Smuggling compassion into care: is the NHS destined for system D?

Editorial: Compassion requires emotional connection, role exchange, empathy, experimentation and exploration of people’s world views and experiences, their perspectives on what troubles them beyond the illness label, and a shift of the professional gaze to the person’s location in a social world of relationships and a life-course legacy of risks which include genetics and life events, and current contextual impacts. A remarkable positive consequence is that the practitioner feels that they can perform their professional role with their full range of skills, and without a conveyor-belt culture of processing and outcome measurement, before and after unthinking intervention. The sense that the system we work in is not socially inclusive, and transmits inequity, as only the most able remain engaged and effective consumers, erodes the ethos of professionals. The skill of exploring the personal biographies and narratives of patients requires flexible and reflexive awareness by professionals of their own histories, and therefore connection with the true self rather than alienation from one’s ethos and values. The notion of smuggling ideas, of commodities, of geopolitical and imperial conquests, of romantic piracy all come together to reveal that smuggling is a pretty ordinary part of the informal economy of organisations and societies (Harvey, 2016). All organisations have creative spaces in which people negotiate and resolve shortages of resources, conflicting interests and avoid scrutiny in order to realise what is not attended to or seen as important in formal economies and structures, alternatively known as System D. Should compassion be relegated to the System D in NHS practice, or health care in any country? Surely not