Website of the Department of Health

To help me find that answer I’ve been asking the people who matter. Not a select group of internal advisers, but the public who use health and social care and the professionals who serve them. I now have a much better sense of what dignity means to people.

People have told me that dignity comes from putting the individual receiving care at the centre of that care. Asking them what their needs and wants are without patronising them. Respecting their rights to independence and privacy, whilst at the same time not leaving them to feel isolated and alone. Staff developing personal relationships with those they care for and taking their religious and cultural needs into account.

One professional told me “Dignity is about respect, not just ensuring physical dignity. It is about listening to patients and valuing them.”

Of course, we didn’t just ask people what dignity was, we also wanted to know what needed to be done to ensure dignity in care for all is a reality. We wanted to find out what people’s priorities for action were.

Some issues came up time and time again.

People felt the process of making complaints needed to be improved. People were not always aware of how they could complain and who to complain to. Those who had lodged a complaint often felt that nothing happened or found they had to wait a long time for a response.

We need to take complaints seriously. They are free feedback on how we need to improve our services. We talk about public engagement and seeking to hear what people have to say, yet we don’t always act or respond when they come to us.

The government is acting - in June we announced changes to the regulations for local authorities’ handling of complaints about adult social care services and published guidance to help local authorities implement these changes.

The result will be a complaints process that has a stronger emphasis on treating people justly, with dignity and respect. There will be greater support for complainants who are vulnerable, or who find it difficult to voice their concerns.

We need to continue to improve the complaints process. We need to take on board what people have said as we move to a comprehensive single complaints system across health and social care by 2009, as promised in the Our health, our care our say White Paper.

Another headline I want to mention – people felt that the importance of support at meal time was neglected. Several respondents had witnessed people who are vulnerable left without assistance at meal times. People who were too weak to cut up their food or lift their fork.

Just like not taking complaints seriously, failing to ensure people get the food they need is a clear own goal. We know how important nutrition is. Patients who are malnourished stay in hospital for a longer time, require more medications, and are more likely to suffer from infections.

Ensuring people get the support they need at meal times is good for people’s dignity, good for people’s health and good for the organisations that care for them.

We have introduced the Protected Mealtimes initiative to help make this happen. This means that on hospital wards all non-urgent clinical activity should stop. During these times patients are able to eat without being interrupted and staff can offer assistance. We need to make sure this happens.

Another issue – People care about how they are addressed by care staff. Something as simple as how you are addressed can affect your esteem and dignity.

As one professional said “the use of endearments such as sweetheart, darling, poppet should be banned from health care language. These terms are predominantly used in communication with older people and it is inappropriate, demeaning and patronising.”

Language that is meant to be friendly can emphasise that older people are not equal. You wouldn’t dream of addressing a colleague in those terms. We must respect people’s dignity and let them determine how they should be addressed.

Linked to this was the issue of appearance. Maintaining your appearance, and dressing in well-kept clothes are important to people’s dignity. We’ve been told that it’s vital that someone receiving care is able to keep themselves looking clean and tidy. Care providers should support them to do this.

As one professional told us “It is the failure to do the little things – such as helping someone fasten shirt buttons properly - that starts the cycle whereby dignity is no longer considered important.”

I do recognise that this is a time issue – staff are very busy and things like this are seen as marginal. We must find ways of working that give them the necessary priority.

So I’ve heard what people have to say. Now comes the tricky part – doing something about it. I want staff and the public to join me in a campaign to put dignity at the heart of care.

I know this is an issue important to staff. The vast majority of people who work in health and social care want to go the extra mile for the people they care for.

Yet they face difficulties, circumstances beyond their control that dictate the kind of care they are able to provide. Sometimes it is organisational cultures, policies and practices that prevent people from delivering the care they want to.

Some staff have successfully challenged those organisational barriers but I want to help all staff to be able to make a difference.

I plan to ask service providers to sign up to Dignity in Care Promise. By doing so they will have to work, with their staff, to identify those policies, practices and procedures that make it difficult or sometimes impossible for staff to deliver care in the way they would like. Care with dignity at the heart.

This Promise will form a key part of my campaign to make dignity central to service delivery and the care experience. Through the campaign, I want to start a national debate about dignity in care.

I want to hear about people’s experiences of the little things that count. Like giving people the freedom to choose when they go to bed. It’s those little things that can really add up to dignity in care and the difference between a life endured and a life enjoyed.

And we must not forgot the many people out there that provide exceptional care. I want us to reward and recognise those who do make a difference and those that go that extra mile.

I will launch the Dignity in Care Campaign at the first of three regional events on 14 November in London. That event will bring together care providers with the older people’s champions, who are joining me in this campaign. The champions will play a central role as local activists. They will be the ones helping bring about change in local care communities.

We have commissioned the Social Care Institute of Excellence and the Care Services Improvement Partnership to develop an online resource guide to support champions and care providers locally. This guide will be available at the Dignity in Care event on 14 November,

My campaign will focus on bringing about a change in culture at a local level. But, we also need to ensure dignity is reflected in national policy making. The Dignity Guardians were set up to help us take dignity into account in our review of National Minimum Standards. I have been considering the role of dignity guardians and whether they are the right vehicle through which to ensure policy is developed with dignity in mind. I know you are discussing the dignity guardians later on – I’ll be interested in hearing what you say.

But let me change tack. I want to consider how does dignity relate to the other two big issues we are thinking about today, namely wellbeing and elder abuse?

Well, let me start with wellbeing. I think there are clear parallels between our desire to improve wellbeing and safeguard dignity. Both recognise that our goal is not solely to keep people healthy. People don’t want to simply have good physical health, they want to live their life fully, be in charge of their decisions, have their privacy respected.

Both wellbeing and dignity are thus centrepieces of a New Ambition for Old Age, Ian Philp’s next steps report on the National Service Framework for Older People.

The report recognises that we have made huge strides in improving the health of older people. Death rates for heart disease, stroke and cancer amongst older people are down. Discrimination in treatment is now less likely. For instance, heart surgery in the over-75s has risen from two per cent to 10 per cent.

But these statistics in improving health are not enough. It matters not just that older people are treated, but how they are treated. The report recognises the importance of a renewed commitment to ensuring the respect for the dignity and human rights of older people in all care settings. Dignity in care is one of the three big themes of the report.

A second big theme is that of healthy ageing. And this of course recognises that a healthy old age links to wellbeing. So activities such as exercise classes and dancing improve not just health and independence, but also lead to social interaction increasing emotional wellbeing.

The report recognises that one of the key tasks of local councils, the NHS and voluntary partners must be to increase the wellbeing of older people.

Let me turn to the relationship between dignity and elder abuse. I know this is an issue that you are looking at in more detail this afternoon. So I will be brief, but I want to acknowledge that they are not one and the same issue.

There is clearly a huge difference between a well-meaning but unthinking member of care staff referring to a resident by a demeaning term of endearment and someone deliberately physically abusing a defenceless old lady.

So I want to make it clear that improving older people’s dignity is not a substitute for tackling elder abuse. We all know there is a lack of evidence around the extent of elder abuse, so the national prevalence study of the mistreatment and abuse of older people is hugely important in informing our actions. As partners and co-funders in that study the Department is playing a substantial role.

We are also making progress on the three recommendations made in Action on Elder Abuse's March report. We are working to instigate a national data collection for reports of abuse to local authorities. Building on that work, we will develop a performance indicator to improve outcomes for abused adults. And we are continuing to look at whether legislation on abuse would make a difference for individuals.

Finally, we have given Directors of Adult Social services a specific responsibility for safeguarding vulnerable adults. That means Directors should have the powers and resources they need from councils to encourage a culture of vigilance against the possibility of adult abuse

Our commitment to tackling the particular issue of elder abuse is undimmed. We want to create a situation where people in this country are as outraged by the abuse of parents and grandparents as they are at the abuse of children.

However, dignity and elder abuse are also clearly related. Abuse flourishes when people have become dehumanised, stereotyped, no longer viewed as equals. This is the climate that can occur when we do not respect people’s dignity.

Therefore, today, I am launching the first ever national dignity in care campaign. Our mission should be no less than creating a care system where there is zero tolerance of abuse and disrespect of older people.

The generation that helped to keep this country free and make it great have the right to be protected from abuse and treated with total respect.

The NHS is Britain's proudest achievement. Twenty first century healthcare should have dignity and respect at its heart.

As well as stamping out maltreatment I want to celebrate the many heroes who on a daily basis ensure older people are valued and respected in the way that they deserve.

If we stop asking people their opinion, stop treating them as they want to be treated we stop viewing them as an individual. Then if we are not maintaining an individual’s dignity we help to foster an environment where abuse is more likely. So we need to be aware that improving dignity and tackling elder abuse are part of a common cause that asserts the independence and worth of older people.

Conclusion

I’d like to conclude by saying that being treated with dignity isn’t a nice to have. Nor an optional extra. It’s a basic human right.

It is not enough that services are efficient. They must also be compassionate. Dignity in care means that all those supported by social care and health, are treated with respect, given the time and attention that they need.

That is what I will be striving for as over the months ahead we encourage providers of services to sign up to making dignity a reality for all older people. I hope and trust you will be striving for it to.

Thank you