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Monthly Archives: February 2012

Moral values in the NHS

The Commission on Improving Dignity in Care published a report today based on its work over the last year, looking at “the extent and root causes of the failure to provide appropriate levels of care to older people” in the NHS and care homes. We’re just not good enough at how we treat the elderly, and the improvement of such services is becoming a priority as more and more people live into their 80s and 90s, and often develop dementia.

What is interesting about the report for me, from a philosophy angle, is the emphasis it puts on the role of values and ethics within the medical system. One of its core recommendations is:

Hospitals should recruit staff to work with older people who have the compassionate values needed to provide dignified care as well as the clinical and technical skills. Hospitals should evaluate compassion as well as technical skills in their appraisals of staff performance.

It was a point repeated by Sir Keith Pearson, one of the authors of the report, when he appeared on the Today show this morning. He said: “Recruiting for values and then training for skills is enormously important.” He said people considering a career in nursing needed to be aware that 60% of patients in hospitals were over the age of 65 and they needed to be able to show compassion and kindness to elderly patients.

The report also says the system needs to put more emphasis on care-givers’ responsibility and personal judgement, that they have the power to challenge practices they see as harmful, and that the dignity and autonomy of the patient is paramount.

It just reminds me a lot of Aristotelian philosophy and of the philosophy of Alasdair MacIntyre, who often warns that our society is becoming over-instrumentalised, over-obsessed with skills and technologies, and losing sight of the ethics, values and human warmth needed to guide any bureaucratic system. I think this report confirms and complements that view. It’s also a point made by David Buchanan, the director of the Institute of Global Health, in this presentation that I saw him give at an AHRC event last September.

The religion for atheism’s class problem

I like Alain De Botton’s energy and chutzpah, but I also think ideas are better when they’re challenged and thinkers are prodded to consider the possible holes in their thinking. So here is what I think is a serious hole which De Botton needs to consider in his ‘religion for atheists’. At the moment, it seems to me pretty much exclusively a religion for the haute bourgeosie.

I was particularly struck by the class-bound restrictions of his religion yesterday, when he tweeted suggesting that hotels need to learn lessons from religions, and be places of solace and consolation for the soul rather than superficial ‘holiday spots’. He wrote:

The tradition of religious retreats reveals a need for a new kind of establishment, a secular hotel for the soul, devoted to satisfying with intelligence and artistry the psychological as well as physical needs of its clientele. Such a hotel would humbly study the extraordinarily structured ways in which Buddhism approaches the topic of relaxation, as well as casting an eye across other faiths and psychological schools in order to arrive at programmes for the care of our troubled minds that would extend beyond the lamentable solutions currently on offer.

So we propose a solution in the form of a Hotel for the Soul. The needs of the mind, or to use an old-fashioned but evocative term, ‘the soul’ remain generally ignored by holsteries. While pampering our bodies, the typical hotel comes up with no more sophisticated response to the needs of the soul than minigolf, the Sunday newspapers and a DVD library. The new institution, positioned either on the slopes of a Swiss alp or to the side of a volcano in Tenerife, will skilfully attend to the needs of both body and soul – and will thereby mark the natural evolution from the luxury spa hotel to the hotel dedicated to the well-being of the whole person and humanity more broadly.

Now this is less radical than Alain might think. In fact, there have been ‘holistic hotels’ for a long time now, where earnest well-being entrepreneurs cater to our spiritual needs. In fact, an article I read recently told me that bookings for ‘holistic holidays‘ were up 250% last year. But it’s not the unoriginality of the idea that concerns me – it’s the exclusivity.

A religion worth its name caters for everyone: not just the rich suffering from affluenza and status anxiety, but the really poor, the sick, the destitute. Alain is comparing monasteries to hotels, but monasteries were alms-giving institutions which supported local communities. They weren’t holiday resorts in Tenerife.

If Alain is serious about starting a ‘religion for atheists’, using a blend of psychotherapy and philosophy, and using places like the School of Life as hubs, then he needs to face this class / wealth problem. The School of Life, based in Bloomsbury, offers life-classes costing £30 or so a pop. How socially diverse is the audience? Entirely middle class? That’s fine if the School of Life is a retail organisation, but not if it’s a religious organisation. A religion, in my opinion, needs to extend beyond Bloomsbury.

This is a problem philosophy has long faced. Epicureanism, Stoicism or Platonism were attractive to the wealthy elite, but what about less educated people, people who simply didn’t have the leisure to follow an extended course of philosophy? Where is the consolation for them? If philosophy only caters to the well-off, then it becomes the cultural equivalent of a gated community – withdrawing from society into private and exclusive communes like Epicurus’ Garden or De Botton’s Tenerife resort.

What Christianity, Islam, Judaism, Hinduism and Buddhism did so well is create systems of belief and practice for the intellectual and the masses, for the rich and the poor. That meant using some of the cultural practices that Alain has identified – paintings, hymns, architecture etc. But it also meant charitable activities, running hospitals, schools, homeless shelters. Above all, it means a commitment to try and help all of humanity, not just the well-off. It meant a willingness to get one’s hands dirty. The only philosophy that came anywhere close to that was Marxism.

People criticise Alain for inheriting a lot of money. So what? He could have not worked at all, but he spent his life working hard, producing books that millions have found helpful, setting up worthwhile institutions like the School of Life, all of which, ironically, have been very successful (ironic because unlike every other philosopher he doesn’t need the money). But that well-off background may have made him diffident about going beyond his own class and his possible reception in other parts of society.

But the practical philosophy movement needs to go beyond the affluent. That might be an awkward process, but it will also be fulfilling, rewarding and inspiring. We need to combine the intelligence of Alain De Botton with the spirit of Jamie Oliver, who has that sleeves-rolled-up willingness to go into rough schools or poor neighbourhoods and try to improve them. Otherwise, philosophy becomes a lifestyle column in the FT’s How To Spend It.

What could be a first step? Well, how about a pro bono initiative involving School of Life faculty and others, to go beyond Bloomsbury and run workshops in local London schools? Or in the NHS? Or in homes for the elderly?

By the by, another of his suggestions is to have high-street therapists as a new caste of priests. He admits there is an economic problem here too – therapy tends to be the preserve of the middle class – and acknowledges the efforts of Lord Layard to make CBT more available through the NHS, but he says ‘progress is slow and vulnerable’.

Really? Layard got half a billion in funding for 6,000 new cognitive therapists. That’s pretty amazing. I’d actually say that of all the real-world impacts by British intellectuals over the last decade, that is the most significant and laudable. It’s taken therapy beyond the middle class.

De Botton writes: ‘Therapists are hidden away. You don’t see them on the high street’. Well, you increasingly do see NHS Psychotherapy and Well-Being Clinics all over London now. But that’s not the main point. The main point is: what is the role of philosophy in all this?

The answer is that the Socratic philosophy that De Botton so often aludes to – Stoicism, Epicureanism, Scepticism and so on – is the source of the CBT now being mass-disseminated by Layard’s National Mental Health Service.

So that’s another way that philosophy can be taken beyond the middle class – by providing classes within the National Mental Health Service that re-contextualise CBT in its original philosophical context, giving people an ability not just to learn instrumental techniques for well-being, but also to consider broader questions of what it means to flourish and live a good life.

What I have made here are not flat-out criticisms but attempts to take the project forward. Oh, and another thing. Drop the name. Why restrict your project to atheists? That’s immediately going to put off people in poorer neighbourhoods, for whom God is a deeper consolation than any philosophy book. Socratic philosophy has room for both theists and atheists, and the same ideas and techniques can provide consolation for both sides. So why restrict your philosophy to 30% of the population – a 30% who are typically middle class? Does The School of Life only cater to atheists? Are believers not welcome?