Delivering Dignity in our hospitals and care homes

Dr Joe Greener, Post Doctoral Teaching Fellow In Social Work, shares his views on the Delivering Dignity report.

The new Delivering Dignity report by the Commission on Dignity in Care for Older People fails to recognise that quality care in our hospitals and care homes rests on better funding. 

The report is keen to emphasise the role of better recruitment and enforcing increasing responsibility onto the frontline workforce – ‘staff must take personal responsibility’ for providing dignified care and ‘challenge practices’ which are not in patients’ best interest.  It emphasises the need for hospitals and care homes to hire employees who have the correct ‘values’.  The problem with this point of view is that it seems to suggest that workers in hospitals and care homes are deliberately engaged in neglectful or even abusive mistreatment of residents and patients.  Whilst on a few occasions this is true, often the failure to deliver dignified care emerges from routines which are embedded in the working day. Most importantly many of these routines and practices followed by care home workers and hospital staff are as much about cost-rationalisation and maintaining low staffing levels as they are about inept, unskilled or uncaring workers. Many care workers and nurses describe demoralising experiences of working in these facilities. Beginning new positions motivated and inspired to deliver the best possible care but quickly realising that this is infeasible in the context within which they perform their work. The codes of good practice written into training courses, policy documents and management dictates are impossible to follow when faced with the reality of their working pressures. 

The report recommends a series of measures for securing better quality care. These include ‘leadership’, ‘practice-based development programmes’, the establishment of a forum to monitor care homes and the growth of new cultures which value respect and dignity. What the document fails to recognise, however, is that cultivating a better social care system relies not on the development of new and fangled policy responses. For example, the document states that hospitals ‘should see older people’s families, friends and carers as partners in care rather than as a nuisance or interference’. Often the reason that staff find relationships with patients’ families strained is because they are aware that the care offered in their facilities is substandard.

It should be recognised that there are some strengths in the document. Most notably, it does distinguish the need to transform the rating system in the care sector. Whilst the principles of independence and dignity espoused in this report cannot be questioned it is the method by which to achieve them which is highly questionable. The relationships between workers and the people they care for emerges from the social, political and economic conditions which surround them. Ultimately, frontline care needs more funding, a point completely missed by this report. Conditions are likely to deteriorate in our homes and hospitals as cuts are made despite these recommendations.