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 Indicator or 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. Methods Sources 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 years quality assurance visits and CQC reports.

11. Common Themes Positives 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 Services Common 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 - still live and Monitored Dignity and Empowerment Training Continuous quality monitoring, Care Home quality assurors meet Robust restrictive practices procedures

29. What do our Contracts Dept Do? Home Care - tendering process Contract, Service Specification I ncentive payments for continuity of care E valuation Surveys/interviews

30. Fairer Contracting initiative Dignity in care is implicitly tested in all quality 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).