Winterbourne View, Mid Staffs: All the ‘compassion’ capitalism affords

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After the ill-treatment of people with learning disabilities was filmed by Panorama, Winterbourne View has been closed, more inspections have taken place, and 11 care workers have been convicted. Between 400 and 1200 ‘excess’ and ‘unnecessary’ deaths between 2005 and 2008 at Mid Staffordshire Hospital Trust have been investigated and reported on. Health minister Jeremy Hunt and the Chief Nursing Officer for England have emphasised the need for “care” and “compassion”.

The scandals have been exposed and investigated, scapegoats tried and convicted, platitudes uttered, and future inspections will be carried out by a new body with a new name, the Care Quality Commission. So we can all sleep confident in the safety and compassion of our health and care services … except for the small detail that the whole process takes us no closer to understanding why such things happen.

‘Nurses who don’t care ‘’should resign’’[1]

When things go wrong the ruling class are always quick to blame workers, whether they are nurses and care workers, as in these scandals, or train or coach drivers following an accident. This hypocrisy is truly nauseating.

When NHS services are shut down months before the end of the financial year (such as i-Health in East London) because there is no more money, leaving patients suffering from their illnesses for longer, where is the ‘compassion’ in that? When new treatments – that can protect sight in macular degeneration, or give a cancer sufferer a little longer – are judged on cost through the National Institute of Clinical Excellence, where is the ‘compassion’ in that?

Then there is the effect of all the targets that have to be achieved in the NHS: “For every condition there is a guideline to follow, a reward for doing so scrupulously, and a penalty for falling short. Patients matter less as individuals than they do as units in a scheme with a public health objective in mind.” (BMJ 18/12/12).

There was no golden age in the NHS. The British state only became interested in the health of the working class when it discovered they were unfit to fight in the Boer War. The NHS grew out of the Beveridge Report in World War II, and the need for labour in the years that followed. It was always limited by delays and underfunding. Now it is no longer in their interests to spend so much money on it.

Jeremy Hunt wants a special sort of compassion from nurses and doctors in order to be able to live within the limits on the NHS, and deny services that are not funded, in a kindly and considerate way. No wonder communication skills are now taught and examined – including, for GPs, the skill of saying “no”.

And no wonder burnout is such an important problem. This is not just a question of overwork but above all stress, which includes the stress of feeling unable to do the job as it should be done. Burnout makes it much more difficult to feel compassion, even if a professional is expected to behave in a proper professional manner regardless of how they feel at the time.

When doctors, nurses and care workers are unable to show appropriate compassion this is most often the result of the conditions they are working in, whether through lack of resources to make their compassion count, or the destruction of their normal compassion by years of working in a system characterised by daily banal and bureaucratic inhumanity.

As for resigning due to lack of compassion – just imagine trying to get Job Seekers Allowance after leaving, or refusing to take, a job on such grounds.

Not just Winterbourne View, not just private hospitals

Mencap and the Challenging Behaviour Foundation have just published a report ‘Out of Sight’ which details a number of serious incidents of abuse at other private hospitals including physical assault, sexual abuse and over medication. The report calls for the government to close these large institutions which are mostly operated by the private and not for profit sector[2]. In other words the same lesson about care of people with learning disabilities and large impersonal institutions as was drawn from similar problems 30 years ago. The difference is that the institutions today tend to be privately run, with only 10% of those in residential care run by social services. Today it is all too easy to equate economy with private profit: “The private sector in particular recognised there was money to be made if you set up nice looking purpose-built homes for some of the most dependant and challenging people. The care could be provided more efficiently (cheaper) in large institutions. A simple case of the economies of scale that could be achieved in catering, care and management costs by replacing a dozen small homes each providing care for four or five people with a ‘hospital’ providing beds for 60 or more residents.” The use of such facilities, with their economies of scale, results from the need for social services departments to keep costs down in line with stretched budgets.

With the British economy, being much stronger than the Greek, we do not face the same level of cuts (see Curing the economy kills the sick). Nevertheless, if we look at the plans to save money in the NHS being rolled out at the moment, we can see that the difference is one of degree and not principle. The plan is to make £20 billion in savings in the 4 years to 2014/15, with an estimated £5.8 bn saved in 2011/12. However despite freezing pay, freezing what Primary Care Trusts pay for healthcare and cutting back office costs (i.e. administration jobs), the National Audit Office has estimated that the real saving is more like £3.4 bn. Because of this shortfall, the cuts to come, we can be certain, will hit both patient care and healthworkers’ pay, conditions and jobs. It will also involve the regulation of health care assistants – people employed to take on aspects of the nursing role that used to be the province of more qualified staff. It used to be called ‘dilution’, now it’s called ‘skill mix’. All this will come in whatever compassion nurses and doctors have for their patients, or indeed the compassion the sick may feel for their carers.

Preparing the ground for the next attacks

Nurses compassion will be measured, according to Jane Cummings, chief nurse for England! As if you could trust the capitalist state to measure such things in a meaningful way! The Prime Minister wants patients in hospital to use the “friends and family test”. “Mark Porter, chairman of council of the BMA, said, ‘Doctors and the NHS, generally, welcome feedback from patients and their families. However, the friends and family test that has been piloted so far is based on a model developed to test satisfaction with consumer products. We would like to see a full evaluation of the pilot before it is rolled out more widely, as there may be better ways of getting useful information from patients in a form that allows the NHS to improve services’.” (BMJ 7/1/13).

These ‘reforms’ will do little if anything to improve care. They certainly won’t overcome the effects of the planned ‘efficiency savings’. But the media concentration on these scandals, and the campaign about ‘care’ and ‘compassion’, can undermine the confidence we feel in our doctors and nurses in the NHS, and create a climate in which they can be blamed for the inevitable failings that will happen as cuts in the health budget are rolled out.

Alex 12/1/13



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