The NHS is a particularly challenging environment

N0038022 A nurse carrying out observations on a patient

By Martin Vogel

The NHS, the focus of our next session on 10th November, is one of the hottest of hot potatoes in politics. This fact in itself makes it a stressful place to work. To be employed in the NHS means you are never far from public scrutiny.

Only this week, The Sunday Times reported that the NHS compares poorly with the best performing countries in terms of keeping people alive. Quoting a report from a think tank, UK2020, it says as many as 46,000 people die each year because the NHS does not match the best international standards for treatments of common cancers such as lung cancer, bowel cancer, prostate cancer and breast cancer.

This is no rogue finding. The OECD consistently reports that, while the NHS provides reasonable value for money and good access to healthcare, the outcomes it provides are among the worst in the developed world:

“Too many lives are still lost because the quality of care is not improving fast enough. Survival following diagnosis for cancer has increased in the United Kingdom over the past ten years, but the United Kingdom still remains in the bottom third of OECD countries in five-year relative survival for colorectal cancer, breast cancer and cervical cancer, though survival rates are improving at least as fast as the OECD average. The United Kingdom does not excel at delivering high-quality acute care either: survival after hospital admission for a heart attack or stroke – albeit improving considerably faster in the United Kingdom than in the OECD on average over the five years leading up to 2013 – is worse than in many OECD countries, including Canada, Italy, the Netherlands and Spain.”

Could part of the reason for these poor outcomes be that the NHS is too focussed on being an efficient system and not focussed enough on the needs and experiences of the people it deals with? Earlier this month, widely-reported research published by the Journal of Public Health found that four in ten people were deterred from booking a GP’s appointment because they found the way receptionists question them about their symptoms to be intrusive. It’s thought this could be a contributory factor to the UK’s poor rates of cancer survival because it creates delays in cancer diagnoses. Dr Richard Roope, a specialist on general practice at Cancer Research UK, told the Telegraph:

“Diagnosing cancer early is something we have to take seriously, so anything that might prevent people from getting their symptoms checked needs to be overcome. We need to ensure that patients are able to get appointments at a convenient time, can book an appointment to see a particular doctor and aren’t put off coming to see them in the first place. This may mean more emphasis on training front desk staff including receptionists to deal more sensitively with patients.”

Although the NHS is facing a particularly serious funding crisis at present, the question of how it can deliver a compassionate experience for patients, their families and staff is a long-standing one. In 1960, Isabel Menzies Lyth published a paper which found that hospital nurses maintained “a social defence system” against the anxieties caused by the profession. The defences included: detaching nursing from experiencing patients as individuals by organising the job into tasks (such as taking temperatures, making beds, etc.); eliminating the individual distinctiveness of patients (for example, by referring to their bed number or their condition rather than by name); reducing the weight of individual responsibility in nurses’ decisions by checks and counter-checks, and so forth. The fragmentation of the nurses’ role meant that, even while the nursing service might provide good outcomes, individual nurses could draw little satisfaction from their contribution.

The defences Menzies Lyth identified did not arise out of inherent callousness on the nurses’ part. If one assumes that nurses are generally drawn to the profession out of an ethos of care, their defences must arise out of the particularly stressful experiences they face in their job. These were well described by Menzies Lyth:

“The nursing service bears the full, immediate and concentrated impact of stress arising from patient-care. The situations likely to evoke stress in nurses are familiar. Nurses are in constant contact with people who are physically ill or injured, often seriously. The recovery of patients is not certain and may not be complete. Nursing patients with incurable diseases is one of the nurse’s most distressing tasks. Nurses face the reality of suffering and death as few lay people do. Their work involves carrying out tasks which, by ordinary standards, are distasteful, disgusting and frightening. Intimate physical contact with patients arouses libidinal and erotic wishes that may be difficult to control. The work arouses strong and conflicting feelings: pity, compassion and love; guilt and anxiety; hatred and resentment of the patients who arouse these feelings, envy of the care they receive.”

Menzies Lyth found that the defences nurses erected against these stresses were ineffective. For coaches, the question arises as to what kind of leadership culture causes staff to resort to such techniques to protect themselves. Before carers can exercise compassion for those for whom they care, they must be able to exercise compassion for themselves. And to do this, they need to be treated with compassion by those who presume to lead them. To what extent is this an issue in today’s NHS?

Our panellists on 10th November – Geraldine Cunningham, Glenn Turp and Nollaig Whyte – have interesting and pertinent views on these questions. Come along and join the discussion on how coaching can help.

Leading for compassion
10th November 2016, 6.30pm to 8.30pm
Space in Marylebone, 10 Daventry Street, London NW1 5NX
Members £30; Non-members £35

Book with Eventbrite

Image courtesy Welcome Images.

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