“Dignity Be Damned ” 4

This blog really started two years ago and was revived by the report from the “Commission on Improving Dignity in Care of Older People”.  (Click on “Dignity be Damned” in the TAG CLOUD).

The report was co-authorised by the Local Government Association, the NHS Confederation and AGE UK.  It is well argued and makes a lot of common sense recommendations.

Few would argue with their aspiration to provide better care for the elderly.  However, I am not sure they have fulfilled their stated ambition to “identify the underlying causes of these persistent failings”.  I have commented on what I think should be a more strategic response on my previous blog on this subject.

Meanwhile, here are my comments on their 48 recommendations:-  (Click on the following link www.nhsconfed.org/Documents/Delivering%20Dignity.pdf  if you want to read the full report).

  1. Deliver care at home in the community
    • Absolutely, but you will have to get GPs out and about first, and build shop window style health centres
  2. Make independence at admission and discharge a key measure
    • Good idea – why not pay a bonus for health improvement
  3. Ban patronising language
    • Yes but it’s hardly a top priority so let’s not get all P.C. about it
  4. Comprehensive geriatric assessment
    • It is wishful thinking in these express service NHS days
  5. Nutritional needs
    • A critical failing that will only be solved with more staff, volunteers and relatives
  6. Families, friends and carers
    • Agreed and see above
  7. ‘This is me record’
    • Nice idea so long as it is not turned into a blizzard of paper
  8. Feedback
    • Needs to be monitored by a panel of independent elderly people with a direct reporting line to health boards
  9. Staff take personal responsibility
    • A platitude
  10. Practiced based development
    • Should lead to a new NVQ/Nurse for the elderly qualification
  11. Recruit compassionate staff
    • Another platitude.  Most staff are compassionate, it is the system that needs changing
  12. Dementia training
    • This is essential, there should be dementia nurses at ward sister level on all elderly wards
  13. Devolved leadership
    • This will never happen inside the NHS.  It is a command and control model and probably should stay that way for short-term acute care
  14. Board leadership
    • It is called “walking the floor” but right now they could well get lynched if they ventured onto elderly wards
  15. Ward leadership
    • Will only happen if you reduce paperwork, give them enough staff and empower them to discipline poor performance
  16. Patient/family feedback
    • Who can disagree
  17. Staff reflection time
    • Ditto
  18. Professional duty of care
    • Motherhood and apple pie
  19. Protection of vulnerable adults
    • A toothless, ineffective process that has nothing to do with leadership
  20. Discharge from hospital
    • Should be controlled by community based staff, otherwise the rush to empty beds takes priority
  21. Care home values
    • Not at all clear what this is about
  22. Care Quality Forum
    • If the Nursing Quality Forum has not worked for older people, why would another forum for care work?
  23. A rating scheme for care homes
    • CQC has only just abandoned one
  24. My home life
    • A good process that should be used more widely
  25. Care plans
    • This is already mandatory but too often its use is limited to basic care tasks by pressure of time
  26. Buildings fit for purpose
    • There needs to be massive capital investment to build new accommodation and thereby eliminate old out-of-date residential care homes
  27. Family and friends, carers as partners
    • Of course
  28. Volunteers in care homes
    • Residents themselves are the most valuable and reliable volunteers
  29. More use of technology
    • Yes in principle, but it all needs to be more “elder-friendly”.  SKYPE could open a window way beyond contact with relatives, so could web cams and CCTV
  30. 360° staff appraisal
    • If it is done constructively
  31. Personal responsibility
    • Motherhood and apple pie again
  32. Access to medical care
    • Of course but it only works if doctors will come out of their surgeries
  33. End of life care
    • Agreed
  34. Board role
    • See answer 14
  35. Non Executive Directors
    • Agreed.  It should be routine and regular, not just ceremonial
  36. Invest in training
    • 5% of staff time should be spent on training
  37. Residents’ charter
    • Rarely worth the paper it is printed on
  38. Feedback
    • See answer 8 and also consider suggestion schemes, resident forums and comprehensive annual surveys of residents, relatives, volunteers and staff.  The results and improvement plans should be published.
  39. NHS Commissioning
    • Cost drives their decisions.  I have little confidence they can put a price on dignity
  40. Ditto
  41. NICE
    • All hot air
  42. More fine words
  43. Local advocacy groups
    • A good idea in principle but toothless in practice
  44. Health Watch
    • Community health councils did not work so what will change this time
  45. Universities and professional bodies
    • They already have this responsibility but are ineffective at guaranteeing good performance or compassion
  46. Regulation
    • This has singularly failed to deliver better care and I have long argued that the DoH should refocus CQC’s remit to focus on best practice and training for improvement rather than ineffective policing.
  47. Healthcare Assistant
    • I think there should be a new qualification of second level, mainly practice base ‘nurse for the elderly’, as already operated in Holland.
  48. Care Quality Commission
    • See point 45.  They should also conduct regular customer satisfaction surveys with residents and their relatives

As I said at the beginning, there is nothing much to disagree with here.  It is mainly good practice that is already implemented in the best care homes and hospitals.  The key question is why is it not done everywhere and that will not be answered by greater exhortation.

Who was it who said “two priorities are no priority at all”?  48 recommendations may be a direction of travel but they are a long way from a road map.

The second stage of the Commission’s work needs to start further back at the root causes of the problem.

This entry was posted in HEALTH, N.H.S. and tagged . Bookmark the permalink.

4 Responses to “Dignity Be Damned ” 4

  1. davidwfreeman237 says:


  2. Maureen o'Neill says:

    Whilst I agree with things you have high lighted John, It seems to me that there should be more training for people who care. I am not talking about nurses in hospital but carers in the community. We would appear to be so short of carers that a carer could change her job from cashier or shelf-filler in a store and within couple of days be visiting homes in the company of a carer (trained?) and very shortly after be visiting on their own. They may have the attributes required of a carer but who is responsible for seeing all these people are properly trained or indeed are honest and caring. I am sure most of them are but it would appear that more training is necessary. The care homes which were in such trouble in Bristol is an example of this lack of training. No body has all the answers but the real need is love.

  3. davidwfreeman237 says:

    I see in the Telegraph this weekend 23/24 march 2012, that parliament/Commons are to discuss the subject of Doctors and not palative care, but death and how to do it? This is rather a blunt tool, to a very sensitive subject.

  4. Mimi says:

    It’s really important that Council’s and the NHS work in partnership to use the extra money that’s has just been released in a strategic way to help improve their Intermediate Care services and enable older people to return to their homes from hospital in a speedy but safe manner. The implementation of services such as reablement, equipment provision and Telecare should be one of the highest priorities of all Council’s at present.Council’s shouldn’t just be looking at their own services though, they should be working with the independent sector providers and third sector partners to ensure that they understand these services and modify their own service provision so that they become part of the reablement culture, aiming to help people be independent in their own homes for as long as possible.

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