Ivan Lewis MP

DIGNITY IN CARE REGIONAL EVENT, BIRMINGHAM

Speech by Ivan Lewis MP, Parliamentary Under-Secretary of State for Care Services — 23 January 2007

I am delighted to welcome you here today at this, my second, Dignity in Care campaign event.

I said recently that during my first six months in the post I have listened to what people had to say about their experiences of being treated with dignity and respect. Now is the time to lead; to provide leadership, whilst being aware that dignity in care can only be enabled if we engage with others. By that I mean professionals, the voluntary sector, active citizens, users of services and their carers — people like you.

On 14 November 2006 I was proud to launch the first ever government campaign to put dignity and respect at the heart of the care services we offer to older people: whether on the hospital ward, in residential and nursing homes or domiciliary and day services; whether public, voluntary or private-sector provider; whether suffering from a long-term condition, dementia or requiring extra support to live an independent life.

The generation that built this country have a right to expect services where personalisation, dignity and respect are not the latest buzzwords but a living, breathing reality. Our society needs to once again value older people as active, positive citizens who may require support but have so much to give to their families and wider community.

As demographic changes and perpetual medical advances combine to support longer lives, our challenge is to ensure that ‘longer’ means a better quality of life, not simply existing. Our aim is to create a system that offers high-quality personalised services, where power and control are transferred from professionals and organisations to those people who use services, their families and carers: a system supported by a sustainable funding system; a funding system which clarifies the responsibilities of the state, families and individual users of services.

Consulting people

Last year I decided to talk to people about their experiences of dignity in care. Over several months, I have talked to people who provided services, people who commission services and, most importantly of all, people who receive services. Over 400 people replied to an online survey that we ran. And what did I learn? I learned that being treated with dignity was very, very important to older people and that they and their families want something done about it. But I learned something else that is important. Older people found it hard to be sure what they could expect of services. I was reminded of the ‘doctor knows best’ approach that characterised previous generations. People were grateful for what they got and didn't complain.

That may have been good enough for previous generations, but it won't satisfy our generation and it certainly won't satisfy our children's generation.

What the survey said about nutrition

So what else did the survey tell us? I have been particularly struck by stories I've heard about older people’s experiences of eating and drinking in care settings. A subject you may have read a lot about in recent days.

Several people told us of occasions when they had witnessed vulnerable service-users being left alone at mealtimes with no support or assistance to eat their meals. Yet some people who were too weak to cut up their food or lift cutlery to their mouth were unable to eat their meals without some help from carers.

People commented that carers were unobservant and had failed to notice that a service-user needed help. Mealtimes seemed to be a process to be got over with as quickly as possible rather than potentially an enjoyable social opportunity.

Some service-users were obviously embarrassed to ask for help, yet care staff seemed not to be aware of what people's needs are at meal times. Many people said that they found it distressing to see a vulnerable adult not being able to eat their own meals and yet being neglected. And I was told of a blind lady not being offered help to drink and then being reprimanded for spilling her drink. Would you believe it?

Other evidence

Just last week, you will have seen reports of the Healthcare Commission's investigation into learning disabilities' services in Sutton and Merton PCT. A heart-wrenching story of institutional abuse.

We cannot tolerate such abuse, non-professionalism and exploitation of people with learning disabilities, and we will certainly take firm action as a consequence of that report. Dignity and respect for older people and also for people with disabilities must be at the heart of a civilised society.

I want to give you some quotes from the inspectors investigating the quality of care provided by Sutton and Merton PCT:

“We found that the model of care was largely based on the convenience of the service providers rather than the needs of individuals. For example, during meal times some people's shoulders were wrapped in a large sheet of blue tissue paper, and they were then fed at a speed that would not allow for any enjoyment of their food”;

“staff spoke to each other at meal times and not to the person whom they were assisting to eat”;

“In one house, people were lined up around a table waiting to be fed in what seemed like a queue . . . There was little evidence of people having any choice in the food they ate and drinks were limited in most of the houses”.

This cannot be acceptable at the beginning of the 21st century! And we must root it out.

Facts about malnutrition

We pride ourselves on the progress we have made in recent times, yet we must be honest that: malnutrition affects over 10 per cent of older people (source: British Association for Parenteral and Enteral Nutrition, 2006); malnutrition is estimated to cost the UK over £7.3bn a year (source: BBC, 2006); and malnourished patients stay in hospital for much longer, are three times as likely to develop complications during surgery and have a higher mortality rate (source: Age Concern, 2006; BBC, 2006).

I pay tribute to Age Concern for their report last summer ‘Hungry to be Heard’, which contained a harrowing analysis of malnutrition in hospital and set out seven steps to address the problem. Having heard those stories and statistics is it any wonder that I feel obliged to give this issue some prominence?

So is it all bad?

I welcome the fact the Daily Mail, Sunday Express and others are highlighting the issue of dignity for older people. This should be an issue that unites the nation irrespective of party politics. Today I have heard from Liberal Democrat and Labour politicians in Birmingham who are working together on this agenda. The media and others have the right to criticise government and demand that more be done. However, they should resist presenting a distorted picture which suggests that:

• The system, as a whole, is starving people
• Ministers run every care home and every NHS ward
• Money is the issue
• We have done nothing to raise standards.

The fact is that we have done a lot: we have toughened up inspection and regulation; we introduced national minimum standards; we have put record investment into the NHS; and we will be regulating the wider social care workforce.

But despite all this, older people are still being let down and some are not being properly supported to have a balanced diet. So, the government will provide leadership, but change will only occur in partnership with others: leaders and managers taking responsibility; frontline staff feeling supported; and older people and families given a strong voice. And yes, charities and newspapers highlighting the issues but also helping to get our message across and helping us to make a real difference on the ground. We are not new to this; we have been tackling these issues for years.

Since the launch of the Better Hospital Food Programme in 2001 we have seen the introduction of a wide range of improvements such as:

• Food being available in hospitals around the clock
• A new post of ward housekeeper on our wards to help patients
• A big increase in the range of choice available from new menus.

Thirty-five million pounds has been invested in the Better Hospital Food Programme.

I recently announced a grant of £67.5mn in 2007–08 to improve the environment in care homes. Schemes that upgrade dinning facilities to improve nutrition are eligible for that scheme.

The government has introduced standards for nutrition and eating in both health and social care and created regulatory bodies to monitor that those standards are met and to do something about it if they are not. The government is playing its part. To say that nothing has been done is a gross distortion

So what to do about it?

I am determined that something must be done to raise the importance of getting right nutrition and eating while in care. I am today announcing that I intend to convene a national summit involving organisations that have an interest in nutrition in care settings. The purpose of the summit will be to identify a clear strategy for tackling this situation. There are many bodies that have an interest in nutrition in older people, and I am sure that between us all we can make a significant difference. I want to capture all good practice there is about nutrition.

So what is best practice?

What would best practice look like? It isn't as if we don't know what is good nutritional practice when looking after older people. The first obvious thing is that the dietary needs and preferences of service-users, and any assistance needed at mealtimes, should be assessed, recorded and referred to by all frontline staff. Give people time to eat; they should not be rushed. Offer privacy to those who have difficulties with eating, if they wish, to avoid embarrassment or loss of dignity. Managers should ensure that mealtimes are sufficiently staffed to provide assistance to those who need it. Don't make assumptions about people's preferences on the basis of their cultural background — people should be asked what their preferences are.

Food should be made to look appetising. Where food needs to be puréed, use moulds to keep foods separate and indicate what they are — for instance a fish-shaped mould for fish. And make sure all care staff, including caterers, are trained on the risk of malnutrition and the importance of providing good nutritional care for all service-users. Like so much of what my Dignity in Care campaign is about — it's vitally important but it's not rocket science!

There is good practice out there. Heart of England Trust is very active with a protected mealtimes initiative. Protected mealtimes are times when all non-emergency work on the wards stops to allow patients to concentrate on their meal. They have taken a multi-disciplinary approach, involving nursing, dietetics and catering.

County Durham and Darlington Trust have introduced pictorial menus, which help patients with communication difficulties to take a full part in selecting their meals. The ward hostess helps them select from a range of photographs, so that they know exactly what they are ordering.

Hull and East Yorkshire Trust have reorganised their menu to better meet the needs of older people. They now serve smaller meals more frequently on their elderly care wards, including a cooked breakfast on weekdays, with a light buffet-style lunch and a cooked evening meal. At the weekend, the main meal is at lunchtime. The challenge is to raise everyone's standards to the level of the best.

The objectives of the campaign

So what am I trying to achieve with the Dignity in Care campaign?

Through the campaign my aim is to:

• Raise awareness of dignity in care and inspire local people to take action
• Spread best practice and support people and organisations to drive up standards
• Reward and recognise those who make a difference and go that extra mile.

Frontline staff are making a difference to people's experiences all over the country.

My aim is to stimulate a country-wide debate about the importance of care services respecting the dignity of those who use them. Public service-users should have a strong voice. I want to encourage people to speak out and tackle services that don't respect dignity, rather than just tolerating them. Greater emphasis ought to be placed on living with dignity in old age rather than just dying with dignity. Dignity is an important feature of improving the quality of people's lives.

That is why we are here today. Being here is a signal that you care about this issue. I need your help to achieve my mission, which I hope will be your mission too. We all have a part to play. One of the themes of today is how we can help you to champion dignity. How we can help each other in this important cause. So, this is the deal on offer.

I want all of you in this room to join the movement and become dignity champions. It's very easy to do. In the delegate pack you got when registering this morning is the dignity card that we are using to publicise the campaign. You'll see on the back of it how you can register to become a dignity champion. You can do this either online or by ringing a national telephone number. You will also be able to register today during the lunchbreak and at the end of the event.

We expect different people to bring different levels of commitment to this cause. As a minimum, we expect all dignity champions to challenge bad practice where they see it and to encourage their colleagues and others to look at how dignity can be improved in their locality.

At the other end of the spectrum, we would like to see dignity champions demonstrating leadership around this agenda, making it a local priority for action, engaging with local media and implementing changes to the way services are commissioned and delivered. I believe that each of you has different levers you can pull to raise the profile of dignity.

When we launched the campaign on 14 November 2006 at an event like this, we asked all those who attended what they would do differently as a consequence of attending the launch. Here are a few examples of what people said:

“I'm going to set up a steering group to lead on dignity in care across the PCT”;

“We'll issue a press statement on our position on the campaign and what we plan to do”;

“I'll suggest putting dignity and respect into all staff's performance appraisals and job descriptions”.

I'm going to review all our current contract arrangements to ensure we only contract with services known to respect dignity.

Some of those things are relatively small; others represent significant changes in the way organisations operate. All of them move the dignity cause forward.

And what will we do in return for you signing up to be a champion? It is our responsibility to support you.

First, each champion will be able to ask for stocks of the dignity card to use within their organisation. On the card, are the 10 dignity challenges that I issued in November. The Dignity Challenge is:

• A clear statement of what people can expect from a service that respects dignity
• Backed up by ‘dignity tests’ that can be used to run the rule over services
• A challenge to service providers to ensure their services respect dignity
• A challenge to commissioners to ensure they commission only services that respect dignity
• A challenge to the public to test how their local services measure up and to tackle services that don't respect dignity rather than tolerating them.

We'll provide Champions with information and tips on how they can be effective in their role as dignity champions and also with information about local networks in their area that they may wish to join. We'll also give details of how to join and use the dignity champions online network and how to access telephone support if they need it. The online network enables dignity champions to talk with each other online and easily share a range of resources and useful information, such as best practice examples and training materials. We've also got an online practice guide, developed in partnership with the Social Care Institute of Excellence, to highlight best practice.

I hope you'll take the deal I'm offering. Sitting in Whitehall, we can pass laws, issue guidance, get the regulatory system right and make speeches like this. But to effect real change I need your help. Help from people who provide services, who use services, who scrutinise services and who commission services. I don't want simply to rely on your own personal commitment and enthusiasm. I want to give official recognition to you in your role as champions. I am giving you authority to speak out in support of the dignity cause.

My aim is to create a new network of local champions of dignity. An army of volunteers working to raise the profile of dignity in care locally, open to anyone who wants to make a difference. We want to support champions to create their own, sustainable, social movement that will ensure greater importance is placed on respecting dignity. I hope you'll get involved in the transformation we are going to bring about.

Conclusion

Respecting dignity in care is everybody's business. It is core business for health and social care and community-care services. The challenge to provide dignity in care is embedded in much wider issues of the way behaviour and standards in society are changing. When our top-rated TV programmes depend for their success on ritual humiliation, confrontation and embarrassment, can we continue to assume that treating people with dignity is the norm? We have to make every effort to influence society's attitudes.

This campaign will be long-term and sustained. It will not be a one-off initiative or limited to the period in office of one minister or another. There are no magic wands or quick-fix solutions. My mission is clear: to bring about zero tolerance of lack of dignity in care. My ambition is clear: to create a society that is as passionate about the ill-treatment of parents and grandparents as it is about the ill-treatment of children. The generation that made our country great has a right to be protected from abuse but, more than that, a right to dignity and respect. And your role is to help us in a practical way.

I have one last favour to ask. When you leave today's event I would be grateful if, on your journey home, each of you would think about the steps you can take to make a real difference. And, when you return tomorrow to your place of work, you set in train things that make those thoughts a reality.

I look forward to working with you to deliver our mission.

Thank you.

Biography for Ivan Lewis MP, Parliamentary Under-Secretary of State for the Department of Health

Prior to joining the Department of Health, Ivan was Economic Secretary to the Treasury from May 2005 to May 2006. From 2003 to 2005, Ivan was Parliamentary Under-Secretary of State for Skills and Vocational Education at the Department for Education and Skills (DfES). Previous roles at the DfES include: Parliamentary Under-Secretary of State for Young People and Learning; Parliamentary Under-Secretary of State for Adult Learning and Skills; and Parliamentary Under-Secretary of State for Young People and Adult Skills.

Ivan has been a Member of Parliament for Bury South since 1997.

Prior to joining Parliament, Ivan worked in the voluntary sector from 1986 to 1997 for Outreach, Contact Community Care Group and as Chief Executive of the Manchester Jewish Federation.