Targets are crowding out compassion in the NHS, claims report
Medicine has become more efficient but less humane, a major report into the NHS warns
Sunday 01 June 2008
A lack of compassion is putting patients at risk in the NHS, a new report will claim today. Failure to provide humane care has become endemic in the health services because beleaguered staff have too little time to pay adequate attention to fundamental human needs, the NHS Confederation report warns.
Nurses and doctors cannot spend as much time as they should with patients, and are sidelining essential care elements such as diet, pain control and hygiene because NHS targets are driven by the need to satisfy budgets rather than by care and quality.
Technical advances have made medicine more efficient but less humane, the report claims, and warns that government plans to tackle malnourishment and MRSA, as well as to give patients more dignity, are destined to fail unless compassion is restored to the heart of healthcare.
Dr Robin Youngson, the report's author, said: "The most shocking thing is that these basic failings are the rule rather than the exception. Compassion as a concept is largely missing from health policy. It is an assumed value that has been beaten out of professionals and systems but one that needs to be put in the NHS constitution and then upheld as a core value. If we can't provide humane and compassionate care for our patients, we are in trouble.
"I don't think there has been a watershed event but things have got accumulatively worse. It is not that doctors and nurses don't care, but aspects of their training, tough professional values and the efficiency-driven institutions they work in limit the possibilities for compassion."
Dr Youngson, a consultant anaesthetist and founder of New Zealand's Centre for Compassion in Healthcare, who trained in the NHS, believes there is a strong link between compassion and patient safety. Any attempt to reduce the spread of superbugs or improve nutrition among vulnerable patients that fails to consider compassion will be futile, he warns: "If we restore compassion, healthcare staff would no longer be able to do things that cause patients' distress, leave them hungry or spread infections. It would have a huge impact on these big issues."
Nigel Edwards, policy director of the NHS Confederation, which commissioned the report, said he hoped the findings would spark an urgent debate within the NHS.
"The need for this debate is in itself extraordinary, as most people would expect compassion to be at the heart of all care, anyway. We need to get NHS staff and organisations talking about it and to acknowledge that it is sometimes missing. It needs to move up the hierarchy because if we get this right, we are likely to get feeding, dignity and cleanliness right as well."
Andrew Lansley, shadow Health minister, said the report was an indictment of the way the Government had organised the NHS. "This is not a criticism of NHS staff but of the ethos that has been created in the health service," he said. "They are working in systems designed around throughput and not quality. This report sends a message to managers that they must create a work ethos where compassion and quality are at the centre of healthcare. Efficiency and compassion are not incompatible but targets and finances should not be ahead of patient safety."
Robin Lamerton, 48, a former RAF serviceman, experienced the shortcomings first hand when he suffered a stroke following a routine operation six years ago, which left him with aphasia, a long-term communication disability. "When I was in hospital after my stroke, I couldn't find the words to choose my lunch, and nobody seemed to know how to help me," he said. "My wife saw I wasn't eating well and brought food in when she could. But in the end I was back on the drip again because I wasn't getting enough nutrition."
The charity Connect said thousands of stroke victims were excluded from important decisions because hospital staff lacked adequate communication skills or simply didn't have time to spend with patients.
Vanessa Bourne of the Patients' Association said: "Privacy, dignity, nutrition and infection control are all about compassion, which costs nothing. If hospital workers cannot have compassion then they shouldn't be doing the job. This is all about leadership and letting people know they won't get away with it."
Pippa Jones of the Winnicott Foundation, a charity supporting NHS staff at a west London neonatal unit to provide compassionate care for fragile babies and their families, argued that time, patience and kindness could be integrated with sophisticated technologies but staff needed more support. "The Winnicott Baby Unit has the level of expertise to ensure that every baby and every family is cared for individually," she said.
Peter Carter, general secretary of the Royal College of Nursing, accepted there were problems but said these had come about unintentionally. "The vast majority of nurses want to provide compassionate care. But when they find themselves overworked, overstretched and reliant on undertrained healthcare assistants it is hardly surprising they are barely able to cope, never mind care for people in the way they would like," he said.
He added: "We need to ask why we have found ourselves in a situation when compassion is no longer intrinsic and needs to be restated as a value."
'The midwives kept telling me not to be silly'
Michelle Moore, 27, gave birth to her son, Oliver David, in November. While pregnant, she was diagnosed with group B strep, an infection that can be fatal to newborn babies.
She and her husband David, 27, feel the care they received during the week they spent in hospital lacked kindness and compassion.
"I was terrified throughout my 18-hour labour because the midwife kept leaving me alone," says Michelle. "After Oliver was born, I was left lying in dirty sheets for five hours because the unit was short staffed. Within a few hours I knew there was something wrong with him but the midwives kept telling me not to be silly.
"When the paediatrician finally came round, Oliver was rushed off to the special care unit but nobody would tell us why. This may have been a normal situation for them but it was our first baby and we were frightened.
"Over the next week I tried to spend as much time as I could in the special care unit even though I was very weak. Never did the midwives call me when meals arrived; if it hadn't been for my husband I wouldn't have eaten. I understand there were terrible staff shortages but it wouldn't have taken much for people to have shown us some compassion. I'm pregnant again and we have put our house on the market so we can move near a different hospital, in case things go wrong again."
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