4 years ago




INTRODUCING HUMAN RIGHTS IN HEALTH AND CARE Healthcare which respects, protects and fulfils our human rights has an important role in ensuring we can all live dignified lives and participate as active members of our communities. Human rights are about each and every one of us, no matter who we are or where we are from. Human rights are the hallmark of a democratic and fair society; providing the rule book for how public authorities, such as NHS healthcare organisations, should treat us. In this way human rights provide a vital safety-net for us all, setting down in law the basic minimums that everyone should have simply because we are human. A human rights approach means putting the human being and their legally protected rights at the centre of policymaking and day-to-day practice. It can be applied to all areas of public life that affect human rights, including housing, education, policing, social care and (the focus of this guide) health. Healthcare and human rights: a shared history Healthcare and human rights have always had a close relationship. In 1948, following the horrors of World War II, the UK championed international human rights laws whilst at the same time creating the NHS here at home. So it is hardly surprising (though sometimes forgotten!) that human rights values such as fairness, respect, equality, dignity and autonomy underpin our public healthcare service ethos, as well as the NHS Constitution, professional codes of conduct, and various healthcare laws and policies. “Principle 1: The NHS provides a comprehensive service, available to all... It has a duty to each and every individual that it serves and must respect their human rights” NHS Constitution Human rights - it’s about healthcare practice Putting human rights into practice – a human rights approach – means moving beyond the spirit of values and expressly using the language of the law to help achieve positive change. The Human Rights Act (HRA) is one of the most important laws protecting our rights here at home. The HRA is a “framework law”, with legal duties on public authorities, such as healthcare services, designed more for culture change than rafts of litigation. The HRA offers fresh ways into the age-old problem faced by healthcare services - how to keep human beings, rather than systems or targets, at the heart of delivery. As the real-life examples in this booklet show, looking at issues through a human rights lens can help: Healthcare staff see things from a different perspective; improve attitudes and practices and provide a useful framework for making (often difficult) decisions at policy and day-to-day service levels (what we’ve called Organisation Journeys in this guide) Empower patients and families/carers (and their advocates) to speak up when things are going wrong and help find an appropriate and fair solution (what we’ve called Individual Stories in this guide) Whilst there is much to celebrate in the NHS, there are also some stark reminders that things do go wrong and much needs to be done to address these failures in care and to prevent repeating the mistakes of the past. For example, a human rights approach means seeing recently reported avoidable deaths due to dehydration, malnutrition and poor care as a right to life issue. Thinking about these legal (not simply moral) duties can lead to better enforcement. Human rights can be a practical tool, providing a framework which helps organisations to make decisions and help mitigate risk. Using this framework can help ensure the process of decision making - in the often busy fast-paced environment of healthcare services - is a fair one, with the individual at its centre. It’s important to remember that human rights are not always about a ‘right or wrong’ answer. Using a human rights framework should help you to make the best decision in the circumstances. It helps to move a decision away from an individual judgement of what is morally best, to one framed in universal legal standards. “Promoting and protecting health and respecting, promoting and fulfilling human rights are inextricably linked.” World Health Organization 4

The changing landscape: economics and policy reforms Healthcare services are grappling with reforms and with meeting increasing needs in tighter economic times. A human rights approach does not eliminate hard choices about where to spend resources, but it does help ensure fair decision-making to guide policy development, service redesign and resourcing decisions. Using a human rights approach can help clarify expectations of fair and dignified treatment, and provide redress when standards fall short. Human rights approaches can provide the basis for ensuring and driving up quality as well as a tool to change the culture of services towards one that supports person centred approaches, co-production, safeguarding and personalisation. Making this shift requires increased understanding – particularly among those using and delivering services – of how human rights can be put into practice. At the end of the day, putting human rights at the heart of healthcare not only ensures NHS organisations are meeting legal obligations, it can also deliver much-need improvements in the quality and accountability of healthcare services. Addressing quality of care and accountability There have been many recent reviews addressing the need for accountability and better quality of care within health and social care services, particularly in light of the tragic loss of life and inhuman treatment at Staffordshire Hospital, and the abuse and neglect at Winterbourne View: “Services should focus on individual dignity and human rights…Workforce should demonstrate that they are providing quality care and support which includes… good understanding of the legislative framework and human rights” (Department of Health Review Final Report, “Transforming care: A national response to Winterbourne View Hospital” 2012) “Patients must be the first priority in all of what the NHS does. Within available resources, they must receive effective services from caring, compassionate and committed staff, working within a common culture, and they must be protected from avoidable harm and any deprivation of their basic rights.” (The Mid Staffordshire NHS Foundation Trust Public Inquiry, the “Francis Report” 2013) “People who use health and care services have the right to be treated with respect, dignity and compassion by staff who have the skills and time to care for them.” (Department of Health Policy “Treating patients and service users with respect, dignity and compassion” 2013) “Place the quality of patient care, especially patient safety, above all other aims. Engage, empower, and hear patients and carers at all times. Foster whole-heartedly the growth and development of all staff, including their ability and support to improve the processes in which they work. Embrace transparency unequivocally and everywhere, in the service of accountability, trust, and the growth of knowledge.” (A promise to learn – a commitment to act: Improving the Safety of Patients in England, “Berwick Report”, 2013) At their core what these reports and reviews reveal is the need for a human rights approach, namely a shift in culture and delivery focused on accountable services, underpinned by fundamental principles, which empower staff, patients and families. Such an approach can help improve patient outcomes and respond to wider systemic issues, identifying risks, taking appropriate action and practice prevention rather than cure. “We will promote a rights-based approach in everything we do, with a focus on outcomes for people…This is more than just ensuring compliance – it is about changing attitudes and behaviours, organisational cultures and practices” CARE QUALITY COMMISSION, Equality and Human Rights Scheme, 2010-13 5

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