The Elderly & the NHS – Delivering Dignity?

Posted by Alexander Hay

The first draft of the Delivering Dignity report meets the press, and neither side comes off well

Does the Dignity in Care report risk defeating itself?Today's Delivering Dignity report by the Commission on Improving Dignity in Care for Older People has certainly attracted press attention. So far, so good. But rather than some of its more sensible proposals, the report's call for an end to 'patronising language' has drawn the most attention, and framed it in ridicule.

The Yorkshire Post described the report's 'PC Police' authors as being 'politically correct', while (somewhat inevitably) the Daily Mail was keen to portray one of the report's authors - Sir Keith Pearson - as a sort of bien pensant zealot, calling for the purging of any health worker who dared break the report's proposed speech code.

Likewise, Channel 4 News quotes the report when it says "...using patronising language such as 'how are we today dear?' belittles them". And there we were thinking that sitting in your own waste for several hours was the problem... Indeed, given the occasionally parlous state of elder care in the NHS, one might surmise that being called 'dear' is somewhat low down on the priorities list for a 72 year old woman who'd much rather have a bath and a sip of water.

The report makes the dual mistake of projecting its own hobby horses on elderly patients - itself rather patronising - and confusing language with being a cause rather than a symptom. The final say on whether a term is offensive should be on the part of those offended (they are, after all, on the receiving end), and it's not being called 'deary' by a porter that's causing people to protest.

Pearson's own message may, however, be somewhat more nuanced. According to the Daily Telegraph, he said:

"...The bit that's falling down and breaking down so often, particularly for older people, is that personal care, that care that is so important to someone who is vulnerable when they're in a hospital."

He said the commission had found that in some hospitals, older patients received better attention from the cleaners than nurses.

"Very often it is the cleaner who might be the person who spends that few minutes talking to a patient, someone who is not necessarily trained in customer contact but who actually has got the communication skills necessary," he added...

In other words, it's not what's said that's important as someone actually bothering to talk to the patient in the first place.

Likewise, The Guardian mentions that the report "urges an end to 'command-and-control' NHS management that it says has disempowered frontline staff," with an emphasis on increased responsibility and powers for ward sisters, and responding to regular feedback from patients, which somehow doesn't encourage the same levels of headlines.

Other no-brainers include, as the BBC notes, recruiting only those student nurses who actually seem to be nice people, and who realise that the bulk of their business is going to come from the over-65s anyway.

The response by the Alzheimer's Society hits the bullseye, however:

...There is no such thing as a one size fits all approach to care. Every person has different needs, preferences and fears. Yet these differences are too often being dismissed or ignored by a system that often seems to have lost sense of its priorities...

Whether the report will challenge this or, with its shopping list approach of new orthodoxies and procedures, risks simply carrying on the institutional remoteness that causes so many problems in the first place is yet to be seen, but its proscriptive nature does not bode well.

Likewise, Nursing Times reports that while the RCN's chief executive, Peter Carter, himself something of an expert on elder abuse, welcomes many of the report's recommendations, he also points out the importance of adequate staffing levels and basing one's approach 'on sound clinical evidence.'

Given the tactless way the report goes about its business, and the equally tactless way it has been received by the media, it would seem he will have to wait a little longer. Evidence and staff numbers, after all, just don't make for good headlines.

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Alexander Hay

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