Wednesday, 10 December 2014

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 matter.
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 proud of.
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), 263-277.
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.

4. article.html?doi=10.1136/bmj.g5185 (due to appear in BMJ print edition 23 August)

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