Dignity in Care report calls for shake-up in staff selection and appraisal - The Guardian

Nurses, doctors and care workers should be recruited as much for their compassion as for their exam results, according to an inquiry into improving the dignity of treatment of elderly people in hospitals and care homes.

A shake-up of the criteria used for selecting and appraising staff should give the same emphasis to their assessed values and capacity to engage with older people as to their formal qualifications, the inquiry recommends. But it stops short of backing any lowering of academic entry bars.

The call is among a raft of proposals by a commission set up jointly by bodies representing NHS organisations and local councils together with a leading charity for older people, following a series of reports and investigations exposing poor care in hospitals and care homes.

A dossier of cases published 12 months ago by the NHS ombudsman found failure to provide "even the most basic standards of care". Later this spring, the conclusions of the Francis inquiry into the breakdown of care at hospitals in mid-Staffordshire is expected to damn the quality of nursing and medical and management supervision.

The draft report of the Commission on Dignity in Care, published on Wednesday, says that improving matters will require nothing short of "fundamental changes to culture, leadership, management, staff development, clinical practice and service delivery".

Sir Keith Pearson, chair of the NHS Confederation, which represents health trusts, said there had been too many cases of failings in care. "We want this report to be a call to arms to the whole health and social care system. We need to work together to earn back public confidence."

The report, which is open to public consultation, urges an end to "command-and-control" NHS management that it says has disempowered frontline staff. It calls on nursing sisters to be given responsibility for everything that happens on their ward and "take the action they deem necessary in the interests of patients", and says that ward teams should have daily discussions on feedback from patients and relatives, with regular reports going up to trust boards.

Residents and their relatives should be involved in the running of care homes, the report says, and a national care quality forum should be set up to investigate all aspects of the staffing of homes, including pay and qualifications, as part of a drive to raise the status of work in the care sector.

Trish Morris-Thompson, NHS London's chief nurse and a member of the commission, said that recruitment and regular career appraisal of staff should consider their values and compassion as much as academic rigour. A pilot scheme involving Great Ormond Street children's hospital in London and the South Bank University nursing course had produced graduates of exceptional quality.

Katherine Fenton, chief nurse at University College London Hospitals foundation trust, said her trust was taking a similar approach, starting with medical consultants, involving assessment of their interaction with patients and group interviews.

The commission insists that many of its recommendations could be implemented at minimal cost. The University Hospitals Birmingham foundation trust, which is singled out for praise in the report, is said to have established a comprehensive "dignity for all" programme with what Morris-Thompson described as "very little resource".

The report, by the NHS Confederation, the Local Government Association and charity Age UK, calls on the government to set a more positive tone for debate about the ageing society.