In October, I was invited to the President’s Conference of the Royal College of Physicians and Surgeons to talk about kindness. On the day, I shared a platform with a range of speakers, from Scotland and further afield, who talked about related concepts – like compassion, listening, psychological safety. Together, we reflected on the importance of such values in the way that we make decisions about what to prioritise for the future of the NHS in Scotland. It felt very different to a traditional healthcare conference.
For the past two years, I have been working with Carnegie UK as an Associate to understand and advocate for the role that kindness can play in improving outcomes for patients and staff across the health and social care services in Scotland. Participating in the conference, it struck me how far this conversation has come in that relatively short amount of time. Things that would have felt bold, indeed radical, in a pre-Covid world – a conference entitled “Time to Heal”, an NHS Recovery Plan that speaks directly to staff, with the commitment, “We will support your wellbeing” – are now embedded in the way that people talk about the health and social care system.
One year ago, Carnegie UK published The Courage to be Kind, which underlined the importance of listening to staff and of creating space for kindness, in order to ensure that our health services are able to deliver the best for both patients and staff. We were told,
“…it’s important to be kind to staff, otherwise they won’t have the reserves to bring that into their work and interactions. [But] if you have staff that are being looked after, this will permeate into how they are with patients.”
Since then, talking to people about this research, we have noticed a growing number of people using the language of kindness. This is now an international movement, evidenced by the connections we have made with colleagues as far away as Australia and New Zealand, and by the inspiring ‘conversations for kindness’ that each month bring together healthcare practitioners from across the globe.
Closer to home, we have also seen this conversation flourish in Scotland. Building on the work of compassionate leadership and psychological safety, a number of health boards have invited Carnegie UK to facilitate leadership events on kindness in healthcare. We have also been inspired by a new cohort of Chief Executives who have the courage (that word again) to address head-on the difficult conversations about workforce wellbeing and organisational culture. In addition, organisations are collaborating: the BMA, GMC and Royal Academies are working together to reach out to members and ensure that the voices of those working within our system have influence.
At all levels, we’ve noticed that people have become much more comfortable talking the language of kindness, bringing real cause for optimism about the future. And yet, over the same period of time, the environment in which we operate has become noticeably less kind. This is true for staff across the system who are managing unsustainable workloads that do not allow the time and space to look after their own wellbeing. It is also true for leaders, who have been under increasing pressure throughout 2021 to deliver ramped-up targets. And 2022 shows no signs of this abating.
In June, after the Holyrood elections, Carnegie UK wrote to the Cabinet Secretary, asking the (rhetorical) question, “Can targets rebuild our NHS?” We had heard again and again that what was happening before the pandemic was not delivering the best outcomes for either patients or staff. And we recognised the risk of returning to the same performance management measures, the same target pressures, that trickle down, squeezing the space for kindness throughout the system.
Currently, the language and aspiration of kindness stand in stark contrast to the lived realities for those working within our NHS. Instead of being supported and valued, we hear about unrelenting workloads having a negative impact on the mental health of the workforce – and we see a media narrative that puts unsustainable pressure on the system to deliver. It is hard to maintain a culture of kindness that supports everyone’s wellbeing in these circumstances.
There are no easy answers to these questions, but this is the challenge that we now face in the NHS and social care in Scotland. How do we create an environment that allows us to move beyond language to something practical and tangible? How do we challenge the unkindness within our system? And how do we support those leaders who demonstrate the courage to speak up and try to do things differently?
As I come to the end of my time as a Carnegie Associate, there is a real sense of fulfilment in hearing healthcare leaders espousing values like kindness. But more, there is the sense of anticipation about the work to come – and a hope that this language will be followed by a much more meaningful shift in the way that we do health and social care in Scotland.
