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Dignity - Behind Closed Doors

Aims of the Campaign

The aim of the campaign is to raise awareness that people, whatever their age and physical ability, should be able to choose to use the toilet in private in all care settings.

“Toilet Access and Use” has been chosen as a marker of Human Rights and Dignity. Wide dissemination of our educational leaflets, decision aides, standards and check lists to voluntary groups, patient and carer groups as well as to care staff, will make patients aware of what they should expect. Giving people back control over their most private of functions will enhance their independence and rehabilitation, reduce lengths of stay and promote continence.

The campaign emphasises the importance of the environment, as well as care practices and will help in the future commissioning of facilities. It will provide commissioners, chief executives and inspectors a measure of good practice and clinical governance.

We are particularly grateful for all the contributions we have received from members of the committee.


The recent publication of A New Ambition for Old Age by the Department of Health (DH) describes how some staff still demonstrate deep-rooted negative attitudes and negative behaviour towards older people. They recommend that each NHS Setting providing care for older people nominate a member of staff to take responsibility for protecting and promoting the dignity of older people.

It is recognised that the dignity of older people is infringed every day in many different ways.

Infringements of dignity include

  • visiting at ward rounds
  • split back night dresses
  • inappropriate hoists
  • mixed sex wards on Medical Admissions Units
  • patients wearing pads without underwear
  • ward curtains or night dresses or smocks which do not fit properly exposing patients or allowing mooning
  • hoisting patients without covers.
  • Patients being referred to as bed blockers, social problems

The British Geriatrics Society (BGS) has welcomed this concentration on these less overt forms of ageism, neglect, loss of dignity and infringement of human rights.[1]

Prior to the DH publication, the BGS brought together a multi-agency committee to look at markers of dignity. Despite welcoming the appointment of members of staff to take responsibility for Dignity it was thought that these concepts should be developed in a multi-disciplinary fashion. It was agreed that the committee would consist of a partnership between :

Age Concern England, British Geriatrics Society, Department of Geriatric Medicine, Cardiff University, Carers UK, Continence Foundation, Help the Aged, Incontact, Royal College of Nursing.

It has been agreed that “Toilet Access” and “Use” should be used as a marker for this campaign. The campaign is timely. The Royal College of Physicians (RCP) National Continence Audit 2 found that few hospitals had identified that they need to do better in privacy and dignity during bladder and bowel emptying. The WASH YOUR HANDS campaign has already demonstrated that there is potential to improve clinical practice with a simple campaign.

The campaign has identified the following groups of people who might seek to infuence change:

Older persons' fora
Older People's champions
Community Health Councils (Wales)
Educators in all education and training programmes Advocacy and patient support groups
Carers groups
Royal Colleges
Patients Association

The campaign aim is to infuence policy via:

The DH Older Persons NSF work programme
The DH Dignity Reference Group
NICE Guidelines Faecal Incontinence (2007)
NICE Guidelines Urinary Incontinence in Women (2006)
NICE Guidelines Dementia (2006)
Future national continence audits / research programmes
The Healthcare Commission’s inspection process

The primary focus of the campaign is on people receiving care but it must be emphasised that if care staff are to be able to respond to others in a dignified manner then they too must be treated with dignity.

The campaign has produced the following:

(a) The Behind Closed Doors Leaflet

(b) The Behind Closed Doors Standards

(c) A decision aid for using the toilet in any care settings

(d) A checklist for use by lay people and

(e) An action plan for the target groups


  1. Dr Jacqueline Morris, Dr David Oliver and Dr David Beaumont. Decent Health Care BMJ Editorial (BMJ, May 2006; 332: 1166 - 1168)
  2. Dr Adrian Wagg, Dr Sarah Mian, Mr Derek Lowe and Dr Jonathan Potter. Health Care of Older People Programme. Pilot of the National Audit of Continence Care for Older People (England and Wales)


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