas should be given appropriate advice on any medical factors that should be taken into account in preparing for their trip, whether they’re going on the Hajj, visiting relatives in Mumbai or taking a holiday in the Gambia.

To my mind, to call any of these things an actual ‘faith-based’ service is a complete misnomer, they are no more than minor variations and accommodations in service provision that take into account individual beliefs.

Where I would draw the line is in relation to what might, from the context of his arguments, be called Prof Sheikh’s ‘headline’ request; that the NHS should provide male infant circumcision services as standard, so that Muslims do not have to resort to using “the poorly regulated private sector”.

My response to that is, categorically, no. The NHS should not provide any such service at all, not if the surgery in question is entirely elective and not predicated on a clinical need.

If, as Prof. Shiekh suggest, the private sector is, indeed, poorly regulated and this is causing a genuine clinical problem, then some action needs to be taken – but that action should be in the form of a review and, if merited, strengthening of current regulation and licencing of private medical practice and not the provision of free elective circumcision at the taxpayers expense. As I stated clearly at the outset, the NHS is there to service the clinical needs of its patients, not their religious beliefs.

To be entirely fair, if a particular NHS or Primary Care Trust has the capacity to provide such a service as private (i.e. paid for) service within NHS facilities and without impacting negatively or unduly on its provision of clinical services, then I’m fine with that. It’s better that spare capacity is used than be left idle and there’s no doubt that NHS trusts would welcome a bit of additional income.

Now I know some on the left are, by nature, a little squeamish about suggestions that the NHS should be involved in the delivery of private medical services and consider such things to be outside the guiding principles upon which it was founded – and generally speaking I’d be inclined to agree with them. But in this particular case I refer to the guiding principle, that healthcare should be provided free of change at the point of need, which I take to mean clinical need, and I ask myself, is there a clinical need for universal access to male circumcision on the NHS. And the answer I come to is no.

If circumcision is necessary for clinical reasons then, of course, it should be provided and it should be provided free of charge. If it elective and ‘required’ only to meet a religious precept then it does not come within the guiding principle of the NHS and I see no reason why the NHS should not charge for providing such a service, provided that its it within its capacity to do so without impacting on the provision of clinical services, which must be given priority.

Male circumcision is the only medical service that Prof Sheikh proposes that can genuinely be said to be ‘faith-based’ because its sole raison d’etre is to be found in religious belief and not clinical need – that’s the distinction that needs to be made and the reason why the NHS should not be providing ‘faith-based’ medical services.