Gareth Morgan, Dignity in Care Programme Secretary; Win Tadd, Chair; Angela Roberts, Vice-Chair

Introduction

In the January 2010 Edition of ‘Generations Review’, a paper on the Welsh Dignity in Care Programme was published. This paper presented details on the background to the programme, how it was launched by Mrs. Gwenda Thomas the Deputy Minister for Social Services, the subsequent working arrangements of the multi-agency National Co-ordinating Group, the progress that was made up to 2010 and some initial conclusions on the programme.

The purpose of this paper is to update on the progress made and present an internal evaluation of the programme by comparing the original aims of the programme, given below, to the achievements that have been made.

Internal Evaluation

1. To collect, critique and organise dignity in care literature.
The National Co-ordinating Group drew membership from a wide range of sectors, including voluntary groups, independent care providers, health services, social care services, academic institutions and representatives of older people. From this wide range of contributors, a considerable amount of literature was collected and discussed. As a product from this, a dignity in care section will be added to the website ‘e-governance’, with some supporting core literature included. Although this website is predominantly developed for NHS Wales, it is available in the public domain and will offer an opportunity for non-NHS organizations to access literature on dignity in care.

2. To debate and discuss dignity in care research and policy.
This initially took place within the National Co-ordinating Group meetings. In 2010, 6 training events and 3 listening events were delivered in Wales. For the 6 training events, research undertaken on dignity in care by Dr. Win Tadd (Group Chair) and European colleagues, was delivered and offered a basis for debate and discussion by attendees, about 500 health and social care professionals in total. Regarding the 3 listening events, a dialogue was held with about 200 older people and those who care for them, both paid and unpaid. To facilitate debate and discussion, a theatre group was commissioned to deliver a play titled ‘Dignity’ which centered on the experience of BME older people in a residential care home.

3. To stimulate or co-ordinate pragmatic dignity in care research projects.
A survey of practice worth sharing was undertaken across Wales. A questionnaire was developed in collaboration with Social Services Improvement Agency, one of the members of the National Co-ordinating Group. This questionnaire was then widely circulated across Wales through existing networks. The scope of this project was to be inclusive, so no criteria were set and no attempts made to systematically map service patterns. This pragmatic research project instead aimed to collect examples of practice and in turn offer a resource to practitioners in Wales. This compendium is still being updated and helps balance negative perceptions of poor practice.

4. To disseminate information on dignity in care using websites.
The survey of practice worth sharing was published on the Social Services Improvement Agency website. Although there is no information available on how well this has been accessed, it is known anecdotally by discussions with colleagues across Wales that the website is considered a useful resource. One of the challenges is to ensure that this resource continues to expand to showcase the extent and range of good practice in Wales. In addition, many organizations across Wales have also included information on dignity on their websites. This was particularly helpful to disseminate the funding call for small grants, which will be described later and produced much interest.

5. To influence dignity in care policy in Wales.
With respect to policy, one direct influence has been the inclusion by Health Inspectorate Wales, a member of the National Co-ordinating Group, of dignity in their ‘spot check’ programme in Welsh hospitals. Health Inspectorate Wales and Care & Social Services Inspectorate for Wales have also included the theme of dignity in their joint review of the National Service Framework for Older People. Links are also being made with the 1,000 lives campaign in Wales, which now includes programmes related to the dignity in care agenda, such as ‘Transforming care at the Bedside’. Information was also given to the Commissioner for Older People who has undertaken a review of dignity in hospital.

6. To influence dignity in care practice in Wales.
At the 6 training events, a ‘Plan Do Study Act’ toolkit was given to attendees to help them improve the quality of their service delivery in the workplace. This toolkit was explained in depth to attendees and initial support given to help plan changes that could be made. As well as this direct influence, more than 20 small projects have been funded to improve practice in Wales, using funding set aside by the Welsh Assembly Government. In total, about 150 applications were submitted to this small grants programme, showing considerable interest. The successful ones offer a diverse range of initiatives and the experience gained from these will be shared across Wales.

7. To correspond with interested partners from outside Wales.
Although the focus of the programme has been a Welsh one, this final aim recognized the value of wider correspondence. Efforts have been made to bring into the public domain the work being undertaken, such as the previous publication in ‘Generations Review’. A poster abstract on the work of the programme was also presented at the NHS Confederation conference in November 2010. This conference included attendees from outside of Wales. In addition, the work of the Patients Association was of interest and following their presentation to a meeting of the National Co-ordinating Group, a commission has been made to consider the experience of Welsh patients. Work has also been completed to translate into Welsh a British Geriatric Society poster on dignity in care.

Conclusion

Based on an internal evaluation, the Welsh dignity in care programme has been successful as measured against our original aims. An external and independent evaluation of the programme has been commissioned to assess the impact of the initiatives undertaken. This impact evaluation, along with all the experience gained to date, will be helpful in respect of taking forward the programme in Wales and building on progress to date. Some projects at an early stage include work on bilingual issues, in accordance with the Welsh Language Act, work on dignity in care with respect to Lesbian, Gay, Bisexual and Transgender individuals and the development of links to other initiatives.