Is choice a human right?
I want to reflect on two remarks within speeches I heard yesterday to celebrate World Social Work Day and the 50th anniversary of the Social Work Scotland Act. They both had to do with choice.
The first speech was making a comparison between different approaches and philosophies around social care and social work, evidencing the change from the spirit of the 1968 Kilbrandon Report which assumed that social work would be delivered by local authorities, much in the vein as some politicians have recently articulated a desire to return to. But then with the passage of the 1970s and 1980s the speaker commented that consumerism and choice within a mixed economy of care had replaced what had happened previously.
The second remark was within an inspiring speech by a young man, Thomas Timlin, who told his own personal story from living in a neglectful environment, being taken into care, experiencing abuse at the hands of foster parents, through the separation from siblings and his natural mother, being told at 16 that the State had fulfilled its duties of care, to enduring periods of homelessness and eventually becoming a children and families social worker. He commented that no-one had asked his views at any time, no-one had given him choice, had asked him what he wanted at any stage whether during fostering or adoption. The lack of choice had denied him a voice.
Two very different comments about choice but they are at the centre of the current debate about social care in Scotland. They are for me at the heart of what a human rights based, person led approach to care and support is all about.
Choice is after all at the core of our primary social care legislation in Scotland. The Self-directed Support (SDS) Act states in its Principles that an individual shall be enabled to have choice whether that be in an outcomes assessment or in support planning or indeed in the delivery of their care and support. They shall have a choice of four options over which to decide how their personal indicative budget should be spent. They shall have a choice on which provider of social care they want and is best fit to meet their own individual needs. There is also a duty upon a local authority to promote such diversity within the ‘market’ and ‘local community’ to enabling a real exercising of choice. After all presenting a person with one provider (statutory or not) as a take it or leave it – is not choice its instruction.
The SDS Act is a true democratisation of control, consent, participation and empowerment. Choice is part of the DNA of social care legislation in Scotland. Our new National Health and Care Standards go even further and articulate this human rights emphasis and root good care and support within the principles of autonomy, control and choice.
So, is choice a right? Is choice just another term for consumerism and therefore should it be limited and curtailed? Is there anything wrong with the consumer (the citizen) exercising control rather than being told what to do or having their options limited by the State? Is choice a human right?
These are all important and critical questions because they are likely to shape debate within the social care sector in the months and years to come.
For me, personally, choice is an alienable right. My perspective is influenced by being a member of the Same As You? Implementation Group nearly two decades ago. This was a key and ground-breaking strategic Scottish Executive policy which stated that someone with a learning disability was deserving of the same rights, dignity, treatment and citizenship as any other person in Scotland. I remember one person with a learning disability speaking at a meeting and summing up what it meant to have choice. She said:
“It isn’t just that I should have the right to choose what to eat, to choose what I should wear, to choose who I spend my time with, to choose where I live as far as I can; it is fundamentally that I should have the right to choose who comes into my home, who attends to my personal needs, who supports me to fulfil my life. It is my right to choose who sees me naked.”
Choice for countless thousands who have been denied control and autonomy means absolutely everything. It is the vibrant spirit of freedom that gives purpose to activity and underpins individual contribution.
So be very careful of those who wish to undermine the choice that has been achieved for citizens in Scotland, whether they have a disability, live with a mental health condition, or live their lives in a nursing or residential care home.
Choice is fundamental and that choice critically includes the right to decide what organisation provides care and support to me should I require it. Our politicians need to tread warily on any of the human rights citizens have struggled for, rights for social care choice which have been achieved over the last two decades.
For many the freedom to exercise choice is about the ability to be fully a person. Choice has no sell-by date; choice is not an option, it is intrinsic to being an autonomous human being. Choice is a human right.
Dr Donald Macaskill