Commissioning Dignity in Care Homes

1. Commissioning Dignity in Care Homes Clare Henderson Asst. Director Planning, Independence & Older Adults Sue Newton Commissioning Manager Older Adults

2. What is commissioning? “Commissioning is the process of specifying, securing and monitoring services to meet people’s needs at a strategic level. This applies to all services, whether they are provided by the local authority, NHS, other public agencies or by the private or voluntary sectors” (Audit Commission, Making Ends Meet). Without the word “strategic” in the definition above any process which understands needs, plans and then delivers services could be seen as commissioning. For example a social worker putting together a care package could be seen as micro-commissioning.

3. Why Dignity? Health and social care services have, in recent years, made significant progress in reducing waiting lists and improving access to services. This has sometimes been at the expense of the quality of care experience. So the Government launched the Dignity in Care Campaign in November 2006 with the aim of re-dressing that balance and putting dignity at the heart of care.

4. Workshop aims: • Share our approach to providing care home services that respect the dignity of residents • Consider how the commissioning process can deliver dignity focused services • Share good practice in an informal and interactive way

5. What did we do in Islington? After the campaign launch Islington’s early good intentions manifested in the following activities: • Both Commissioning Managers signed up as Dignity Champion • Presentation were made at 2 key provider forums to raise awareness and encourage each agency/home to nominate Dignity Champion(s), which many did. • Began to introduce dignity principles and related key performance indicators into contracts • Set up Quality Care Review Service - trained volunteers interview care home residents and home care users about the quality of the services received

6. Early learning Process stalled because: • Dignity is difficult to pin down - we talked to providers and they agreed it was important, they said there ways of working took account of people’s dignity • We struggled with how to represent dignity in our service specifications and contracts • We got caught up in how to describe dignity, set targets for it and indicators to measure it • We didn’t understand how to effect change in people’s behaviour because we didn’t have direct relationships with our providers

7. A Fresh Perspective A number of things came together: • a couple of incidents in our care homes that were dealt with through the Safeguarding Adults procedure involved dignity issues • a quality review project we had commissioned in one of our care homes came back with clear examples of practise that impacted on dignity: • the gravy jug incident • the lunch room incident • the television incident • New members of staff joined the department which meant fresh ideas and more time to work on getting things right • The Overview and Scrutiny Committee undertook a review of our care homes earlier this year

8. Current Activities: We realised that we should be considering dignity as part of our drive to improve quality. • Commissioners started to attend Dignity Network Meetings to find out what was happening elsewhere • End Of Life Strategy – Care home providers engaged in its development • Short term project at a care home seeking views of residents and relatives (including those with dementia) on range of topics including dignity • Recruited Care Homes Nurse Specialist to support our Care Homes and encourage them to enroll in the GSF programme • Quality Network: • initiated this summer after incident in a residential unit • professionals can report concerns about any service in the borough • monitored daily with monthly panel meetings to action issues

9. Planned Activities: • Older Peoples Reference Group to: • develop dignity code for inclusion in all service specifications; train to participate in induction programmes, recruitment and procurement; have presence in care settings to promote the dignity agenda • Care Settings and Home Care Quality Review Service - a pilot project which is in the planning stage at the moment but which we hope to be able to mainstream • Joint working with our colleagues at UCH to further develop the work they have already done, using art to improve relationships between care staff and residents • Identifying existing Dignity Champions in Islington and working with them to develop the role.

10. Developing the Role of Dignity Champions: These ideas have all been suggested at the Dignity Network meetings we’ve attended and reflect the range of activities that Dignity Champions can become involved in: • user involvement work to promote involvement • research, audits and evidence gathering mechanisms to challenge process and push for greater inclusivity • evaluation activities such as Equality Impact Assessments • development of Dignity Code

11. Moving forward - the key for Islington • Delivering quality services to our residents • Not being afraid to use new ways of working to help us do that e.g developing quality outcomes