The health and social care sector must place greater value on its most important attribute – compassion, says Camilla Cavendish.
In the five months I spent researching and writing the Cavendish Review, only two people used the word “kindness”. One was Deborah Holman of St Christopher’s Hospice, which explicitly advertises for staff who are kind and reckons it can train them in almost everything else. The other was Eileen Sills, chief nurse at Guy’s and St Thomas’ hospital, who started a revolution when she closed three elderly wards and took the clinical teams off site for two weeks to think afresh about what good care looks like.
What Deborah and Eileen know is that good care is not just about ensuring that someone is clean or fed. It also involves responding to the needs of each person as an individual. This is particularly true of the elderly, who can find it particularly difficult to articulate their own needs.
Yet when JRF’s Better Life programme urges us to “see and hear the individual”, this is no small task. Caring takes time. It is not a commodity that can be made more and more efficient without damaging the psychological wellbeing of both staff and patients.
Many of the domiciliary care workers I met are on the brink of leaving the sector, partly because they can’t make ends meet but also because they can no longer bear not being able to look after people properly. That is why I believe that commissioning care by the minute must end: it is a false economy, because we will lose some of the best staff. It is also why I believe we must pay staff for travel time.
Research suggests that the kindest staff are often the most psychologically affected by the nagging feeling that they have left too many tasks undone at the end of each day. That is why I am concerned that twelve-hour shifts have become the norm on so many hospital wards. They deprive patients of continuity, they limit handovers and they put a huge emotional and physical strain on nurses and healthcare assistants.
Two organisations have done inspirational work to help staff to establish “support in meaningful relationships”, in the words of the Better Life programme. Macmillan Cancer Support realised that cancer sufferers struggle to define ‘dignity’ but can readily say what behaviours signify the opposite.
Macmillan’s Values Based Standard lists eight behaviours which improve staff-patient relationships. These include ‘I’d like to understand what will happen to me’, ‘I’d like not to be ignored’, and ‘I don’t want to feel alone in this’. MacIntyre, the national charity which looks after people with learning disabilities, videos its best carers to help other staff learn that even small daily interactions can have a profoundly positive effect. These carers have a distinctive psychological profile which MacIntyre uses to recruit new staff.
My review recommended recruiting for values, as MacIntyre does. It also proposed practical training with a golden thread of values spanning both health and social care, and help to make caring a career. For if we don’t recruit, train and support intelligent kindness, we all face a bleak future.