It's just not right.
Grumpy old psychiatrist wonders why - and tries things to escape oppression, institutionalisaton, industrialisation of mental health and digital tyranny.
Hopefully by only bending the rules, but never breaking them.
Well, we'll see.
NHS morality and care based on compassionate values
It is difficult to disagree
with the main thread of Cox and Gray's argument (1), that the NHS as a whole
has lost its grip on being person- centred in any genuine way, amidst the industrialisation
and authoritarian managerialism of the modern NHS. However, I would take issue
that the College Centre for Quality Improvement (CCQI) is being idle about the
For over twelve years, I have
worked with CCQI staff to set up and develop three projects to promote exactly
what Cox and Gray are asking for: robust systems of quality assurance and
quality maintenance which focus on the emotional experience of the patients in
their particular treatment environments. The Community of Communities quality
network (2) for therapeutic communities started in 2002; the Enabling
Environments award (3) (which is suitable for any setting) was established in
2009; and the National Enabling Environments in Prisons project began to
improve relational-based practice in participating British prisons in 2009. All
three projects continue to flourish, and more are planned.
The Enabling Environments award
is based on a set of ten value statements which define 'relational excellence'
in work environments. These value statements have been processed to form ten
standards, each with several criteria for demonstrating that they have been
met. Naturally, compassion and the quality of relationships are at the centre
of the expectations. The standards are measured by submission of a portfolio -
for which we have designed a flexible and hopefully enjoyable process, rather
than a persecutory inspection. Rather than being part of the regulatory burden
that many units nowadays feel, our experience to date is that participants take
great pride in the process and receiving the resultant award. It is important
to note that the existence of this award was prominently mentioned in OP92:
"The Enabling Environments Award recognises that good relationships
promote well-being, but that many organisations and groups fail to address this
aspect of people's lives". It therefore already forms part of the
College's response to the Francis Report.
Unfortunately, the response
from NHS organisations (mental health and others) has not been encouraging -
and the award is much better used and recognised in the prison service and all
sorts of different third sector units. I believe this may be caused by a deeper
malaise in the NHS, very much in line with what Cox and Gray are arguing in
their paper. In short, the NHS is being run with a competitive business model
to such an extreme and aggressive extent, that 'soft' values such as empathy,
emotional intelligence and kindness are given no force.
Related to this, it is worth
mentioning that the Institute of Group Analysis, alongside other organisations
including RCPsych, are running a six-month listening exercise to gather
information from staff across the range of NHS professions and specialties (4).
When the information is collected and collated, it will be used to negotiate
with politicians of all parties in advance of next year's general election. As
Cox and Gray argue, this is a moral question - and a profoundly important one
for all of us who want the NHS to survive in a form that we can once again be
1. Cox J and Gray A, The
College reply to Francis misses the big question: a commentary on OP92,
Psychiatric Bulletin, August 2014 38:152- 153
2. Haigh R., & Tucker S.
(2004). Democratic development of standards: the community of communities--a
quality network of therapeutic communities.Psychiatric Quarterly, 75(3),
3. Johnson R., & Haigh, R.
(2011). Social psychiatry and social policy for the 21st century: new concepts
for new needs-the 'Enabling Environments' initiative. Mental Health and Social
Inclusion, 15(1), 17- 23.