Will Marsh: Compassion and contracts—a leadership critique

will_marshAt this year’s London Psychiatric Trainee conference, I listened to Penelope Campling speak eloquently about the importance of compassion in the delivery of healthcare. In her book Intelligent Kindness, she argues that when we fail to promote connectedness between staff, and kinship with patients, we fail to address the “key dimension of what makes people do well for others.” Following last week’s decision by the BMA to suspend industrial action and re-enter Junior Doctor contract negotiations, the secretary of state for health, Jeremy Hunt, tweeted:

Victory for common sense. Strike shouldn’t have been called w/o talking to govt first but great for 7 day services

The ensuing reaction on social media led me to reflect on Hunt’s leadership style as the secretary of state for health. Was this latest manoeuvre consistent with his past approach to the ongoing dispute and how does this marry with what we know about the importance of compassionate leadership?

In 2009 the Healthcare Commission found that a failure to provide compassionate care led to maltreatment of patients in Mid-Staffordshire. Robert Francis QC found that this reflected the culture at a leadership level. As a result, reviews in response to these findings promoted “a rededication of the NHS to living its core values, with compassion being central within this.” Subsequent investigations into NHS Leadership have reinforced this demonstrating that “when we care for staff, they can fulfill their calling of providing outstanding professional care for patients.”

In 2012 Hunt rightly placed “respect and compassion at the centre of new standards for NHS leaders.” Subsequently in 2014 NHS England released guidance on “leading with compassion,” identifying the 10 most important characteristics of a compassionate leader; emotional intelligence, trust, integrity, authenticity, openness, caring, commitment, genuineness and an ability to listen and be reflective.

Following victory in the 2015 general election, Hunt reaffirmed his commitment to a “seven-day NHS service.” The British Medical Association consistently asked the Department of Health and Hunt to state clearly what “seven-day services” meant practically—they received no reply.

Rather than engaging in discussion, Hunt stated he would impose a contract on junior doctors if they were not willing to accept the recommendations of the Doctors and Dentists Review Body (DDRB). This suggested that an increase in doctors at weekends alone would result in a fully fledged seven-day service. Not satisfied with undermining the necessity and value of all other healthcare professionals Hunt demonstrated a lack of emotional intelligence in declaring that the new contract would help doctors regain a “sense of vocation and professionalism.” To those junior doctors who are suffering from record low morale as a result of rising work demands this displayed an alarming absence of caring, as well as undermining their vocation to date.

In the name of independence the DDRB did not include any NHS clinical staff. Their recommendations were met with condemnation from most Medical Royal College leaders concerned about their potential impact on patient safety. Despite this Hunt reiterated that the recommendations must be adhered to due to their independence. The integrity of this statement had to be questioned, when a 1% consolidated pay rise, recommended by the very same review body, was deemed unaffordable. Hunt subsequently publicly promoted the proposed contract as commanding an 11% pay rise. How could this now be affordable? The statement lacked authenticity; the pay rise refers to basic pay alone, the proposed contract’s redefinition of out-of-hours may actually result in a pay cut.

Such disingenuous statements give rise to potential inflammatory responses in social and national media, damaging already fragile morale. Having changed course from a narrative of compassion Hunt appeared to have forgotten that staff can only fulfil their caring potential when valued. Instead he has referred to junior doctors as “militants“—a term usually restricted to individuals engaged in warfare or combat and suggested doctors stay and treat their sick patients for financial reasons rather than through duty of care. The fallout from this has been record numbers of doctors applying to practice abroad and worrying reports of an increase in doctors attending services for sick doctors.

A more dynamic seven day service that is more responsive to demand will not be achieved without a dedicated, committed, and above all compassionate workforce. We have seen that “like high stress levels, a lack of compassion too flows through teams and organisations.” As a result, Hunt’s leadership during this dispute carries worrying implications for patient care. If Hunt had listened to his earlier self and placed compassion at the centre of his leadership this protracted dispute may not be over a solitary contract but how best to provide a more flexible and compassionate seven day service. On this basis, regardless of recent developments, is it time for new leadership of the NHS?

Will Marsh is a CT1 trainee in psychiatry at South London and the Maudsley NHS Trust. Following his attendance at Schwarz Centre rounds during foundation training he became interested in the types of leadership styles and culture that enable healthcare professionals to provide the compassionate care they are trained to deliver.

Competing interests: I am a BMA rep for South London and Maudsley.