Measuring compassion

Simon Caulkin is the most perceptive writer on management in the UK. He’s also been a relentless critic of the Labour government’s obsession with ‘targets’ in the public services. This morning he excoriates the latest absurdity, namely

Alan Johnson’s inexpressibly depressing announcement the week before last of a ‘compassion index’, the results to be published on an official website, to show how kind hospitals are to their patients. This is so tragic that it’s hard to know where to begin (although I already have an idea of the ending). But let’s try.

The question is not whether compassion is desirable. It should go without saying that it is vital. For at least 50 years, it has been known that recovery from injury or illness is a delicate joint venture in which dedicated medical care and will and optimism on the part of the patient feed off and reinforce each other. A health service without compassion is therefore a contradiction in terms – compassion indeed figured among the important reasons the NHS was set up in the first place. In such a context, the question that needs answering is: how and why did compassion get lost that it now has to be inspected and audited in again?

The culprit is the dehumanising, Soviet-style regime of league tables, inspection and audit by which the UK public sector is now run…

The effect of targets is to create professions that are increasingly administrative rather than vocational.

First, simplistic targets (waiting times, exam results, detection rates) take away from professionals the duty to use independent judgment and make them accountable to inspectors, auditors and ministers rather than the citizens they are serving. Then, to deal with the mountainous bureaucracy that targets generate, the next step is to break the professions in two. As a Guardian blogger noted, over the last decade nursing has been turned into an academic and ‘managerial’ discipline, with wards turned over to managers and the basic caring component (bathing, feeding and comfort) hived off to less trained, lower-status heath care support workers. Exactly the same process of separating out the menial, ‘volume’ tasks from the rest can be seen at work in schools (classroom assistants) and the police (community police support officers), all in the vain quest for economies of scale.