Why there’s a crisis of compassion

The UK government’s Commission on Improving Dignity in Care for Older People, tasked with looking at ways care is delivered in hospitals and care homes, published its draft report on Wednesday. The commission leader and chair of the NHS conferderation, Sir Keith Pearson, said the report was ‘a call to arms to the whole health and social care system’.

Pearson’s call to arms follows hot on the heels of NHS ombudsman Ann Abraham’s report last year, which criticised the treatment of elderly people in the NHS. At the time, evidence of elderly people’s mistreatment was everywhere. There was the particular case, for example, of the elderly woman who was transferred from hospital to a care home with bruises, ‘soaked in urine, wearing someone else’s clothes held up with large paper clips’. For Pearson, such incidents typify the profound lack of compassion within present care arrangements for the elderly. The findings of Pearson’s draft report are also reinforced by the recent findings of an inquiry into NHS care quality conducted by the Care Quality Commission and Patients’ Association. Of the hospitals the association looked at, 40 per cent failed to provide ‘dignified care’.

Little wonder that Pearson now recommends ‘root and branch reform of the [care] system’, including giving back authority to ward sisters and ending a ‘command and control style of management’ that erodes the autonomy of frontline staff in carrying out the everyday practical tasks of care. Recruitment critera should also be altered, Pearson urges. So while still insisting that nurses should have certain academic qualifications, Pearson suggests that potential employees should also be assessed for their capacity to care and to be compassionate. And alongside all this, hospitals which fail to meet a ‘standard for dignity’ will be financially penalised.

And herein lies the rub. How can a virtue, like compassion or dignity, be turned into a something that can be measured, assessed and ticked off on a list? Moreover, while the Pearson report demands greater care to be delivered, this comes at a time when there exists within British officialdom a widespread distrust of our ability to develop caring relationships without some form of official ‘advice’ or endorsement. Hence the rise of CRB checks, the avalanche of parenting advice and the alarmist accounts of ‘carer abuse’. Lying behind these phenomena is the idea that to care for another person is either too risky for ordinary people to get involved in, or too complicated, hence the demand for expert advice. In such a climate, it is hardly surprising that some people find themselves becoming less able or willing to feel or show compassion towards the elderly.

Although I would applaud any measures in the Pearson Report that encourage professionals to make their own individual judgements, I suspect the heart of this problem lies elsewhere – at an altogether deeper and more complex cultural level, rather than at the level of failing systems.

Having recently attended the funeral of my father, who spent his last incapacitated years in India, I met with several people who had cared for him there. And when I say care, I mean they fed him, clothed him, bathed him, attended to ‘his toileting needs’, and washed his soiled clothes and bedding. They also sat and watched cricket and religious programmes with him, even when he was unable to respond in any way; massaged his legs when his circulation weakened; and slept in the same room as him at night because my mum was unable to help him on her own. These carers were young and not particularly well educated or from well-off families. Yes, they were paid for their labour, but there was never any contract, checks or monitoring; they were found through word of mouth. Moreover, they called my dad, silent and bed-bound as he was, ‘uncle ji’. (The ‘ji’ is a term of respect used by the young when referring to someone older.)

I am not defending the material conditions in India that mean so many have so little choice in how they earn a living. And no doubt some would say the term of respect, ‘ji’, could be little more than a fairly routine show of deference based on the unequal power relationship between employer and employee. But when talking with the carers, it struck me that, even if true, these things hadn’t stopped a genuine relationship of caring from developing. I do not know how this can be ‘measured’ or ‘proved, I just know that it existed. And this was a main reason why my mother chose to remain in India, even though England had been my parents’ home and the medical facilities are generally better here.

As philosopher Tzvetan Todorov argues in his study of man’s inhumanity to man during the Holocaust, it is in the recognition and practice of everyday virtues that we are better able to fulfil our humanity. But, Todorov cautions, virtues such as caring and dignity are only meaningful and valuable for as long as they do not become ‘entrenched behaviour’ (1). When demanded in an automatic way, such virtues become something else entirely. Todorov makes another salient point regarding dignity: we can call for dignity all we want, but if society as whole cannot value it, it is meaningless.

In this light, contemporary calls for dignity to be afforded to the old have to contend with the coexisting trend in Britain of devaluing aspects of old age, such as knowledge and experience. Recent public discourse also reveals ill-founded and petty-minded anxieties about the elderly. For example, commentators often turn growing old into a problem, pointing out the cost of an aging population, or asking if the elderly are holding younger people back in the job and housing markets.

Furthermore, others suggest that in these supposedly egalitarian times, why should we automatically respect the old? This is especially problematic if some old people are believed to have ideas and values way out of kilter with those of a modern politically correct culture. After all, to grant respect on the basis of age alone is as patronising as it is to grant respect on the basis of gender or skin colour alone.

But there is a good reason why older people should be respected. They have lived longer and therefore have experienced and learned more about life and people. In hearing about the stories of their lives and times we can learn how to better judge what is and isn’t important about our own. Moreover, we ought to treat older people with respect, even when we may quite justifiably disagree with certain outmoded ideas or actions, not because of their merits or otherwise, but because we are, to paraphrase the Bard, acting in accordance with our own standards of ‘honour and dignity’.

So if we want more genuine caring in the NHS, maybe we should eschew the checklist/threat approach and encourage potential employees to read Shakespeare. After all, literature is more likely to encourage empathy than another ‘standard of national quality’.

Alka Sehgal Cuthbert is reading for a PhD in the philosophy of education. She is a member of the Institute of Ideas Education Forum.