At the end of 2008, King's Fund chief executive Niall Dickson was reported as saying that NHS staff have lost their compassion and that his organisation wants to help bring it back. I could not agree less.
From my empirical evidence, here are a few things that used to happen in the so-called good old days:
young single mothers given no pain relief during labour to "teach them a lesson";
people who had taken overdoses labelled attention seekers;
people deemed "not for resuscitation" just because they were old.
In my opinion, based on 36 years of personal data collection, NHS staff have become increasingly kind and compassionate. Why else would they choose a caring career that brings neither great fame nor fortune, but ever more public criticism? In any group, there will be bad apples, but we should not base our judgements on extremes such as Harold Shipman or Beverly Allitt. In the main, staff set out trying to do their best. Our job is to provide an environment that supports them.
A wise colleague, Claire Murdoch from Central and North West London foundation trust, recently told the incoming Care Quality Commission that you cannot legislate for kindness. I absolutely agree with her, and what is more, if we treat our people as though they are not to be trusted to act out of human compassion, they may start to live up to such expectations. The media, and some politicians, should take note of this.
World class healthcare
Primary care trusts are one group that has been having a pretty rough time of it recently. In mid-January, the Commons health select committee said that not only were they not fit for purpose, they probably never would be. Was that meant to be motivating? We will shortly see the results of the recent world class commissioning assessments. These are said to be as stringent as the Monitor assessment process, and will apparently show that all PCTs have some way to go to become world class. This will no doubt see more criticism heaped on PCT shoulders.
Is this really fair? These organisations have been reorganised and assessed more times than the rest of us put together. They manage really important community services that help keep people well and out of hospital. Having been set up to run them, they are now being told that to become world class, they must divest themselves as quickly as possible, as though these services were a distraction.
In seeking world class commissioning, we should be careful what we wish for. Do we want a US-style system where 30-40 per cent of available health resources get eaten up in transaction costs and third-party companies trying to prove procedure x or y was not warranted? Is that really world class?
You would not expect a provider to be a natural defender of commissioners, but I come from the whole system school of thinking. Whatever you do, you will only ever be as good as your partners. As commissioners flex their muscles, we have had a couple of minor bloody noses recently over the tendering of services. That is what they are meant to do, of course. I am just grateful when they do it with kindness.