Taking action on dignity standards

Dianne Jeffrey CBE DL, Chairman of Age UK and Co-chair of the Commission on Dignity in Care
Dianne Jeffrey CBE DL, Chairman of Age UK

This blog was contributed by Dianne Jeffrey, Chairman of Age UK. 

Dignity Action Day was a great opportunity to raise awareness of people’s rights to dignity in care.

Dignity in care is an important and widely discussed concept, but it is often hard to pin down its exact meaning.

To me, dignity is about treating people in care with respect and courtesy – treating them the way they want to be treated. Continue reading “Taking action on dignity standards”

Government responds to the Francis Inquiry

The first inquiry into Mid Staffordshire NHS Foundation Trust  catalogued extensive examples of neglectful care and appalling patient experiences. Stories of people being ignored, dehydrated, abused were visible signs of an organisation that had forgotten basic principles of care and at worst, wilfully put organisational considerations ahead of patients. Many, if not most, of the patients involved were older people.

The second inquiry reported in February and included 290 recommendations
that could help to avoid the same situation arising again, not just in Staffordshire, but throughout the NHS. You can see what we said about it in our blog. 440x210_care_home

The government yesterday gave its response to the report in a paper titled Patients first and foremost, and there’s much to be positive about in what it says.

The paper outlines changes to how services are regulated, reflecting an on-going review by the health and care regulator the Care Quality Commission (CQC). It describes much wider use of expert inspectors in hospitals including members of the public that bring expertise derived from their experience of care. Continue reading “Government responds to the Francis Inquiry”

Working together to support older people

The Autumn Statement announced bleak growth figures and more cuts ahead, reminding us all, once again, we face hard times and unprecedented and prolonged pressure on public services many of which older people rely.

This is why now, more than ever, we all need –  the government, public, private, and voluntary sectors and individuals – to work together to meet the challenges and maximise the opportunities our growing ageing population presents.

Age UK, together with our national and local partners, is playing its part. In 2012 we reached over 7 million older people with our information and advice services, our handy person service visited nearly 14,000 homes and we helped more than 65,000 older people keep active and healthy through our Fit as a Fiddle programme. In tough economic times we understand supporting people in later life to make informed choices and maximise their wealth, health, independence and wellbeing is important for the individuals and helps drive down inefficient and unnecessary costs in our public services. Continue reading “Working together to support older people”

Dying in hospital and the Liverpool Care Pathway

There has been a great deal of press interest recently in the Liverpool Care Pathway for the dying patient (LCP). It has been described in more colourful language, which I will return to later, but I should start out by explaining what it is – and just as importantly what it isn’t.

The LCP was developed in the late 1990s by a hospital in Liverpool and a local Marie Curie hospice. The aim was to bring high-quality hospice care for cancer patients to hospital settings. Later, this was expanded to non-cancer patients and has been adopted by a large number of hospitals throughout the NHS and other countries.

Why was (and is) this necessary? Modern hospice care emerged in the 1960s out of a desire to improve the experience of dying for terminally-ill patients. Hospitals are traditionally very good at delivering curative care, but do less well at caring for people whose greatest need is to be as pain-free and as comfortable as possible, and to have the reassurance that their families are supported to prepare and come to terms with a loved-one passing away.

The reality today is that the majority of people are in hospital when they die.  Though the circumstances may vary – for example they may have been recently admitted as an emergency, or they were being treated for an illness that they may not recover from – past reports have shown that poor experiences can be very similar.

Continue reading “Dying in hospital and the Liverpool Care Pathway”

The NHS must do more to help patients have a good death

Death is often said to be the last taboo, despite being the one event that we all have coming to us at some point. Talking about dying can be very difficult for many people, not just the individual and their loved ones but also medical professionals who may be equally uncomfortable approaching such a sensitive topic or regard death as the ultimate failure of their skills.

The NHS has over its lifetime played perhaps a leading role in this country in bringing up life expectancy to the point where  of the  nearly  half a million people who die annually, around four fifths are over 65 and two thirds are 75 plus. The major workload of the NHS has changed from treating working age adults with single acute problems to treating patients in later life – about of every ten patients in hospital around 6 will be over the age of 65. In later life, patients are more likely to be frail or living with more than one serious condition and so require a different  approach to their care.

The recent national confidential inquiry into perioperative deaths (NCEPOD) showed that the  NHS has yet to grasp universally that its success in making sure that most of us don’t die before we get old requires a rethink of its medical model and how it approaches care.

According to the report less than a third of acutely ill patients admitted to hospital got good care when they had a cardiac arrest. Whilst the report did not solely focus on older patients, the vast majority were over 65 and the mean age of people in the study was 77. And most people had at least one co-morbidity.

In nearly half of the admissions, patient assessment was deficient and in over a third of cases did not pick up warning signs that the patient was deteriorating and might arrest. Better training and understanding of geriatric care would, we believe, help medical staff to see beyond the immediate presenting problem and understand that an older person is likely to have other serious underlying medical issues, helping to better anticipate deterioration. All health professionals need to have the skills required to deliver healthcare in the 21st century. Continue reading “The NHS must do more to help patients have a good death”

Guest Blog: Dignity in Care – so have we any solutions?

This guest blog was contributed by Brendan McCormack, Professor of Nursing Research from the University of Ulster, Northern Ireland and a trustee of Age UK.  

The Commission on Dignity in Care is well into its programme of work.  As the Chair of the ‘Academic Reference Group’ I had the pleasure of being in attendance for one of the ‘oral evidence’ sessions, which had a primary focus on evidence-based tools and processes that would help ensure dignity in care.

I take away some impressions that are largely positive but which also raise some challenges to the way forward.  The evidence presented highlights reasons why we need to be focusing on dignity (even if many of us regret that we are still needing to do this given the developments that have happened over many years of service improvement work).   Some reflections from me on the evidence are presented here.

Firstly, throughout the day, a number of new models that are influencing the way care cultures in hospital and LTC facilities are developing and being transformed, locate themselves within models of relationships.  The most significant of these is that of ‘relationship-centred care’ which is sometimes presented as an advancement of person-centred care.  Some of the problems with this claim relate to the way in which person-centred care is defined, particularly when the dominant discourse of person-centred care as being about individual choice, autonomy and rights.  At the level of values and principles, relationships are only 1 key component of personhood and person-centredness.  However they are not the only part and thus relationships have to be placed alongside other characteristics of personhood, such as – space, place, aspects of ‘self’, existential time and issues associated with human rights and dignity.  However, irrespective of these conceptual issues and challenges, we can never deny the importance of relationships in all of our lives. 

The second issue relates to the importance of interdependent relationships.  The idea of seeing care relationships as interdependent is hugely important and reinforces my own position (adapted from the philosopher Margaret Meade), i.e. ‘that I as a nurse can learn as much from a patient/resident as a patient/resident can learn from me’.  The idea of interdependence raises significant and important considerations about multiprofessional working that seemed to come in and out of conversations today.  We all accept that the only way that the cultures of care settings can change is through a concerted multiprofessional effort.  Thus the challenges associated with enshrining dignity in all our work is not just a nursing issue.  It is my view that the Royal Colleges, National Associations and Unions can take a significant and lead role in ensuring that all professionals see this as a priority.

Thirdly I believe we need to stop saying that we ‘can’t measure dignity’ – because we can.  But to do so requires creativity and embracing of evaluation methodologies that are not the common parlance of health service managers nor indeed the majority of health service researchers.  A pluralistic approach to measurement and evaluation is needed – approaches that integrate staff and service user voice with survey data as well as observations of practice.  Additionally, we need to be more open to proxy measures of dignity and embrace them as key indicators of a complex phenomenon. 

Finally, I believe the evidence presented made it strikingly clear that one cannot think about having dignified care for patients/residents if staff feel demoralised, put upon, not valued and disenfranchised.  The need to develop ‘nudges’ to changes practice that are locally developed, owned by practitioners and embedded into the everydayness of practice is paramount.  The holders of a workplace culture are the staff set within a macro culture of regulation, policy and economics and so we ignore the need to develop effective workplace cultures at our peril.

So yes, I believe we do have solutions that are informed by international evidence, are locally grown and are shown to be effective.  What we need now are levers for change that ensure that executive leaders cannot ignore these solutions whilst they are lured by quick-wins and short-termism.

Find out more about the Dignity in Care Commission

Read the Terms of Reference for the Commission