An ‘Empathy in Public Services Bill’?
Our research strongly suggests that the most oppressive traumas[1] experienced by the majority of families with disabled children – result from the behaviour of public services: traumas caused by the actions of Children’s Services, Education and the Health Services. All too often these systems are the antithesis of being ‘person centred’, ‘joined up’ and ‘proactive’.
These are systems that have been described as ‘risk averse’ rather than ‘risk sensible’:[2] systems that focus on ‘budgets’ not ‘cost’: systems designed to manage demand rather than quality[3] – and in consequence, they are incredibly inefficient. If staying within budget (say the housing Disabled Facilities Grant[4] budget or the disabled children’s services budget[5] or an NHS Continuing Care budget[6]) results in an utterly disproportionate and massive ‘hit’ on some other budget (such as the ‘looked after children’ and legal budgets), so be it. Managers don’t get promoted ‘for putting their organisation’s interests second’.[7]
In this Looking Glass world, where it has proved impossible to wean organisations off their obsession with ‘budgets’, how can we begin to detoxify these deeply unpleasant systems?
Listening to families might be a sensible place to start – they experience, first hand, what the systems can do – for good and bad. They are intimately aware of the painful detail and the bigger picture: they are possessed of decades of knowledge and policy memory.
In my experience, when asked “what needs to change?”, many families start with a plea for ‘kindness’ and for an appreciation of the highly stressful, undignified, and traumatic nature of their many interactions with public services.[8] Why can’t all practitioners who have contact with families with disabled children ‘be kind’; why can’t they express empathy?
Well, a great (open access) paper on this question has just been published – jointly authored by scholars at Manchester Metropolitan University and Sheffield University.[9] Their underpinning research sought to explore kindness in the lives of family carers and adults with learning disabilities – and involved interviews with family carers. The paper identifies (among much else) the vital importance of ‘embedding a socially just, cultural politics of kindness[10] in health and social care services and systems that are entangled with the lives of carers and adults with learning disabilities’.
The paper is replete with powerful insights. For example, of how, on the one hand, for some practitioners ‘emotional distancing and learning to care less about … clients can become a way to cope in increasingly pressurised environments’[11] but on the other hand, how for other practitioners ‘acting with empathy and kindness [can become] a form of resistance within the workplace, a way to fight back and promote social justice despite the constraints imposed by austerity and neoliberalism’.[12]
It’s a great paper and it deserves reading and re-reading. And like all great papers it gets one thinking. For me this included a thought about the possibility of encouraging an MP to introduce a Private Members Bill with a title such as ‘The Empathy in Public Services Bill’. An idea that I then ran past some of my political/social policy colleagues. In response, and without exception, they all did their best to supress a giggle: that, in effect, it was hopelessly naive to even contemplate that the pursuit of ‘kindness’ would be something Parliament would wish to endorse – which begs the Elvis Costello question: “What’s so funny about ’bout peace, love and understanding?”.
If it is simply impossible to get public bodies to share budgets, to be proactive, to have systems that actually walk the walk of ‘person centred practice’ – why is it so absurd to make the simple ‘ask’ that practitioners and their managers be a little kinder? We all know of practitioners who do this – and the research paper highlights the immense value of these ‘moments of connection and kindness’; how families value being listened to, and of their desire to be ‘heard and seen … celebrated, not ignored or hidden away’[13] and much more.
In discussing this idea with families, some have expressed the view that kindness is not enough: that honesty is also of crucial importance. Families who remember (for example) how they were told by a kindly practitioner that their child did not have specific therapy needs, even though the practitioner must have known full well that was not true: but they also knew that the particular service would not be available. Had families been told the truth, they could then have found some way to get the support (crowdfunding, going private etc) and saved their child from a lifetime of living with a profound impairment.
Can Parliaments legislate for ‘good behaviour’ or are they only able to prohibit the bad?
Well, the Health Act 2009, section 2 and the NHS Act 2006, section 1B both require healthcare practitioners to ‘have regard’ to the NHS Constitution,[14] including the principle that ‘[r]espect, dignity, compassion and care should be at the core of how patients and staff are treated’.[15] In addition, certain health and social care practitioners are also subject to a limited duty of candour[16] – but largely confined cases of ‘when things go wrong with care and treatment’ – and the Westminster Government is proposing to enact further duties of this kind. These are, however, ‘reactive’, ‘incident ‘focussed’ duties, largely to address high profile healthcare / police cover-ups – such as the Hillsborough and the Mid Staffordshire NHS scandals. These existing and proposed duties are attempts to create seriously dissuasive penalties for certain practitioners (front line through to board rooms) for whom to ‘cover up’ has historically been the default option. All the evidence suggests however, that behaviour of this kind is hard wired into domestic institutional cultures. In 2013 Robert Francis QC in his Mid Staffordshire NHS Foundation Trust Public Inquiry Report observed that lurking within institutional systems was an ‘instinct which, under pressure, will prefer concealment, formulaic responses, and avoidance of criticism’.[17] His report was followed by the 2014 ‘duty of candour’ regulations – since when we have had the Contaminated Blood scandal, several (and on-going) Maternity Hospital scandals, the Post Office scandal and (sadly) many more.[18]
Without in any way questioning the importance of ‘duty of candour’ provisions backed up by serious individual sanctions, a strong argument can be made for a parallel and a simple ‘Empathy in Public Services Bill’: a Bill that nudges, is proactive and general in scope. A Bill that addresses the immense harm experienced by families: the trauma generated by current social welfare systems. A Bill that (to cite colleagues at Manchester and Sheffield), supports the many wonderful practitioners for whom ‘acting with empathy and kindness [can become] a form of resistance within the workplace, a way to fight back and promote social justice despite the constraints imposed by austerity and neoliberalism’.[19]
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[1] L Clements & A L Aiello Systems Generated Trauma: when asking for help causes harm (Cerebra 2025).
[2] E Munro The Munro Review of Child Protection: Final Report (Department for Education, Cm 8062, 2011) pp. 124, 134 and 135.
[3] ‘focusing on cost drives costs up. Managers need to learn to focus instead on value’. J Seddon, Systems thinking in the public sector Triarchy Press, 2008, p52
[4] L Clements and S McCormack Disabled Children and the Cost Effectiveness of Home Adaptations & Disabled Facilities Grants: a Small Scale Pilot Study (Cerebra 2017).
[5] See for example the case of Bournemouth, Christchurch and Poole Council v Mother & Ors [2025] EWFC 78 (B) considered in my posting ‘Disabled children 3 times more likely to be the subject of safeguarding’ (2 December 2025 ‘Disabled children 3 times more likely to be the subject of safeguarding’.
[6] See for example my posting A disregard for the humanity of those involved 18 July 2025.
[7] As one manager explained, during the above research (see endnote 4 above).
[8] Draft Guidance: Assessing the Needs of Disabled Children and their Families (University of Leeds, 2023). The Guidance results from a series of consultations with English Parent Carer Groups (parents caring for disabled children) facilitated by Professor Luke Clements and Dr Ana Laura Aiello and funded by Research England 2023.
[9] F Ribenfors, M Smith, K Runswick-Cole & S Ryan Kindness and curious kinships in the lives of family carers of adults with learning disabilities International Journal of Care and Caring 2025.
[10] Ibid – the paper contains a fascinating section ‘Curious kindness and kinships of care’ – hence the kin is italicised in this section – which explains ‘[t]hinking kindness means rethinking kinships’.
[11] In this context, the authors cite Grootegoed, E. and Smith, M. (2018) The emotional labour of austerity: how social workers reflect and work on their feelings towards reducing support to needy children and families, The British Journal of Social Work, 48(7): 1929–47
[12] In this context, the authors cite Hill, D. and Laredo, E. (2020) The personal is political: reframing individual acts of kindness as social solidarity in social work practice, European Journal of Social Work, 23(6): 969–79.
[13] F Ribenfors, M Smith, K Runswick-Cole & S Ryan Kindness and curious kinships in the lives of family carers of adults with learning disabilities International Journal of Care and Caring 2025.
[14] Department of Health and Social Care The NHS Constitution for England 17 August 2023.
[15] Principle 3.
[16] Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 reg 20,
[17] Robert Francis QC Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Volume 1: Analysis of evidence and lessons learned (Part 1) HC 898-I The Stationery Office 2013 p.183
[18] See for example, K Dewsnip A Duty of Candour? The Government’s new Proposals Examined The Constitution Society 9 August 2024; S Gardiner, D Morrison & S Robinson Integrity in Public Life: Reflections on a Duty of Candour Public Integrity (2022), 24: 217–228; E Warren, E Cyhlarova et al The contaminated blood scandal in England: exploring the social harms experienced by infected and affected individuals Health Economics, Policy and Law. 2025;20(4):381-396, Judith Smith, Naomi Chambers Mid Staffordshire: a Case Study of Failed Governance and Leadership? Volume90, Issue2 April–June 2019 Pages 194-201; Blundell, D., & Elliot, K. (2024). The Government’s Proposed ‘Hillsborough Law’ – Drawing the Materials of Future Wisdom from the Errors of the Past? Judicial Review, 29(3), 169–181.
[19] See endnote 12 above.
Posted 15 January 2026