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.