The changing place of care and compassion within the English NHS: an Eliasean perspective
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In the wake of the Francis Report, a public conversation has arisen in England about the place of compassion within healthcare settings, particularly regarding the causes of failures in the provision of adequate healthcare, and the desirability and possibility of fostering compassion in the NHS. A contribution to this conversation, this article takes as a starting point an oft-overlooked socio-historical phenomenon: social expectations of compassion in healthcare practice have shifted in comparison to what was the case at the NHS’s inception in 1948, so that both healthcare professionals and the public have come to perceive and expect compassion as an intrinsic component of healthcare. We argue that this expectation can be partly explained drawing on Elias’s concept of ‘functional democratisation’: as power asymmetries between different social groups (e.g. doctors and patients) have declined in recent decades, so have norms and expectations of compassionate care increased. Failures to provide compassionate care in some specific settings can also be partly understood as an outcome of a wider erosion of functional democratisation resulting from the growth in social inequality witnessed in England and much of the world since the 1970s. We thus call for addressing failures of care within healthcare settings through broader social policies.
KeywordsFrancis Report Functional democratisation Functional de-democratisation Inequality Norbert Elias Process sociology
We would like to thank Iain Wilkinson and two anonymous referees for their very constructive comments, feedback and suggestions on earlier versions of this article. Our work with, and insights from, Andy Alaszewski (on historical perspectives), Stephen Mennell and Rineke van Daalen (on Eliasian approaches) have been important influences behind this work. Of course any weakness are solely attributed to ourselves.
- Berger, P., and T. Luckmann. 1967. The social construction of reality: A treatise in the sociology of knowledge. London: Penguin Books.Google Scholar
- Blendon, R.J., and J.M. Benson, 2017. Public opinion about the future of the affordable care act. New England Journal of Medicine 377 (9): e12. doi: 10.1056/NEJMsr1710032.
- Boyle, D., and M. Harris. 2009. The challenge of co-production. London: Nesta Foundation.Google Scholar
- Butler, I., and M. Drakeford. 2005. Scandal, social policy and social welfare. Bristol: The Policy Press.Google Scholar
- Campbell, D. 2013. Mid Staffs hospital scandal: The essential guide. The Guardian, February 6. https://www.theguardian.com/society/2013/feb/06/mid-staffs-hospital-scandal-guide.
- Castel, R. 1991. From dangerousness to risk. In The foucault effect—Studies in governmentality, ed. G. Burchell, C. Gordon, and P. Miller, 281–298. Harvester Wheatsheaf: Hemel Hempstead.Google Scholar
- de Swaan, A. 1988. In care of the state: Health care, education and welfare in Europe and the USA in the modern era. Cambridge: Polity Press.Google Scholar
- Department of Health. 2001. National service framework for older people. London: Department of Health.Google Scholar
- Dunning, E., and J. Hughes. 2013. Norbert Elias and modern sociology. London: Bloomsbury.Google Scholar
- Elias, N. 1996. The Germans: Power struggles and the development of habitus in the nineteenth and twentieth centuries. Cambridge: Polity.Google Scholar
- Elias, N. 1978. The civilising process. Oxford: Blackwell.Google Scholar
- Elias, N. 2000 . The civilizing process: Sociogenetic and psychogenetic investigations. Oxford: Blackwell Publishers.Google Scholar
- Elias, N., and J. Scotson. 2008. The established and the outsiders. Dublin: University College Dublin Press.Google Scholar
- Flores, R. 2013. When charity does not begin at home: Exploring the British socioemotional economy of compassion. Sociological Research Online 18(1). http://www.socresonline.org.uk/18/1/17.html.
- Francis, R. 2013. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive summary. London: The Stationary Office.Google Scholar
- Giddens, A. 1990. The consequences of modernity. Cambridge: Polity.Google Scholar
- Goffman, E. 1959. The presentation of self in everyday life. Garden City: Doubleday.Google Scholar
- Graeber, D. 2015. The Utopia of rules: On technology, stupidity, and the secret joys of bureaucracy. New York: Melville House.Google Scholar
- Hochschild, A. 2012. The outsourced self: Intimate life in market times. New York: Metropolitan Books.Google Scholar
- Hunt, J. 2015. Francis report: Update and response. Oral address to parliament. https://www.gov.uk/government/speeches/francis-report-update-and-response. Accessed 18 Apr 2016.
- Jeffreys, M. 2000. Recollections of the pioneers of the geriatric medicine specialty. In Oral history, health and welfare, ed. J. Bornat, R. Perks, P. Thompson, and J. Walmsley, 75–96. London: Routledge.Google Scholar
- Judt, T. 2011. Ill fares the land: A treatise on our present discontents. London: Penguin.Google Scholar
- Khullar, D. 2015. The importance of sitting with patients, Well (New York Times Blog), March 19. http://well.blogs.nytimes.com/2015/03/19/the-importance-of-sitting-with-patients/.
- Madan, A. 2017. Sustainability and transformation plans: Transforming patient care through GP services (Blog). NHS England. https://www.england.nhs.uk/blog/stp-blog/. Accessed: 1 June 2017.
- Mennell, S. 2004. Not so exceptional? State-formation processes in America. In The sociology of Norbert Elias, ed. S. Loyal, and S. Quilley, 157–174. Cambridge: Cambridge University Press.Google Scholar
- Mennell, S. 2007. The American civilizing process. Cambridge: Polity.Google Scholar
- Menzies Lyth, I. 1960. Social systems as a defense against anxiety: an empirical study of a nursing service in a general hospital. Human Relations 13: 95–121.Google Scholar
- Meštrović, S.G. 1997. Postemotional society. London: Sage.Google Scholar
- Nussbaum, M.C. 2001. Upheavals of thought: the intelligence of emotions. Cambridge: Cambridge University Press.Google Scholar
- Parliamentary and Health Service Ombudsman. 2011. Care and compassion? Report of the Health Service Ombudsman into ten investigations into NHS care of older people. London: The Stationary Office.Google Scholar
- Raghuram, P., J. Bornat., and L. Henry. 2011. The co-marking of aged bodies and migrant bodies: migrant workers’ contribution to geriatric medicine in the UK. Sociology of Health and Illness 33 (2): 321–335.Google Scholar
- Rohloff, A. 2008. Moral panics as decivilizing processes: Towards an Eliasian approach. New Zealand Sociology 23 (1): 66–76.Google Scholar
- Sennett, R. 1998. The corrosion of character: The personal consequences of work in the New Capitalism. New York: W.W. Norton.Google Scholar
- Townsend, P. 2010. The political sociology of mental handicap. In The Peter Townsend Reader, ed. A. Walker, D. Gordon, R. Levitas, P. Phillimore, C. Philipson, M. Saloman, and N. Yeates, 528–538. Bristol: Policy Press.Google Scholar
- van Dantzig, A., and A. de Swaan. 1978. Omgaan met angst in een kankerziekenhuis. Utrecht: Het Spectrum.Google Scholar
- Wouters, C. 2007. Informalisation: Manners and emotions since 1890. London: Sage.Google Scholar
- Wouters, C. 2014. Universally applicable criteria for doing figurational process sociology: Seven balances, one triad. Human Figurations: Long-term Perspectives on the Human Condition 3(1). Permalink: http://hdl.handle.net/2027/spo.11217607.0003.106.
- Wouters, C. 2016. Functional democratisation and disintegration as side-effects of differentiation and integration processes. Human Figurations: Long-term Perspectives on the Human Condition 5(2). Social character, historical processes. Permalink: http://hdl.handle.net/2027/spo.11217607.0005.208.
- Wright, O., and J. Laurance. 2013. NHS's darkest day. In The Independent, 7 February.Google Scholar
- Young, J. 1999. The exclusive society: Social exclusion, crime and difference in late modernity. London: Sage.Google Scholar