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Dignity In Care Standards Audit Tool

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					               Health and Social Care Advisory Service

                          Dignity in Care Standards


Introduction

The Dignity Challenge was launched in November 2006 by the Care
Services Minister, Ivan Lewis following a number of listening events and
an on line survey that explored what dignity meant to older people.

Definition of Dignity

Dignity has been identified as consisting of a number of overlapping
aspects of: Respect, Privacy, Autonomy and Self Worth and has been
defined as: “a state, quality or manner worthy of esteem or respect; and
(by extension) self-respect. Dignity in care, therefore, means the kind of
care, in any setting, which supports and promotes, and does not
undermine, a person‟s self-respect regardless of any difference”

Social Care Institute for Excellence (November 2006) Dignity in Care Adult Services Practice
Guide 09

http://www.scie.org.uk/publications/practiceguides/practiceguide09/challenge/index.asp


The meanings of dignity


Research with older people, their carers and care workers has identified
dignity with four overlapping ideas:

    Respect, shown to you as a human being and as an individual, by
     others, and demonstrated by courtesy, good communication and
     taking time
    Privacy, in terms of personal space; modesty and privacy in
     personal care; and confidentiality of treatment and personal
     information




                                                                                               1
   Self-esteem, self-worth, identity and a sense of oneself, promoted
    by all the elements of dignity, but also by „all the little things‟ – a
    clean and respectable appearance, pleasant environments – and by
    choice, and being listened to
   Autonomy, including freedom to act and freedom to decide, based
    on opportunities to participate, and clear, comprehensive
    information.

Factors which protect, support and promote the dignity of older people in
health or social care contexts are grouped under three headings:

   Resilience describes the inner strength which, research has found,
    enables older people to bear difficult situations. A sense of self-
    worth and meaning was maintained by many, by reference to their
    families and previous life experiences and achievements, and a
    focus on everyday pleasures. Resilience could be reinforced or
    undermined by care workers.

   The rights of older people receiving care at home, in hospital or
    care homes are outlined here. Some analysts see the enforcement
    of these rights, and increasing awareness of them among service
    users as the best way to overcome outdated attitudes and systems.
    Inspection and research have found that the framework of rights is
    gradually affecting standards of care.

   Person-centred care puts the needs and aspirations of the
    individual service user at the centre of planning. Embedding the
    principles of person-centred care is still in progress, and evidence is
    mixed about how successfully this is being done. Barriers to
    achieving this kind of care in some settings include bureaucracy,
    tight budgets and restrictive commissioning which, reduce staff time
    for flexible, personal care.




                                                                          2
The overview identifies threats to dignity with fundamental ways in which
society is organised:

   Ageism – prejudice against people purely on grounds of age – has
    been challenged by legal and policy changes which have
    successfully combated overt discrimination against older people –
    for example, in some areas of the NHS. But ageist attitudes and
    practice remain a serious issue, demanding much further effort.

     The effects of ageism are compounded for many older people by
     other forms of inequality, disadvantage and discrimination. These
     include poverty, social class, gender, ethnicity, physical and
     learning disabilities and sexual preference.

   The abuse of older people has been increasingly recognised as a
    serious issue in health and social care. Despite legislation to protect
    vulnerable adults, and detailed guidance for local action, there is
    evidence that more remains to be done.

The Dignity Challenges

The Dignity Challenge sets national expectations of what constitutes a
service that respects dignity and focuses on ten different aspects of
dignity that matter to people most.

Guiding Questions

To develop discussion around each of Dignity Challenges a number of
guiding questions are suggested, which include:
    How do we know we have respect for people‟s dignity?
    How can dignity be observed in practice?
    Where is it demonstrated through documentation that dignity is at
      the centre of the Trust‟s thinking and processes?
    How can we ensure that dignity embedded into training and
      education to future proof dignity within all groups of the workforce?




                                                                          3
                         The Dignity Challenge


                                 1. Zero
                               Tolerance of
                                  Abuse
                 10. Act to                   2. Support
                  alleviate                   people with
                  people’s                      respect
                loneliness &
                  isolation


  9. Assist                                                   3. Treat each
  people to                                                   person as an
  maintain                                                      individual
confidence &
 self-esteem
                                  Ten
                                Dignity
                               Challenges

 8. Engage                                                      4. Enable
 with family                                                    maximum
  members                                                        levels of
and carers as                                                 independence
care partners


                 7. Ensure                    5. Listen and
                people feel                      support
                  able to                       people to
                 complain       6. Respect       express
                                 people’s
                                 right to
                                  privacy




                                                                              4
Challenge 1: Zero tolerance to all forms of abuse
1.0 Core Elements
   Demonstrates where respect for dignity is seen as important by everyone in the
     organisation.
   Care and support is provided in a safe environment, free from abuse and it is
     recognised that abuse can take many forms including physical, psychological,
     emotional, financial and sexual, and extend to neglect or ageism

1.1 Key questions
    Is valuing people as individuals central to our philosophy of care? For
      examples, is this demonstrated within ward and MDT philosophies of care?
    Do our policies uphold dignity and encourage vigilance to prevent abuse?
    Do we have in place a whistle blowing policy that enables staff to report abuse?
    Have the requisite Criminal Records Bureau and Protection of Vulnerable
      Adults checks been conducted on all staff?

1.2 Links with National and Local Performance Measures
    Standards for Better Health C8, C10, C11 and C13a
    Criminal Records Bureau checking within Human Resources

1.3 Current Policies and Practice
    Protection of Vulnerable Adults Policy and Multi agency groups with local
      Primary Care Trusts and Social Services
    Links with Mental Capacity Training

1.4 Examples of Potential Actions
    Provision of training to all key groups of staff working with Vulnerable Adults on
      Adult Protection
    Robust records of staff attendance at training on Adult Protection
    Ensure Whistle blowing policy in place and there are systems within corporate
      and local inductions to ensure all staff made aware of the policy
    Ensure HR systems for Criminal Review Bureau in place and effective




                                                                                      5
Challenge 2: Support people with the same respect as you would
want for yourself or a member of your family
2.0 Core Elements
    People should be cared for in a courteous and considerate manner, ensuring
      time is taken to get to know people.
    People receiving services are helped to participate as partners in decision-
      making about the care and support they receive.
    People are encouraged and supported to take responsibility for managing their
      care themselves in conjunction with, when needed, care staff and other
      information and support services

2.1 Key Questions
    Are we polite and courteous even when under pressure?
    Is our culture about caring for people and supporting them rather that being
      about doing tasks?
    Do our policies and practices emphasis that we should always try to see things
      from the perspective of the person receiving services?
    Do we ensure people receiving services are not left in pain or feeling isolated or
      alone?

2.2 Links with National and Local Performance Measures
    Standards for Better Health C13a - 1a, 2a & 3a
    People to People Expectations

2.3 Current Policies and Practice
    Trust Privacy and Dignity Policy
    People to People Expectations
    KSF Personal and People Development, Quality and Equality and Diversity

2.4 Examples of Potential Actions
    Review and relaunch the Trust Privacy and Dignity policy
    Explore the scope for dedicated Dignity web pages on the Intranet
    Training and Awareness sessions on People to People expectations with HR
      and line managers piloted in key areas and evaluated




                                                                                      6
Challenge 3: Treat each person as an individual by offering
personalised services
3.0 Core Elements
    The attitude and behaviour of managers and staff help to preserve the
      individual‟s identity and individuality.
    Services are not standardised but are personalised and tailored to each
      individual.
    Staff take time to get to know the person receiving services and agree with
      them how formally or informally they would prefer to be addressed.

3.1 Key Questions
    Do our policies and practices promote care and support for the whole person?
    Do our policies and practices respect beliefs and values important to the person
      receiving services?
    Do our care and support consider individual physical, cultural, spiritual,
      psychological and social needs and preferences?
    Do our policies and practices challenge discrimination, promote equality,
      respect individual needs, preferences and choices, and protect human rights?

3.2 Links with National and Local Performance Measures
    Standards for Better Health C13
    People to People Expectations

3.3 Current Policies and Practice
    NSF Older People Group and Elderly Care Steering Group
    Trust Privacy and Dignity Policy
    Comprehensive patient assessment through the Gloucester patient profile

3.4 Examples of Potential Actions
    Review and relaunch the Trust Privacy and Dignity policy
    Explore the scope for dedicated Dignity web pages on the Intranet
    Multi-professional record keeping




                                                                                   7
Challenge 4: Enable people to maintain the maximum possible level
of independence, choice and control
4.0 Core Elements
    People receiving services are helped to make a positive contribution to daily life
      and to be involved in decisions
    Care and support are negotiated and agreed with people receiving services as
      partners
    People receiving services have the maximum choice and control over the
      services they receive

4.1 Key Questions
    Do we ensure staff deliver care and support at the pace of the individual?
    Do we avoid making unwarranted assumptions about what people want or what
      is good for them?
    Do individual risk assessments promote choice in a way that is not risk-averse?
    Do we provide people receiving services the opportunity to influence decisions
      regarding our policies and practices?

4.2 Links with National & Local Performance Measures
    Standards for Better Health C15a element 1 Patients are offered a choice of
       food
    C15a element 2 Food is prepared safely
    C15b element 1 Patients are offered a choice of food

4.3 Current Policies and Practice
    MDT working and Transforming Intermediate Care Project
    Patient Nutritional Assessment and Red Tray system
    Essence of Care benchmarking on Nutrition

4.4 Examples of Potential Actions
    Review patient information on wards
    Monitor progress of Essence of care action plans for Nutrition
    Review effectiveness of Nutritional assessments and Red Tray system




                                                                                      8
Challenge 5: Listen and support people to express their needs and
wants
5.0 Core Elements
    Provide information in a way that enables a person to reach agreement in care
      planning and exercise their rights to consent to care and treatment.
    Openness and participation are encouraged.
    For those with communication difficulties or cognitive impairment, adequate
      support and advocacy are supplied

5.1 Key questions
    Do all of us truly listen with an open mind to people receiving services?
    Are people receiving services enabled and supported to express their needs
      and preferences in a way that makes them feel valued?
    Do all staff demonstrate effective interpersonal skills when communicating with
      people particularly those who have specialist needs such as dementia or
      sensory loss?
    Do we ensure that information is accessible, understandable and culturally
      appropriate?

5.2 Links with National and Local Performance Measures
    National Patient Survey
    Feedback from Patient Forums and Local Involvement Networks
    Feedback from Trust Patient Council and other User Groups

5.3 Current Policies and Practice
    Patient suggestion cards and Patientline feedback
    Department of Medicine for the Elderly User Group

5.4 Examples of Potential Actions
    Review of information that available to diverse cultural groups
    Ensure staff are made aware of the Patient and public involvement policy
      through corporate and local inductions




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Challenge 6: Respect people’s right to privacy
6.0 Core Elements
    Personal space is available and accessible when needed.
    Areas of sensitivity which relate to modesty, gender, culture or religion and
      basic manners are fully respected.
    People are not made to feel embarrassed when receiving care and support

6.1 Key Questions
    Do we have quiet areas or rooms that are available and easily accessible to
      provide privacy?
    Do staff actively promote individual confidentiality, privacy and protection of
      modesty?
    Do we avoid assuming that we can intrude without permission into someone‟s
      personal space, even if we are the care giver?
    Can people receiving services decide when they want „quiet time‟ and when
      they want to interact?

6.2 Links with National and Local Performance Measures
    Standards for Better Health C13a
    Essence of care Privacy and Dignity
    Trust Privacy and Dignity Policy

6.3 Current Policies and Practice
    Development of Action plans as a result of Essence of care benchmarking on
      Privacy and Dignity

6.4 Examples of Potential Actions
    Audit of quiet rooms/areas for access for private discussions
    Ensure staff are made aware of the Trust confidentiality policy through
      corporate and local inductions
    Monitor progress of Essence of care action plans for Privacy and Dignity
    Review and relaunch the Trust Privacy and Dignity policy




                                                                                     10
Challenge 7: Ensure people feel able to complain without fear of
retribution
7.0 Core Elements
    People have access to the information and advice they need.
    Staff support people to raise concerns and complaints with the appropriate
      person.
    Opportunities are available to access an advocate.
    Concerns and complaints are respected and answered in a timely manner.

7.1 Key questions
    Do we have a culture where we learn from mistakes and are not blamed?
    Are complaints policies and procedures user-friendly and accessible? Are
      complaints dealt with early, and in a way that ensures progress is fully
      communicated?
    Are people, their relatives and carers reassured that nothing bad will happen to
      them if they do complain?
    Is there any evidence of audit, action and feedback from complaints?

7.2 Links with National & Local Performance Measures
    Standards for Better Health C13a, C14 and Developmental Standard 8
    Response to complaints within 20 days
    Patient Suggestion Cards/Patientline feedback

7.3 Current Policies and Practice
    Trust Complaints Policy, PALS service and feedback and Advocacy Project
    Patient Suggestion Cards/Patientline feedback

7.4 Examples of Potential Actions
    Ensure complaints are responded to with 20 days as reported within the
      performance scorecard
    Ensure there are robust systems to ensure follow up and learning from
      complaints
    Ensure there are systems to follow up learning from PALS feedback, and
      suggestion cards/patientline feedback
    Work towards achieving excellence with the developmental standard for
      complaints




                                                                                   11
Challenge 8: Engage with family members and carers as care
partners
8.0 Core Elements
    Relatives and carers experiencing a welcoming ambience and are able to
      communicate with staff and managers as contributing partners.
    Relatives and carers are kept fully informed and receive timely information.
    Relatives and carers are listened to and encouraged to contribute to the
      benefits of person receiving these services.

8.1 Key Questions
    Do employers, managers and staff recognise and value the role of relatives and
      carers, and respond with understanding?
    Are relatives and carers told who is „in charge‟ and with whom issues should be
      raised?
    Do we provide support for carers who want to be closely involved in the care of
      the individual, and provide them with the necessary information?
    Are we alert to the possibility that relatives‟ and carers‟ views are not always
      the same as those of the person receiving services?

8.2 Links with National & Local Performance Measures
    Standards for Better Health C16 element 1 Information on services (all
       organisations) element 2 Information for individual care and treatment (all
       organisations)
    Identified within NSF for older people

8.3 Current Policies and Practice
    Carers as partners identified within Gloucester Patient Profile
    Developments through Transforming Intermediate Care
    Part of Ward and MDT Philosophies

8.4 Examples of Potential Actions
    Review Ward and MDT Philosophies
    Review and relaunch the Trust Privacy and Dignity policy
    Development of Trust/PCT/Multi agency strategy for carers




                                                                                     12
Challenge 9: Assist people to maintain confidence and a positive
self-esteem
9.0 Core Elements
    The care and support provided encourages individuals to participate as far as
      they feel able.
    Care aims to develop the self-confidence of the person receiving services,
      actively promoting health and well-being.
    Adequate support is provided in eating and drinking.
    Staff and people receiving services are encourage to maintain a respectable
      personal appearance

9.1 Key questions
    Are personal care and eating environments well designed for purpose,
      comfortable and clean?
    Do we maximise individual abilities at the all times during eating and personal
      care and hygiene activities?
    Do we ensure people receiving services wear their own clothes wherever
      possible rather than gowns etc?
    While respecting the wishes of the person receiving services as far as possible,
      are they respectable at all times and are staff tidy and well presented?

9.2 Links with National & Local Performance Measures
    Standards for Better Health C15b element 2 Individual patient nutritional,
       personal, cultural and religious dietary requirements and element 3 assistance
       with eating and drinking
    PEAT assessments
    Essence Care – Nutrition, Personal and Oral Hygiene and Mental Health

9.3 Current Policies and Practice
    Trust Uniform policy
    Benchmarking of Essence of Care for Nutrition, Personal and Oral Hygiene and
      Mental Health
    Adoption, pilot and roll out of Liverpool Last Days of Life Care Pathway

9.4 Examples of Potential Actions
    Ensure staff are made aware of the Trust Uniform policy through corporate and
      local inductions
    Monitor progress of Essence of care action plans for Nutrition and Personal and
      Oral Hygiene
    Review and relaunch the Trust Privacy and Dignity policy
    Monitor compliance with Trust Uniform Policy
    Promote and support of the roll out of the Last Days of Life Integrated Care
      Pathway for patients dying



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Challenge 10: Act to alleviate people’s loneliness and isolation
10.0 Core Elements
    People receiving services are offered enjoyable, stimulating and challenging
      activities that are compatible with individual interests, needs and abilities.
    People receiving services are encouraged to maintain contact with the outside
      community.
    Staff help people receiving services to feel valued as members of the
      community.

10.1 Key questions
    Do we provide access to varied leisure and social activities that are enjoyable
      and person-centred?
    Have we reviewed the activities we offer to ensure they are up to date and in
      line with modern society?
    Do we provide information and support to help individuals engage in activities
      which help them participate in and contribute to community life?
    Are responsibilities of all staff towards achieving an active and health-promoting
      culture made clear through policies, procedures and job descriptions?

10.2 Links with National & Local Performance Measures
    Standards for Better Health C13a
    Trust Privacy and Dignity Policy
    People to People expectations

10.3 Current Policies and Practice
    Trust Privacy and Dignity Policy
    People to People expectations
    Part of Ward and MDT Philosophies

10.4 Examples of Potential Actions
    Training and Awareness sessions on People to People expectations with HR
      and line managers piloted in key areas and evaluated
    Review and relaunch the Trust Privacy and Dignity policy




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Standards Framework Audit Took kit

 1.    Abuse
 2.    Respect
 3.    Personalised service
 4.    Independence, choice and control
 5.    Listen and support people
 6.    Privacy
 7.    Complain
 8.    Care partners
 9.    Self-esteem
 10.   Loneliness and isolation




                                          15
1 Abuse

There is zero tolerance in this organisation to all forms of abuse.

Respect for dignity is seen as important by everyone in the organisation, from the leadership downwards. Care and support is provided in a safe
environment, free from abuse. It is recognised that abuse can take many forms including physical, psychological, emotional, financial and sexual,
and extend to neglect or ageism.

Statement                       Evidence
                                Documentation                 Interviews                 Observation                   Patient / Service User
                                                                                                                       comment
1.1 Valuing people as
individuals is central to our
philosophy of care.

1.2 Our policies uphold
dignity and encourage
vigilance to prevent
abuse?

1.3 We have in place a
whistleblowing policy that
enables staff to report
abuse confidentially.

1.4 The requisite Criminal
Records Bureau and
Protection of Vulnerable
Adults List checks been
conducted on all staff.




                                                                                                                                                16
For example:

We have developed systems and processes to gain patients, service users and carers views about dignity

Links with Healthcare Commission inspection guides for standards for better health

C8a Healthcare organisations support their staff through having access to processes which permit them to
raise, in confidence and without prejudicing their position, concerns over any aspect of service delivery,
treatment or management that they consider to have a detrimental effect on patient care or on the delivery
of services
C8b Healthcare organisations support their staff through organisational and personal development
programmes which recognise the contribution and value of staff, and address, where appropriate, under representation
of minority groups
C10a Element 1 The necessary employment checks are undertaken for all staff in accordance with Pre and post employment checks for all
persons working in the NHS in England (HSC 2002/008) and CRB disclosures in the NHS (NHS Employers 2004).
C10 b Element 1 & 2 Healthcare organisations require that all employed professionals abide by their relevant published codes of professional
practice
C11a Healthcare organisations ensure that staff concerned with all aspects of the provision of healthcare are appropriately recruited, trained and
qualified for the work they undertake
C11b Healthcare organisations ensure that staff concerned with all aspects of the provision of healthcare participate in mandatory training
programmes.
C11 c Healthcare organisations ensure that staff concerned with all aspects of the provision of healthcare participate in further professional and
occupational development commensurate with their work throughout their working lives.
C13a Healthcare organisations have systems in place to ensure that staff, treat patients, their relatives and carers with dignity and respect.

Links with other Health and Social Care Initiatives

Criminal Records Bureau checking within Human Resources

Mental Capacity Training


Links with other local policies, initiatives and performance measures




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2 Respect


We support people with the same respect you would want for yourself or a member of your family.

People are cared for in a courteous and considerate manner, ensuring time is taken to get to know them. People receiving services are helped to
participate as partners in decision-making about the care and support they receive. People are encouraged and supported to take responsibility for
managing their care themselves in conjunction with, when needed, care staff and other information and support services.

Statement                    Evidence
                             Documentation                 Interviews                    Observation                  Patient / Service User
                                                                                                                      comment
2.1 Are we polite and
courteous even when
under pressure.

2.2 Our culture about
caring for people and
supporting them rather
than being about „doing
tasks‟.

2.3 Our policies and
practices emphasise that
we should always try to
see things from the
perspective of the person
receiving services.

2.4 We ensure people
receiving services are not
left in pain or feeling
isolated or alone.




                                                                                                                                               18
For example:

All users are given information about ward routines, including information about meal times etc.
Service user‟s personal hygiene needs are met according to their individual and clinical needs.
Users are treated with dignity and respect, and their views are taken into account.
Care is offered to recognise the individuality of each person, without stereotyping them as old people.
Any cultural needs affecting care are identified and assessed.
The spiritual concerns of users are identified as part of the admission process
Service users are aware of and are offered the services of religious leaders of their own faith
Religious leaders respond to requests for their presence quickly.
The spiritual needs and concerns of families are taken into account.
Private space is available for religious practices when required.
The religious dietary needs of users are met.
Members of staff are trained to understand and meet spiritual needs.

Links with Healthcare Commission inspection guides for standards for better health

C1a Healthcare organisations protect patients through systems that: identify and learn from all patient safety incidents and other reportable
incidents, and make improvements in practice based on local and national experience and information derived from the analysis of incidents
C2 Healthcare organisations protect children by following national child protection guidelines within their own activities and in their dealings with
other organisations
C3 Healthcare organisations protect patients by following National Institute for Health and Clinical Excellence (NICE) interventional procedures
guidance
C13a element 1A The healthcare organisation has taken steps to ensure that all staff treat patients, carers and relatives with dignity and respect at
every stage of their care and treatment.

C13a element 2A The healthcare organisation acts in accordance with relevant equalities legislation, with particular regard to the Disability
Discrimination Act 1995, the Race Relations Act 1976 (as amended) and the Human Rights Act 1998, to meet the needs and rights of different
patient groups with regard to dignity and respect.

C13a element 3A The healthcare organisation has systems in place to identify areas where dignity and respect may have been compromised and
takes action in response.



Links with other Health and Social Care Initiatives

People to People Expectations


                                                                                                                                                  19
Links with other local policies, initiatives and performance measures




                                                                        20
3 Personalised Care

We treat each person as an individual by offering a personalised service.

The attitude and behaviour of managers and staff help to preserve the individual‟s identity and individuality. Services are not standardised but are
personalised and tailored to each individual. Staff take time to get to know the person receiving services and agree with them how formally or
informally they would prefer to be addressed.

Statement                        Evidence
                                 Documentation              Interviews                     Observation                   Patient / Service User
                                                                                                                         comment
3.1 Our policies and
practices promote care
and support for the whole
person.


3.2 Our policies and
practices respect beliefs
and values important to the
person receiving services.

3.3 Our care and support
consider individual
physical, cultural, spiritual,
psychological and social
needs and preferences.

3.4 Our policies and
practices challenge
discrimination, promote
equality, respect individual
needs, preferences and
choices, and protect
human right/


                                                                                                                                                  21
For example

A comprehensive needs assessment is carried out as soon as possible after admission, including any sensory impairment
There is evidence that users are involved in the assessment process, and their own goals are reflected in care planning.
For frail service users with mobility difficulties, attention is paid to managing any risk to their safety
Lighting levels can be controlled for each bed space at night.
Patient quiet rooms are available on the ward.

Links with Healthcare Commission inspection guides for standards for better health

C13a element 1A The healthcare organisation has taken steps to ensure that all staff treat patients, carers and relatives with dignity and respect at
every stage of their care and treatment.

C13a element 2A The healthcare organisation acts in accordance with relevant equalities legislation, with particular regard to the Disability
Discrimination Act 1995, the Race Relations Act 1976 (as amended) and the Human Rights Act 1998, to meet the needs and rights of different
patient groups with regard to dignity and respect.

C13a element 3A The healthcare organisation has systems in place to identify areas where dignity and respect may have been compromised and
takes action in response.



Links with other Health and Social Care Initiatives

People to People Expectations

Comprehensive patient assessment through the Gloucester patient profile


Links with other local policies, initiatives and performance measures

Trust Privacy and Dignity Policy

NSF Older People Group and Elderly Care Steering Group




                                                                                                                                                  22
4 Independence, choice and control

Enable people to maintain the maximum possible level of independence, choice and control

People receiving services are helped to make a positive contribution to daily life and to be involved in decisions about their personal care. Care
and support are negotiated and agreed with people receiving services as partners. People receiving services have the maximum possible choice
and control over the services they receive.

Statement                     Evidence
                              Documentation                 Interviews                    Observation                   Patient / Service User
                                                                                                                        comment
4.1 We ensure staff deliver
care and support at the
pace of the individual.

4.2 We avoid making
unwarranted assumptions
about what people want or
what is good for them.


4.3 Individual risk
assessments promote
choice in a way that is not
risk-averse.


4.4 We provide people
receiving services the
opportunity to influence
decisions regarding our
policies and practices.




                                                                                                                                                 23
For example

Up to date and accurate information on relevant health and social care related issues is readily available to users and carers, to cover all stages of
the care process.
Users can ask to meet with any member of staff concerned with their care, and are supported in asking questions about their care.
Communication is appropriate to user‟s needs, including sign language, and is supported by written information where necessary.
Written information is available in the main languages of the area served by the hospital.
Translators are available in all the minority languages of the area served by the hospital.
Independence and self-care is promoted wherever possible including the opportunity to self-medicate.
Service users are enabled to consume food (orally) which meets their individual needs.
Service users contribute to decisions about their own health care as far as possible, and expression of their own opinion is encouraged.
There is evidence that discharge planning is considered from the start of the admission.
Key signs and notices are suitable for visually impaired.
An information leaflet for carers for each ward is available.
Information and support is offered to carers by staff as requested, with the users consent if necessary.

Links with Healthcare Commission inspection guides for standards for better health

C15a element 1 Patients are offered a choice of food.
C15a element 2 Food is prepared safely.
C15b element 1 Patients are offered a choice of food.

Links with other Health and Social Care Initiatives



Links with other local policies, initiatives and performance measures

MDT working and Transforming Intermediate Care Project

Patient Nutritional Assessment and Red Tray system

Essence of Care benchmarking on Nutrition




                                                                                                                                                   24
5 Listen and support

We provide people receiving services the opportunity to influence decisions regarding our policies and practices

Provide information in a way that enables a person to reach agreement in care planning and exercise their rights to consent to care and treatment.
Openness and participation are encouraged. For those with communication difficulties or cognitive impairment, adequate support and advocacy
are supplied.

Statement                         Evidence
                                  Documentation            Interviews                    Observation                   Patient / Service User
                                                                                                                       comment
5.4 All of us truly listen with
an open mind to people
receiving services


5.2 People receiving
services are enabled and
supported to express their
needs and preferences in
a way that makes them
feel valued.

5.3 All staff demonstrate
effective interpersonal
skills when communicating
with people, particularly
those who have specialist
needs such as dementia or
sensory loss.


5.4 We ensure that
information is accessible,
understandable and
culturally appropriate.


                                                                                                                                                25
For example

There is a clear procedure for communicating with users, carers, and others about the user‟s care.
Users and carers experience effective communication that is sensitive to their individual needs and preferences and that will promote high quality
care.

Links with Healthcare Commission inspection guides for standards for better health



Links with other Health and Social Care Initiatives



Links with other local policies, initiatives and performance measures

National Patient Survey

Feedback from Patient Forums and Local Involvement Networks

Feedback from Trust Patient Council and User Groups

Patient suggestion cards and Patientline feedback

Departmental User Group feedback




                                                                                                                                                 26
6 Privacy

We respect people‟s right to privacy

Personal space is available and accessible when needed. Areas of sensitivity which relate to modesty, gender, culture or religion and basic
manners are fully respected. People are not made to feel embarrassed when receiving care and support.

Statement                     Evidence
                              Documentation                Interviews                    Observation                   Patient / Service User
                                                                                                                       comment
6.1 We have quiet areas or
rooms that are available
and easily accessible to
provide privacy.

6.2 Staff actively promote
individual confidentiality,
privacy and protection of
modesty.

6.3 We avoid assuming
that we can intrude without
permission into someone‟s
personal space, even if we
are the care giver.

6.4 People receiving
services are able to decide
when they want „quiet time‟
and when they want to
interact.




                                                                                                                                                27
For example:



Links with Healthcare Commission inspection guides for standards for better health

C13a element 1A The healthcare organisation has taken steps to ensure that all staff treat patients, carers and relatives with dignity and respect at
every stage of their care and treatment.

C13a element 2A The healthcare organisation acts in accordance with relevant equalities legislation, with particular regard to the Disability
Discrimination Act 1995, the Race Relations Act 1976 (as amended) and the Human Rights Act 1998, to meet the needs and rights of different
patient groups with regard to dignity and respect.

C13a element 3A The healthcare organisation has systems in place to identify areas where dignity and respect may have been compromised and
takes action in response.



Links with other Health and Social Care Initiatives



Links with other local policies, initiatives and performance measures

Development of Action plans as a result of Essence of care benchmarking on Privacy and Dignity




                                                                                                                                                  28
7 Complaints

We ensure people feel able to complain without fear of retribution.

People have access to the information and advice they need. Staff support people to raise their concerns and complaints with the appropriate
person. Opportunities are available to access an advocate. Concerns and complaints are respected and answered in a timely manner.

Statement                      Evidence
                               Documentation                Interviews                  Observation                   Patient / Service User
                                                                                                                      comment
7.1 We have a culture
where we all learn from
mistakes and are not
blamed

7.2 Complaints policies
and procedures are user-
friendly and accessible.
Complaints are dealt with
early, and in a way that
ensures progress is fully
communicated.

71.3 People, their relatives
and carers are reassured
that nothing bad will
happen to them if they do
complain.


7.4 There is evidence of
audit, action and feedback
from complaints.




                                                                                                                                               29
For example

There is a structured process to review and learn from serious incidents and from complaints.

Links with Healthcare Commission inspection guides for standards for better health

C14a element 1 Information and access to complaints procedures.
C14a element 2 Opportunities for patients to feedback.
C14b element 1 Systems to ensure patients, carers and relatives are not discriminated against as a result of having complained.
C14c element 1 Response to complaints.
C14c element 2 Improvement to service delivery.

Links with other Health and Social Care Initiatives



Links with other local policies, initiatives and performance measures

Trust Complaints Policy, PALS service and feedback and Advocacy Project

Response to complaints within 20 days

Patient Suggestion Cards/Patientline feedback




                                                                                                                                  30
8 Care Partners

We engage with family members and carers as care partners

Relatives and carers experience a welcoming ambience and are able to communicate with staff and managers as contributing partners. Relatives
and carers are kept fully informed and receive timely information. Relatives and carers are listened to and encouraged to contribute to the benefit
of person receiving services.
Statement                      Evidence
                               Documentation                Interviews                     Observation                  Patient / Service User
                                                                                                                        comment
8.1 Employers, managers
and staff recognise and
value the role of relatives
and carers, and respond
with understanding.

8.2 Relatives and carers
are told who is „in charge‟
and with whom issues
should be raised.


8.3 We provide support for
carers who want to be
closely involved in the care
of the individual, and
provide them with the
necessary information.

8.4 We are alert to the
possibility that relatives‟
and carers‟ views are not
always the same as those
of the person receiving
services?

                                                                                                                                                 31
For example

Users and carers are appropriately involved in care planning.
The views of the user‟s family are taken into account.
Staff are able to act as advocates of user‟s needs.
Visiting hour policies accommodate individual needs.
Discharge care packages are discussed with potential contributors and providers as early as possible.
Carers are informed about possible discharge as early as possible.
Information about discharge arrangements is shared with involved people as soon as possible.
Systems are in place to ensure timely availability of the drugs which are to be taken home.
There is provision to accommodate multiple visitors at times of death.
Carer‟s needs are assessed if appropriate.
The active contribution of family and carers to the care of the user is encouraged and supported.
Carers are told about proposed discharge arrangements as early as possible.
The Patient Advice Liaison Service (PALS) can be contacted by carers.
Clear arrangements exist to enable family and carers to stay overnight if necessary.
Visiting hour policies accommodate carer‟s needs.
There is a room for family and carers
Food and drinks are available for carers at reasonable times.
Clear arrangements exist, and are publicised, to enable family and carers to travel to and from the hospital.

Links with Healthcare Commission inspection guides for standards for better health

C16 element 1 Information on services (all organisations).
C16 element 2 Information for individual care and treatment (all organisations).

Links with other Health and Social Care Initiatives




Links with other local policies, initiatives and performance measures

Carers as partners identified within Gloucester Patient Profile

Developments through Transforming Intermediate Care

Part of Ward and MDT Philosophies


                                                                                                                32
9 Self esteem

We assist people to maintain confidence and a positive self-esteem.

The care and support provided encourages individuals to participate as far as they feel able. Care aims to develop the self-confidence of the
person receiving services, actively promoting health and well-being. Adequate support is provided in eating and drinking. Staff and people
receiving services are encouraged to maintain a respectable personal appearance.
Statement                     Evidence
                              Documentation                Interviews                     Observation                   Patient / Service User
                                                                                                                        comment
9.1 Personal care and
eating environments well
designed for their purpose,
comfortable and clean.

9.2 We maximise
individual abilities at all
times during eating and
personal care and hygiene
activities.


9.3 We ensure people
receiving services wear
their own clothes wherever
possible rather than gowns
etc.

9.4 While respecting the
wishes of the person
receiving services as far as
possible, patient are
respectable at all times
and are staff tidy and well
presented?


                                                                                                                                                 33
For example

Service user‟s oral hygiene needs are met according to their individual and clinical needs.
The condition of service user‟s skin is maintained or improved.
Appropriate care is provided for people who are dying.
Users have opportunities to discuss end of life issues, if they wish
When users are dying, dignity is respected and spiritual needs are met

Links with Healthcare Commission inspection guides for standards for better health

C15b element 2 Individual patient nutritional, personal, cultural and religious dietary requirements.
C15b element 3 Assistance with eating and drinking.


Links with other Health and Social Care Initiatives



Links with other local policies, initiatives and performance measures

PEAT Assessments
Essence of Care – Nutrition, Personal and Oral Hygiene and Mental Health
Adoption, pilot and roll out of Liverpool Last Days of Life Care Pathway

Trust Uniform policy




                                                                                                        34
10 Loneliness and Isolation
We act to alleviate people‟s loneliness and isolation
People receiving services are offered enjoyable, stimulating and challenging activities that are compatible with individual interests, needs and
abilities. People receiving services are encouraged to maintain contact with the outside community. Staff help people receiving services to feel
valued as members of the community.
Statement                      Evidence
                               Documentation                Interviews                      Observation                   Patient / Service User
                                                                                                                          comment
10.1 We provide access to
varied leisure and social
activities that are enjoyable
and person-centred.

10.2 We have reviewed
the activities we offer to
ensure they are up to date
and in line with modern
society.


10.3 We provide
information and support to
help individuals engage in
activities which help them
participate in and
contribute to community
life.

10.4 The responsibilities of
all staff towards achieving
an active and health-
promoting culture made
clear through policies,
procedures and job
descriptions.



                                                                                                                                                   35
For example:



Links with Healthcare Commission inspection guides for standards for better health

C13a element 1A The healthcare organisation has taken steps to ensure that all staff treat patients, carers and relatives with dignity and respect
at every stage of their care and treatment.

C13a element 2A The healthcare organisation acts in accordance with relevant equalities legislation, with particular regard to the Disability
Discrimination Act 1995, the Race Relations Act 1976 (as amended) and the Human Rights Act 1998, to meet the needs and rights of different
patient groups with regard to dignity and respect.

C13a element 3A The healthcare organisation has systems in place to identify areas where dignity and respect may have been compromised
and takes action in response.



Links with other Health and Social Care Initiatives



Links with other local policies, initiatives and performance measures

Trust Privacy and Dignity Policy

People to People expectations

Part of Ward and MDT Philosophies




                                                                                                                                                 36
References
     HASCAS Report on the Quality of Inpatient Care for Older People 2003 – 2006
..\References\Final QUIP report with Apps 180107.pdf

     Launch of the Dignity in Care initiative
http://www.dh.gov.uk/assetRoot/04/14/04/66/04140466.pdf

..\References\Dignity in Care gateway 7388 letter.pdf

     DH about the Dignity in Care Campaign
http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/SocialCare/DignityInC
are/DignityInCareArticle/fs/en?CONTENT_ID=4140529&chk=HWbwla
..\References\About the Dignity in Care Campaign.doc

     The Dignity Challenge
http://www.scie.org.uk/publications/practiceguides/practiceguide09/challenge/index.asp
..\References\Practice Guide 09 Dignity in care.doc

     The Practice Guide
http://www.scie.org.uk/publications/practiceguides/practiceguide09/index.asp

http://www.scie.org.uk/publications/practiceguides/practiceguide09/files/pg09.pdf
..\References\The practice guide.pdf

      Educating for Dignity

http://www.ccels.cf.ac.uk/literature/publications/2006/taddpaper.pdf

http://www.bgs.org.uk/Publications/Publication%20Downloads/Educating_for_dignity2.pdf

http://www.bgs.org.uk/Publications/Publication%20Downloads/Educating_for_dignity1.pdf

     Dignity Champions
http://www.dh.gov.uk/assetRoot/04/14/29/99/04142999.pdf
..\References\Information for Dignity Champions.pdf

     OP NSF
A New Ambition for Old Age Next Steps in Implementing the National Service Framework for
Older People
..\References\New ambition for Old Age.pdf

     Listening Events
http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/SocialCare/DignityInC
are/DignityInCareArticle/fs/en?CONTENT_ID=4134925&chk=9vSAqy



                                                                                         37
..\References\listening events.doc

..\References\Listening event 200306.pdf
..\References\listening event 050606.pdf
..\References\Listening event 130306.pdf
..\References\listening event 270206.pdf
..\References\listening event 270306.pdf
..\References\listening event 060306.pdf

      Standards for Better Health

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/
PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4086665&chk=jXDWU6

..\References\Standards for better health.pdf

      Healthcare commission Inspection guides

http://www.healthcarecommission.org.uk/_db/_documents/04021535.pdf

Patient focus domain Inspection guides C13, C14,C15 & C16

     Dignity and Human Rights
Age Concern‟s submission to the Joint Committee on Human Rights‟ inquiry into the human
rights of older persons in healthcare

http://www.bgs.org.uk/Word%20Downloads/Age%20Concern%20%20Human%20Rights.doc

..\References\Age Concern Human Rights.doc

Chris Harvey
Regional Director
Health and Social Care Advisory Service




                                                                                        38

				
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