A number of reports have highlighted concerns about the quality of care experienced by patients and carers and reviewed how aspects of the environment, attitudes and behaviour, culture of care and specific care activities diminish or preserve dignity.
Some of the resources below are in PDF format - see how to access PDF files.
The reports are arranged in alphabetical order of authoring organisation, and then by date order. For related resources see also the Older peopl resource in particular Older people: policy and reports.
BMC Nursing (2008) Dignity in the care of older people - a review of the theoretical and empirical literature
This literature review critically reviews the theoretical and empirical literature relating to dignity and clarifies the meaning and implications of dignity in relation to the care of older people. The authors argue that "what is required is to provide sufficient support and education to help nurses understand dignity and adequate resources to operationalise dignity in their everyday practice" and point to the direction of future research using themes based on themes identified by the research. The article is published and made freely available by BioMed Central.
Care Quality Commission (CQC): Dignity and nutrition NHS
This programme of themed inspections looked at the care provided to older patients at 50 NHS trust hospitals in England during 2012, focusing on dignity and nutrition. It followed a programme of inspections of 100 hospitals in the previous year looking at the same broad themes. "Comparing the results of the 2011 dignity and nutrition review with these latest findings, we were pleased to see that broadly more hospitals were meeting people’s nutritional needs..... On the other hand, there were fewer hospitals where we saw that patients were always treated with dignity and their privacy and independence respected." See the full reports:
- Time to listen: Dignity and nutrition in NHS hospitals (PDF 1.23MB).
- Time to listen: Dignity and nutrition in care homes (PDF 1.34MB).
- Time to listen in NHS hospitals - summary (PDF 1.1MB).
Care Quality Commission & British Geriatrics Society (2012) Meeting the health care needs of people in care homes
The CQC has published the results of a review of how the healthcare needs of care home residents are met. The review addressed how older people and people with learning disabilities living in care homes access healthcare services, whether they have choice and control over their healthcare and whether they receive care that is safe and respects their dignity. Some key findings are that only staff at 38% of homes reported they got regular visits from GPs, with one in 10 care homes saying they had to pay GPs to get them to visit residents. A third of homes also said they sometimes had difficulty getting medicines to residents on time. The regulator suggested that both care homes and the NHS need to address the issue.
Care Quality Commission (2011) Dignity and nutrition inspection programme: national review (DANI national report)
The Care Quality Commission inspected 100 hospitals looking at whether older people are treated with respect and whether they get food and drink that meets their needs. 45 hospitals met both standards; 35 met both standards but needed to improve in one or both; 20 hospitals did not meet one or both standards.
Commission on Improving Dignity in Care for Older People (2012) Delivering dignity: securing dignity in care for older people in hospitals and care homes
This is the final report which draws on the submissions to the consultation on the draft report published in February, in addition to the body of evidence gathered over the first eight months of the Commission’s work. The report and its follow-up programme of activities aims to builds on the good practice already in place and focus on how to tackle the underlying causes of poor care. It calls for a major cultural shift in the way the system thinks about dignity which will require “empowered leadership” on the ward and in the care home, and changing the way staff working with older people are recruited.
The Commission was established as part of a joint initiative from the NHS Confederation, Age UK and the Local Government Association (LGA), to help improve dignity in care for older people in hospitals and care homes see Commission on improving dignity in care.
Department of Health: Mixed-sex accommodation
From 1 December 2010, the collection of monthly Mixed-Sex Accommodation (MSA) breaches was introduced. NHS organisations submit data on the number of occurrences of unjustified mixing in relation to sleeping accommodation.
- Department of Health (2011) Record low for mixed sex accommodation. 70 per cent of the NHS now free from mixed sex accommodation. A record number of hospitals have reported zero cases.
- Royal College of Nursing (2010) Mixed-sex accommodation has no place in 21st century health care. The RCN has stated that mixed sex accommodation with shared bathrooms has no place in 21st century health care. The comments come as the coalition government confirms its intention to end most mixed-sex hospital accommodation in England.
- Chief Nursing Officer (2007) Privacy and Dignity - A report by the Chief Nursing Officer into mixed sex accommodation in hospitals. Set out the position on privacy and dignity in acute care, as it relates to mixed sex accommodation. It reports what patients and the public want, and points to good practice.
Department of Health (2010) My year as National Dignity Ambassador
Sir Michael Parkinson has written a personal account of his year as the nation's Dignity Ambassador. In his report he talks about how and why he got involved in the Dignity in Care campaign, the places he has visited, people he has met along the way and experiences of the services available.
Department of Health (2009) Dignity in care: input assessment - DH interventions
In May 2009, Opinion Leader was commissioned to undertake an independent review of the Dignity in Care campaign. This report sets out the range of interventions employed by the Department of Health in taking forward the Dignity in Care campaign to support Opinion Leader's analysis of interventions at a national level.
Department of Health (2008) Public perceptions of privacy and dignity in hospitals
Research conducted by Ipsos MORI explores perceptions towards privacy and dignity in hospitals, with particular emphasis on the importance of single-sex accommodation. Cleanliness and staff attitudes are the most important factors for patients to feel they are treated with privacy and dignity in hospital.
Foundation of Nursing Studies (FoNS) Developing Practice Improving Care Dissemination Series
The Foundation of Nursing Studies, relaunched as the Centre for Nursing Innovation in September 2010, has published three dignity related projects:
- Maintaining privacy and dignity of patients admitted to a district general hospital NHS trust (2009) (PDF 462.91KB)
Concerns about the lack of privacy and dignity that older people with dementia in an acute orthopaedic unit were receiving led to a project that enabled staff to increase their understanding and knowledge of patients with dementia and how to meet their needs.
- Patient dignity - promoting good practice (2006) (PDF 102.2KB)
The aim of this programme was to raise awareness of and encourage active involvement of nurses, midwives and health care support workers in the promotion of patient dignity.
Help the Aged (2007) The Challenge of Dignity in Care: Upholding the rights of the individual (PDF 447.85KB)
This report put forward a statement of principles on which dignity in care should be based and set out some thoughts on how metrics could be developed in a more person-centred and human rights-based way.
Help the Aged and Picker Institute (2008) Measuring dignity in care for older people
A research report for help the aged (PDF 663.94)
This study was carried out to identify indicators of dignity in care for older people. The aim was to make recommendations on the best way to measure each of the Help the Aged domains of dignified care: personal hygiene; eating and nutrition; privacy; communication; pain; autonomy; personal care; end-of-life care and social inclusion.
Help the Aged and Picker Institute (2008): On our own terms. The challenge of assessing dignity in care (PDF 1.29MB)
This report provided by the Picker Institute Europe for Help the Aged looks at how to measure the delivery of dignified health and social care and sets out a framework for measuring dignity.
King's Fund (2008) Seeing the person in the patient. The Point of Care review paper
This report looks at some of the problems that patients experience with their care and at the factors that shape that experience. It suggests initiatives that have the potential to create sustainable change in patients' care.
Joint Commission on Human Rights (2007) The human rights of older people in healthcare
In this report the committee examines how human rights principles can be applied to ensure that older people in hospitals and care homes are treated with greater dignity and respect.
National Institute for Health Research Service Delivery and Organisation Programme (2011) Dignity in practice: an exploration of care of older adults in acute NHS trusts (PDF 2.71MB)
This study, commissioned by the National Institute for Health Research, sought to build upon an earlier study undertaken by Tadd and Calnan (2005) (Dignity and Older Europeans), together with other research and national reports in order to develop a body of evidence derived from exploring the experiences of service user, those of their carers together with interviews and observation of the behaviours and practices of providers, from which explicit recommendations and guidance on the provision of dignified care can be developed. It is made available on the British Geriatrics Society website.
Northern Ireland Human Rights Commission (2012) In Defence of Dignity. The Human Rights of Older People in Nursing Homes (PDF 607.2KB)
The report finds that practices in nursing homes are failing to deliver many aspects of care in a human rights compliant way. It also finds that current laws and regulations fall short in their ability to protect residents.
Nursing standard article:
Hatfield C (2011) Lack of seniority should not stop me from speaking out. Nursing Standard 25(18) 5 January page 29
This article describes the experience of a student on a ward placement when the dignity of an older patient was compromised. The full text of the article can be accessed via the RCN e-journals.
Old people’s Commissioner for Wales (2011) ‘Dignified Care?’ The experiences of older people in hospital in Wales
Ruth Marks, the Older People’s Commissioner for Wales, has described the treatment of some older people in Welsh hospitals as 'shamefully inadequate' and has called for fundamental change to ensure older people are always treated with dignity and respect when they are in hospital. Evidence was gathered through hospital visits and written evidence. Positive examples are also highlighted. The report makes a series of recommendations. There is also an executive summary, YouTube video and video transcript.
Parliamentary and Health Service Ombudsman (2011) Care and compassion?
This report is based on the findings of 10 independent investigations into complaints about NHS care for people over 65 across England. It said: “These accounts present a picture of NHS provision that is failing to respond to the needs of older people with care and compassion”. The investigations show how these patients suffered unnecessary pain, indignity and distress while in the care of the NHS.
Patients Association: We’ve been listening, have you been learning?
This is the third compendium of patient stories from the Patients Association highlighting experiences of poor nursing and medical care. The report details sixteen accounts of poor hospital care heard by its Helpline in the last year. To view the previous two reports, ‘Patients Not Numbers, People Not Statistics’ (2009) and ‘Listen to Patients, Speak up For Change’ (2010) visit: Research publications.
Scottish Government (2009) Better together: Scotland's Patient Experience Programme. Patient priorities for inpatient care
This research was commissioned by the Scottish Government as part of Better Together. The object was to establish a hierarchy of issues important to Scottish patients receiving hospital inpatient care and to test for differences in priorities among demographic groups.
University of Birmingham Health Services Management Centre (2011) Time to care? Responding to concerns about poor nursing care
This paper makes a series of recommendations to support nurses working in acute hospital care to deliver a better service for patients. Seven core recommendations focus on leadership; the need for a recognised training programme for health care support workers and the need for a systematic approach to supporting nurses with the emotional stress of caring work.