Compassionate leadership and the 10 Year Health Plan: addressing moral injury

How can I help?

These are perhaps the most significant four words for any leader in health and social care. They are the foundation of compassionate leadership – a style of leadership that focuses on excellent patient care and enabling a thriving workforce through compassion, inclusion and kindness. There is ample evidence for the impact of this style of leadership in health and social care, including higher quality care, greater patient satisfaction, lower levels of workforce stress and burnout, and improved financial organisational performance.

Those four words ‘How can I help?’ powerfully convey what it means to be compassionate. A compassionate leader takes notice and is present with their colleagues, they listen carefully and take time to understand the issues at hand, they appreciate what it feels like for the other person, and they engage and take action to help address the issues. Basically, they care, and they show it appropriately. This requires courage – leaders must be willing to face difficult truths and engage with the actual and emotional realities of their teams.

The King’s Fund has long supported and advocated for compassion to be front and centre of patient and staff experiences within health and social care. This seems even more imperative now as the health system, and those working within it, face intractable problems. ‘Moral injury’ was Wes Streeting’s choice of words in the 10 Year Heath Plan to describe the effect of these challenges on staff. Those challenges include persistent health inequalities and poor prevention focus, ballooning waiting lists, falling user satisfaction, burnout, low morale, bureaucracy and long overdue system reform, budget gaps and funding deficits.

We were heartened to see moral injury recognised in the 10-year plan. In our work as senior consultants, we witness daily the extent of moral injury experienced by health and social care staff. This recognition is welcome, but it is not enough.

The words ‘moral injury’ are not easily skimmed over, they hit hard. They refer to the psychological, emotional and spiritual harm that arises when an individual experiences a betrayal of their core moral beliefs – for example, when health and social care staff know the ethically correct action but are constrained from taking it due to systemic limitations (staffing, resources, time etc). In 2021, the British Medical Association surveyed its members – 51% said moral injury resonated with their experiences at work. The courage of compassion, The King’s Fund report from 2020, similarly reported on the psychological and emotional effects on clinical staff caused by moral distress and injury – which can cause feelings of guilt, anger and shame and are linked to severe mental health conditions such as depression and post-traumatic stress disorder.

Now, there is nuance here. Compassionate leadership does not excuse leaders from setting clear expectations for those they lead, from upholding standards or from addressing toxic behaviours. Nor can compassionate, inclusive and kind leadership alleviate all the challenges we see in health and social care. Finding a way forward that delivers the health and social care people in the UK need and deserve will take resolve, innovation, time, trust and collaboration across traditional boundaries – professional, organisational, political etc. But compassion is a non-negotiable part of the solution and must be embedded at all levels of the 10-year plan – not just on the front line but in the structures and processes that shape the future of health and social care. Without compassionate leaders showing the way and supporting their teams, the 10 Year Health Plan will be just that … another plan that never took hold.

You cannot wish an entire workforce out of a state of moral injury. Healing requires active engagement with compassion – both self-compassion and compassionate leadership. Compassion must be embedded at all levels of the 10-Year Plan – not just at the front line, but in the structures and processes that shape the future of health and social care. The way we build the future must reflect the future we want to see.

Too often, leadership of the health and social care sector has been modelled on directing, ie, this is what you must do. Leaders have had to show up as authority figures robustly using their power to demand better or else. Or they have had to absent or numb themselves to the experiences of their colleagues in order to keep services going. In our opinion, the lack of compassionate leadership has caused real, traumatic and lasting damage to the health and social care workforce.

Continuing like this will break the system, and it will break the hearts and spirit of so many people committed to providing the very best health and social care. It already is. So, we are advocating for leadership of, and in, health and social care to shift to one of support. If we want compassion to show up, we first need to act with compassion and lead with compassion.

We know the NHS needs to change. We all want it to be better, for patients and for the workforce. So our plea to health and social care system leaders is to ask, ‘How can I help?’. This simple question embodies the essence of compassionate leadership and can help alleviate moral injury.

The King's Fund stands ready to support leaders at all levels in this journey – how can we help?