[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 4, November 2011].
This report represents Royal College of Physicians’ (RCP) response to the Dignity in Care consultation. The Commission on Improving Dignity in Care (of older people) was set up by the NHS Confederation, the Local Government Group (LG Group) and Age UK to address numerous cases reported in the press where older people had received sub-standard levels of care in hospitals or care homes. The NHS Confederation has previously issued the 2010 report “Acute awareness: improving hospital care for people with dementia” about improving the quality and efficiency of acute care.
The RCP’s response clarifies how patient safety and the care for older people can be improved. Quotation:
“The provision of good care is a fundamental part of what it means to be a doctor. This includes seeking to address instances of poor practice where patient safety may be compromised, raising these concerns with hospital management and sector and professional regulators where necessary”.
The RCP performs audits (in particular, those recently conducted on continence, falls and dementia) and issues guidelines to help ensure health professionals can offer patients high quality care compliant with best practice.
The RCP’s dementia audit will be published soon, and will adopt a broad approach covering issues such as nutrition and medication. This audit is to be produced jointly with the Royal College of Psychiatrists, the BGS, the RCN and Age UK.
The PANICOA (Preventing Abuse and Neglect in Institutional Care of Older Adults) reports highlighted the widespread view that the acute hospital is the “wrong place” for older people. This view usually results in the physical environment, staff skills and education and various organisational processes acting as barriers to delivering dignified care to older people. Hospitals were not designed to meet the needs of frail older patients and patients with dementia. The care setting itself is not usually conducive to the provision of dignified care. PANICOA described acute hospital wards as “confusing and inaccessible”, and typically “not fit for purpose” as a place for patients aged over 65.
Evidence cited in the RCP’s response suggests that the following factors are important:
- Adequate staffing, having sufficient time to care for patients (including those with complex needs such as dementia, frailty and communication difficulties).
- Education and training, supplying the workforce with appropriate skills to deal with the current and future mix of patients.
- Improved communication with patients, relatives and carers. This includes communication on difficult issues such as dementia, dying and disability.
- Continuity in the management of patients in acute settings (and across providers). This includes better communication between staff across departments, and improved information flows within the system.
- Improving care of patients outside normal working hours.
- High quality systems which effectively monitor and regulate the care patients receive, operating together effectively on multiple levels in the NHS (from frontline staff and all the way up to the Care Quality Commission, Monitor and the General Medical Council). The separation between social and health care presents a barrier to continuity of care. Arrangements for discharge and access to social care support need to be improved.
Professional networks have potential for the provision of advice and information, and for identifying poor practice and sharing ideas on good practice. There are proposals for the RCP’s regional advisory network to be strengthened accordingly.
The RCP works closely with BGS (British Geriatrics Society) on the Joint Specialty Committees on Geriatric Medicine and Palliative Care. The BGS’ response to the Dignity in Care consultation provides a comprehensive overview of the issues faced by older people in the acute sector and care homes, including how to meet the needs of patients with dementia.
Commission in improving dignity in care for older people: Royal College of Physicians’ evidence, September 2011. London: Royal College of Physicians (RCP), September 2011.