SCIE Practice guide 09: Dignity in care
Overview of selected research - Background
'Modernising social services' (DH, 1998) set the tone for social services by acknowledging the importance of dignity for all service users. The 'NHS Plan' followed in 2000 by including a chapter on 'Dignity, security and independence in old age’, and many subsequent documents developed the theme. The National Service Framework (NSF) for Older People (DH, 2001), for example, which established a 10-year service development programme, 'was triggered by concerns about widespread infringement of dignity and unfair discrimination in older people’s access to care’. Opportunity Age (DWP, 2005), the government strategy for improving services for older and more vulnerable citizens, also highlights the need to continue the fight against ageism and age discrimination, and defines one of the principles of service provision in terms of older people’s entitlement to dignity, respect, freedom from abuse and good quality care.
Health services, in partnership with social services and other agencies, will need to recognise the specific needs of older people in caring for them:
- demonstrating proper respect for the autonomy, dignity and privacy of older people
- treating the person, not just the most acute symptoms, by taking account of the full needs of older people, including the importance of good nutrition … and enabling the older person to remain as active as possible while in hospital
- making high quality palliative and supportive care available to those older people who need it
- ensuring good clinical practice which recognises the complexities of caring for older people …
NHS Plan, Ch.15
Similar themes appear in documents by a range of agencies. They deal with all services for older people (Audit Commission, 2004) housing and housing-related support (HLIN, 2006) mental health services (CSIP, 2005), consent to treatment: standards in care homes (DH, 2004a), social exclusion (SEU / ODPM, 2006) and so on. Voluntary organisations have based campaigns around the idea of dignity in care (Help The Aged and Royal College of Nursing, 2000), and the Wanless Social Care Review (Wanless, 2006) uses the idea of dignity as one factor explaining the relative fairness of different funding systems. Codes of conduct for health and social care practitioners aim to preserve dignity.
In the international field, the World Health Organization has called for healthcare systems which promote dignity: 'The standard equation of ideas used by international agencies is well known: Respect for Persons = Autonomy + Confidentiality + Dignity’ (Horton, 2004).
Research has analysed dignity in care - the term itself, what it means to older service users and their carers, and the care professions working with them, and what the implications are for care of all kinds.
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