Dignity and respect should be the cornerstones of care for older people, but is this the reality in the UK’s hospitals?
We all know someone older than us. We are an ageing society. And we expect that, as people age, they are entitled to appropriate and compassionate care – particularly when they become ill or vulnerable.
It has been four years since the publication of the Francis report – a public inquiry into the role of the commissioning and regulatory bodies in monitoring the Mid Staffordshire NHS Foundation Trust. The report found that hundreds of people suffered unnecessarily and were failed by a system that ignored the warning signs of poor care. But since then, how much has changed – and what still needs to change to ensure dignity, good care and respect for older people?
At the heart of things, there is (as there has always been) a core of committed NHS staff who work tirelessly to provide the best possible standards of care. We would do well to remember that, and recognise their contribution to our health service in the face of immense pressures. Alongside this, the Patients Association continues to work on behalf of patients and their families when care is not what we would hope.
Changes for the better
The good news is that much has changed since 2013, and accountability at all levels has increased. For regulators, there have been significant changes. The Care Quality Commission (CQC) has five core questions for inspections, throughout which run the themes of dignity and respect:
- Responsiveness to people’s need
The CQC states that people must be treated with dignity and respect at all times. This includes the provision of privacy, equal treatment for all and support to help people remain independent and involved in their communities.
It is embedded in the NHS Constitution that we all have a fundamental right to be treated with dignity and respect. But research by Age UK found that only 31% of the British public feel that older people are treated with dignity and respect in hospitals. Clearly, we’ve got some work to do to understand what we mean by those terms – and then apply them in practice.
One of the challenges of addressing dignity is that it affects all aspects of a person’s life. We cannot fix one aspect of care and ignore others. While regulation now aims to address the fundamentals of what dignity means in hospitals and care homes, what about the community, domiciliary care and support services?
There is much going on at a community level, but the challenges are immense. For every example of kindness, compassion and dignity linked to a fantastic initiatives like Nutrition and Hydration Week or the Malnutrition Task Force (and there are many), there are cutbacks that threaten these efforts. Research for the National Association of Care Catering reveals that just 48% of authorities currently provide a service, compared with 66% only two years ago. This increases vulnerability, hospital admissions and the number of older people at risk of malnutrition. In addition, research from 2016 found an increase in hospital beds taken up by people with malnutrition. This rise in malnutrition has been linked to increases in poverty and cutbacks in community services and the voluntary sector.
Where do we go from here?
Four years after the Francis report, there have been changes, but the cogs are slow to turn. Dignity runs through every aspect of the way we relate to older people. We can provide training for healthcare professionals, but how do we ensure that the older person in the hospital bed is spoken to, not merely spoken about? How does a home carer make someone feel valued when they only have 15 minutes with that person? How does an older person not feel like a burden when everyone around them appears overworked and undervalued? How can we help people to stay independent and healthy as they age if we remove the services that enable them?
I’m not sure there is a template, but it is clear that we need more resources, more support and more focus on older people’s issues. In the meantime, we regulate where we can, we consider people’s needs as they age, and – at some point – it comes down to simple humanity. Treat others as you would wish to be treated. Keep telling the stories and pointing the finger at the bad and the good. One day, we will all be old. Let’s age with dignity.