Over the last nine months Scottish Care has published two human rights documents, the Convention on the Rights of Residents in Care Homes for Adults and Older People and two weeks ago at the annual Care at Home and Housing Support Conference, the Convention on the Rights of People receiving Care at Home and Housing Support Services. Both were products of collaborative work where individuals who used support services articulated their sense of what constituted for them basic rights and quality in service provision.

Nearly two decades ago the Human Rights Act incorporated the European Convention of Human Rights into domestic legislation enabling individuals if they felt that there had been a breach in their human rights to take their case to a local court without having to have recourse to a court distanced from them in Europe. The whole process was badged as ‘Bringing Rights Home.’

In some sense that is what both of the Scottish Care Conventions have sought to do. They have sought to bring ‘human rights’ into the homes of individuals who use social care support whether they live in residential care or in the wider community. They have sought to make human rights something which spoke to their needs and aspirations, something which was real rather than a set of abstract concepts used by the media and politicians to score cheap points in a debate. As one of the participants said:

‘Human rights are ours.’

The First Minister in a speech in the Pearce Institute in Govan in September 2015 in addressing attempts to repeal the Human Rights Act spoke of the need to see the Act as a floor rather than as a ceiling beyond which one could not go or aspire.

“When the Human Rights Act was passed in 1998, the intention was that the Convention would provide a floor for human rights across the UK. That’s because it would be incorporated within the domestic law of all nations of the UK – through the Human Rights Act, and the different devolution settlements.

But the Convention was always intended to be a floor, not a ceiling. Devolved governments have the flexibility to go further, if we choose. And so complying with the Convention should not be the limit of our ambitions.”

(First Minister Nicola Sturgeon, Pearce Institute, Govan, 23 September, 2015)

The First Minister challenged civic and public society in Scotland to attempt to work together to achieve a context where human rights were at the heart of all we do in Scotland. In a small way the Conventions seek to contribute to that process.

The analogy of bringing rights home is a helpful one. To a considerable degree we have indeed brought rights home but I also suspect that we have kept human rights at the doorstep. Human rights have not entered into every room and corner of our ‘house of care’. We have, and are increasingly articulating the role human rights can play in the delivery of quality services which respect and enhance the dignity, voice and choice of those who use services and supports. The new National Care Standards will go a long way to embedding a rights-based approach to care. But if that is all we do – and that’s not to diminish that process – we will still be keeping human rights in one small room, a room about individual relationships and rights.

For human rights to mean more than just platitudinal rhetoric they have to infiltrate the whole of our health and social care system. Put simply you cannot have a human rights based approach to care and support without a human rights based approach to budgeting, to finance allocation and to commissioning.

It is all very well to require providers and those who work in care services to embed human rights at the heart of their work and services, but unless you have a system whereby human rights can direct the decisions we make about spending limited resources, and unless we change procurement processes to properly operate on a human rights basis then we are just tinkering with rights, we are just keeping human rights at the doorstep.

So at the Care at Home Conference we called upon our partners in Scottish Government and local authorities to work with us in building and developing a human rights based approach to commissioning and budgeting. We are partly there with good rights based procurement guidance, but we have a long way to go.

So what might such a model look like? Well it could perhaps be based on the widely recognised PANEL principles, which is an approach to what a human rights based approach means in practice. PANEL stands for Participation, Accountability, Non-Discrimination, Empowerment and Legality.

What might this mean for budgeting, procurement and commissioning?

 

Participation – People should be involved in decisions that affect their rights. So providers and those who use services should be key partners in strategic and local decision making, not informed or engaged in consultation after decisions have been made.

Accountability – There should be monitoring of how people’s rights are being affected, as well as remedies when things go wrong. If insufficient resource is allocated to enable an individual to be adequately supported then something is done to address this.

Non-Discrimination – Nobody should be treated unfairly because of their age, gender, ethnicity, disability, religion or belief, sexual orientation or gender identity. Is the allocation of public resources discriminatory for older people? Do we enable the same degree of choice and personal budget allocation to those over 65 as to those under 65, to those who live in our care homes and those who live in their own homes?

Empowerment – Everyone should understand their rights, and be fully supported to take part in developing policy and practices, which affect their lives. Do those who use supports adequately understand their right to involvement in decisions around their support and care e.g., in terms of self-directed support?

Legality – An approach like this is about going beyond the minimum legal requirements and mainstreaming human rights in services, policies and practice to make them run better for everyone.

The challenge is to fully bring human rights home, so that whatever part of our system of care and support from assessment to delivery, from budget allocation to workforce support, we have human rights at the heart and core, not rhetoric but a person centred approach that values the individual and gives real choice, control, involvement and dignity.

Scottish Care is committed to embedding both our Conventions and building upon that work in the months and years to come. So feel free to keep visiting us and join us as we bring rights home.

Dr Donald Macaskill, 5^th July 2016

@DrDMacaskill

This blog builds on a speech delivered to the 2016 Care at Home and Housing Support conference on 23rd June. This can be seen at https://www.youtube.com/watch?v=X7uUf0v6phY

 

Welcome to the first blog on our new website. Every month you will be able to read two new blogs, one from our CEO, the other from a guest blogger. Our aim is to inform you about what is happening in the independent sector, to encourage debate on issues of the moment and to promote innovation in the way that individuals are supported and cared for. We hope you enjoy them.

Last Sunday I had the privilege of taking part in the Royal College of Nursing 100th anniversary Congress which was held in Glasgow for the first time.

Together with the Director of the RCN in Scotland, Theresa Fyfe, and Scotland’s Chief Nursing Officer, Prof Fiona McQueen  I was invited to debate the contribution of third and independent sector nurses to care and health in Scotland.

My contribution was to reflect on the question ‘What needs to change for the independent and third sectors to be seen as equal partners in delivering health and care?’

To answer that question perhaps we need to ask something even more basic – What does it mean to be a nurse?

I’m probably not the right person to be answering that but it’s a question I can remember asking from an early age because every summer holiday I spent time with my aunt who was a district nurse in an island community… The archetypal navy-uniformed, Mini-driving, doctor-repelling, straight-talking Highland district nurse!

I remember asking her probably at a precocious ten years of age why she wasn’t a nurse in a hospital and amongst all her responses one thing stuck in the memory –

” I can get to know people, when they are ill and when they are well, I get to know them all, their sons and daughters, their neighbours and friends… And here I have time…  I didn’t have that in a hospital.

Maybe that’s a romanticised recollection of a ten year old but I remembered those words when recently I spoke to a nurse in a care home I was visiting. I was asking her what was different about nursing in a care home compared to a hospital. She said:

“Here I have time to get to know people, to sometimes become a friend, to nurse to the whole of the person and their family… It’s especially important at the end of life to be able to have known the person whose hand you are holding and who is spending their last moments with you.”

Time, relationship, being with, are some of the characteristics which mark out the especial circumstances of nursing in social care, whether in a care home or in someone’s own home. That’s not to say that they are alien to an acute environment but they are just more possible in non-hospital settings.

As we increasingly hear of the importance of people remaining at home or in a homely setting for as long as possible; as we read new policy initiatives such as the National Clinical Strategy or the Review of Out of Hours Provision, the potential and role of social care in achieving better health outcomes for people becomes a real one. In that regard nursing in social care settings becomes all the more important. There is real potential for those who want to nurse in care homes and in community locations to become a key ally in achieving the outcomes that people want for their lives. But to get there things need to change.

What needs to change for the independent and third sectors to be seen as equal partners in delivering health and care?

Perhaps not a lot for the person who is cared for at home and in a nursing home… but for the nurses themselves – the answer is that equality seems so very far away…

Do we really have equality when nurses in a care home setting are worse off (in terms and conditions) to the degree of around £6,500? Do we really have equality when nurses aren’t given the same opportunities for shared learning and development that colleagues in the NHS have? Do we have equality when countless nurses have told me about how lecturers in college dismissed care of the elderly as not ‘real’ nursing? Do we have equality when frontline nurses feel they have to justify working in a care home or in social care to their fellow professionals?

We need to give value to those who work in non-traditional settings, we need to honour and celebrate nursing staff in care homes and in the community as an essential contributor to the care and support of our communities. And yes value is in part by financial reward but its much more than that. It is about respect, being given a place, being listened to, being heard, having your contribution noticed and indeed celebrated.

The more nurses I have the privilege to speak to the more I know that despite the suffocating amount of paperwork and procedure that gets in the way- I might say unnecessarily so – it is the ability to form relationship, to nurture contact and to be with people that marks out nursing in an independent sector care home or care at home organisation as something which attracts.

In some essential truth nursing in the independent sector is authentic – it is genuine, honest, hard graft but at its best it is relational, human and valuable

What needs to change?  – we all do, society does, Scotland does. We need to change into a country that values those who have been labelled and limited by being described as old; we need to recognise contribution beyond location and value beyond number… Only then will nursing our older citizens be truly celebrated for the critical art it is.

Dr Donald Macaskill  Twitter: @DrDMacaskill