Call to improve dignity of care for older people

Independent Commission issues 'call to arms' on improving dignity of care of older people in hospitals and care homes

NHS Confederation, Age UK and Local Government Association join forces in a bid to get it right for every person every time

The care of older people needs fundamental change so that hospitals and care homes stamp out undignified care and ensure all patients and residents are treated with dignity and respect.

That is the message from the Commission on improving dignity in care for older people, an independent body set up by the NHS Confederation, Age UK and the Local Government Association (LGA).

The Commission today publishes a draft report for consultation that recommends 'fundamental changes to culture, leadership, management, staff development, clinical practice and service delivery'.

The report aims to identify ways of ending the persistent failings across the health and social care system after years of reports exposing severe shortcomings.

Co-chairing the Commission is NHS Confederation Chair Sir Keith Pearson, Age UK Chair Dianne Jeffrey CBE DL, and Chair of the LGA's Community Wellbeing Board Councillor David Rogers OBE.  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.

The Commission has spent eight months reviewing and gathering  evidence, taking written submissions from some 40 organisations, holding three days of public hearings, and getting advice from academic, medical and nursing reference groups.

Its report, Delivering Dignity, published today for a one-month consultation, stresses that there are many hospitals and care homes providing high quality, dignified care to older people.  

In a joint foreword the three co chairs say: "Like many others, we've been deeply saddened by  the 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 person-centred 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.

'We have to do much more to listen and respond to patients and residents. The care system must  bar the way to prejudice, and keep our services free from language that belittles older people  and causes them to be seen as a burden. Hospitals and care homes should be beacons to the rest of the community, demonstrating how we are all the richer when older people are respected, valued and celebrated.

'Achieving all this will mean changing the way we design, pay for and monitor services that provide dignified care as the numbers of  older people in care continues to grow.'

The three organisations are working on a joint action plan to persuade all those involved in the provision, commissioning and monitoring of care to take up the Commission's final proposals.

They aim to seek support from national and local health and social care leaders to make dignity an equal priority alongside safe and effective care; spread best practice across hospitals and care homes; help older people and their families understand what they have a right to expect; and help frontline staff to recognise and take responsibility for high standards.

Following the publication of the report, the chairs of the Commission will be writing to every hospital trust board and all the major care home providers to highlight the recommendations and invite them to respond to consultation.

Recommendations for hospitals include:

• 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. Hospitals should give staff the time to reflect on the care they provide and how they could improve; this is an essential part of giving good care.
• 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.

Recommendations for care homes include:

• Residents and relatives should be involved in the running of their care homes. All care homes should provide a residents' charter, have a residents' group, and ensure that the recruitment of staff involves a demonstration of how candidates interact with residents.
• The status and role of those working in the care sector needs to be elevated so they feel valued and supported in their day to day work. The Government should establish a Care Quality Forum to look at all aspects of care home staffing, including  pay, qualifications, recruitment and regulation.
• Care home managers should be recognised as experts in their field. They have demanding jobs, leading and motivating teams of relatively low paid staff doing difficult work. Care home providers should invest in support and regular training for their managers. Local authorities have an important role to play in facilitating this as commissioners of care.

Recommendations affecting hospitals, care homes and the whole care system include:

• Universities and professional bodies responsible for preparing the health and care workforce must recruit for values as well as skills. They must satisfy themselves that applicants have both the academic qualifications and the compassionate values needed to work with older people.
• Language which denigrates older people has no place in a caring society and should be as unacceptable as racist or sexist terms. Hospitals and care homes should not tolerate this 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 - who pay for, and plan services - 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.

Download the full report (PDF 756KB)

-ENDS-

Media contact: Natalie Owen
Email: natalie.owen@ageuk.org.uk 
Direct line: 0203 033 1438
 

Notes to editors

1. The Commission aims to complement the work of the public inquiry regarding Mid Staffordshire NHS Foundation Trust.  The public inquiry's terms of reference focus on regulatory and supervisory issues where as the commission has focused on organisations providing and commissioning care.

2. The commissioners are :
• Sir Keith Pearson, Chair, NHS Confederation (co-chair)
• Dianne Jeffrey CBE DL, Chair, Age UK  (co-chair)
• Councillor David Rogers OBE, Chair of the LGA's Community Wellbeing Board (co-chair)
• Hugo Mascie-Taylor, medical director, NHS Confederation
• Lise Llewellyn, Chief Executive, NHS Berkshire East
• Professor Heather Tierney-Moore OBE, Chief Executive at Lancashire Care NHS Foundation Trust
• Jenny Owen CBE, Deputy Chief Executive/Executive Director Adults Health and Community Wellbeing, Essex County Council
• Martin Green, Chief Executive, English Community Care Association (ECCA)
• Professor Trish Morris-Thompson, Chief Nurse, NHS London
• Dr Elizabeth Kendrick, GPwSI Older people and Chair End of Life Clinical Innovation Team NHS North East, County Durham & Darlington NHS Foundation Trust
• Gillian Buck, service user representative
• Catherine Westcott, service user representative

5. Further information on the commission can be found at  www.nhsconfed.org/dignity 

6. The NHS Confederation represents all organisations that commission and provide NHS services. It is the only membership body to bring together and speak on behalf of the whole of the NHS.  We help the NHS to guarantee high standards of care for patients and best value for taxpayers by representing our members and working together with our health and social care partners. We make sense of the whole health system, influence health policy and deliver industry-wide support functions for the NHS.
 
7. Age UK is the new force combining Age Concern and Help the Aged, dedicated to improving later life. We provide free information, advice and support to over five million people; commercial products and services to over one million customers; and research and campaign on the issues that matter to people in later life. Our work focuses on five key areas: money matters, health and well being, home and care, work and training and leisure and lifestyle. We work with our national partners, Age Scotland, Age Cymru and Age NI (together the Age UK Family), our local Age UK partners in England and local Age Concerns. We also work internationally for people in later life as a member of the DEC and with our sister charity Help Age International.

8. The Local Government Association is made up of six organisations that work together to support, promote and improve local government. These are Local Government Leadership; Local Government Association; Local Government Improvement & Development, Local Government Employers, Local Government Regulation and Local Partnerships.

9.  Contact Francesca Reville 020 7074 3312 (NHS Confederation); Cherie Willers 0207 664 3120 (LGA); or Natalie Owen 0203 033 1438 (Age UK)  For out of hours media enquiries, please call the NHS Confederation duty press officer on 07880 500726.