09 / 08 / 2012
What we did and why
How we did it
Results and next steps
NHS Central Lancashire is a primary care trust (PCT) responsible for managing local health services, such as general practitioners (GP’s) dentists, opticians and pharmacists and works closely with local hospitals and social services and other local authorities to commission and provide high quality healthcare for people in their community. The PCT employs approximately 2,500 staff and serves approximately 460,000 people.
What we did and why
The challenge for the PCT was the Equality Act in 2010 and in particular the duty around age which established a new legal duty on public bodies to have due regard to the need to eliminate discrimination, advance equality of opportunity and foster good relations in the exercise of its functions in relation to eight protected characteristics, including age.
This context was the backdrop for a project focused on older age members of the community through promoting dignity in care for those people with long term conditions who were unable to leave their homes without assistance. The overarching project aim was to understand the reality of service experience for both staff and patients through eliciting views and taking a snapshot of their experience.
The objective of the project was to review the extent to which existing practice achieves the following:
- NHS values such as dignity, respect and equality are put into practice.
- Services and procedures are designed to put the human at the heart of healthcare.
- Staff and commissioned providers are effectively supported to fulfil their specific duties under the equalities legislation.
How we did it
The PCT decided to adopt a human rights based approach based around four elements to treating people with dignity:
- Behaving as though all people have equal human value, by valuing their views and wants, even if practitioners cannot follow all users’ wishes.
- Helping people to have self-respect, by helping people manage as much as possible their own affairs and remain in control of decisions.
- Helping people to have autonomy, by helping them to do things on their own and to make choices where possible.
- Promoting a ‘positive mutuality’, including supporting their relationships with others, and encouraging positive attitudes to doing things with other people Chan (2004).
The PCT sent 253 questionnaires to patients and staff and 122 responses were received (48%). NHS Central Lancashire PCT received 17 of the 26 questionnaires (65%) from the Community Matrons and 105 of the 227 questionnaires (47%) from their patients.
In addition the following tasks were undertaken:
- Workshops were held to develop patient letters, information leaflet and questionnaires (patients and staff).
- People identified who accessed Community Matron Services to ascertain their experiences and the experience of staff delivering this service.
- The Community Matron caseload evaluated to identify specific target groups to pilot this programme e.g. black and minority ethnic people, people who are housebound and people with long term conditions.
- Independent staff identified to facilitate the questionnaires with the Computer Research and Technology (CRT) system.
The results and next steps
The questionnaire and workshops revealed the following feedback:
Areas for development
The survey revealed a concern over lack of knowledge around cultural issues such as religion and belief.
- Patients feel that they are valued and respected. Evidence suggest that staff have consistency demonstrated respect, through viewing patients as human beings and individuals, and demonstrated by courtesy, good communication and taking time.
- Communication between staff and patients is clear, transparent and respects their individuality. Evidence suggests that 84 per cent of patients feel that community matrons show respect for their religious and cultural belief when discussing nutrition. This seems to suggest that patients and communities are provided with appropriate communications and support from staff and information about services - and that patients are able to make informed choices.
- Pro active patient care encourages privacy, dignity, and modesty - through communication and relationships, choice, privacy and hygiene. Of those surveyed, 96 per cent of patients felt that their individual wishes were respected. This suggests that patients report positive experiences where they are listened to and respected and the services they receive are safe, effective and personalised to their specific needs.
The learning has been shared with the PCT, NHS North West, the collaborative group, Age Concern and the Picker Institute.
Programme Manager Equality and Diversity