With so many difficulties, I think some of the compassion has been eroded from our public services. But, based on my long experience as a clinician and my more recent experience as a carer, I strongly believe that compassion should be given high priority by organisations, in professional bodies and by individual members of staff.
I want to make a case to you for compassion.
Firstly, perhaps, I should say what I mean by compassion. It’s more than empathy, because as well as putting yourself into the shoes of others, as empathy means, you are doing something about it. It means actions are taken. Empathy and compassion, as well as love, kindness and sympathy, should all be basic principles of our public services, but I believe that compassion should be our greatest focus.
During the COVID pandemic, Rosemary, my wife of more than 50 years, and who had vascular dementia, required surgery for kidney cancer.
I was told that despite her complete dependency on me as her registered carer with lasting power of attorney I would not be allowed to be with her in hospital during her admission. I had to leave her at the door unsupported, despite self-isolating for two weeks and being shown to be COVID test negative. Eventually I was allowed in by proving that in being a carer, not a visitor, I added value to the team looking after her.
I asked all nursing staff, especially the most junior and the nursing assistants what they felt about the restriction of access. Comments included: ‘It’s appalling, and I’m horrified over what I’m expected to do but I dare not say anything because I’d be labelled a troublemaker’; ‘All our nurse managers are concerned about is ticking boxes’; ‘Our consultants don’t ask us what we think, it’s never discussed on ward rounds.’
It was clear that managerial compliance had over-ridden basic humanity.
My wife deteriorated quickly, being forced to admit her to a memory care home at the point of carer ‘burnout’, which I tell more fully on my website (Aynsley-Green.com).
We found a rare care home with an owner determined to build homes to the standard his own mother would require were she to need residential care.
After nine months of loving care, she fell, fracturing her hip. I was instructed by medical staff to admit her to hospital forthwith for her hip to be pinned under surgery – this on a day with a six-hour wait for an ambulance, two hours outside the emergency department, and up to 12 hours on a trolley before anyone would decide if she was fit enough for surgery; had she been so judged she would have needed a high dependency bed before a difficult rehabilitation back to a life of severe dementia.
I saw this to be unspeakable cruelty and demanded palliative care to allow her to die in dignity, in accord with her previously expressed wish never to be admitted to hospital again. I was told nobody had ever refused this surgery, but a compassionate GP overseeing the home agreed, and triggered our community nurses to set up a diamorphine drip to relieve her pain and distress.
She died quietly three days later. Care home staff sat with us; they held our hands and wept as she died; they came to her funeral to celebrate what she had meant to them through her contented demeanour.
In family conferences organised by CHI (Congenital Hyperinsulinism International), I asked the more than 200 families of babies born with this devastating illness whether they had received compassionate care in the children’s hospitals to which they had been admitted. Individual doctors and nurses were remembered for their care, but not one family felt that compassion was embedded in the institution as a fundamental principle.
I visited a famous hospital. ‘Is it compassionate?’ I asked? ‘Of course, we are,’ the staff replied. When asked how they knew that to be true, they were flummoxed. ‘Well, people smile at us,’ they said! I discovered that compassion was not even mentioned in induction programmes for new doctors and nurses.
Medical students asked what they should do about the attitudes and behaviour of a senior consultant on his ward rounds. They claimed he was arrogant and failed to show empathy let alone compassion for his patients.
My advice was clear – don’t do anything by themselves lest they be identified as troublemakers, but, if several felt similarly, they should approach their postgraduate dean and leave it to him/her to take forward their concerns. Other students also exposed the dismal role models that they are seeing so often. They suggested that ward rounds and consultations should be videoed for feedback to senior staff and that they should be included in any appraisal for them, alongside inspection processes by regulators.
In recent years, there has been a growing recognition of the importance of compassion in healthcare, both for patients and for staff.
The NHS Constitution for England, the Francis Report into the failings of care at the Mid-Staffordshire NHS Foundation Trust, the NHS Long Term Plan, NHS staff surveys and innumerable research studies have all explored the link between compassion and healthcare.
Compassionate care can lead to better patient outcomes, increased patient satisfaction, and improved staff morale.
Despite this, my experiences show that there is a mismatch between theory and rhetoric and the realities of frontline service delivery.
Why this has happened and what to do about it are key questions to be answered.
The effects of COVID-19; staff shortages and lack of time are undoubtedly true but in my view are excuses for poor behaviour.
We need a cultural transformation with a cascade of actions:
- Compassion being a key operating principle in NHS and care settings led by the Chief Nurse’s Office
- Every care organisation promoting its importance at the professional level
- Much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all grades of staff
- The views of patients and families should be sought regularly
- The 'can do so will do’ attitude of some consultants needs to be confronted
- Compassion being inspected against by the Care Quality Commission
- A willingness to encourage staff at all levels to expose poor practice alongside celebrating excellent care.
We need a ‘momentum for compassion’. Do you agree and if so, what are you going to do about it?
Sir Al Aynsley-Green was the first children’s commissioner for England, a past-president of the BMA, and is the founder of Aynsley-Green Consulting