Ruw Abeyratne: Health Equality: it starts with self-compassion

A colleague recently described me as having “a relentless commitment to wellbeing”. At first, I was slightly taken aback; I was not immediately convinced that being relentless about anything is what I want to be known for, with its connotations of stubbornness and lacking balance and pragmatism. I would have preferred ‘determined’. But if, as a wise someone once said, “you’ve got to stand for something, or you’ll fall for anything,” I would rather stand firm in my commitment to wellbeing than waver for vanity’s sake. And here’s why.

I am surrounded every day by conversations about how we must be better, how we must improve and how we must deliver more. The energy is inspiring and humbling, the famous ‘good will’ that is the beating heart of the NHS makes me proud to belong to the team. But energy transforms and burns out. Then what? The exhaustion and demoralisation that plagues the NHS workforce is undeniable. It is visible in the unfilled gaps in rotas, audible in the chatter amongst colleagues, in the press and on social media and it is tangible in the air as we emerge from one winter to plan our way to another.

Health inequalities are avoidable differences in health between different groups of the population. If health inequalities are avoidable, are they not also deeply unjust? Why should one group be better or worse off than the next? When I ask colleagues to consider how their services and practice are impacting or worse still, compounding the inequalities that our patients experience, what I am really asking them to do is to recognise injustice.

Our ability to recognise injustice is entwined with our sense of compassion. Compassion is a core NHS value written into the NHS constitution and it is central to achieving health equality for all. But in as much as wellbeing has become an NHS buzz word, so too has compassion. How often have you heard terms such as compassion fatigue, compassionate leadership, compassionate care? All are very real phenomena with the power to influence and transform our collective experience of healthcare but what do they mean? The Compassionate Mind Foundation defines compassion as “a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it”. This makes perfect sense as a practising clinician; those of us entrenched in ‘front line’ care see suffering first hand every day in its many ugly guises.

The crucial point of The Compassionate Mind Foundation’s definition is in the recognition that sensitivity to suffering in oneself comes before sensitivity to suffering in others. When we fail to recognise our own distress and pain, whatever the cause, no matter how incidental, we consume energy in compensating for the injury that is experienced as a result. In the context of the NHS as a workplace, the source of the injury is varied and no single profession or professional can speak for all. But it is consistent in the rhetoric: over-worked, under-resourced. The accumulation of injuries over a whole workforce translates into workforce attrition and high levels of burnout, with well documented negative impacts on quality of care.

In a workforce that is vulnerable to injury and burnout the capacity to recognise suffering and injustice in others’ experiences is not only limited but impaired. Burnout is a workplace phenomenon resulting from unresolved workplace stress, but taking lessons from previous reflections, focusing on what is in our immediate control and influence helps. Placing oneself at the centre of caring for others feels counter-intuitive to the collective energy we share. Counter this though with the argument that while we wait for more; more money, more resource, more people, our patients, especially those most exposed to healthcare injustice are waiting for us to find new ways to transform our individual and collective energy into new ways to care; to create, innovate and deliver equitable healthcare. The journey to achieving this starts with self-compassion.