Social Theory & Health

, Volume 16, Issue 2, pp 156–171 | Cite as

The changing place of care and compassion within the English NHS: an Eliasean perspective

  • Ruben FloresEmail author
  • Patrick Brown
Original Article


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.


Francis 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.


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Copyright information

© Macmillan Publishers Ltd 2017

Authors and Affiliations

  1. 1.Higher School of EconomicsMoscowRussian Federation
  2. 2.University of AmsterdamAmsterdamThe Netherlands

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