- Dignity in care means treating service users with respect in a care environment free from abuse.
- It includes having respect for a person’s privacy, human rights, cultural values and their right to make choices.
- Treating people with dignity and respect are fundamental care values that should be at the heart of all care services.
- Social care organisations should consider using the Dignity Challenge and supporting the Dignity Champions network.
What is meant by dignity in care and what can adult social care providers do to ensure they provide services that respect the dignity of their users?
In February 2013 the Francis Inquiry into failings at Mid Staffordshire NHS Foundation Trust published its recommendations. The report called for major reforms, including new ‘fundamental standards’ to reflect greater respect for the dignity of service users. The Care Quality Commission (CQC) has taken up this recommendation and is working to support basic standards across health and social care.
The inquiry followed a Dignity in Care Commission report in 2012. The report, Delivering dignity, identified the need for a ‘major cultural shift’ in the way people think about dignity.
The CQC itself has also focused on dignity in its inspections. Last summer it carried out inspections looking at whether older people receiving care were treated with respect and dignity, including whether they got the food and drink they needed.
Its review, Dignity and nutrition for older people, was published earlier this year and found that many hospitals and care homes need to make improvements. In particular, inspectors witnessed basic care not being provided, including people not being given appropriate help to eat and drink, and people given personal care in a way that did not respect their privacy.
In addition, the Care Bill has now been amended to give greater emphasis to personal dignity as a component of well-being in care and support.
What is dignity?
There are many definitions of dignity, and many factors that contribute to ensuring service users are treated with dignity. In many ways dignity involves being treated with respect, including respect for a person’s privacy, human rights, cultural values and their right to make choices.
According to the Social Care Institute for Excellence (SCIE) guidance Dignity in care, people should be cared for in a courteous and considerate manner. They should be helped to participate as partners in their own care and have support to be as independent as possible.
Respect for dignity should be seen as fundamental by any social care provider, from the leadership downwards, and appropriate care and support should be provided in an environment free from abuse.
Dignity and abuse
The relationship between dignity and abuse is a fundamental one.
Cases such as Mid Staffordshire and Winterbourne View underline the need for staff and managers to support the dignity of service users by taking a zero tolerance approach to abuse, including abuse such as bullying, neglect and discriminatory abuse like ageism.
Any form of abuse represents a failure to support the dignity of an individual and both the Dignity in Care Commission report and the Francis Inquiry make the point that poor or neglectful care is an abuse of dignity in itself. The reports note how devastating its effects can be. They quote evidence from older service users who describe how their ‘skills, self-confidence and ability to look after themselves can deteriorate as a direct result of the way they are treated’.
Dignity in Care guidelines
The SCIE guidelines identify eight main factors that contribute to a person’s sense of self-respect and should all be present in care:
- Choice and control – enabling people to make choices about the way they live and the care they receive.
- Communication – speaking to people respectfully and listening to what they have to say.
- Eating and nutrition – providing a choice of nutritious, appetising meals that meet the needs and choices of individuals, and offering support with eating where needed.
- Pain management – ensuring people living with pain have the right help and medication.
- Personal hygiene – enabling people to maintain their usual standards of personal hygiene.
- Practical assistance – enabling people to maintain their independence.
- Privacy – respecting people’s personal space, privacy in personal care and confidentiality of personal information.
- Social inclusion – supporting people to keep in contact with family and friends.
According to the guidance, care organisations should help to preserve individuality and services should be personalised to each individual. Service users should have the maximum possible choice and control over their care – including those with mental capacity issues, whose rights should be protected. Openness and participation should be encouraged.
Advocacy should be provided for those with communication difficulties or cognitive impairment, such as service users with dementia, and areas of sensitivity – such as gender, culture or religion – should be fully respected.
Nobody should be made to feel embarrassed when receiving care and support.
The Dignity in Care campaign
The Dignity in Care campaign was originally launched in 2006. It aims to ensure dignity and respect are at the heart of care services by providing:
- the Dignity Challenge
- a network of ‘Dignity Champions’.
The Dignity Challenge
The Dignity Challenge, originally developed by SCIE, states that high-quality care services which respect people’s dignity should:
- have zero tolerance of all forms of abuse
- support people with the same respect staff would want for themselves or their own families
- treat each person as an individual by offering personalised services
- enable people to maintain the maximum possible level of independence, choice and control
- listen to people and support them to express their needs
- respect people’s right to privacy
- ensure people feel able to complain without fear of retribution
- engage with family members and carers as care partners
- assist people to maintain confidence and a positive self-esteem
- act to alleviate people’s loneliness and isolation.
Health and social care providers should use the challenge to assess their own services and to promote dignity initiatives among staff.
Dignity in Care champions
The Dignity in Care campaign has recruited over 45,000 registered Dignity Champions.
Anyone can become a Champion. Care providers are encouraged to enlist people on the scheme, including staff, volunteers, relatives or service users.
Dignity in Care Champions are asked to take forward the dignity in care agenda by:
- raising the profile of dignity in care locally challenging bad practice in their services
- acting as role models influencing colleagues sharing experiences and expertise
- encouraging all providers to take up the Dignity Challenge.
Further information about dignity in care can be found on the National Dignity Council website at www.dignityincare.org.uk.
The site contains a range of resources as well as a link to enlist as a Dignity Champion and a search facility to find other champions and networks.
The Council supports an annual Dignity Action Day with the next one scheduled for 1 February 2014.
After Francis: making a difference, House of Commons Health Committee, available at:
Delivering dignity, Dignity in Care Commission, available at: www.nhsconfed.org/Documents/dignity.pdf.
Dignity and nutrition for older people, Care Quality Commission, available at: www.cqc.org.uk.
Dignity in care, Social Care Institute for Excellence, 2009, available at: http://bit.ly/SOePyE.
Use the following items in the toolkit to put the ideas in this article into practice:
- Form - Dignity Competency Assessment48 KB
- Form - Dignity Competency Assessment - Action Plan42 KB
- Policy Dignity privacy (care homes)57.5 KB
- Policy - Dignity privacy (domiciliary)56.5 KB
About the author
Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care.
This article was first published in the January 2014 issue of Quality & Compliance Magazine.