Putting care back into health care

Over twenty years ago, my first job at the Department of Health was setting up the NHS Health Technology Assessment programme. At the same time, another programme was coming into being – the Cochrane Institute.

Led by Iain Chalmers, the Institute set out to distil the knowledge around best practice through meta-analysis of the many randomised control trials that exist in any given field. While Cochrane has become synonymous with evidence-based medicine, whenever I hear his name, I am called back to an extract from one of his diaries that Iain used as a foreword to a report.

The extract described an experience that Archie Cochrane had as a young medic during the war. Responsible for a badly wounded soldier who kept crying out, he offered a range of interventions but, no matter what he tried, the young man kept crying, much to the distress of others on the ward. Finally, without any medical places to turn, Archie did the most human of things; he took the man in his arms. At that point the young man stopped crying and peacefully died.

I think this recollection must have been in my mind last month when I decided to volunteer to host a ‘Birds of a Feather’ dinner at the Wisdom 2.0 conference. The idea was that delegates would put forward topics for discussion and anyone else interested in them could join them at a restaurant of their suggestion. So, I put forward the topic of ‘Putting Care back in Healthcare’ and I spent a thoughtful evening with six complete strangers, all of whom were drawn to this call.

On getting back to work the following week, the report into the Morecambe Bay Inquiry had been published – once again we hear of the things that should never happen and we constantly ask ‘Why?’ and say ‘Never again’. But, as ever, the system defaults into more regulation and monitoring, more training, more oversight.

It left me wondering, if ‘care’ was the most important thing in health care then would these tragedies of neglect happen? When health care can deliver so much that could never have been imagined when the NHS was set up, have we lost sight of the basic principles of care?

But it isn’t just about the extremes in the breakdown of care that make this an important question. There are more fundamental reasons to put care back into health care. As Archie Cochrane found, people so often want ‘caring for’ rather than simply ‘treating’. They want ‘healing’, not just ‘curing’. And not just that, we are enriched as people when we care for others. Has the unintended consequence of the welfare state been the ‘professionalisation’ of care, stripping those of us without training of the confidence in our own ability to care for others?

I can imagine that anyone working in the current health care system might find the idea of providing more care challenging. Caring requires you to give something of yourself and in a job where death is a natural outcome, this is undoubtedly a big ask.

So, perhaps the place to start is for those in leadership roles to start showing more care for their workforce. As someone said at a recent SCIE roundtable discussion, ‘People don’t aspire to greatness if they are constantly being battered for what they haven’t done’. Likewise, people struggle to show compassion when they don’t experience compassion themselves.

One of main messages from our Constructive Comfort report is the need to pay more attention to how the workforce is supported. The challenge of working in health care is only set to get greater as demand increases and resources shrink. And although it’s true that kindness costs nothing – except to give of oneself – if we want a better quality health service then we need to start by thinking about how we support the million plus people working in the NHS to give a little of themselves each day.

Jo is Director of Strategy and Innovation at the Health Foundation, www.twitter.com/JoBibbyTHF