Dignity in care has been made one of the top priorities for NHS Wales, says Jean White
I am writing this article on the day the media was discussing the findings of the dignity inspections for older people carried out in 100 English hospitals by the Care Quality Commission. It was depressing hearing the case studies described and I was concerned that some professional colleagues were failing their patients so badly. It is the nurse’s primary role to provide safe, effective and compassionate nursing to each and every individual in their care. Abuse and neglect should not be tolerated and a bright light shone on areas of failure.
One point that struck me as important from the reports was that sensitive, considerate care was delivered in areas where there were resource issues. Lack of time and staff are often the reasons given for lapses in the standards of care. In some cases that would be fair but it is equally fair to say it costs nothing to deal with patients in a caring and compassionate way in every interaction. Nursing is more than just a collection of tasks to be done.
“It costs nothing to deal with patients in a caring and compassionate way in every interaction”
But I did gain something positive from this episode. The stories of organisations’ reactions to the negative reports showed how the results being publicised acted as a wake-up call to organisations about the quality of care being given. I am convinced unannounced spot checks are a key tool to help drive out poor practice and to highlight good care.
In March 2011, the Older People’s Commissioner for Wales published her first review, which looked at the dignity and respect shown to older people in acute hospitals in Wales. Good and bad practice was found, and the report identified 12 recommendations for action by the Welsh government, NHS Wales organisations and their partner local authorities. One consequence of the review was to make dignity in care one of the top priorities in the NHS Wales Delivery Framework for 2011/2012, on which NHS Wales must deliver.
In addition to the action plans that the Welsh government and NHS organisations have in place, Healthcare Inspectorate Wales (HIW) will be conducting unannounced dignity spot checks from November 2011. Conducted by small teams, including a senior nurse and a lay reviewer, they will focus on the experience of the individual, particularly in terms of dignity and respect, and whether their essential care needs were met in a timely manner.
HIW’s analysis of its previous inspections and other published reports has identified the following themes that will form the backbone of the spot checks: staff attitudes; discharge planning; fluid and nutrition; communication; toileting; personal care and hygiene; care planning; medicines management and prescribing; physical care environment; activities and stimulation; and management of patients with confusion and cognitive impairment.
The reviewers will also look at the individual’s pathway, specifically asking: should the person have been admitted? How long have they been in hospital? Should they still be in hospital? Are there appropriate plans for discharge?
There is clear evidence that it takes a very short time in hospital for older people to lose their independence and their confidence - a benchmark of 20 days is often referred to as the turning point. If older people get stuck in the hospital system for any length of time, their chances of being discharged home with a similar degree of independence to that enjoyed before admission can be severely affected. Providing effective reablement/rehabilitation and active discharge planning with all relevant agencies is vital if we want to reduce the number of people going from hospital care straight into residential or nursing care homes.
Jean White is chief nursing officer for Wales