The United Kingdom has recently been rocked by a series of reports and scandals relating to the care of patients in hospitals and in care homes. The independent inquiry in 2010 led by Robert Francis into the failings of the Mid Staffordshire hospital followed by the Public Inquiry reported in 2013 make for painful reading. The statistics – up to 1200 preventable deaths – are shameful, but it is the personal stories that truly shock us. The relatives’ accounts of the degradation, neglect, callousness and even cruelty experienced by patients create a picture of a living hell. How did it come to this? How did the healthcare professionals so comprehensively lose their moral compass and eschew their fundamental duty to care for and protect their patients from harm and unnecessary suffering? How on earth can we make sense of it all? Above all, how can we learn from this, such that the words ‘never again’ do not ring hollow in a few years time? It is sobering to reflect that a Public Inquiry report in 2001 on failings of a hospital paediatric cardiac unit identified similar problems – a targetdriven closed culture, with command and control management and lack of resources as key issues. As in the Francis report, a shift to an open no-blame culture was mandated. It is clear that the prioritisation and focus on financial and managerial targets rather than patient safety and well-being were contributory factors to the Mid-Staffordshire tragedy. This was combined with weak or coercive leadership and insufficient or poorly trained staff creating a culture where flaws were hidden or ignored, bullying was rife and patients suffered grievously. Staff members described a climate of fear. Those who had the courage to speak up were ignored or even punished. Those retaining a professional ethic describe suffering intense moral distress. The gap between their moral vision and their actions – what they were actually able to do in the harsh circumstances – became wider by the day. Some gave up and left, and others became inured. The brutalised became brutalising. Compassion can be described as a deep awareness of the suffering of another coupled with a commitment to relieve it. It is a complex mentality that includes awareness, perspective taking, distress tolerance and a motivation to relieve suffering. In the neuropsychology account, humans have three emotional regulation systems: the affiliative or compassion system linked to our attachments and our capacity for nurturing and soothing, the incentive system and the threat system. The latter, key to our evolutionary survival, is by far the most easily activated and the most powerful at times of stress. Crucially, fear shuts down our capacity for compassion. We are hunkered down in a self-orientated survival mode, our attentiveness is narrowed and our creativity reduced. If we are distressed, tired or overwhelmed, our capacity to cope is weakened and our compassion and clinical effectiveness impaired. Another very important finding from social psychology is our tendency to conform to authority, even if malign and contrary to our values. Neuroscientists such as Damasio have synthesised a model that integrates emotions with our values, moral decisions,