Explores the concept of dignity and its significance to the adult social care sector.
The common core principles to support dignity in the adult social care sector
Identifies the seven principles.
The importance of the values in adult social care
Considers the importance of values in social care and support services.
Using the common core principles to build a confident workforce
Guidance on how leaders, managers, education and learning providers, commissioners and care and support workers can use the principles to address issues of workforce development, standards and quality.
Throughout the document we use the overarching term of ‘care and support workers’. This term includes all those who work in a social care setting, such as caterers, care assistants, managers, maintenance staff, nurses, occupational therapists and social workers. This list is not exhaustive but serves to illustrate the breadth of the roles included in the term. Those who use services are also referred to throughout as ‘individuals’ and no specific reference is made to age, gender, sexuality or ethnicity.
Purpose and structure of the guide
This guide presents seven common core principles to support dignity in adult social care. They can be used to support workforce development for any member of the social care workforce and are relevant to any setting in which care and support is provided. The principles can be used by all care and ancillary workers who support adults across the social care sector. They can inform leaders, managers and commissioners when looking at workforce development, standards and quality of service provision and can be incorporated in the design and delivery of learning and development opportunities for the workforce.
The principles aim to encourage care workers to identify and reflect upon the centrality of dignity in the provision of all care services and to commit to upholding the dignity of those they support. It includes a set of ‘Stop! Think dignity Principles to practice’ guides to encourage employers and care and support workers to apply the principles in real life situations.
Whilst they have been written primarily for the social care sector, they will also be of wider interest to other sectors where workers are customer focused such as health, voluntary or housing services and retail.
Dignity focuses on the significance and value of every person as a unique individual. We show our commitment to upholding other people’s dignity by the ways in which we treat them; fairly, truthfully and with care and compassion. We respect other’s views, choices and decisions and do not make assumptions about what they want, like or how they want to be treated.
We can also conduct our own lives with dignity, behaving honourably in a way that respects our own character and self worth, values our attributes and helps to make us worthy citizens within our communities or wider society. In this context we have control over our own dignity, although it can be diminished by the actions of others.
Dignity embodies the belief that everybody has equal worth and is entitled to be treated respectfully. Each individual, regardless of age, ability to consent, gender or disability, should be valued and treated as if they were able to think, feel and act in a way that would uphold their own self-respect and dignity.
The importance of upholding the dignity of citizens is considered to be of such significance as to be enshrined in UK law (Human Rights Act 1998). “At the heart of human rights is the belief that everybody should be treated equally and with dignity - no matter what their circumstances.” (Equality and Human Rights Commission). The Human Rights Act details a range of human rights which protect this belief including the right to have access to public services and to be treated fairly by those services, respect for private and family life, and the right to liberty and security.
The Centre for Public Scrutiny found, in a 2009 study, that those in need of social care support experienced an increased risk of losing their dignity and self-respect, ‘by their nature, health and social care services are provided when people are most vulnerable - when they are feeling at their weakest, when they are afraid and when they have to expose the most intimate and personal parts of themselves (their bodies and their minds) to inspection and handling by others.’ (Walk a mile in my shoes: Scrutiny of dignity and respect for individuals in health and social care services: a guide. Centre for Public Scrutiny, 2009).
Upholding the dignity of individuals who use social care and support is therefore a key priority for all those who are involved in the design and delivery of care and support.
Public policy recognises this priority and its relationship with the provision of learning and development that delivers a suitably skilled and empathic workforce, ‘People who work in care and support are absolutely essential to enable us to deliver better care and support, and make sure that people are treated with dignity and respect. We want to develop an empowered, confident and capable workforce that is able to support more integrated and personalised approaches to care.’ (Caring for our future: reforming care and support White Paper: July 2012).
To support the continued development of high quality services that uphold dignity, the government has introduced a number of resources and services to the sector including strengthening the status of registered managers as critical leaders and advocates for quality care, and placing dignity and respect at the heart of the new code of conduct and national minimum training standards for care workers. The drive to uphold the dignity of individuals using care and support is not new. There are individuals, networks and organisations who have championed the cause for a number of years, producing a range of materials to support the sector.
- the ‘Dignity Challenge’ produced by the Dignity Council.
- the ‘Dignity Code’ developed by the National Pensioners Convention.
- Dignity in Care: SCIE Guide 15.
- ‘Delivering Dignity’ the final report of the Commission on dignity in care for older people.
However, situations continue to arise where social care and health services fail to uphold the dignity of individuals in many aspects of their care. Organisational failure and abuse is highlighted in cases such the death of Steven Hoskin in Cornwall in 2006, the widespread institutional abuse of patients at Budock Hospital, Falmouth, in the same year, the mistreatment of vulnerable adults by staff at Winterbourne View hospital and the failures of mid Staffordshire NHS Foundation Trust hospital where, amongst other horrific failures between 2005 and 2008, patients were denied basic healthcare; ‘Privacy and dignity, even in death, were denied’ (Mid staffs public enquiry: executive summary Feb 2013). These situations, which have taken place across both health and social care, provide stark and distressing examples of where the dignity of the individual is disregarded, and illustrates how the sector must continue to go further to ensure that all individuals are treated with dignity and respect when receiving services.
Skills for Care recognises that one of the prime routes to improvement lies in the continued development of a quality workforce that truly understands what dignity means and places it at the very heart of care services. To achieve this, Skills for Care has worked with advisors from key organisations across the sector to develop a resource that focuses specifically on the knowledge, understanding, skills and practices required by the workforce to deliver such care. This resource, which presents seven common core principles to support dignity in adult social care, has been designed to complement and build on resources currently available to the sector.
The principles will:
- highlight the importance of placing dignity at the heart of all care and support services.
- provide seven common core principles that are applicable across all services, for all individuals who use services and all care and support workers.
- describe the understanding, knowledge, skills and practices required by the social care workforce to deliver care and support that upholds the dignity of the individual.
- provide good practice guidance, giving real examples, for implementing each of the principles in the workplace.
- make ‘Stop! Think dignity’ a common place phrase that encourages organisations to develop workplace cultures that give care workers time to reflect upon and take ownership of their practice.
- influence the content of future materials developed by publishers.
- provide learning providers with a valuable underpinning resource, reminding them of the importance of including issues of dignity in all their learning and development resources and training.
The common core principles to support dignity in the adult social care sector
Value the uniqueness of every individual
Uphold the responsibility to shape care and support services around each individual
Value communicating with individuals in ways that are meaningful to them
Recognise and respect how an individual’s dignity may be affected when supported with their personal care
Recognise that an individual’s surroundings and environments are important to their sense of dignity
Value workplace cultures that actively promote the dignity of everybody
Recognise the need to challenge care that may reduce the dignity of the individual
The importance of values in adult social care
The actual delivery of care and support is a complex activity, the quality of which is determined not only by the knowledge and skills of the care and support worker but also by the relationship between the care and support worker and the individual using care and support. The nature of this relationship depends upon a number of factors including the mutual respect between those giving and using care and the values and attitudes of the care and support worker.
Values are sets of beliefs or views that people hold about what is right or wrong and reflect a person’s sense of what is good or bad. They may have a strong influence upon people’s attitudes and behaviours and act as a set of guidelines or rules about how to behave in certain situations. Individuals may develop or alter their values throughout their lives, influenced by such factors as family, school, religion, employment and communities. People may experience difficulties if their personal values do not match other belief systems they interact with such as those found within the workplace.
Holding or developing professional values which ensure care and support workers uphold the dignity of individuals, relies on a mixture of innate personality traits such as integrity, respect and empathy alongside learnt behaviours gained through experience or training. Many care and support workers enter the profession because they feel a compassion for and a desire to help fellow individuals. Ongoing learning and development opportunities provided within a positive workplace culture further supports them to capture and refine these valuable attributes enabling them to empower individuals to achieve their goals and aspirations.
Current codes of conduct and standards within the social care sector can support this process. The code of conduct and the national minimum training standards for health and social care developed by Skills for Care and Skills for Health, the Health and Care Professions Council (HCPC) standards of proficiency for social workers in England and the College of Social Work’s Professional Capabilities Framework (PCF), which sets out the key capabilities expected of social workers as they develop throughout their career, all support the sector to develop a workforce with a strong value base that underpins empathic and individualised care.
The qualifications for the social care workforce, including the social work degree and the health and social care diplomas found on the qualifications and credits framework, also reinforce the importance of care and support workers holding strong positive values and require learners to evidence this alongside knowledge and skills.
Using the common core principles to build a confident workforce
The common core principles to support dignity in adult social care have been designed to support the development of a confident workforce, which has a strong commitment to upholding the dignity of individuals using care and support services. They support current policy drivers towards personalised care and support and have been developed in partnership by individuals who use services and professionals across the adult social care sector. The principles can form the foundation for good practice in any setting and provide a framework for learning and development. Whilst they have been primarily designed to be used by leaders, managers and care and support workers, they are also intended to have a wider application and relevance to commissioners and education and learning providers.
Leaders and managers
The commitment of leaders and managers to uphold dignity is central to the delivery of services that respect the dignity of staff and individuals. As outlined in principle 6 leaders and managers carry the primary responsibility to develop positive workplace cultures.
The principles support them in this process, highlighting the importance of working in partnership with individuals, families and communities to deliver person-centred care and giving workers opportunity, time and space to gain the necessary knowledge and values to deliver services that respect and value the individual’s dignity. The principles inform a range of HR activities, for example creating job descriptions, defining new roles or contributing to a framework that identifies learning and development needs.
Current social care policies and legislation emphasise the critical role that commissioners play in driving up the quality of services though good commissioning practices. Those practices seen as detrimental to the quality of service provision can impact upon the dignity of individuals using those care services. Therefore commissioners need to consider how the services they commission are committed to upholding the dignity not only of the individuals using the service, but also of the care and support workers employed by the organisations they are commissioning with. Principles 5, 6 and 7 are of particular relevance here. They can be used as indicators or measures that the services or organisations they contract with have the necessary knowledge, skills, practices and attitudes within their workforce to deliver care and support that upholds dignity.
Education and learning providers
The principles serve to remind education and learning providers of the importance of learners understanding the centrality of dignity in care and support services. All the principles can be used to inform curriculum design and delivery, so that learning and development opportunities build on the learner’s existing value base and knowledge around dignity issues. The principles, illustrate desired knowledge and skills which can be used to inform more informal learning in the workplace.
The guidance is further designed to become a familiar publication in environments where care and support is provided in more communal settings, such as residential care homes. The poster highlights the place of dignity at the heart of care and support services and the principles can be shared with families and carers to evidence the organisation’s commitment to upholding the dignity of their relatives or friends.
‘Stop! Think dignity Principles to practice’
These guides provide guidance on how the principles can be implemented in real life situations. They were developed to provide tangible examples of where care and support services uphold an individual’s dignity, often in complex and challenging situations. They evidence the difference that can be achieved by skilled and reflective care and support workers and, together with the quotes and dilemmas, suggest actions that make a difference in everyday situations. The practice scenarios within the guides support workforce development by providing opportunities for thought provoking and solutions focussed discussions within the workplace.