The NHS and the true meaning of compassion

NHS Leadership
Published on Friday, 08 February 2013 14:21
Written by Professor Paul Crawford

Let's compare two statements and see which we think might be nearer the truth in describing the state of present-day healthcare...

 1. "The patient always comes first."

2. "It's a nice way of getting rid of the patient. You scribble something out and rip the thing off the pad. The ripping off is really the 'f*** off'."

The first, of course, is an enduring mantra of healthcare throughout the developed world. The second is a quote from an NHS doctor, interviewed for a 2003 academic study, explaining how prescriptions can serve as a convenient "closure device" – to put it politely – when dealing with patients.

It might be argued that one represents the ideal and one the reality. The Francis Report into the scandalous treatment of patients by Mid-Staffordshire NHS Trust underlines in the starkest possible terms how the two have grown ever more diametrically opposed.

After all, although it continues to appear in numerous policy documents, analyses, reviews and forecasts, the first statement is now routinely employed as little more than a predictable rider to a new set of targets or metrics. It represents an increasingly hollow reassertion of a faded paradigm.

The second is much more in keeping with a healthcare sphere in which a production-line mentality and a procedure-centred approach have seen the language of compassion surrender to the language of threat and the basic notion of humanity reduced to the realm of occasional afterthought. No time to talk. No time to think. No time to feel.

There is clearly a need for a more inclusive, outward-facing philosophy – one that goes beyond the purely medical, fosters a shift from narrow explanations to nuanced understanding and moves away from the ethos of the car factory by affirming that healthcare practice, like the performance of a musician, can be a richer experience for all concerned if there is room for improvisation and originality.

In short, there is a need – an increasingly urgent one – to restore humanity to healthcare.

This brings us to the vexed question of "compassion", a word that in recent years has been championed as utterly central to the nursing profession but, curiously and tellingly, little else in the NHS.

Traditionally, the near-automatic response to the issue of compassion depletion – acting with coldness, cruelty or disinterest to the suffering of others – has been that the fault must lie entirely with the nurse rather than with the target-driven, box-ticking surroundings in which many health systems often demand their practitioners work.

Of course, it is all too easy to attribute the problem to a single group of individuals and thus seek to burden them with the exclusive responsibility for its successful incorporation. It is also quite wrong.

The fact is that compassion should be at the very heart of the design of the healthcare system. It should be fundamental to place, process and person alike and a focus for all the professionals who work in the NHS – and, just as importantly, all those who manage its services.

The ultimate aim should be to generate compassionate environments in which patient and practitioner alike are encouraged to engage for mutual benefit. Patients should not have to be treated amid management-dominated cultures that lead to compassion fatigue and moral slide; and practitioners should not have to work in them.

This transformation will not occur simply through mandating angelic nurses or conjuring up new initiatives that promote compassion as some sort of "skill". It will require a significant and absolutely essential change in both government policy and NHS organisation.

We need egalitarian, appreciative and substantively connected communities of shared hope and solidarity within a healthcare setting. And if that seems too grandiose, maybe even too pompous for some tastes, it may be worth expressing the objective even more plainly while the appalling shortcomings and systemic failures exposed by the Francis Report are still fresh in our memories.

It is as simple as this. The goal should not only be to cultivate a healthcare arena in which a disinterested "f*** off" is never inflicted on a patient: it should be to cultivate one in which the very thought could never be conceived by a practitioner in the first place.

That this will even now sound almost fanciful to some is itself a damning indictment of where we currently find ourselves.

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