13 May, 13 | by BMJ
Reading the Francis Report for many of us is like looking in a mirror. The mirror is at an angle, magnifying the perversities in the picture, but it is all recognisable. We see our NHS reflected back at us, the NHS in England in the early years of the 21st Century.
As the weeks since it was launched pass and the Francis Report fades rather too rapidly from the news headlines, there is little cause for cheer and much to dishearten. True, the concept of compassionate care is being bandied around in evangelical fashion and squeezed into every document possible. But frankly, there is an Orwellian touch to the way the word is being used and a real danger that the concept will be rendered trite and meaningless. Over the last few weeks, I have listened to an operating department assistant describe how he was dragged away from looking after a patient three times by an anxious manager wanting him to amend a form ticking boxes saying he was providing compassionate care to the patient; I have heard someone from the workforce planning department moaning about how busy he was having to amend job descriptions to include the word compassionate; and I have been approached by someone in medical education asking me to invent some exam questions that tested for compassion!
It is far from original to liken the NHS to a patient at the mercy of multiple unpiloted, misapplied interventions. But the simile holds strong in the face of rising panic about the severity of its condition and major (largely unwanted) surgery in the form of the structural changes following the introduction of the Health Bill. Add to this the potential for a glut of polypharmacy following from the 290 recommendations from the Francis Report (not enough for David Cameron who felt compelled to invent at least one more!) and the already overtreated patient is likely to get an awful lot worse. So what the hell, let’s add in a “compassion pill” on top of everything else! Even better, a “compassion pill” that can be measured, audited, benchmarked, and examined!
This will, of course, make matters worse. What is needed instead is intelligent diagnosis followed by careful formulation of the underlying conditions that can nurture or hinder compassionate care. Some of this is about balance, weighing up priorities, making informed judgements whilst keeping a unflickering eye and finger on the pulse of the patient. Addressing some of the iatrogenic causes of the problem would be a good start. Reducing anxiety in the system, pruning the stranglehold of bureaucracy, cutting down the number of top down initiatives, and minimising micromanagement of frontline staff is likely to do far more good than introducing yet another “pill.”
Penny Campling is a psychiatrist and psychotherapist and was a clinical director for many years. She has recently co-written a book entitled “Intelligent Kindness: reforming the culture of healthcare.”