The Dignity in Care Challenge event on 3 February 2010 opened with Amanda Reynolds, Deputy Director (Social Care & Partnerships, from Government Office for East of England) introducing the programme for the day.
AR introduced the participants for the conference:
- Norwyn Cole, Regional Director, Care Quality Commission
- Kristina Nilsson-Lindstrom, Head at Malmgarden Residential Centre, Sweden
- Kent Soderberg, Manager Malmgarden Residential Centre, Sweden
- Amanda Waring, filmmaker / advocate for elderly rights
- Beverley Hallpike, Nurse Consultant, NWMH NHS Foundation Trust
There was a choice of one hour workshops - full details on the Agenda. The most popular subject was 'Carers - Dignity & Respect for Family Carers is not Rocket Science", and this workshop was run morning and afternoon (by Julia Hiley, Becca Winwood and Jaqui Martin).
Further information re Dignity in Care was presented, including both the national and regional perspectives. : We now have 874 dignity champions in the East of England; 25 Feb is Dignity Action Day; dignity champions across the region have all been offered the opportunity to join action learning sets.
AR's presentation was guided by slides, ie: (i) "Dignity in Care" - the way we deliver the care NOT the medical aspect. (ii) "Why Dignity in Care" - the commonest complaint from patients and their families is lack of dignity; acceptance of poor treatment can lead to tolerance of low standards and risks of abuse.
(Slides/PL presentation on website).
AR asked us all to think about - how we apply dignity in our own work place and lives.
Norwyn Cole, CQC, has seen 100's of reports on Care and done a lot of work in the field, the recurring theme is always - poor treatment/ lack of dignity in the UK. He has been involved with the Swedish study group.
The Swedish team showed a film, "The Swedish Way" from the Malmgarden day care and residential unit and held a discussion on how they provide Care to the elderly, particularly looking at Dementia in Care.
Twenty-nine people from the East of England - (CQC/SHA-GO, Senior Nurses, & representatives from Herts/Thurrock/CB) had been on a study visit to Sweden. They have excellent programmes for the elderly and have a lot of people in the age group affected by dementia and other LTCs.
The film highlighted the importance of getting leadership and management right, making people the centre of the work. Of course there are cultural differences (and even health & safety restrictions/differences) but the overall philosophy of care should be universal.
The four cornerstones they go by are:
- social measures,
- the individual (behind the diagnosis),
- next of kin
- and staff.
The film demonstrates the benefits of integrating the family in decisions, including the patient in day to day activities, outings encourage memories & conversation, preparing food and eating together, assists care givers in problem-solving and shows dignity and respect for the whole person and who they were before illness. The information gathered about a patient provides the tools to work with.
Postscript: The DVD called "Putting People First, The Swedish Way" is available to Dignity Champions for training purposes in the East of England (contact Chrissie Bligh Chrissie.email@example.com).
The next presentation came from Amanda Waring, actress/writer/filmaker/campaigner/advocate for elderly rights. Her personal story of caring for an elderly relative and the poor standards moved her to become a passionate advocate and filmmaker on the subject of dignity in care. Her film, 'The Heart of Care' demonstrated the lack of dignity and compassion in care in the UK and showed how easily it could be given. There is another film on the subject called, "The Big Adventure" which comes with a training pack covering the effects of ageism, dignity in care and carer issues. The film/training packs are not only used in Care Homes, but prisons and hospitals too. Her plea is to eradicate loneliness, helplessness and boredom. And the message..."Look closer, I'm not just an old woman, see ME ( I have a personal story/life/history)".
Postscript: Amanda Waring's training pack is available for loan for up to a week by care homes and care providers - please email firstname.lastname@example.org.
Some interesting facts to come out of discussions:
- Essex is the county with the most elderly in the country
- In the next 20 years, the over 65 yr old population will increase by 55%
- In the next 20 years, the number of 85 yr olds will increase by 100%
- And we are living 11 years longer than in 1940.
The conference took an hours break for lunch and networking, before proceeding to the next choice of workshop. The two workshops that notes were taken in were:
Workshop Session 1b - "Carers - Dignity & Respect for Family Carers is not Rocket Science" by Julia Hiley and Becca Winwood, Carers Experience Leads and Jaqui Martin, Chair Regional Carers Leadership Board.
This was the most subscribed to workshop, morning and afternoon. The list filled up so quickly for both these sessions, people had to sign up for second choices.
The workshops had a good mix of attendees - health workers, voluntary community workers, family carers, private sector care homes.
Some of the challenges/queries facing these groups were noted (flipchart JH)
- Terminology should be addressed - what is a family carer vs carer
- 6000 people taking up caring roles each year
- Inadequate support facilities
- So many diverse groups these days (ethnic, MH, elderly, LTC etc); not all services fit each case
- History of families equals understanding
- Government asking more families to do more caring at home - better environment & support at home; this requires more training - Government aware
- Lack of knowledge within family carer
- Developing regional guidance/support
The group did a role playing exercise - "What is your Experience?". Each table given a different scenario putting themselves in the shoes of a carer in a challenging caring role. We hoped to raise awareness of the many aspects that need to be considered on a case by case basis.
Workshop 2a - "Achieving Dignity within End of Life Care" with Penny Lavis, Programme Manager, NHS EoE, presenting. There are many end of life situations not just with the elderly in care and her experience within midwifery highlighted this. PL's presentation was guided by slides (on website).
Some statistics presented were:
- 55,000 deaths in EoE a year w/ 77,000 births
- Places of death: 54% of people die in hospitals / 16 - 26% at home / 4% die in hospices.
PL asked us to think about the psychological aftermath of a 'bad death' - families should be able to look back with fondness, not how bad it was - these things can affect family members and their work for many months.
The subjects PL covered and delegate comments were:
What Are We Trying to Achieve:
- Where to die, choice, PCTs trying to have people die where they want to
- CQC & SHA trying to build into End of Life care
- Personal health plan - preferences, how
- Bereavement Services
- Survey on how to manage what people need ie: counselling
Advance Care Planning
- Proposal: national common assessment
How Services Provided
- Essential services should be 24 hrs/7 days a wk
- Coordinated care & support
- Services should be in place
- IE: overdose preventable by a core/key work stream having electronic information re allergies etc.
Working w/ National Coalition
- National Council for Palliative Care / PCT LA together
Commissioners & Cancer Care Groups
- Marie Curie assisting with choices programmes
- Creating managed palliative care/end of life networks incorporating coordination / cooperation / choice
PL asked the conference....
WHAT ARE SOME OF THE KEY FACTORS
(i) that arise with End of Life issues
(ii) contribute to achieving dignity at end of life
(i) Raising awareness - talking about the physical realities of death / signposting symptons / what to expect/wiping out the taboo of talking about death.
(ii) Choices, more training, family involvement / support ie talk about arrangements/ awareness, openness,
Respecting wishes (but whose? patient or family), emotional support. Hospice training for at home care.
South West Essex are running an event for members of the public asking about end of life issues.
Some thought if one dies out of hospital, police always called; others thought only if a sudden death.
Organ donorship was mentioned. PL advised the SHA has a campaign through the Public Health Directorate re organ donors.
WHAT IS IT THAT WE NEED TO DO TO GET CHANGE?
Mandatory training, communication, case studies (DVD), central contact for advice
(Luton have their own training groups, not NHS)
WHAT INFO DO YOU WANT FROM PROGRAMME BOARD TO HELP IMPROVE DIGNITY AT END OF LIFE?
Dignity Champions - but what do they do
GP/Patient relationships - non existent nowadays
Care Homes - huge challenge, have a huge turnover of staff
Joined-up working groups
People who work with people
Delegates reconvened for a presentation from Chris Birbeck (NHS EoE) called:
From Here to Dignity... Exploring and Advancing Dignity in the EoE Health & Social Care System
CB then asked what are 'Practical Next Steps' and 'What Would Good Look Like to You' and 'What Could You do Differently Tomorrow to Move Forward to GOOD'?
- Partnership working/seamless working: too many people falling through too many holes
- Strategic support: role of dignity champions, change culture & attitudes
- Inclusivity of: elderly, dementia, role of staff/carers, change culture and thought processes
How Dignity in Care Supports Safeguarding & Quality in Adult Care by Penny Furness-Smith
The day finished with Penny Furness-Smith speaking on How Dignity in Care Supports Safeguarding & Quality in Adult Care, with a final summing up from Margaret Berry, the new Chair of the SHA's Patient and Carer Programme Board.
FLIPCHART NOTES FROM WORKSHOP B:
CARERS - DIGNITY & RESPECT FOR FAMILY CARERS IS NOT ROCKET SCIENCE
Presented by: JULIA HILEY - EoE EDC CARERS EXPERIENCE LEAD
BECCA WINWOOD - DoH CARERS EXPERIENCE LEAD
JAQUI MARTIN - CHAIR SUFFOLK FAMILY CARERS
The Groups were asked:
WHAT CAN WE DO?
Self directed support - how's it going
Encouraging carers to give feedback easily
Offer help to carers with assertiveness/confidence
Information about what carers care entitled to ....... Plus
Choice.... what is out there / how can I complain
Joined up delivery / knowledge
Don't assume all carers want statutory services
Ensure services are offered in different ways; ie: through social activities / voluntary orgs
Carer involvement in: assessments face to face / ask cared for if they are happy / for nominate
person to be their carer
Make clear confidentiality policies - sharing info
You As A Family Carer
Allocated support - same as patient or not?
How we are "badged"
Ask ME how I am
Sensitive admission/discharge policies
What are my rights/entitlements
Your Friend/Relative "Cared For"
Ask ME what I need
CHAMPIONING CARERS' DIGNITY TOO
CANCER - people affected by cancer:
CQC inspections about to change
LINKS can enter private organisations
YOU CAN CARE, BUT NOT BE A CARER!
HOW ARE FAMILY CARERS TREATED NOW?
Carer will simply do it
Partner may have relationship problems
Level of care / who cares / mixed messages / roles within family - don't assume
Daughter is willing to take responsibility
Carer is ok to care, doesn't have personal circs / needs / history
Carers are female
Carer doesn't have opinions about 'cared fors' treatment
Professional Carers know best
Mum - kept informed, ensure son knows you care
Son's wishes are paramount
Could compound already difficult relationships
Carers not listened to
I'm a mum as well as being a Carer
Communicate with whole family & multi agency working
Assessed - holistically
Treat me as an "expert partner"
Opportunity to speak for my loved one, when they can't do this themself
Lack of info
Where are the Carers - we need to identify them
A right to a life
PERSON CENTRED SERVICES
THE DIGNITY IN CARE CHALLENGE
3RD FEBRUARY 2010
DIGNITY / DEMENTIA
Workshop notes: What do you see? Look closer ... see ME - Dignity in Dementia
What do we do well!?!
- Training at the core - follow up
- Being here today, sharing & going back to change things
- Excellent staff
- Life story work & family engagement
- Dignity work!
- Outcome based commissioning - more flexible
- Befriending to maintain/restore dignity
- Individual focussed
- MH liaison nurses
- Tiptree boxes
- Encouraging innovation
- Reduce stigma
- Engaging with users & carers
- Dementia specific network to share good practice locally/regionally
- Staff goodwill, eg. during snow
What do we do poorly?! Same challenge
Not doing well
- Not funded properly, therefore carers not well paid
- People with more challenging behaviour
- Better at training??
- Need to evaluate impact of training
- Need to train managers - leadership
- Not enough time to work in a person centred way for domiciliary care -15 mins call - task orientation not involving person. Feature of how care is commissioned - dignity not embedded
What should we be doing more of (good practice)?
How can we get better?
- People with learning disabilities - health action plan (Norfolk yellow book) - extend to people with dementia
- Alzheimers life story book (forthcoming)
- Accompany with change in practice
- Care homes have form to send in with patients to acute hospitals/domestic care agencies do this but hospitals tend to ignore. Could do this in a co-ordinated fashion - Local Authorities, PCTs, hospitals & care providers
- GP & PCT involvement in medicine management (pharmacy adviser in PCT)
- GP engagement??
- Addressing medication in hospital
- Drug rounds = time misspent (impact on residents & staff) if medication has not been reviewed
- Raising EOL issues
When and how are we going to start?
- How can we de-medicalise dementia but also get specialist MH input when needed (which is more cost effective & gives better outcomes)
- Feed into local work on pathways
- Continuing health care & dementia (regional work)
- Need good practice examples to shape services across the region
My Ideas (flipchart notes from workshops)
- When arranging day care/surgery/OPD is it possible to Choose & Book to plan male only and female only sessions?
- In the Swedish model staff wore ordinary clothes, not uniforms. We should consider abandoning our uniforms.
- In partnership we need to work out and provide what someone needs to live in their own home, this includes appropriate equipment/building adaptations in place ASAP as well the right support from paid carers
- Make care homes more aware of information and campaigns. Although it is available online mailshots may be useful.
- More champions needed in care homes
- CQC please enforce supervisions in care homes and ensure they are effective and ongoing
- Support managers and staff to support basic ADC, eg cooking and not be confined by H&S
- Individuals, groups, organisations need to lobby their elected representatives to improve the status, pay and funding of social care and its staff
- Clean toileting facilities important rather than just single sex toilets
- How did mixed sex accommodation become acceptable?
- Lowest common denominator - good enough is good enough
- Staff beaten down
- People need to be asked direct questions
- Don't want to complain - may have to use the system again
- Emergency - wait to be treated
- Lack of dignity in single sex bays as well
- Promote the use of people living with dementia rather than 'suffering' (also promote this in the media
- Can we find ways of using the Alzheimer's Society Counting the Cost Report (2010) in East Anglia? How can we do this?
- Stop talking about older people as a 'ticking time bomb' - pejorative, lack dignity, makes older people sound like a problem
- Do not segregate the elderly in hospital, abolish geriatric wards - people are admitted because they are ill not because they are old
- Amanda Waring captured my imagination, could she do a TV series on the subject? Can we not get more publicity, eg a newspaper to do a weekly column?
- Cleaning bathrooms more than twice daily - in hotels facilities cleaned hourly
- How will EoE/region support changes to traditional commissioning to support proposed good practice in extra care as per the Swedish model?
- How can PCTs include carer issues within contracts?
- Don't let family carers fall between the gaps
- Don't make assumptions
- Current respite beds are used - service providers are aware of respite beds and use them. This may prove that more beds are needed.
For copes of the presentations, please go to the SHA site http://events.eoe.nhs.uk/1782
Please see below for a copy of the agenda for the day and photographs from the day.
- Eastern March 2010 photo 1 (jpg - 39Kb) (opens new window)
- Eastern March 2010 photo 2 (jpg - 50Kb) (opens new window)