FOR the benefit of staff and society, all sectors need to cultivate moral and emotional understanding writes Graham Leicester
It has been quite a summer for two of my favourite things: hope and inspiration.
They were in evidence again last night at the Royal Society of Edinburgh when Dr Iona Heath, president of the Royal College of General Practitioners, gave the Michael Shea Memorial Lecture.
She spoke about what goes out of society, and in particular out of professional practice, when we lose touch with these essential life forces. She asked us to remember that public service relies on them.
I found myself recalling R F Mackenzie, the visionary head teacher who sought to bring these virtues to Scottish education in the 1960s. He refused to beat children, for example: he regarded it as inimical to learning, compassion and human dignity. His stance did not find favour with the authorities. Eventually he was suspended.
The young journalist Harry Reid recalls meeting Mackenzie at his house one evening shortly after the verdict. “That night”, he writes, “I gradually realised that for the first time in my life I was in the presence of someone of genuine vision: a prophet”.
It was scarcely a revolutionary vision Mackenzie communicated. “He talked in the soft Aberdeenshire accent he has never lost; he spoke of his love and care for young people; he referred to his favourite parable, that of the lost sheep.” Yet his words held the power of prophecy in a culture that had somehow become blind to timeless virtues.
I know how Harry Reid must have felt in that encounter. I get the same feeling from Iona Heath. Her address last night was likewise shot through with the simple human qualities she wishes to see flourish not only in healthcare but in public service more generally: compassion, humility, trust, love, poetry, moral courage.
How have these values been systematically squeezed out of our public services? In place of the simple tale of people helping each other live fulfilled lives in a well-functioning society, we now find a mechanistic pursuit of efficiency and “outcomes”. Professionals find themselves hedged between government indicators and regulation on the one hand and the market forces of commercial competition on the other.
What has been lost in the process is not only our humanity – which it seems we have always cheerfully sacrificed in pursuit of economic success. We have also lost our professional effectiveness. It was Heath’s point, as it was Mackenzie’s, that the two are inextricably linked.
Heath recalled “the greatest book ever written about general practice”, John Berger’s A Fortunate Man – a portrait of his friend John Sassall, a country doctor in the 1960s. “He is a fortunate man”, wrote Berger, “because his work occupies and fulfils him; his work and his life are not separate.”
“His satisfaction comes from the cases where he faces forces which no previous explanation will exactly fit, because they depend upon the history of a patient’s particular personality. He tries to keep that personality company in its loneliness.” This is not about delivering a service, it is an encounter between two unique, living, breathing, caring individuals. As Heath says, “a labour of love”.
Yet by 1996 Berger was playing a very different tune: “I have come to mistrust most doctors because they no longer really love people.”
What had happened in the meantime was a shift in the culture. As we moved along the spectrum from a planned towards a more open-market economy, so the assumption crept in that “the customer is always right” and professionals are not likely to act in anything other than their own interest unless constrained by regulation.
“When I embarked on my career in 1974”, says Heath, “to be a public servant was to be doing something good. By the end of the 1980s, the same role had become, through a painful and demoralising process, somehow despicable.”
It is easy to see how trust was eroded on both sides. Doctors seemed no longer to love people, because they were not loved themselves. And both the nature and the quality of the clinical encounter suffered as a result.
Few people noticed. When the only instruments we have to hand to improve public services are science and economics it is not surprising that other critical dimensions are ignored. Heath talked about the narrowing of the intellectual, emotional and moral space we operate in when we become enthralled to the “false certainty” of these disciplines.
The story of Dr Ludwig Guttmann, who in 1944 became the first director of the spinal injuries centre at Stoke Mandeville, provides a timely illustration. He entered a world in which soldiers who were crippled on the front line were regarded as good as dead, and lived out the rest of their short lives under sedation, waiting only to be moved on to the mortuary. Based on the evidence, this was a rational approach. The men even arrived at the centre in coffins.
But Guttmann refused to live in that narrow space. He sensed the humanity and the potential in these people, people just like himself. His vision was no different from Mackenzie’s, or Heath’s. Like them, he chose to apply his considerable technical knowledge and skill (he was a gifted neurologist) within a different moral universe. The Paralympic Games, which he founded in 1948, has just carried the essence of that moral vision into the homes and the hearts of millions.
We do not all possess the talent or the courage to be Guttmanns. But we can all at least reflect on our own professional practice and ask how to expand the space we work in to allow more of life to flow through it.
Heath suggests we do so by expanding our range of “literacies”. Technical literacy is important: knowing the biomedical science, making the diagnosis etc. But it must be complemented by physical literacy – understanding your own body; by emotional literacy – witnessing and acknowledging the other’s pain and suffering; and cultural literacy – enriching the search for meaning with knowledge of how others have made healing sense of the same kinds of hurt and pain.
Most important of all is moral literacy – the capacity to exercise moral courage when the algorithms run out and it is only your professional judgement and common humanity that can guide you in “‘doing the right thing”.
After such a summer I sense the balance in the culture is shifting again. I am encouraged to hear a public figure like Iona Heath calling for the restoration of the human in professional practice. I am encouraged that the management consultancy Accenture, as sponsor of last night’s lecture, is ready to engage in this level of dialogue.
And I am encouraged by the countless workers I encounter in all sectors in Scotland who, in spite of all pressures to act otherwise, absolutely come from a place of moral courage and humanity as they perform their labours of love. I have had the privilege from time to time of working with such individuals, “keeping them company in their loneliness” (as Berger put it). But they are not alone. They are the midwives of a new culture.
• Graham Leicester is director of the International Futures Forum (www.internationalfuturesforum.com)