Amongst all the controversy over the Coalition Government’s introduction of a complicated bill to reconstruct the National Health Service on a commercial basis, there comes yet another report on the deficient care home and hospital care of elderly people. A consortium made up the NHS Confederation, Age UK and the Local Government Association have just published their draft report on delivering dignity in care for elderly people many of whom are no longer able to look after themselves.
I have been looking at the key recommendations for hospitals and care homes. Most of the advise for hospitals are obvious enough, such as emphasising that the human qualities of compassion are as important as technical skills, how wise leadership and good training is necessary, as well as links with the families of patients. A comprehensive geriatric assessment should be normal practice so that a care plan can be coordinated. There should be time for carers to reflect on the care that is provided.
There are precise recommendations for care homes, following recent scandals that have resulted in the closure of some of them. They include the establishment by the government of a Care Quality Forum to look at all aspects of care home staffing with a clear rating system based on nationally agreed standards. Older people should be allowed to be active participants in shaping their lives rather then being seen as passive recipients of care. Buildings should be fit for use and medical care accessible.
The report argues that alongside the consistent application of good practice and the rooting out of poor care, there needs to be a cultural shift in the way people working with the elderly think about dignity, to ensure care is person-centred not task-focussed. ‘Empowered leadership’ on the ward and in care homes means having the right values as well as skills.
I have seen many of the examples that the report applauds and condemns, both as a frequent hospital visitor and as a patient. For some months last year I visited a colleague in a private care home where she eventually died. She was doubly incontinent and bedridden. The care was exemplary, rough sometimes but above always kind; my only criticism being that it was hard to find someone who was actually monitoring her condition. It bore no comparison with some of the appalling local authority homes I knew in the 1970’s. The ‘task’ to which the Dignity report refers can be an exceedingly difficult and unpleasant one.
Aware of misrepresentation by the government and apprehensiveness by the public, it can’t be easy to work for the health services in the U.K. today. But if this report helps to transform professional brusqueness into natural human benevolence, it will have done a good job.