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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 6; 335(7622): 689.
PMCID: PMC2001075

Treat elderly people with dignity, trusts warned

NHS trusts in the United Kingdom must ensure that older people are given care in a way that respects their dignity, and trusts will face spot checks where there is evidence for concern, the healthcare watchdog for England has warned.

The Healthcare Commission compiled a report from assessments at 23 NHS hospitals, surveys of 80 000 NHS inpatients, and nearly 130 000 NHS staff, the commission's analysis of 10 000 complaints, and information on safety incidents from the National Patient Safety Agency.

The 23 hospitals inspected were chosen because of concerns about levels of care. Although no serious breaches of government standards were found, only five of the trusts were found to have fully complied with all the standards relating to dignity, privacy, and nutrition.

Eight trusts were given letters warning them that they were at risk of not meeting the standards and that they would be scrutinised carefully again next year. The remaining 10 trusts were told to make improvements.

The commission found that in some cases there were inadequate arrangements for providing privacy, such as curtains and locks on toilets and washing facilities. And although hospitals tried to avoid placing patients in mixed sex wards this still occurred, especially at busy times.

One in four complaints received by the Healthcare Commission was about poor nutrition. A survey of inpatients used in the report showed that of the older people who needed help to eat, less than a fifth said that they received it.

The commission warned that NHS trusts could face further checks, including unannounced visits if there were “clusters of evidence suggesting a problem at a hospital or on a ward.” It said that patients, their carers, and the public should tell the commission if they have reason for concern.

The chief executive of the Healthcare Commission, Anna Walker, said, “Trusts should know that where there is evidence that the right care is not being provided consistently, we will use all our powers of assessment and inspection. Patients and the public do not want to let this issue go, and we have no intention of doing so.”

The British Geriatric Society has led the multiagency campaign Behind Closed Doors, which focuses on access to and use of toilet as a marker of human rights and dignity. The chairwoman of the campaign, Jackie Morris, welcomed the Healthcare Commission's report but said that it still hadn't paid enough attention to the recognition of human rights of older people. “There are still older patients not being taken to the toilet and told ‘you've got pads on—do it in those.' This is simply not acceptable.”

She told the BMJ, “The message is really very simple: older people should be treated with manners, asked what they want and listened to.”

Gordon Lisman, director general of Age Concern, said, “There has been welcome progress in some areas—such as better help with eating for people who need it. But more needs to be done. Almost half of patients who need help with eating are still not guaranteed that support.”

Gill Morgan, chief executive of the NHS Confederation, said, “We need to make sure that proper standards of dignity are fully embedded into the work of NHS organisations so that high quality care is consistent for all patients. This will require effective systems to listen to what patients want, leadership from the top, and a zero tolerance approach to poor practice among all staff.”

The 23 NHS trusts inspected

Trusts warned

  • Barts and The London
  • West Dorset General Hospitals
  • West Hertfordshire Hospitals
  • Queen Elizabeth Hospital
  • Luton and Dunstable Hospital
  • Oxford Radcliffe Hospitals
  • The Princess Alexandra Hospital
  • Hull and East Yorkshire Hospitals

Improvements needed

  • Whipps Cross University Hospital
  • University Hospital Birmingham
  • South Manchester University Hospitals
  • Walsall Hospitals
  • Royal Berkshire and Battle Hospitals
  • James Paget Healthcare
  • Sherwood Forest Hospitals
  • Homerton University Hospital
  • United Lincolnshire Hospitals
  • Addenbrooke's

No action needed

  • Central Manchester and Manchester Children's University Hospitals
  • East and North Hertfordshire
  • North Middlesex University Hospital
  • Hillingdon Hospital
  • Wirral Hospital


Caring for Dignity is available at

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