Human rights are at stake in Scotland’s social care.

On Thursday last week within the beautiful setting provided by Clydesdale Bank’s Banking Hall in Glasgow Scottish Care held its first Care Lecture. I hope it will become an annual opportunity to hear a guest speaker explore an issue of the day relevant to the care and support of older people.

We were honoured to have Judith Robertson, Chair of the Scottish Human Rights Commission as our lecturer. She spoke to the theme of “Human rights in social care.’ The full text of her address with added analysis will be available in our second Care Cameo to be published in a few weeks time.  Needless to say it was both challenging and thought provoking and centred upon a strong critique of both the UK and Scottish Governments failures to properly embed human rights in social policy.

I will leave further comment on Ms Robertson’s analysis for another time but what I want to focus on today is a wider issue of the prevalence of human rights in contemporary public and policy discourse. This is a markedly different position to where rights were in public discourse even some five years ago and in no small part is down to the work of the SHRC and its National Action Plan for Human Rights (SNAP).But there is always a concern that the rhetoric and pervasiveness of the use of the language of rights isn’t followed through in the realities of their adherence and at what is happening at the care face. That is probably a concern which is beginning to have validity. So briefly I want to explore where rights are engaged and may be facing challenge.

The Guardian newspaper this week  had a helpful article which explored some of the challenges faced by social workers in the assessment of clients in an environment where middle and senior managers are faced with hard decisions around austerity. They have utilised a human rights based approach to highlight where there is a restriction or diminution in these rights. I have personally been highly critical of the systems which are currently operating around Self-directed Support and which seem antithetical to the exercising of a human rights based approach. However as Carlyn Miller  has shown in her recent report it is absolutely possible to use human rights to support stretched social workers to adhere to the values and principles at the heart of good social work. In that regard we need to support a hard-pressed group of workers to resist the compromises of the system which serve to limit the rights of older Scots.

However, it is perhaps in the area of procurement and commissioning that we feel a particular sharpness and restriction of rights. The statistics around Self-directed Support and the limitation of informed decision-making and exercising of choice by older people speaks to me at best of poor training and inadequate advocacy and at worse of blatant age discrimination. But they also speak to a system which is disproportionately unbalanced. How can one person/organisation be assessor, commissioner and provider and still remain transparent and equal? Certainly not in that Scottish IJB which recently declared that it wants 70% of social care provision to be provided by one provider (itself) – I wonder if they have told the older people of their communities that that is their extent of choice?

At other areas of social care in Scotland there is a deficiency of rights –

•           where electronic call monitoring systems are being used by local authorities to monitor homecare contracts but result in the demeaning of a workforce by effectively treating them as human automaton in a trustless Big Brother approach;
•           where there is a failure to properly resource providers to adequately train and support staff in our communities and care homes who are delivering the majority of palliative and end of life care;
•           where the levels of regulation and registration are such that the same is expected of an individual with 3 weeks training as a care worker as of someone who has had 3 years preparation for the role of a nurse for social worker;
•           where the inadequacy of resourcing is resulting in thousands of older Scots being prevented from being given sufficient finance to allow them to remain as part of their communities;
•           where an appropriate focus on dementia is used to mask the lack of recognition for the other mental health needs of older Scots.

And I could go on. The rhetoric and talk of rights is cheap and casual, the exercising and implementing of rights are costly and hard. It is the latter we need to engage in or we will continue to use the language of sound bite. We sometimes imagine the abuse and limiting of human rights as out there, somewhere distant from where we are and the now, the truth is that human rights are on the line right now and right here as we deliver social care in Scotland. 

Dr Donald Macaskill

@DrDMacaskill