Measuring Dignity in Care Homes & Taking the Dignity Campaign Forward in Brighton and Hove Sara Fulford Sara.fulfor

1. Measuring Dignity in Care Homes • & • Taking the Dignity Campaign Forward in Brighton and Hove • Sara Fulford • Sara.fulford@brighton-hove.gov.uk • Tel.01273 295036

2. Measure Dignity????!

3. Dignity • “Not being funny but do we really have to do it… I mean …Is it a Performance Indicatoror Something?”

4. Competing Priorities? • Budgets ‘The Big Squeeze’: Economies of Scale, Time and Motion Studies,Value for Money, Efficiency Savings • Expediting Hospital Discharge • Independence, • SDS, • Infection Control • Performance Indicators, &Targets Throughput, Turnover, Occupancy,Efficiency

5. Competing Priorities?

6. Contradictions?Pressures?Tensions?Compromises or Challenges?How do we keep personalised services that afford dignity?

7. Measure Dignity?? • ??! Designed tools to measure the Challenges

8. MethodsSources of evidence collated to contribute to the evaluation : • Service user and informal carer dignity surveys -guided interviews focussed on the Challenges • Info. from regularly administered questionnaires • Anonymous carer/visitor surveys during consultation week

9. Methods (cont): • Staff consultation Session • Staff anonymous surveys focussed on Dignity. • Stakeholder surveys e.g. to G.P.s, D/Ns, therapists hairdressers and other regular visitors to the home.

10. Methods (cont) • Extended ‘Regulation 26’ visits to the home focussed on Dignity –observations, met with the manager and staff, and examined documentation and records • Evidence from past year’squality assurance visits and CQC reports. 

11. Common ThemesPositives • Very high levels of satisfaction expressed with staff attitude, patience and treatment of service users . • Nearly everyone reported they had been treated with dignity and respect , ‘ very well, all of the time’.

12. very caring and always find time for you”, “ • Mum always comments that she is treated with kindness” • “All appear, sincere, polite and helpful” “I feel well understood by staff”, “They are wonderful friends to me” • “We have always felt able to say what is important to mum”

13. “Difficult to improve something so perfect”. • Staff said “we try to make people feel special while they are with us’

14. High levels of respectful interactions between staff and residents observed. Offering choices. Negotiating care timing. • People using the services reported being made to feel very welcome when they arrived. • Several services had strong multi- disciplinary support within ICS service to assist rehabilitation and independence. Care staff have also been trained in assisting independence.

15. Flexibility re routines observed in practice- including where and when to eat. (Try to adapt round individual).Service user comments included, ‘Staff work with you, rather than making you fit in with them.’ • Generally high standard of dignified décor and environment- most areas, & addressed promptly where lacking. • Recording detailed, respectful and non- judgemental.

16. Comprehensive staff training reported to help in meeting peoples needs. • Robust staff safeguarding training. • Welcome of Diversity statement is advertised well in posters some services. • Visitors and Carers are welcomed well

17. Dignity Audit Brighton and Hove City Council Older Peoples’ ServicesCommon Development Themes • 1.Greater attention to monitor pain control. • 2. Opportunity for activities/ engagement need to be developed further . • 3. Furniture and general equipment should be reviewed by OTs/Sensory team to maximise independence.

18. 4.Statements of rights and welcoming diversity. • 5.Translation of brochures & information, and different formats. • 6.Choice of male/ female staff for personal care.

19. 7.Culture of recording low level complaints officially as complaints/ comments.  • 8. Waiting for an answer to knock before entry. • 9. Service users tend to feel that use of kitchenettes is a staff domain

20. 10. Service users tend to feel that use of kitchenettes is a staff domain • 11 Service users tend to report that care plans, and how their needs will be met, are decided by staff rather than themselves.

21. 12.Approximately 30% of all people admitted in night clothes or hospital gowns, and without their own possessions with them. • 12. Further develop some holistic, person centred, care planning

22. Examples of Improvements: • Knocked doors being answered, • Pain management • Activities programmes, • Staff photo boards , name badges • Admissions to our services in own clothes - get possessions. • Better recording of low level comments and complaints

23. Revision of service user information to achieve more accessible formats, • Re vamped rights statements, • Care support plans to ensure they give a better sense of the person and their life history and preferences. • Encourage more use of Kitchenettes

24. “Is it a Performance Indicator or Something?”The SAS wants to know… • What have Brighton and Hove Been Doing About Dignity??:

25. Nominated Adult Social Care Lead Dignity Champions •  Corporate Lead Dignity Champion •  USED OTHER PEOPLES IDEAS AND METHODS: • eg Sarah Restall, Catherine Mullins, Warwick, Health Champion colleagues, Used Website

26. KEEPING THE DIGNITY IN CARE AGENDA LIVE: • Dignity Updates: • Part of Personalisation briefings • Dignity Challenges are advertised in posters • Dignity workshops at yearly Safeguarding Conferences • Dignity Workshop as part of a Senior Managers Forum

27. SPECIFIC DIGNITY MEETINGS • Dignity Champions forums • High Level overarching Dignity Meetings • Director / Lead Councillor Chairs • Joint meetings with the health trust lead champions • Joint meetings with Independent Providers

28. What else do we do? • Dignity Audits 2007-Action plans - stilllive and Monitored • Dignity and Empowerment Training •  Continuous quality monitoring, • Care Homequality assurors meet • Robust restrictive practices procedures

29. What do our Contracts Dept Do? • ·Home Care - tendering process Contract,Service Specification • ·   Incentive payments for continuity of care • ·   Evaluation Surveys/interviews

30. Fairer Contracting initiative • Dignity in care is implicitly tested in allquality monitoring.

31. Rewarding Dignity in Care?? • R&R • Incentives • Publicising Good Practice • FEEDBACK - PRIDE

32. Not being funny but do we really have to do it…? • Front Line Staff do Small Things that make Dignity all the Time • The Right Quality Measures and PIs audit Dignity and ensure improvement • Yes, …We Really Have to (and already do a lot of the time).