The Commission on improving dignity in care was established as part of a joint initiative from the NHS Confederation, Age UK and the Local Government Association (LGA), to help improve dignity in care for older people in hospitals and care homes. The Commissioners include representatives of patients and residents, experts from the world of nursing and medicine, and management of health and social care services.
The focus of the Commission:
The Commission has been trying to understand how and why older people's care is failing on dignity and what will drive improvement.
Understanding the problem and the need:
- understanding the extent and root causes of the failure to provide appropriate levels of care to older people and the aspirations of older people and their families in terms of care provided.
Establishing what really works:
- collating existing tools and guidance that support improved levels of care for older people and identifying good practice examples across the health and social care system.
Driving change and improvement:
- developing practical, long-term solutions to help tackle the underlying causes of undignified care.
Draft report and recommendations:
On 29 February 2012, the Commission published its draft report and recommendations for public consultation. The draft report sets out ten key recommendations for hospitals and ten key recommendations for care homes to help them tackle the underlying causes of undignified care, as well detailed recommendations on the changes the Commission believes need to take place across the wider health and social care system.
Any organisation, individual or member of the public is invited to feed in their views. The Commission will use the feedback that it receives during the consultation to help inform its final report scheduled for publication by summer 2012.
The last thing the Commission wants to produce is a report that generates more noise than practical action, so with Age UK and the LGA, it will publish a long term action plan alongside the Commission’s final report that will focus on working with its members and partners across health and social care to deliver the Commission’s recommendations.
Evidence submissions:
The draft report draws on the body of evidence that the Commission has been gathering over the past eight months, including written evidence submissions from over 40 organisations, three days of public hearings and expert opinion from academic, medical and nursing reference groups.
Why this Commission was set up – making change happen:
This Commission was established following the publication in February 2011 of Care and Compassion?, the report by the Parliamentary and Health Service Ombudsman, Ann Abraham, which exposed shocking failures in the care of older people. It was the latest in many years of reports identifying what is wrong with the level of dignity in the care of older people and saying what service they should receive.
These include Defending Dignity: at the heart of everything we do, a Royal College of Nursing campaign in 2008, the Nursing & Midwifery Council’s Guidance for the Care of Older People in 2009, Patients not Numbers, People not Statistics by the Patients Association and Counting the Cost: caring for people with dementia on hospital wards from the Alzheimer’s Society in the same year, and Age UK’s Still Hungry to be Heard campaigns 2006-10.
The NHS Confederation, the independent body representing organisations providing and commissioning NHS services, joined with the Local Government Association and the charity Age UK to establish the Commission on Dignity in Care for Older People. The Commission has a good understanding of what the problems are but need to understand why they are persisting and what drives improvement. The aims of the Commission are therefore to understand the aspirations of older people and their families, identify the physical and personal care that older people have a right to expect, establish what works in improving care, and drive improvements across health and social care which secure dignity in care for older people in hospitals and care homes. The recommendations in this report are directed at the system in England but the Commission believes that the key messages will be of value to practitioners in Scotland, Wales and Northern Ireland, several of whom were generous enough to share their expertise with the Commission.
Comments on
The Commission on Dignity in Care for Older People
Delivering Dignity: Securing dignity in care for older people in hospitals and care homes
The Royal College of Physicians of Edinburgh is pleased to respond to the Commission on its report on Delivering Dignity: Securing dignity in care for older people in hospitals and care homes.
The College is supportive of this paper as it considers important challenges for health and social care services as the population ages. It is entirely inappropriate for vulnerable older people to be treated differently, and health and social care professionals have a particular duty to protect the dignity of our older patients when in their care. The College notes there was no consultant in Geriatric Medicine on the group compiling these recommendations and believes this may have been helpful.
Specific comments follow:
- The great majority of older people live in the community, many in their own homes, supported by their families, carers and primary care services. There was very little in the paper addressing the problems faced by older people in society as a whole. Only by addressing the way society views and values ageing will some of the problems of protecting dignity be solved.
- Those older people requiring hospital admission stay longer than their younger counterparts, often due to the additional recovery time. As hospitals struggle to meet new targets and make financial savings, lengths of stay are reviewed critically and doctors come under pressure to discharge early. Inappropriate or early discharge from acute hospital will only lead to an increase in the institutionalisation rates for older people.
- While the Department of Health suggests that 25% of older people can be managed in their own home, this can only occur when the necessary services in the community are in place. There is evidence in the literature that “hospitals at home” and their equivalents and early supported discharge schemes for such conditions as stroke and orthopaedics allow the older person to be discharged home earlier and with better outcomes. However, the College is concerned that financial pressures will force the pace of this change before necessary community services are in place and that the system will fail. Under such circumstances, the acute hospital will remain a place of last resort to protect the safety of vulnerable older people.
- The College strongly supports the recommendation to provide a Comprehensive Geriatric Assessment (CGA) for all older people as it is a proven technique and ensures that older people are not denied care on age grounds alone. Also, chronological age does not equate to physiological age and some older people become rightly upset when they go through an age-related Geriatric Medicine Service. Perhaps targeting the frail older person for CGA is the way forward. However, a CGA is labour intensive and will require additional resources.
- Foot care plays an important part in a patient’s recovery and a shortage of podiatrists contributes to delayed therapy and discharge.
- Following the National Service Framework (NSF) for Older People, the concept of NSF champions developed. The College suggests that these people could be re-engaged as champions for dignity and care of older people.
- Finally, some of our Fellows find the suggestion that discharge summaries are not routinely shared with GPs surprising. It should be standard practice to issue discharge summaries, although the system can be overloaded and the paperwork/e-mail delayed.