Views & Reviews Review

Kindness in healthcare: what goes around

BMJ 2012; 344 doi: (Published 22 February 2012) Cite this as: BMJ 2012;344:e1171
  1. Iona Heath, president, Royal College of General Practitioners
  1. iona.heath22{at}

Kindness is essential in helping patients to heal, but healthcare professionals need to be treated with kindness too. Unkind though it may be, Iona Heath would force you to read this book

This wonderful book is an urgent plea for kindness as both the driving force and the touchstone of healthcare in the NHS. Anyone who has been seriously ill knows that it is the individual acts of kindness, thoughtfulness, and sensitivity on the part of healthcare staff that make it possible to cope with the panic and indignity of a failing body. Kindness helps healing. Yet, as recurrent scandals unfold, most recently in the Mid Staffordshire NHS Foundation Trust, it is all too clear how quickly the sustaining web of kindness can unravel into neglect and even abuse. Why should this be?

Authors Ballatt and Campling remind us that, “it is easy to forget the appalling nature of some of the jobs carried out by NHS staff day in, day out—the damage, the pain, the mess they encounter, the sheer stench of diseased human flesh and its waste products.” Of course, such forgetfulness is not at all easy for those actually doing this work, those struggling not to allow any hint of their physical revulsion to show, but these challenges seem hardly to register in the conscience or consciousness of those charged with the running of the NHS. Parts of the NHS have become repositories for aspects of humanity that our contemporary hedonistic and individualistic society finds difficult to acknowledge.

The NHS represents the last vestige of social inclusiveness and solidarity for frail, elderly people; for traumatised children; for people with intellectual disability, dementia, or severe mental health problems; and for people who repeatedly harm themselves, either directly, or persistently through the misuse of drugs and alcohol. And yet the staff who do the hard work of maintaining that solidarity are subject to a constant stream of criticism, efficiency savings, and instructions to do better. Exposed to precious little kindness themselves, they are nonetheless expected to provide it unstintingly. “There is a lack of understanding, a lack of thoughtful connection—a lack of kindness in the way the organisation as a whole is treated.”

This book is published by the Royal College of Psychiatrists, and the text is suffused with fascinating psychoanalytic insight. Psychiatry has a long history of dealing with those whom society has seen fit to lock away, and psychiatrists have seen this done with more or less kindness over the centuries. They are fully aware of the toll the task of caring in these circumstances can take on the individual member of staff and on attempts to work together in teams. “The capacity for groups of staff—be they in prisons, children’s homes or hospitals—to participate in cruel and abusive regimes is ever evident. It is well to remember that such teams often have to face and process distress and disturbance that cannot be managed elsewhere in personal and community life.” Ballatt and Campling see clearly the extent to which the “culture of ‘efficiency’ and engineered processes” discriminates systematically and pervasively against the most vulnerable patients with the most complex and inexorable needs.

The book is timely and carefully unpicks the degree to which the continuous and public dissatisfaction with the NHS shown on the part of our political leaders, and the insistent emphasis on the need for so called reform, undermines the potential for acts of kindness at the front lines of healthcare. The authors ask a telling question: “Could it be that the constant restructuring . . . is in part a social defence system that distracts from the existential anxieties associated with the uncertainty of sickness, pain and death, or the enormity of the task of dealing with it? The powerful denial of the cost of the consequences of the disruptions involved suggests that this might be so.”

In calling for intelligent kindness, and in stark contrast to the stated aspiration of the current government, the authors call for reform of the culture of healthcare without further tampering with the structure. They note that “the behaviour of government purporting to believe clinicians know best, while systematically ignoring their general discomfort and alarm in the face of the commissioning arrangements proposed under the Health and Social Care Bill 2011, has been depressing to witness.”

What is really needed, they argue, is a culture of kindness throughout the organisation, against which proposals for change would be evaluated and within which the real difficulties faced by front line staff would be acknowledged rather than denied. The priority of everyone involved would be to “help front line staff to help patients.” Such a culture of kindness would play out in encouragement, support, and the celebration of achievements rather than the current obsession with condemnation and rooting out poor practice. Staff should be given the space and stature to take pride in their work, not forever feeling the dead hand of inspection and regulation.

This book is more than recommended reading. If I ruled the world, I would arrange for everyone who wields any power in the NHS to be locked in a room until they had read it. But then, of course, that is precisely the sort of dictatorial behaviour that the authors see as the antithesis of intelligent kindness, and so I am obliged to fall back on an unrestrained enthusiasm that I hope will prove infectious.


Cite this as: BMJ 2012;344:e1171


  • Intelligent Kindness: Reforming the Culture of Healthcare

  • A book by John Ballatt and Penelope Campling

  • RCPsych Publications; 224 pages; £25

  • Rating: ****

  • Competing interests: None declared.

  • IH is writing in her personal capacity.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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