Dignity in health and social care

There has been a lot of talk about dignity lately - politicians, charities, even celebrities are talking about it. Policies, projects and legislation in health and social care are rarely discussed without reference to the concept. But what do we mean when we talk about dignity in health and social care?

Dignity runs the risk of becoming a buzzword - for despite all the high-level activity, what dignity means in practical terms is often lost. If the NHS is to deliver dignity to all, it is equally essential that people on the front line and those running healthcare organisations understand what they mean when they say “dignity in care”. But it is almost impossible to define and people will have different understandings of the word.

In our eyes dignity is the outcome of high quality care across the board; it is the end of the care, but achieving it requires a shift in the means by which we deliver care.

Tales of older people left in pain, ignored, or distressed by a lack of privacy emerge so often they cannot be dismissed as isolated cases. It is clear many older people suffer routine lapses of dignity in care.

Yet for this largest group of health and social care service users, it is of paramount importance. So what do older people mean when they say they want to be treated with dignity?

To effectively monitor and assess the dignity of older people using health and social care services, Help the Aged research has identified nine important criteria: autonomy and choice; communication; eating and nutrition; end of life care; pain management; personal care; personal hygiene, bathing and using the toilet; privacy; and social inclusion.

Although there is no shortage of guidance available on what good quality care looks like in many of these nine areas, it is not routinely implemented or monitored. Barriers may include lack of resources (either people or equipment), inappropriate performance management systems encouraging the wrong kinds of behaviour, or simply insufficient training for staff.

Practical steps to promote dignity in care

There are no quick fixes. But there are many simple, practical steps that can have a huge impact.

Gowns that do not gape and pegs clipping curtains together when a person is receiving intimate care can make a huge difference. Identifying those who need special assistance with their meals - providing appropriate help and support with opening packaging and placing food close enough for a person to reach - are all small steps towards better nutritional care.

The importance of communication can never be underestimated. Speaking clearly, writing down instructions and information as necessary, ensuring someone understands what to expect of treatment and how it is progressing should be core practice.

Going to the toilet is often a taboo subject. However, for many older people, not being helped to go when they need to can result in the demeaning and unjustifiable experience of lying in soiled bedclothes. Staff need to be aware that assisting individuals with such intimate care is not optional but essential.

Improved assessment and management of pain must also be at the heart of any effort to improve dignity in health and social care settings. Too often pain is assumed to be a natural part of the ageing process - nearly five million people aged 65 and over are in some degree of pain or discomfort. Yet research shows health and care staff routinely fail to ask about or treat pain in older people.

We are not claiming these kinds of practical behaviours and activities are new. Nor will they alone ensure dignity in care. But we do know that looking out for the dignity of the individual is not consistently occurring.

Help the Aged and Age Concern have both supported the Royal College of Nursing in developing resources to reinforce in nursing teams the kind of care which maintains dignity. But we recognise nurses do not work in a vacuum. The physical environment, the support from the team around them and management priorities all affect their ability to ensure dignity.

Away from the front line, we need clarity in how all the aspects of care in our dignity framework are prioritised and progress is monitored. Forthcoming quality accounts must include measures for each of these aspects of care. Only when there is commitment to ensuring dignity in care at all levels, from the wider clinical community, hospital managers and the boardroom to policy makers and parliamentarians, will we make sustained progress in this persistent but often misunderstood issue.