‘That’s because they feel guilty…’ Really? I’m not so sure

Her daughter’s here everyday without fail – well that’s because she’s guilty.’ ‘Do you know, he never comes – well that’s because he’s guilty’. ‘He’s always questioning us about everything we do – well that’s because he’s guilty’. ‘ She’s constantly complaining and pointing out stuff she says we haven’t done for her mum – well that’s because she’s guilty.’ So families and relatives are guilty if they come too often and guilty if they stay away. Seems like they can’t win! Ask any staff what they make of relatives and many will turn amateur psychologist and bring up the G-word. It may indeed be guilt at times but when it is used so often it can become an all too convenient excuse and deflect away from real opportunities to build bridges with these frightening guilt ridden complaints waiting to happen! Ask staff too if they have any ‘nightmare families’ or ‘families from hell’ – Immediately people in the group will smirk as no doubt one or two individuals will spring to mind. Some may name and shame, but what it does reveal is not the level of guilt that families and friends may be feeling but our own shortcomings in building positive treatment partnerships. More worryingly it reveals the extent to which we sit in judgement of others. Are we really referring to a feeling of guilt or are these families guilty of perceived crimes – such as interference, neglect, meddling, asking awkward questions. Build those bridges. Let’s move away from nightmare families to concerned families. I remember listening to tales of the most awful family who’d gone to the press over the care of their mother in one particular home. they’d even marched outside with placards. When they arrived at a new home the relationship was full of tension. staff at the new home could only see aggressive ‘guilt-ridden’ relatives, prejudiced already by the advanced information they’d received. they were getting very defensive. when working with the staff I invited them to take the initiative an get together with the family to listen to them, to let them tell their story. Surprise surprise the staff reported that they too would have taken up placards and marched alongside the family, having heard of previous experiences. 

We just do not do enough to welcome families. When a person comes into our services they are already part of a wide network of relationships. We cannot ignore that, yet to what extent to we assess the families when assessing an individual prior to accessing a service? What do we know about the charisma of the relatives in terms of how they want to engage? Do they want to be hands on? Do they want to take a step back from care tasks to recover the more gratuitous side of relationships? Who knows if you don’t ask? We can’t expect every family to comply with the role we expect of them. When they don’t then the labels come flying out – ‘unrealistic expectations, they can’t accept they can’t care any more, they don’t know about dementia (well invite them to your training!!!!! – that’s another issue) and of course well, they’re guilty aren’t they?’


Compassion – be careful Jeremy

I’ve been thinking about the meaning of compassion in health and social care in the light of the word getting bandied about at every turn. It’s one of the 6 C’s – the big NHS push to respond to Francis. Jeremy Hunt our health secretary is really pushing it – telling his nursing staff to show compassion, put patients first and at the same time forget about complaining about insignificant pay rises.  But this is not a diatribe about pay and conditions, rather a call to Jeremy for a bit of humility. Dear Jeremy The word, ‘Compassion’, is fast becoming a cliche and I fear is bordering on the meaningless  – alongside words and phrases such as ‘dignity and respect’ – hugely powerful words  – used now as general guff in glossy leaflets of every care trust keen to show they are ‘on message’ (another awful phrase). The problem is that the abuse and bastardisation of these words is managed by PR (from you, Jeremy via  slick in house (in Trust) press officers and chief execs down to the front line)  and  so cannot be truly owned by front line care staff. Does it really work to be told – ‘you need to be compassionate’? Of course not. How patronising!  How dare you use that word to me, Jeremy! Are you the guru I admire on whose every word I would hang? No. There are one or two people in the world who could say that to me. I won’t name them but I can tell you they are people who have lived out a certain option in life, made sacrifices and lived with an admirable humility. They have lived, loved laughed and cried with the most vulnerable and dedicated their lives to that.  It is that experience that gives life and meaning to compassion. It is the daily experience building meaningful and mutually nourishing relationships (however transitory) over years and in making ourselves open (vulnerable) to making real connections that builds a true understanding of the meaning of compassion. Even then I’m not sure that is the right word. As an ‘A’ Level Latin Scholar (don’t tell your pal Michael Gove it was only an E Grade) I have gone back to the original meaning.  ‘Cum Passus’  – Literally ‘Suffering with’. It’s much more than holding hands, Jeremy.  I have thought a more appropriate word you are after is in fact ‘Communion’ – Literally ‘Union with’.  (Now don’t panic, Jeremy, – or should I say ‘Calm down, dear’-  just because it’s got the word ‘union’ in it). Being with those we care for, acknowledging the daily human encounter we are gifted every day, being able then to see beyond the shell of the broken body may go some way to equipping us with real compassion.  Front line staff need support to  get to that point and I’m afraid you’re not it, Jeremy.   I cannot swallow a call to compassion from a career politician.  You might want to start thinking of a few more C’s because you are wearing that one out before anyone gets a chance to really embed it into their culture.  I guess you’ve only got until next May.