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Disrespect for dignity in care services

'The people providing the care can forget that they are looking after people: they get praised for emptying beds quickly, not for providing quality care'

Several professionals responded with examples of lack of dignity in care which they attributed to low numbers of staff, lack of staff time and a focus by management on throughput rather than on quality.

Several people told us of their experiences of lack of dignity in a physical sense eg. not being properly dressed, not being fed or not being given adequate privacy during intimate care.  A few felt that this was due in part to the physical environment eg. busy waiting rooms, flimsy curtains between beds etc 

'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.'

Others told us of more subtle but nonetheless distressing instances of lack of dignity.  These included:

 - staff talking about patients and their condition as if they were not there
- individuals being cared for by a constant stream of different staff
- being treated in an infantile manner and/or being patronised by staff

A number of people told us of times where nurses either refused to answer bed calls or took a long time to answer - in some instances this resulted in the person soiling themselves.  Others told us of being left with a commode rather than being helped by staff to use the toilet. Several people told us of times where people had been left without food or water or not being helped to eat.

What action you took

The majority of people who said they were able to do something said their action was to bring it to the attention of the people either in charge of or running the service.  Most of these people however did not feel the outcome of their complaint was satisfactory. Some people felt the staff were as powerless as them to do much about it.  Some said they did not feel they could take action for fear of reprisals.

'I tried to educate the person by explaining the importance of respect and helping the person put himself in the position of the older person'

Some professionals provided examples of actions they had taken to improve dignity  such as working with providers to drive up standards of dignity or taking action themselves eg. providing pegs for curtains so they could not inadvertently come open during a consultation.

A few said they resorted to formal complaints through CSCI but some felt the process was very long and the outcome not satisfactory.  Others said they took responsibility themselves for making up the gap in care provided by staff by taking on some of their tasks eg. helping at mealtimes.

Suggestions for how Government and service providers can help

People told us that training needed to be better funded, mandatory for all staff, on going and more person focused.  Some people suggested involving service users and their families in the development and delivery of training.

They said that complaints systems needed to be:

Several people felt the current complaints system often left people in fear of complaining in case they were penalised.  Some suggested that complaints systems focus more on service improvement eg. envelopes for suggestions for anonymity or suggestion boxes.  People also said that some people needed support to be able to complain and that details of how to complain needed to be widely publicised and visible.  Some people felt the whole complaints system needed much more independence and that an independent complaints body should be set up.

In relation to inspection and regulation of dignity in care several people suggested:

Other issues raised by several people included:

Top three priorities for Government

'Ensure that people realise that the services are there for them - that it is their entitlement. To push the point that they are not a nuisance'

The top three priorities for Government action were:

 - Ensure complaints procedures are simplified, that individuals who wish to complain are supported, and not in fear of recriminations should they complain

 - Ensure that people know their rights, know what action can be taken and encourage them to raise concerns

 - Make greater use of patient and public forums and generally listen more to service users and their families.

Your general comments

Three new issues emerged from the general comments.  These were that:

Other issues raised included: