The changing place of care and compassion within the English NHS: an Eliasean perspective.

Social Theory & Health. 2017. P. 1–16.

Flores R., Brown P.

In the wake of the Francis Report, a public conversation has arisen inEngland about the place of compassion within healthcare settings, particularlyregarding the causes of failures in the provision of adequate healthcare, and thedesirability and possibility of fostering compassion in the NHS. A contribution tothis conversation, this article takes as a starting point an oft-overlooked socio-historical phenomenon: social expectations of compassion in healthcare practicehave shifted in comparison to what was the case at the NHS’s inception in 1948, sothat both healthcare professionals and the public have come to perceive and expectcompassion as an intrinsic component of healthcare. We argue that this expectationcan be partly explained drawing on Elias’s concept of ‘functional democratisation’:as power asymmetries between different social groups (e.g. doctors and patients)have declined in recent decades, so have norms and expectations of compassionatecare increased. Failures to provide compassionate care in som e specific settings canalso be partly un derstood as an outcome of a wider erosion of functionaldemocratisation resulting from the growth in social inequality witnessed in Englandand much of the world since the 1970s. We thus call for addressing failures of carewithin healthcare settings through broader social policies.

Keywords: England, compassion, Norbert Elias, NHS, process sociology, functional democratisation, figurational sociology