Abstract
We read with great interest the recent article by Crowther et al. 1 and were able to see many similarities between their work and the findings of the European Implementation of Quality Indicators in Palliative Care study (IMPACT). 2
The Francis report highlighted the lack of compassion in the health service, in particular for older patients. 3 Crowther et al. 1 clearly add to this evidence, but encouragingly also demonstrate examples of kindness and compassion shown by professional carers, and also strangers. They discuss some of the possible responses to lack of compassion and kindness, highlighting that ‘compassion burnout should be identified and addressed within the healthcare system’. Although we do not disagree with them about this we suggest that ‘routinisation’ and the standardisation of practice also get in the way of spontaneity.
Palliative care professionals have described to us how their discipline had started outside the National Health Service (NHS), breaking boundaries and rules to optimise patient care, but is now becoming like any other kind of service, standardised and bounded by rules and structures. 4 This leaves little room for spontaneity and doing what is best for the patient, and therefore for kind and compassionate care.
We suggest what Crowther et al. 1 are referring to are the psychological and emotional characteristics of individuals within the health service, whereas we found that it was structures, organisational pressures and the actual work role which prevented end-of-life care for people with dementia being of consistently high quality. Finally, we suggest that the relationship between families and professionals is extremely important and it is not simply the compassion and kindness of professionals that is needed but that families also require trust, support and guidance at the end of life. 5