Introduction

Since 1999, Wales has had a system of devolved government.  In the intervening decade, Wales had pro-actively developed a number of initiatives relating to the care of older people.  The post of an independent Commissioner for Older People, for example, is believed to be unique.  Another programme in Wales relates to dignity in care.    

In 2007 on October 1st which is International Older People Day, a Welsh ‘Dignity and Respect in Care Programme’ for older people was announced by the Deputy Minister for Health and Social Services, Mrs Gwenda Thomas.  To support the first phase of the programme, the Welsh Assembly Government provided £2,000 funding to all NHS Trusts in Wales plus teaching resource materials, including work books and case studies. The money and resource materials were used to raise staff awareness of issues related to dignity and respect in caring for older people, supporting the production of an action plan for the Trusts.  These action plans were submitted to Healthcare Inspectorate Wales in their 2008 / 2009 ‘Healthcare Standard Improvement Plan’ returns.

The National Dignity in Care Co-ordinating Group for Wales

Mrs Thomas also announced that a multi-agency and multi-disciplinary National Dignity in Care Co-ordinating Group would be set up to offer advice on the implementation of a 3 year programme.  The overarching rationale for the Dignity in Care National Co-ordinating Group is to ensure that all developments pertinent to this agenda in Wales are progressed systematically and effectively.  Dr Win Tadd, of Cardiff University, was appointed by Mrs Thomas as Chair of the Group.  The first meeting of the Dignity in Care National Co-ordinating Group took place  on July 14th 2008 with subsequent meetings taking place on a quarterly basis.

The inaugural meeting introduced members, received background papers for discussion, received presentations and allowed time for each member to outline their particular perspective on dignity in care.  Membership included representatives of older people and a wide range of organisations were invited to attend from across the health and social care spectrum.  Other organisations, such as academic institutions and inspectorate and improvement agencies, were also invited to attend.  One initial success of the Dignity in Care National Co-ordinating Group was the range of groups and organisations that were represented and committed to taking forward this agenda in Wales.

Given the work previously progressed on the health side, it was also agreed at the inaugural meeting to establish a Social Care Subgroup.  Angela Roberts, Crossroads Wales and also representing an umbrella organisation of voluntary groups known as Age Alliance Wales, was nominated as Chair of the subgroup.

Since the inaugural meeting, there have been a number of outcomes.  For example, the Social Services Improvement Agency website publishes  practice worth sharing in respect of dignity in care in Wales.  The Care Forum for Wales, an all-Wales umbrella organisation for care providers in Wales, has a ‘Dignity in Care Award’.  This is presented by Mrs Thomas at their annual award ceremony and is sponsored by the Welsh Assembly Government. 

Further Development of the Dignity in Care Programme

In July 2009, Mrs Thomas announced that £100,000 of Welsh Assembly Government funding would  support the dignity in care programme by awarding a number of  research grants (see Box 1) and 6 training events will be delivered across Wales in February and March 2010.  These events are targeted at commissioners, procurement managers and providers across all social care sectors.  Although the focus will be on social care, colleagues from health services may also benefit from attending.  Dr Win Tadd will be delivering the training in conjunction with Sandra Jones from Denbighshire County Council.  The training will be evaluated at 2 levels, namely process and impact.  The process evaluation will focus on the number of attendees, each event has capacity of 100, as well as the quality of the training.  The impact evaluation will focus on how each attendee implements the training within their own organisation, using the ‘Plan Do Study Act’ model of change.

In March 2010, 3 listening events are planned, inviting older people, carers and health and social staff.  These events will initiate dialogue on dignity in care issues, helping to determine the priorities and actions for the programme in 2010 / 2011.    

Conclusion

The Dignity in Care  programme is managed as part of the National Service Framework (NSF) for Older People in Wales.  The NSF is currently being evaluated by Health Inspectorate Wales and Care & Social Services Inspectorate for Wales, with dignity being one of the cross cutting themes. 

Of course, dignity in care is difficult to define, as it may be subjective and understandings may vary between individuals, settings, cultures and generations.  Therefore, person centred care must remain the cornerstone of dignity in care and we all have a responsibility to ensure this is delivered. 

In Wales, the national programme on dignity in care will continue to influence practice.  For example, the National Leadership Innovation Agency for Healthcare is working with the new NHS bodies in Wales to develop Boards using the ‘Harvard model’ of case-studies.  Dignity in care case-studies have been offered to this programme.  Furthermore, the forthcoming Dementia Action Plan in Wales offers a further avenue to progress this agenda.    

Box 1 : Small grants programme : Summary of successful bids