Dignity: Information and good communication

People often find it difficult to navigate social care and health provision to find out what is available and how their needs might be met. Giving people the information they need to make their own plans and decisions is central to the Care Act 2014, to the Mental Capacity Act 2005 and to the person-centred care agenda. It is the basics of promoting dignity in care.

Information makes choice possible, and ‘decisions’ real. It underpins freedom and self-respect. It reinforces a person’s rights.

Information is the foundation for people to be engaged in their health, care and support. Tailored information, that makes it useful for the individual, is the first step to ‘personalisation’. Information may come in many forms, but in care contexts … Communication between people and staff is the principal way in which information is conveyed, discussed and tailored. More than that, it is the opportunity for the person to surface their own expertise, feelings, values and preferences. Communication should be two-way and as equal as possible.

Person-centred care in 2017: evidence from service users

The Care Act places a duty on local authorities to establish and maintain information and advice services relating to care and support for all people in its area. This can be achieved by working to ensure the coherence, sufficiency, availability and accessibility of information and advice relating to care and support across the local authority area.

Importantly, this duty to establish and maintain an information and advice service relates to the whole population of the local authority area, not just those with care and support needs or in some other way already known to the system.

Can people access information easily?

Every year, the Personal Social Services Adult Social Care Survey asks a sample of people in adult social care settings in England the following question: ‘In the past year, have you generally found it easy or difficult to find information about support, services or benefits?’

The figures showed only 28 per cent had found it ‘very easy’ to find the information they needed (‘Better care in my hands’ (CQC, May 2016).

In the following year, the proportion finding it very easy had gone down to 21 per cent (PSS ASCS England 2016/17: Annex Tables).

Over to you

Let’s take a few moments to imagine how we would feel if ourselves or our family needed care.

  • Imagine for a moment that you are a carer – caring for an elderly parent with several long-term conditions, or a partner with physical a disabilities. Write down the kind of help you might both need.
  • Imagine that you use some care and support services, but you and your family can see that your need for support is increasing sharply. You don’t really know what you want or need. Where will you start?

Since the Care Act 2014 there has been a duty on local authorities to involve people in decisions made about them, and their care and support. If a person needs help with this involvement, it must be provided – if necessary, by appointing an independent advocate. Find out more in SCIE’s guide to Independent advocacy under the Care Act 2014 (SCIE)

The need for information and involvement doesn’t end with finding the ‘right service’. One of the factors CQC Inspectors use to judge all regulated services is the extent to which they make the search for information easy for people. Do they provide general information about what’s available, and how to get it? Do they advise on where to go for help with specific choices and preferences?

Information is only useful if it is communicated effectively.

What does the CQC look out for?

How does the service make sure that people can understand the information and explanations about their healthcare and treatment options, including medicines, and their likely outcomes?
CQC KLOE: E5.2

Do staff make sure they give information to people, their families and other carers about external bodies, community organisations and advocacy services that can provide independent support and advice, answer questions about their care, treatment and support, and, where necessary, advocate for them? How does the service support people to contact and use these services?
CQC KLOE: C2.2

What makes communication effective?

  • Plain English: avoiding long-winded language or jargon. Keep it clear. Simple doesn’t have to mean patronising.
  • Cater for people who speak other languages, or are from other cultures.
  • Consider how you will communicate with people with learning disabilities or dementia.
  • Consider how you will communicate with people with cognitive impairment or limited speech.
  • Think of ways of communicating with people who have sensory impairments like limited hearing or sight.

Getting a message across doesn’t only depend on language. It also involves getting the right tone, and understanding the person you’re talking to.

Real communication depends on having the time to talk. It also means being open and honest with the person you’re talking to. It means ensuring that people who use the service have a genuinely easy way to make complaints or suggestions, which will be listened to.

For more information about real ‘listening’, see Warmth and kindness.

Accessible information is information that people can understand. It means different things to different people. For some people it is information in large print or Braille. For others it might be information translated into their first language.

When CHANGE talks about accessible information we are thinking of the needs of people who find reading and writing hard. For us, accessible information means Easy Words and Pictures.

how to make information accessible (CHANGE, 2016)

The way people communicate is central to upholding the dignity of the individual and forming positive relationships to enable person-centred care. It is a two-way process, where individuals must be appropriately supported to communicate their needs, wishes and preferences to enable choice and control in decision-making. Body language, words and tone are all indicators of communicating with respect, courtesy and integrity.

The Common Core Principles: Dignity, Principle 3 (Skills for Care)

Messages for practice

  • Good communication is essential in ensuring dignity in care.
  • It is important that people have time to express their needs and preferences and that staff understand the person they are supporting.
  • It is vital that staff develop other ways of communicating with people who have a cognitive impairment of limited speech.
  • People with dementia or people with learning difficulties can be assisted to choose things by being offered a selection of things or show pictures.

What does the CQC look out for?

How does the service identify and meet the information and communication needs of people with a disability or sensory loss? How does it record, highlight and share this information with others when required, and gain people’s consent to do so?
CQC KLOE: R1.5

Does the service show honesty and transparency from all levels of staff and leadership following an incident? How is this shared with people using the service and their families in line with the duty of candour, and how does the service support them?
CQC KLOE: W1.4

How well do people who use the service know how to make a complaint or raise concerns and how comfortable do they feel doing so in their own way? How well are people encouraged to do so, and how confident are they to speak up?
CQC KLOE: R2.1

How easy and accessible is it for people to use the complaints process or raise a concern? To what extent are people treated compassionately and given the help and support they need to make a complaint?
CQC KLOE: R2.2

How can technology help with communication?

Technology can help people at home, or in supported or residential settings, maintain and develop contacts with family and friends. It can be particularly helpful to people living with dementia. People’s access to social care support from family, friends and services can be improved using email, Skype, WhatsApp and other familiar digital channels.

However, some of these initiatives can be said to increase social isolation, by reducing physical contact. There are also people who may be excluded from all digital activity because they have no opportunity to learn or do not wish to.

For more information, see Using technology to keep in touch (SCIE).

Over to you

Take a few moments to list here how technology can support people using social care in a range of settings.

  • What are the opportunities?
  • What are the benefits?
  • What are the risks?

Anchor homes introduced iPads as part of their Anchor Inspires model to deliver the highest quality and standards of dementia care.

Research published by Anchor and the University of Worcester found that iPads enhance the quality of life for people living with dementia. This research shows that with the right approach, using iPads helps deliver person-centred care and a range of positive outcomes for people living with dementia in care homes, including increased interaction, greater inclusion and improved communication with relatives.

Anchor Inspires dementia care (Anchor Inspires, 2015)

The Local Government Association found that technology can also help improve purposeful engagement between citizens and care professionals. Its digital self-assessment indicated that across both adult and children’s services, 36 per cent of councils are already offering citizens a way of engaging with professionals through digital channels – whether this is through the better use of email or online video conferencing/instant messaging offers.

A number of councils highlighted pilot work underway using video messaging as a way of communicating and engaging with citizens and their carers (e.g. providing ‘virtual’ visits).

Transforming social care through the use of information and technology (Local Government Association and Institute of Public Care, 2016)

  • Multi-party video calls
  • Two-way messaging
  • One-click photo sharing
  • Noticeboards
  • Forums
  • Alerts and reminders
  • Online activities such as multi-player games and language lessons provided through 3rd party apps.
In these ways, the InTouch Social Support Program has been shown to have a dramatic effect in significantly reducing the cost that social isolation has on elderly Australians and the overall health sector. ‘Social Isolation in the UK – with a focus on the use of technology’, Hannah Griffiths (IoTUK 2018, p 17)

Vincles provides an older person with a tablet computer loaded with the Vincles app. The app has two elements. The first connects the individual with friends, family, neighbours and caregivers, and provides a platform for the network members to coordinate the care of the elderly person.

The app allows the user to invite up to 10 close family members, friends or neighbours, social or healthcare employees to be part of their private circle.

The second element is a social network, which puts older people in touch with each other. The app also suggests activities for older people who might prefer to meet in person. By giving the elderly access to tablets, apps and a good internet connection, Vincles hopes to stitch together family, friends and professional caregivers and help the elderly feel less lonely.

‘Social Isolation in the UK – with a focus on the use of technology’, Hannah Griffiths (IoTUK 2018, p 18)

What does the CQC look out for?

‘How is technology used to support people to receive timely care and support? Is the technology (including telephone systems, call systems and online/digital services) easy to use?’
CQC KLOE: R2.2

Finally

In this section, we’ve seen that information, if communicated effectively, is an essential part of treating people with dignity.

  • A person who needs the support of a social care service needs information from the beginning about what is available, suitable and accessible.
  • They need information to make informed choices, and it is the responsibility of service providers and practitioners to supply it.
  • Good communication depends on language, listening and time.
  • Of course, communication is not just about ‘information’: it is the basis of relationships, between managers and staff, care workers and the people needing care, and between social care settings and rest of the community.
  • The loss of relationships – for example, in older age – can lead to social isolation.
  • New ideas about ‘digital social care’ may have the potential to reduce isolation, but should not replace human contact.

The way people communicate is central to upholding the dignity of the individual and forming positive relationships to enable person-centred care. It is a two-way process, where individuals must be appropriately supported to communicate their needs, wishes and preferences to enable choice and control in decision-making. Body language, words and tone are all indicators of communicating with respect, courtesy and integrity.

The common core principles: dignity, principle 3 (Skills for Care)

Further reading