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

Abstract

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.

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Notes

  1. 1.

    From the foundation of the first children’s hospitals in the late 19th century up until World War I, these institutions were ‘kindly places’; however, ‘by the 1920s, this had changed to a more industrialised environment, and hospitals became grim places for children’ (Jolley and Shields 2009, p. 166). Jolley and Shields argue that experience of World War II played a big role in the development of ‘family-centred care’ (inter alia, allowing parents to spend time with hospitalised children). Further investigating these changes from a long-term figurational perspective would be worth doing, but it is beyond the scope of this paper.

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Acknowledgements

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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Correspondence to Ruben Flores.

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Flores, R., Brown, P. The changing place of care and compassion within the English NHS: an Eliasean perspective. Soc Theory Health 16, 156–171 (2018). https://doi.org/10.1057/s41285-017-0049-y

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Keywords

  • Francis Report
  • Functional democratisation
  • Functional de-democratisation
  • Inequality
  • Norbert Elias
  • Process sociology