Ten key recommendations for hospitals
1. All hospital staff must take personal responsibility for putting the person receiving care first. Staff should be required
to challenge practices they believe are not in the best interests of the people in their care.
2. Hospitals should recruit staff to work with older people who have the compassionate values needed to provide dignified care as well as the clinical and technical skills. Hospitals should evaluate compassion as well as technical skills in their appraisals
of staff performance.
3. Hospital boards need to embrace a devolved style of leadership that values and encourages staff and respects their judgment when they are the people working closest with older people and their families. Hospitals must enable staff to ‘do the right thing’ for patients.
4. The leadership role of the ward sister or charge nurse is crucial. They should know they have authority over care standards,
dignity and wellbeing on their ward, expect to be held accountable for it, and take the action they deem necessary in the interests
of patients. They should play a leading role in coordinating services to provide the most dignified and seamless care for each person.
5. Hospitals need to provide older people with a comprehensive geriatric assessment when they are admitted, so that a coordinated
care plan can be developed. They need to be reassessed regularly throughout their stay in hospital and before they are discharged, and action taken as a result. When undertaking assessments staff must take time to understand and record the needs and preferences of older people and their relationships with family, friends and carers, in addition to recording physical and mental health.
6. Hospitals should see older people’s families, friends and carers as partners in care rather than as a nuisance or interference. Hospitals should encourage family, friends and carers to come in and augment care if the older person wishes it, while retaining responsibility for ensuring care is delivered.
7. Boards should regard maintaining each patients’ independence as a key measure of their hospital’s performance in delivering
care for older people. They need to work with patients, relatives and carers to compare a patient’s level of independence when they are discharged from hospital with how independent they were before
they were admitted.
8. Hospital boards must understand how people experience care in their hospital, and view dignity as a key measure of performance. All boards and management teams must have robust processes in place to collate feedback and complaints from older people, their families and staff so they can identify emerging trends and respond
to them. This should include effective whistle-blowing procedures for staff who are concerned about care standards. Hospital boards must respond quickly to any suggestion of deterioration in
9. Feedback from patients and their families should be discussed and responded to on the ward every day. Hospitals should give
staff the time to reflect on the care they provide and how they could improve; this is an essential part of giving good care.
10. Hospitals should introduce facilitated, practice-based development programmes – ‘learning through doing’ – to ensure staff caring for older people are given the confidence, support and skills to do the right thing for their patients.
Ten key recommendations for care homes
1. The Government should establish a Care Quality Forum (in parallel with the Nursing Quality Forum) to look at all aspects of care home staffing, including issues of status and pay, qualifications, recruitment, retention, development, monitoring and regulation. In the longer term the profession should consider working towards establishing a College of Care to lead on these issues.
2. The care sector should work with professionals, residents, relatives' organisations, local authorities and government to develop a clear rating scheme for care homes based on nationally
agreed standards and benchmarks.
3. Care homes need to work with residents to create an environment that make their lives happy, varied, stimulating, fulfilling and dignified. This means involving older people as full and active participants in shaping their daily lives, rather than seeing them
as passive recipients of care.
4. Building links with the wider community is an important part of creating a caring environment and developing a culture of openness. Volunteers can greatly enhance the quality of life in care homes.
5. Care homes should invest in greater use of technology to improve the quality of care and support residents in enjoying active and independent lives.
6. All care home staff must take personal responsibility for putting the person receiving care first, and staff should be urged to challenge practices they believe are not in the best interests of residents.
7. Care home providers should invest in support and regular training for their managers. Local authorities have an important role to play in facilitating this as commissioners of care.
8. Boards and managers have a duty to ensure buildings are fit for use for older people, particularly those with dementia.
9. Ensuring access to medical care is an important responsibility of care homes. Residents in a private care home have just the same rights to NHS care as everyone else.
10. Providing end-of-life care tailored to the wishes and needs of each individual is central to dignified care in all care homes. Residents should be allowed to die in their own care home if that is their wish.