Dignity in care

What is dignity?

Dignity consists of many overlapping aspects, involving respect, privacy, autonomy and self-worth. The provisional meaning of dignity used for this guide is based on a standard dictionary definition:

A state, quality or manner worthy of esteem or respect; and (by extension) self-respect. Dignity in care, therefore, means the kind of care, in any setting, which supports and promotes, and does not undermine, a person€™s self-respect regardless of any difference.€

While €˜dignity€™ may be difficult to define, what is clear is that people know when they have not been treated with dignity and respect.

What does €˜in care€™ cover?

This covers all care provided by paid workers in any setting (hospital, residential, nursing, day centres and in people€™s own homes), including care that is paid for either partially or wholly by the recipient.


The issue of dignity features prominently in the new framework for health and social care services:The Department of Health€™s Green Paper, ‘Independence, well-being and choice’ (2005a) and subsequent White Paper, ‘Our health, our care, our say’ (2006f), are set around seven key outcomes identified by people who use services, one of which is personal dignity and respect.

Factors that have been held responsible for the absence of dignity in care include:

  1. Bureaucracy
  2. Staff shortages
  3. Poor management and lack of leadership
  4. Absence of appropriate training and induction
  5. Difficulties with recruitment and retention leading to overuse of temporary staff.

There are also wider societal issues, including ageism, other forms of discrimination and abuse. A great deal of work is needed to tackle negative attitudes towards older people, to bring about a culture change and to ensure that such attitudes have no place in the health and social care sectors.

Respect for dignity is seen as important by everyone in the organisation, from the leadership downwards. Care and support is provided in a safe environment, free from abuse. It is recognition that abuse can take many forms including physical, psychological, emotional, financial and sexual, and extend to neglect or ageism.

Dignity tests:

  1. Is valuing people as individuals central to the philosophy of care?
  2. Do policies uphold dignity and encourage vigilance to prevent abuse?
  3. Is there a Whistleblowing policy in place that enables staff to report abuse confidentially?
  4. Have the requisite Criminal Records Bureau and Protection of Vulnerable Adults List checks been conducted on all staff?

Support people with the same respect you would want for yourself or a member of your family

People should be cared for in a courteous and considerate manner, ensuring time is taken to get to know people. People receiving services are helped to participate as partners in decision-making about the care and support they receive. People are encouraged and supported to take responsibility for managing their care themselves in conjunction with, when needed, care staff and other information and support services.


Dignity tests:

  1. Are members of staff polite and courteous even when under pressure?
  2. Is the €˜culture€™ about caring for people and supporting them rather than being about €˜doing tasks€™?
  3. Do policies and practices emphasise that the setting should always try to see things from the perspective of the person receiving services?
  4. Do all staff ensure people receiving services are not left in pain or feeling isolated or alone?

Treat each person as an individual by offering a personalised service

The attitude and behaviour of managers and staff help to preserve the individual€™s identity and individuality. Services are not standardised but are personalised and tailored to each individual. Members of staff take time to get to know the person receiving services and agree with them how formally or informally they would prefer to be addressed.

Dignity tests:

  1. Do policies and practices promote care and support for the whole person?
  2. Do policies and practices respect beliefs and values important to the person receiving services?
  3. Does €˜care€™ and €˜support€™ consider individual physical, cultural, spiritual, psychological and social needs and preferences?
  4. Do policies and practices challenge discrimination, promote equality, respect individual needs, preferences and choices, and protect human rights?

Enable people to maintain the maximum possible level of independence, choice and control

People receiving services are helped to make a positive contribution to daily life and to be involved in decisions about their personal care. Care and support are negotiated and agreed with people receiving services as partners. People receiving services have the maximum possible choice and control over the services they receive.

Dignity tests:

  1. Do members of staff deliver care and support at the pace of the individual?
  2. Do settings and members of staff making unwarranted assumptions about what people want or what is good for them?
  3. Do individual risk assessments promote choice in a way that is not risk-averse?
  4. Does the setting provide people receiving services the opportunity to influence decisions regarding our policies and practices?

Listen and support people to express their needs and wants

Provide information in a way that enables a person to reach agreement in care planning and exercise their rights to consent to care and treatment. Openness and participation are encouraged. For those with communication difficulties or cognitive impairment, adequate support and advocacy are supplied.

Dignity tests:

  1. Does everyone truly listen with an open mind to people receiving services?
  2. Are people receiving services enabled and supported to express their needs and preferences in a way that makes them feel valued?
  3. Do all members of staff demonstrate effective interpersonal skills when communicating with people, particularly those who have specialist needs such as dementia or sensory loss?
  4. Do settings and members of staff ensure that information is accessible, understandable and culturally appropriate?


Respect people€™s right to privacy

Personal space is available and accessible when needed. Areas of sensitivity which relate to modesty, gender, culture or religion, and basic manners are fully respected. People are not made to feel embarrassed when receiving care and support.

Dignity tests:

  • Are there quiet areas or rooms that are available and easily accessible to provide privacy?
  • Do members of staff actively promote individual confidentiality, privacy and protection of modesty?
  • Do members of staff avoid assuming that they can intrude without permission into someone€™s personal space, even if they are the care worker?
  • Can people receiving services decide when they want €˜quiet time€™ and when they want to interact?


Ensure people feel able to complain without fear of retribution

People have access to the information and advice they need. Members of staff support people to raise their concerns and complaints with the appropriate person. Opportunities are available to access an advocate. Concerns and complaints are respected and answered in a timely manner.

Dignity tests:

  1. Does the setting have a culture where all members of staff can learn from mistakes and are not blamed?
  2. Are complaints policies and procedures user-friendly and accessible?
  3. Are complaints dealt with early, and in a way that ensures progress is fully communicated?
  4. Are people, their relatives and carers reassured that nothing bad will happen to them if they do complain?
  5. Is there evidence of audit, action and feedback from complaints?


Engage with family members and carers as care partners

Relatives and carers experience a welcoming ambiance and are able to communicate with staff and managers as contributing partners. Relatives and carers are kept fully informed and receive timely information. Relatives and carers are listened to and encouraged to contribute to the benefit of the person receiving services.

Dignity tests:

  1. Do employers, managers, and staff recognise and value the role of relatives and carers, and respond with understanding?
  2. Are relatives and carers told who is €˜in charge€™ and with who issues should be raised?
  3. Do settings provide support for carers who want to be closely involved in the care of the individual, and provide them with the necessary information?
  4. Are settings and members of staff alert to the possibility that relatives€™ and carers€™ views are not always the same as those of the person receiving services?


Assist people to maintain confidence and a positive self-esteem

The care and support provided encourages individuals to participate as far as they feel able. Care aims to develop the self-confidence of the person receiving services, actively promoting health and well-being. Adequate support is provided in eating and drinking. Staff and people receiving services are encouraged to maintain a respectable personal appearance.

Dignity tests:

  1. Are personal care and eating environments well designed for their purpose, comfortable and clean?
  2. Do settings and members of staff maximise individual abilities at all times during eating and personal care and hygiene activities?
  3. Do settings and members of staff ensure people receiving services wear their own clothes wherever possible rather than gowns etc.?
  4. While respecting the wishes of the person receiving services as far as possible, are they respectable at all times and are staff tidy and well presented?


Act to alleviate people€™s loneliness and isolation

People receiving services are offered enjoyable, stimulating and challenging activities that are compatible with individual interests, needs and abilities. People receiving services are encouraged to maintain contact with the outside community. Members of staff help people receiving services to feel valued as members of the community.

Dignity tests:

  1. Do settings provide access to varied leisure and social activities that are enjoyable and person-centred?
  2. Do settings review the activities offered to ensure they are up to date and in line with modern society?
  3. Do settings provide information and support to help individuals engage in activities which help them participate in and contribute to community life?
  4. Are responsibilities of all staff towards achieving an active and health-promoting culture made clear through policies, procedures and job descriptions?