A DIGNIFIED REVOLUTION
Alone we can do so little; together we achieve so much!
June 2008
Welcome to the June update. This month we have come across two papers that are interesting and very relevant to the issue of dignified care.
The first was published in May 2008 by the NHS Confederation. It is entitled:
Compassion in healthcare: the missing dimension of healthcare
It explores how, despite the scope and sophistication of modern healthcare, care and compassion appear to be under strain in current health systems. It demonstrates this through the story of an anaesthetist and clinical leader in New Zealand, and his daughter’s treatment in hospital after an accident. In traction she could not see who was coming into her room, watch TV or read a book. Neither could she help herself, and had it not been for her family she would have starved.
What is striking is that as a health professional working in the hospital in which his daughter was a patient he was powerless to influence the system and culture that prevailed. This is similar to many of the experiences that health professionals have shared with us.
The account that is given also reflects many of the issues that come to our attention with regard to older people. These appear to occur because patients needs do not seem to have been adequately assessed, nor met.
The author of the paper suggests that compassionate caring is needed (compassionate being defined as a humane quality of understanding and suffering in others and wanting to do something about it). He believes this can only be achieved by effective communication, listening and understanding of patients needs. He also makes the point that we cannot afford not to listen, as there is compelling evidence to show that empathic concern and investing time up front to assess a patient’s needs increases efficiency, safety and patient satisfaction. These are all significant targets that the NHS is currently striving to meet.
The second paper is:
Dignity and the Essence of Medicine: the A,B,C and D of Dignity Conserving Care
This is an excellent paper that makes the point that kindness, humanity and respect, core values of medical professionalism (nursing and other allied health professionals), are too often being overlooked in the time pressured culture of modern healthcare. However, the author has developed a framework to combat this i.e. the A.B,C and D of dignity conserving care.
A = Attitudes – attitude underscores the need for healthcare providers first and foremost to examine their attitudes and assumptions towards patients. Changing attitudes is fundamental to ensuring sustained improvements in communication skills
B = Behaviour – healthcare providers behaviour towards patients must always be predicated on kindness and respect
C = Compassion – refers to a deep awareness of the suffering of another coupled with the wish to relieve it. Compassion speaks to feelings that are evoked by contact with the patient and how those feelings shape the approach to care
D = Dialogue – is a critical element of dignity conserving care . It requires time with patients, something that it is acknowledged to be difficult to measure in performance targets set by healthcare funders
The paper concludes by saying that “for anyone privileged to look after patients, at whatever stage of the human life cycle, the duty to uphold, protect, and restore the dignity of those who seek our care embraces the very essence of medicine”
This brings to mind the Bombay Hospital motto that we have shared previously:
“A patient is the most important person in our hospital. He is not an interruption to our work, he is the purpose of it. He is not an outsider in our hospital, he is a part of it. We are not doing a favour by serving him, he is doing us a favour by giving us an opportunity to do so”
If you would like copies of the above papers please contact us
AN UPDATE ON ACTIVITY
Below is an update of activity for the month of May. We have:
m participated in the Age Concern Cymru Elder Abuse Seminar in May, In Llandrindod Wells. Feedback below
m met with the Help the Aged. We are grateful for their support in circulating information about A Dignified Revolution through their networks
m attended the Denbighshire Dignity in Care and Equalities (DICE) group. More details below
m been invited to join the Welsh Assembly Government Dignity in Care National Co-ordinating Group. This group is being established to advise on the implementation of a 3 year programme of Dignity in Care
m been invited to meet with Ruth Marks, the Older People’s Commissioner for Wales
m been contacted by the Wales Audit Office. They are interested in our work on care of older people and have requested to meet with us
m uploaded our news update on Age Alliance Wales website. Age Alliance Wales is encouraging people to participate in information sharing about improvements in service delivery for older people by placing information on its website. Anyone who is interested in participating should contact martin.pengilley@accymru.org.uk tel: 029 2043 1538
m been invited to speak at a Socialist Health Association (SHA) meeting in Birmingham. SHA have also offered to include information about A Dignified Revolution on their website until our own website is ready
m been contacted by Ken Jarrold CBE who writes a regular column in the Health Service Journal. He has mentioned the work of A Dignified Revolution in an article to be published on 24 June 2008
m been in touch with Patient Opinion. Patient Opinion provides service users with the opportunity to document their hospital experience online. Health Trusts who subscribe are made aware of any experiences that are documented and given the opportunity to respond
Patient Opinion believes that all health services need to hear the voices of their users if they are to improve what they do. Nobody knows better than patients, and their carers and relatives, about what it feels like to use the service – and often, where and how it could be better. Already there are signs that hospitals are making changes to their services
A DIGNIFIED REVOLUTION LEAFLET
Thanks to the Welsh Language Board our leaflet has been translated into Welsh. However, we are currently unable to develop a Welsh language leaflet as the volunteer who assisted previously is unwell. If anyone is able to assist in any way please let us know
CASE STUDIES
We continue to send out copies of our case studies to people in health, local authorities and the voluntary sector and we are aware that people have been made aware of them through other networks (e.g. the Older People’s Advocacy Network {OPAN} and the NHS Centre for Equality & Human Rights). Around 30 requests a month are being received. Individuals who have requested copies have reported that they are using them for training, planning and to inform the development of resources. For example:
m a number of case studies have been used in the development of the NLIAH Discharge Planning Toolkit, which was launched on 11 June 2008. For more information about the toolkit email Matt.Wyatt@nliah.wales.nhs.uk
m a sister in a Day Hospital requested copies of the case studies. The multi-disciplinary team in which she works are interested in how elderly patients perceive the NHS. They want to check whether what they are offering is what older people want and expect. If not then they will look at what they do and set about making improvements to the service.
If you would like copies of case studies email info@dignifiedrevolution.org.uk
AGE CONCERN CYMRU SEMINAR ON ELDER ABUSE
This seminar was held on 22 May in Llandrindod Wells and was attended by a wide range of people from health, local authority, police, voluntary sector and the Crown Prosecution Service.
Ruth Marks, the newly appointed Commissioner for Older People in Wales also attended the event and gave a short presentation in which she outlined four key issues on which she would be focusing over the next year. These included:
m raising awareness of the human rights of older people in service provision
m active participation: a commitment to meet with as many local groups as possible
m developing robust communication methods to ensure inclusive consultation
m evaluation of the service that is provided
The Older people’s Commission requires a logo and a strap line for immediate identification. A competition is being run to which anyone, regardless of age, can apply. Both the logo and the strap line need to have a clear, positive and bilingual messages in keeping with the development of the Older People’s Commission strategy. If you would like further information about the competition email logocompetition@olderpeoplewales.com or tel: 07521 414743
The Commissioner for Older People can be contacted at Cardiff Executive Centre, Temple Court, 13 Cathedral Road, Cardiff CF11 9HA tel:029 2078 6579; email ask@olderpeoplewales.com or visit the website
Seminar Discussion
A range of anonymous case studies were used throughout the seminar to discuss various forms of elder abuse. With regard to hospital care the examples drew attention to:
m the lack of respect towards older people
m the lack of protection
m staff not talking, or talking inappropriately to older people
m medication omissions
m the lack of emphasis on providing and helping older people with food
Delegates made the following comments about the case studies:
m It is shameful that we have to have a dignity in care agenda
m staff need to experience the care themselves
m appropriate training in values – do we teach values?
m protected mealtimes are needed
m attitudes of staff towards older people
m whether there are adequate numbers of staff on duty to care for patients
m some shortfalls in practice equate to abuse
m finding positive stories of good care – how?
m Care appears to be task oriented rather than person centred, with a focus on meeting targets rather than need
DIGNITY IN CARE AND EQUALITIES (DICE)
A representative from A Dignified Revolution attended the Denbighshire DICE meeting on 2 June 2008. The Denbighshire DICE group is a sub group of the older people’s partnership board and the older people’s well-being steering group. It is focused on implementing the Welsh Assembly Government (WAG) Dignity & Respect in Care programme locally. The group has developed an action plan and is in the process of establishing a dignity charter. The Trust has trained lead people to deliver the WAG awareness training and is due to roll out a programme in September. It was agreed that all members of the DICE group would receive the training at their next meeting so that they are able to cascade it more widely through their own organisations and networks
HEALTHCARE INSPECTORATE WALES (HIW)
You will recall that in last month’s update we reported that we had written to HIW to enquire:
m how they will be monitoring the Fundamentals of Care
m whether it monitors pre- registration nurse training and if so, how?
m How it plans to involve patients and public in monitoring and inspection
We have now received a response, which reports that:
m this year, the Healthcare Standards validation work is focussed on privacy and dignity and other aspects of Fundamentals of Care such as hospital cleanliness and nutrition
m HIW has a contract with the Nursing and Midwifery Council (NMC) to undertake, on their behalf, approval and monitoring activity for all programmes that lead to the NMC’s professional register
m HIW intends to publish a formal Patient and Public Involvement/Engagement strategy later this year
If you would like a copy of the letter email info@dignifiedrevolution.org.uk
ASSEMBLY MEMBER GRILLS FIRST MINISTER ON GOVERNMENT PROVISION OF ADVOCACY SERVICES
Eleanor Burnham, Welsh Liberal Democrat Assembly Member for North Wales and chair of the Assembly Cross Party Group on Old People and Ageing has criticised the First Minister over the Assembly Government’s provision of advocacy services for older people. Ms Burnham is concerned that the current advocacy services available to older people in North Wales are intermittent, understaffed and under funded. During discussion at the Assembly plenary session on 3 June 2008 the First Minister stated that:
“the new Commissioner for Older People would be investigating advocacy services to make sure that they are up to speed and up to scratch”
we want to make sure that the Commissioner and her staff have the ability to take up complaints, which is a form of advocacy. She can also help people make complaints or to use the relevant complaints procedure, or she can represent the person. Therefore, that is part of the Commissioner’s job, as well as checking up on the advocacy services provided by others”
A Dignified Revolution maintains that whilst the support of the Commissioner is welcomed older people and their families, where appropriate, require effective independent advocacy at the point of need. This is crucial, for example, for those in hospital who might be faced with making life changing decisions about their future care through involvement in the continuing care assessments. It is also crucial for older people living in care homes
We are also aware that there is a statutory requirement to provide advocacy under the Mental Capacity Act. Whilst this is a positive development the role of the Independent Mental Capacity Advocate (IMCA) is very narrow in what it is able to achieve. The introduction of IMCAs over the past year has been helpful to some older people who do not have mental capacity. However, their remit is narrow and largely confined to older people who have no family or friends to assist them. There is a statutory requirement to instruct an IMCA in cases of serious medical treatment and change of accommodation. There is a discretionary requirement when there is a Protection of Vulnerable Adult (POVA) case or with some case reviews.
There is a view by some that IMCAs will help solve the problem of inadequate independent advocacy services for older people. However, it is essential that there are more generic independent advocates for older people who fall outside of the IMCAs remit.
What do you think? Please let us know your views on the issue and we will feed them into the campaign to provide better independent advocacy services for older people in Wales.
SHARING EXPERIENCES
Human rights inquiry – request for evidence
The Equality and Human Rights Commission launched its Human Rights Inquiry on 6 March 2008 to find out how public authorities in England and Wales are responding to the Human Rights Act. As part of the Inquiry, the Commission is calling for evidence from individuals and organisations. They want to build up an accurate picture of how well human rights legislation is working. Share your experiences, whether positive or negative, and encourage others to do so. Forms should be sent by 21 June 2008 and can be submitted in Welsh or English
SHARING GOOD PRACTICE
Conwy & Denbighshire NHS Trust
“We are currently running a level 1 BTEC in Fundamental Nursing Care for all our Health Care Support Workers (HCSWs) in the Trust. This initiative came about because we delivered the sessions to all HCSWs working in the care of the elderly wards & it was so positively evaluated that it was felt that the benefits should be transferable across all departments. The course
concentrates on raising standards of care through improving knowledge and skills in areas such as dignity and respect, communication, eating & drinking, toileting & keeping ward & departmental areas clean and tidy. We have used patient stories and we have had patients come to the group and tell us about their experiences so that we can use them for learning opportunities for staff, to refresh their practice & to view things from a different perspective”
Cwm Taf NHS Trust
A staff nurse in the trust has reported that she organises induction for students on their first ward placement. Included in the day is dignity /fundamentals of care and elder abuse
We would welcome feedback from other trusts to hear how their programmes are progressing, particularly the action plans that are currently being developed
USEFUL RESOURCES
Write it Down
Whilst it is probably the last thing that you want to think about when faced with a stressful and unfamiliar situation we would encourage you to keep a diary of events. This could be helpful in:
m calming your nerves
m better understanding the situation in which you are involved
m establishing what information you need to help make an informed decision about your care, or that of a relative
m making a complaint should you feel that this is a necessary course of action
In order to assist you we have developed a writing guide that provides advice on what information you need to document and gives suggestions for keeping a diary. Please email if you would like a copy of the guide
New Human Rights Legal Advice Line
Liberty has launched a new legal advice line, which should be a helpful resource for advocates. For free advice on the Human Rights Act and its implications advocates can phone 0845 122 8621, while members of the public can phone 0845 123 2307
SCIE good practice guide 09: Dignity in Care
This guide is aimed at a wide audience. People who use services and their carers will find much useful information on what they can expect from services. The guide will also help frontline workers, practitioners, managers and commissioners to ensure that dignity and respect are integral to the services they provide. It is interesting that the guide recommends the use of serviettes, not bibs, to protect clothing. We have recently come across a poster submitted as a celebration of good nursing practice which uses photographs of older patients wearing bibs at mealtimes
Going into Hospital
You have a legal right to a reasonable standard of care and treatment from hospital staff. What is defined as reasonable is judged by what other members of the same profession would do in similar circumstances. There are also some basic standards which NHS hospitals are required to meet, details of which can be found here
IN THE NEWS
Care services failing Welsh older people
The vast majority of doctors believe care services for older people in Wales are not good enough. A survey by the British Medical Association (BMA) found that more than 90% of doctors said not enough money was being spent on NHS care for older people, while 85% said they were concerned about healthcare services for older people
Tackling malnutrition among older people in the community
The Welsh Consumer Council has published Tackling malnutrition among older people in the community which provides a summary of discussions of a roundtable event held on 29 January 2008. The main aim of this event was to facilitate discussion between informed partners and stakeholders on the practicalities, and possible barriers, of using malnutrition screening tools in community settings (including in the home), and what more should be done to raise public awareness of this important issue
Planning guide to support implementation of NSF for Older People in Wales
The National Public Health Service has produced a planning guide to assist the Welsh Assembly Government in producing guidance on the appropriate care and support of older people with mental health problems. Mental health issues in older people are addressed as part of the National Service Framework (NSF) for Older People in Wales
New ambassador for Dignity in Care campaign
Sir Michael Parkinson is determined to use his new role as ambassador for the government's dignity in care campaign to "make a real difference". He will work to ensure the issue of dignity "moves to the heart of all NHS and care services
Killed by NHS neglect: How a fit and fiesty pensioner lost the will to live in hospital
Since the death of her husband in 2005, Joan Dorling, a sprightly, intelligent and fiercely independent 83-year-old, had been cared for in her own home by her family and care agencies, apart from week-long stays in Longlands, a respite centre in Daventry, Northamptonshire. Mrs Dorling was admitted to a NHS hospital ward in Northampton earlier this year, after a deterioration in her physical and mental health due to her suffering with vascular dementia. This article provides extracts from a diary, kept by a friend of her daughter Linda Clark, of the care she received in hospital
Long term care: a national disgrace
The Daily Mail Dignity for the Elderly campaign reports on the crisis of long term care. A four page Money mail investigation looks at the crumbling care system
Funding tomorrow today: social care for older people and vulnerable adults
Social care funding must be fairer if provision of social care is to survive. This paper argues that the long term solution to society’s biggest problem – how to fund social care for older people – could be a minimum package of entitlement paid for through a new insurance system. A new system of a sensible level of care backed up by top-ups through social insurance and government support for the poorest would reward those who save, favour prevention over high cost ‘last resorts’ such as care homes and hand control of how money is spent to the users rather than the funders of care
Commission for Social Care and Inspection publishes report on dementia care
This report, See me, not just the dementia, looks at the experiences of people with dementia living in care homes in England, with a particular focus on whether their care offers dignity and respect. Most similar studies have relied on the views of carers, care staff and people in the early stages of dementia. This study examines directly the experiences of people including those with advanced dementia
Age Concern acts on massive worries about the quality of care
Eight out of out ten people in Wales are very concerned about the quality of care that they or a loved one would get in later life, research by Age Concern reveals. Four out of ten people are not even confident they will be treated with dignity or respect, dealing another huge blow to the image of care services across the country. The charity described the findings as further evidence of how the care system is routinely failing older people and their families.
Preceding a major Westminster Government consultation about the future of care, Age Concern is calling for radical reform of the system. The charity has launched a nationwide campaign “The Big Q to demand better care that enables people to keep their dignity, their rights and control of their lives
Solutions to care home boredom and monotony
BBC Radio Four 'Today' programme has recently highlighted the fact that many care home residents are offered little or no form of stimulation or variety during the course of a day. However, NRS, an award-winning and leading provider of disability and rehabilitation equipment, offers a wide selection of indoor and outdoor activities to suit a variety of abilities and ages. These include group craft packs, therapeutic resources such as simple musical instruments, games, reminiscence stimulation products, room decoration packs, plus simple items like sing-a-long books and exercise balls, which are especially appropriate to use in residential and care homes
FORTHCOMING EVENTS
2008 OPAN annual conference: Growing Old in Wales: A Showcase of Ageing Research
23 July, Swansea
For more information click here
AND FINALLY……………
We welcome you comments and suggestions. If you have any information that you would like to share with others please let us know and we will be happy to circulate it in the next newsletter.
If you are reading a copy of this email forwarded to you by a colleague we may not have your contact details. If you would like to guarantee a regular monthly copy of the mailing send your details to info@dignifiedrevolution.org.uk
A Dignified Revolution
Britannia House
11 High St
Cowbridge
CF71 7AD
Tel: 07811 159800
Email: info@dignifiedrevolution.org.uk
