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Cesagen · Research

Dignity in Practice

Win Tadd, Alexandra Hillman

Start date


Affiliated staff

Anthony Bayer, Michael Calnan, Sian Calnan and Simon Read

Funded by

Department of Health and Comic Relief


The importance of providing dignified care for older people is increasingly cited in a range of UK health and social policy documents and recent high profile audits have emphasized the importance of meeting dignity standards in acute as well as long term care settings. Lack of dignity in care provision results in many complaints and substantial media interest. A recent national report on Caring for Dignity showed marked variations in the level and provision of dignified care for older people in acute hospital trusts, however, there is little explicit guidance about how to translate dignity into practice. This study addresses a central issue in care provision, which is the contribution of the health care workforce in maintaining patient dignity, particularly for older people.


The aim of this study was to develop a body of evidence about dignified care provision for older people derived from exploring the experience of service users, that of their informal carers, and both senior and ward staff working in Acute NHS Trusts together with a service evaluation involving observation of the behaviours and practices of providers within a number of wards in 4 Acute Trusts. From this information explicit guidance on the provision of dignified care can be developed.

The objectives were to:

  • identify older people’s and their informal carers’ views and priorities in relation to dignified care.
  • examine senior NHS manager’s’ beliefs, in relation to dignified care.
  • examine healthcare practitioners’ beliefs, in relation to dignified care.
  • examine Trust policies and guidance in relation to dignified care.
  • observe behaviours, practices and processes in Acute NHS wards to identify the occupational, organisational and cultural factors that impact on dignified care.
  • develop evidence-based recommendations and guidance for dignified care.


The evidence will be derived from an ethnography of four acute hospital trusts in England and Wales which will involve semi-structured interviews with older people recently discharged from hospital and their relatives/informal carers about their experiences and priorities in relation to the provision of dignified care. This will be complemented by evidence from an observational evaluation of practices and activities in 16 wards across 4 acute NHS Trusts , together with interviews with practitioners and other key informants to identify patterns of practitioner behaviour and the occupational, organisational and cultural factors which foster or detract from dignified care. In each study site, 4 wards will be chosen for the valuation: two offering care exclusively for older people; two offering care for adults including older people.


  • The study confirmed that care provision was variable. In none of the wards was care either totally ‘dignified’ or totally ‘undignified’ and variability occurred from ward to ward, in the same ward when different staff were on-duty, and at different times of the day.
  • The study found that acute wards are poorly designed to meet the needs of their main users, older people, they are not ideal as a place to treat older people with dignity, as the physical environment is confusing and inaccessible. The disempowering nature of acute wards and the boredom resulting from the loss of communal spaces and activities, add to the disorientation experienced by many older people on admission to hospital. Older people expressed concern about by being in close proximity to patients of the opposite gender. The staff, while doing their best, are often ill-equipped in terms of their knowledge and skills to care for older people whose acute illness is often compounded by physical and mental co-morbidities. This often leads to the view that older patients are not in the ‘right place’.
  • The research showed that individuals working in the NHS are motivated to represent patients’ interests but these motivations are frequently compromised by systemic and organisational factors including: setting acute Trust priorities on the basis of measurable performance indicators; a culture of blame; the management of ‘secondary risks’; high bed occupancy rates together with increased specialisation and rationalisation.


Tadd, W., Hillman, A., Calnan, S., Calnan, M., Bayer, T., Read, S. (2011) ‘Right place - wrong person: dignity in the acute care of older people’, Quality in Ageing and Older Adults, 12: 1: 33-43

Further information

To view the Dignity in Practice Executive Summary please click the link below:

Dignity in Practice Executive Summary

To view the full Dignity in Practice Report please click the link below:

Dignity in Practice Full Report

For any further information on the Dignity in Practice project, please contact