Health Service Focus

Compassion is crucial in healthcare

Compassion and care should go hand-in-hand and, in many cases, it does so. However, at times the values for providing compassionate, personalised care are not reached. David Stevenson reports from the NHS Expo in Manchester.

During the Health and Care Innovation Expo 2014, one of the most emotional sessions involved Jane Cummings, chief nursing officer, NHS England, and Dr Kate Granger, specialist registrar, cancer patient and the ‘hello my name is’ campaigner, discussing compassion and care within the healthcare sector.

Cummings, who in December 2012 launched Compassion in Practice – a three-year vision and strategy for nursing, midwifery and care staff – highlighted the importance of listening to what patients are saying in order to help them.

“It is about asking the questions, but understanding what extra needs to be done on a person-by-person basis as it can really
help make a difference,” she said.

6Cs

One of the main aims of Compassion in Practice, according to Cummings – who last discussed the strategy with NHE when we interviewed her for our May/June 2013 edition – is to get back to the very essence of what great care means for patients and how care staff can put far reaching changes in place that translate into real improvements for patients and the staff who care for them.

She said: “The result was the 6Cs initiative – care, compassion, competence, communication, courage and commitment. We are now on a longer cultural journey to ensure the 6Cs are embedded in every corner of the health service, cultivating a culture where great care is at the heart of everything we do, of openness and transparency where people feel encouraged and supported to speak out about poor care. It is this environment that ensures that all staff can deliver compassionate care to the best of their ability.”

Dr Kate Granger, a specialist registrar in Geriatric Medicine from Leeds, told delegates how, after being diagnosed with a terminal illness aged 29, she soon became an observer of her own care.

“Becoming a patient was something out of the blue for me. I had never been ill before and that was something that took a number of months to adjust to, and accept,” she said. “And from the beginning of my care, I became an observer of it. Knowing how I care for people, and how it should be done, sometimes my standards weren’t met or communication fell down and sometimes I felt like a girl with a rare cancer, rather than anything else.”

Remembering the ‘little things’

Dr Granger stated that remembering the little things, such as that a patient is also a person with feelings, are a vital part in providing compassionate care.

Known for her highly personal blogs and tweets about her illness, Dr Granger started a campaign called ‘hello my name is’ to remind health care professionals and all staff of the importance of introducing themselves to patients and how this relatively ‘little thing’ can positively affect a patient’s experience of the treatment and care they receive.

She added: “In my mind ‘the little things’ aren’t little at all; they are huge and of central importance in any practice of healthcare.

“When I say ‘little things’ I mean someone sitting down next to you rather than standing over you; someone holding your hand when you’re upset or distressed; someone taking that extra moment to really listen and allow you to express your fears; someone recognising you are in pain and being gentle when they examine you.”

Saying ‘hello’

Additionally, Dr Granger stated that she would like every clinician, whoever they are, to introduce themselves to every patient they meet – “that is a real passion of mine”, she said. Clinicians’ body language is important too, as it can make them seem either empathic on the one hand, or unapproachable on the other. These are all things that must be considered by care staff, she added.

Speaking alongside Dr Granger, Cummings said that great, compassionate patient care is about listening to patients, talking to patients and responding to their needs. It’s also about having the courage to step back when you think you might not be doing something right and having the ability to reflect and constantly improve the care we provide for patients,” she said.

During the ‘Compassion and Care’ seminar, the inaugural Kate Granger Awards were presented, recognising individuals or teams delivering outstanding compassionate care (see below).

Patient-centred personalised care

As well as looking at compassion in the healthcare sector, there was an interesting session dedicated to the development of patient-centred personalised care, chaired by Sir Muir Gray, chair of the Health and Social Care (HSCDS) Board, NHS England.

Sir Muir said: “This personalised patient care future is not like Helvellyn, a natural structure; it is like the Manchester ship canal. We have to imagine it, plan it and build it.”

During the discussion, Dr Mark Duman, chair of the Patient Information Forum, said clinicians have to set aside time to listen to patients, and truly listen to them.

In 2011 the Royal College of GPs published the ‘Improving the Lives of People with Long Term Conditions’ paper, which said that, despite concerted efforts to tackle problems with consultations, the  biggest issue is the reluctance of clinical staff to provide active support for patient engagement.

Dr Duman said: “If we are not being the leaders and emulating what we are saying about providing personalised care, how can we expect other people to practice what we preach? Let’s stop preaching and start practising.

“In conclusion, it is not policy, nor is it performance management that is important. It is simply people.”

Needs, preferences and values

Dr Sian Rees, director of the University of Oxford Health Experiences Institute, added that everyone in the healthcare system wants
to provide great care, whether as a practitioner or manager.

“It is all about doing the right thing with the right people at the right time and place in the right way,” she said. “Personalising care means it takes into account people’s needs, preferences and values. However, to be personal we have to make choices – and in healthcare choices have to be made, because things are not certain.

“To exercise choice we must understand the options and the information about these options; and we need somebody to talk to us about what our preferences are. They could be in terms of a treatment option – it is not true that every person wants to share decision making at every point in their care – but we need to have the conversation about this with them.”

Dr Rees added that care planning is important to deliver personalised care, and the right mechanisms must be embedded in the system to do this. “It sounds easy, but it isn’t – as everyone involved in the process has to believe in it in order to deliver personalised care,” she said.

“Change can only happen when you have the right people in place, when you have the right system that allows people to comment on the care being provided and you must have mechanisms in place to embed that into your system.”

Professor Adrian Davis, director of the NHS Newborn Hearing Screening Programme, stated that the only thing anyone needs to know about personalised patient-centred care is “communication, communication, communication”.

However, he also believes that a one-size fits all approach, which can be customised to individual patient needs, may be the most cost-effective way to provide patient-centred personalised care. 

The Kate Granger Awards

Following the Compassion and Care discussion, the first Kate Granger Awards, which recognise individuals or teams delivering outstanding compassionate care, were presented by the campaigner herself.

Dr Sophie Edwards, a consultant geriatrician at North Middlesex University Hospitals NHS Trust, won the ‘individual’ category for
her work to improve the experience of patients with dementia.

Dr Edwards developed ‘10 things about me’, an initiative that sees each inpatient with dementia at her Trust having a card at the
end of their bed listing 10 things about them and their background. The information enables ward staff and other staff to build and
maintain engaging and meaningful relationships with patients who have dementia.

The winner of the Kate Granger Award for Compassionate Care in the organisational or team category was the Teenage and Young Adult Service (TYA) at University Hospitals Birmingham (UHB) NHS Foundation Trust, for its work with young people diagnosed with cancer.

Nicky Pettit, teenage cancer trust lead nurse, said: “This was completely unexpected and has come about very quickly. I feel quite humbled about the entire thing.

“The work we are doing does make a big difference to the children and what we’re doing isn’t rocket science – we are just looking at the young people and meeting their needs in the best way that we can. So it is adapting the NHS to fit young people.”

The TYA, which is funded through three charities – the Teenage Cancer Trust, Queen Elizabeth Hospital Birmingham and CLIC – provides care for 16 to 24 year-olds from across the West Midlands who have been diagnosed with cancer.

Following a principle of ‘Young Person first, Cancer Diagnosis second’, the TYA cares for oncology and haematology patients going through a range of cancer treatments and makes a point of keeping services as flexible as possible to maintain ‘normality’ for
the young people it supports.

For example, its Young Persons Unit has an 11-bedded ward and two-chair day unit, offering a ‘home from home’ environment with open visiting, free wi-fi, a ‘mobiles on’ policy and extensive IT facilities.

Delphine Beddall, Young Person unit ward sister, added that the award means so much “not just for the patients and relatives but
the staff and whole team. It is such an unbelievable honour”.

The awards were named after Dr Granger and established by the NHS Employers organisation and NHS England. Dr Granger and
her husband Chris Pointon chose the two winners from 13 finalists, who had been shortlisted for 80 nominations across the health and care service.

Dr Granger said: “It was a difficult decision but the winners really are outstanding examples of patient-centred care.”