An independent commission has been set up by the NHS Confederation, Age UK and the Local Government Association (LGA), with a view to improving dignity in care for older people.
A draft report, published by the commission, is calling for ‘fundamental changes to culture, leadership, management, staff development, clinical practice and service delivery’. Co-chairing the commission is NHS Confederation chair, Sir Keith Pearson, Age UK chair Dianne Jeffrey, and chair of the LGA’s Community Wellbeing Board councillor, David Rogers. There are nine additional commissioners including representatives of patients and residents, experts from the worlds of nursing, medicine, and management of health and social care services. In a joint foreword, the three co-chairs commented: “Like many others, we have been deeply saddened by reports highlighting the undignified care of older people in our hospitals and care homes. In too many cases, people have been let down when they were vulnerable and most needed help. We want this report to be a call to arms to the whole health and social care system. We need to work together to earn back public confidence. We know there are some hospitals and care homes providing great care, and we need to learn from them to get dignified care right for every person, every time. “Solving the problems will require the consistent application of good practice and the rooting out of poor care. But we also need to trigger a major cultural shift in the way everyone in care thinks about dignity to ensure it is personcentred and not task-focused. This will require empowered leadership on the ward and in the care home, as well as in the boardroom. It will mean changing the way we recruit and develop staff so they have the right values as well as skills.” The report outlines the following recommendations:
• Freeing the ward sister from command and control management is crucial to ensuring that older patients are treated with dignity and respect. They should feel they have the authority and responsibility to show leadership over everything that happens on their ward, and take the action they deem necessary in the interests of patients.
• Feedback from patients and their families should be discussed and responded to on the ward every day and by hospital boards at every meeting.
• In addition to recording physical and mental health needs, staff undertaking assessments should take time to understand and record the personal preferences of older people and their families and carers, so they can care for the person as well as the patient.
• Universities and professional bodies responsible for preparing the health and care workforce must recruit for compassionate values as well as skills.
• Language which denigrates older people should be as unacceptable as racist or sexist terms. Hospitals and care homes should not tolerate such language and should make this explicit in their policies and practices.
• The new NICE quality standard for patient experience in adult services, which includes dignity, should be used by providers, commissioners and regulators across health and social care to provide a consistent standard by which to define and measure performance.
• Commissioners should set out in their contracts the dignity standards they expect, and ensure the service providers regularly report on progress in meeting them.
• Individual staff should be required to challenge at the time practices they believe are not in the best interests of the people in their care, and help colleagues understand how their interaction with a patient or resident could be improved.
• The Government needs to take a lead by setting a positive tone for debate about our ageing society, celebrating the contribution that older people already make and seeking to build on this, rather than casting them as a problem to be solved.
