Florence Nightingale was not an angel, you'll be happy to know. She was a formidably tough, principled and obstinate woman, whose main goal was to create a climate in medical care that was properly professional. And for her, proper professionalism was whatever served not only the physical health but the dignity of those being cared for. She saw the unspeakable conditions of the military hospitals of the Crimea and rebelled not simply against the waste of life but against the offence to life represented by the squalor and filth of contemporary practice. You could say that the modern profession of nursing was born out of a passion for human dignity - not just the sense of a practical job to be done, but a serious conviction that what is due to people in situations where they are helpless and even dying is time, respect and patience, no less than practical skill.

For Florence Nightingale, this was a straightforward matter of religious conviction, just as much as it was for that more recent figure, Mother Teresa. Both took it for granted that the level of human respect given to any patient is the same whether they are rich or poor, young or old, likely or unlikely to recover; because they stand on the same ground before their creator. And the nursing profession exists in the way it has done these last hundred and fifty years or so because this assumption has remained constant. Sickness and helplessness are not only matters of bodily incapacity. As so many writers have reminded us - and indeed as we mostly know for ourselves by experience - sickness or injury or disability is also about our pictures of ourselves. We are damaged or deprived in respect of what we think and imagine about who we are. The self is what is ill or hurt or restricted, not simply a set of bodily functions and processes. Healing is therefore about sustaining and restoring that vulnerable sense of who we are. It is about the service of human dignity. When our New Testament lesson associates forgiveness with healing, it's not saying that sickness results from sin, but that the restoration of the whole self, body and spirit, is a proper dimension of caring for the sick or injured.

Quite a lot in our current environment threatens to take our eyes off that particular ball; and I want to look briefly at some of the elements that we need to keep an eye on if we are to be faithful to the inheritance we celebrate today.

The first thing is perhaps one of the most difficult areas you have to face at the moment, and it is particularly on our minds in these next few days. We are once again dealing with proposals to legislate for assisted dying in our medical system. And it is significant that the word 'dignity' has been adopted as the name of a pressure group seeking to change the law on this matter. There is a powerful argument that to deny to suffering people the freedom to end an unbearable existence at the moment of their choice is a refusal of just that dignity which Florence Nightingale cared about so passionately. And if you have ever lived close to someone declining slowly towards death in circumstances of pain or humiliation, you will feel the strength of the argument.

Yet it has been observed that in the health care professions, the closer you come to actually having to bring this about, the deeper the opposition. GPs or consultants may manage a substantial proportion in favour, nurses in general are far less convinced, and palliative care workers are overwhelmingly against. There will be wide difference of opinion, I guess, on the abstract principle in a group like this. But there will also be a keen personal awareness that once we let go of the principle that everyone deserves care and respect, we are in uncharted territory. And if there is ever what looks like a short cut in dealing with the terminally ill or even the outstandingly inconvenient, resource-intensive, patient we have to face the possibility of any number of subtle pressures that may be at work in favour of assisted dying, however little the proponents of this may want it or approve of it. These are pressures upon the patient - but they are also pressures on the carers, the front-line agents of support. Those pressures will be all the stronger in a climate dominated by economic stringency.

And this is the second point that calls for sharp awareness just at the moment. A target-obsessed NHS, managed with an eye to brisk traffic through its beds and reduction of expense, doesn't feel a very good place in which to have a reasoned and balanced discussion of assisted dying. But this is only one aspect of a widespread concern. NHS Trusts vary enormously; but there are enough whose style of management seems driven by short-term economics to give real concern. Anecdotes abound of senior and responsible people in hospitals being given ridiculously short notice of economies to be achieved. Appeal to the overall numbers employed in the NHS doesn't deal adequately with the fact of plain local insecurity in this or that particular institution. And we have to ask whether the increased budgetary role of local medical practices in the running of hospitals will do anything to halt this or whether it will accelerate the most worrying trends.

There are complex questions there, but there is also a very general point. If management itself can fail to deliver respect to carers through these structures and practices that breed insecurity, it is harder to sustain a culture of radical respect in the whole system. If nurses and other staff are not treated with dignity, what help do they have in treating patients with dignity? One of the great Christian mystics said, 'Where there is no love, put love and you will find love'. We could easily adapt the point and say, 'Where no-one puts respect, where will you find respect?' The problems which now face nurses as a profession- problems acutely in the public eye in recent weeks- are not about the successes or failures of particular politicians, but about a culture that has grown up in the NHS over recent decades, in which accountability and accountancy have become seriously confused, and false and destructive models of what counts as meeting targets have distorted a good deal of our practice.

Which leads me to a final set of concerns. Since the 1980's especially, many of our institutions, schools, universities, hospitals, charities, have been told that their earlier definitions of what good professional practice looks like need to be changed, and changed in a particular direction in which models of consumer power and market methods prevail. Some of the change has been good for us, in challenging bland assumptions that someone else is always going to take responsibility for money management; but a lot has not been at all good for us. Specifically in the health care professions, a growing number of people now say that the simply personal and relational skills of healing are squeezed out in training and seriously undervalued in favour of mechanistic skills. And for nurses especially, this is a huge and damaging shift away from that fundamental commitment to the service of human dignity with which we began. This is not at all to suggest that nursing training now is universally dominated by what I called the mechanistic. We all know of first class practice, balanced professionalism, in more than one training context. But the question which preoccupies many is how the climate of medical care as a whole now values those properly professional elements of personal growth and attentiveness to individuals. Are we in danger of creating a culture of health care in which there is no recognition of the professional importance of the personal? Are we at risk of undervaluing just the distinctive skills and practices that first created and shaped your profession and that are so significant in the calling that drew you to this work?

Of course, we are overcompensating for long years in which it might have seemed that nurses existed primarily to provide basic personal care in the shadow of the 'real' scientific professionals - simply to be 'angels', with a minimal equipment in practical skills. That era has gone and is better dead, and the seriousness of training and the more developed career structures of modern nursing are welcome. Yet a professionalism that does not include the skills of serving human dignity is no professionalism at all. To sacrifice this element in the name of a superficial - it's tempting to say 'macho' - myth of what 'professional' means is to buy into some of the most depressing features of the modern health care world, and to challenge that radical conviction at the centre of it all, that health care is the care of persons, not biological systems alone.

Again and again it seems that the real task for health care in these days is not just to fight the constant battle for proper resourcing, but to hold on to the belief that what needs to be resourced is a system that has to be kept human - that is, a system that puts resources at the service of dignity as an intrinsic and vital aspect of health. It must be a system that treats its own professionals with dignity and doesn't assume that the only professional skills worth developing are the material ones, or that the only goals that matter are the economic ones. Florence Nightingale certainly believed that she was professionally accountable for what she did; accountable to the God whose respect for the dignity of the humans he had made was eternal and inflexible. Whether we share her religious faith in all its fullness or not, we need just that sense of real responsibility to something beyond all negotiation. Our Old Testament lesson today reminded us of how that 'something' has been understood by believers: it is the divine wisdom, which gives us the insight to respond to what lies below the surface of things- and of people - which gives us awareness of the mysteriousness of what's in front of us. And this sense of mysteriousness is a necessary element in any system that tries to express the kind of basic respect we've been thinking about.

When we have a system of health care, especially a national system, that does express this, our work in health care becomes not just a matter of containing suffering and solving physical problems but a powerful witness to the whole of our society about what it needs to believe in for its corporate and social health. And Florence Nightingale would certainly, in a decorous Victorian way, of course, have stood and cheered for that.

© Rowan Williams 2006