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Human rights the foundation of great care
Human rights: the foundation of great care
We hear about human rights but can get confused when we think about how they fit into the care we give people day by day. It can seem all very abstract, and miles away from hands-on relationships based in shared trust. So why, and how, should we put the human rights of the people we serve at the heart of everything we do?
What are human rights?
Human rights combine to create the framework that helps all of us, whoever we are, to live our lives as we want to. As soon as we realise this, it becomes a lot easier to see how essential human rights are to ensure person-centred care that, at its simplest, makes people happy.
The FREDA principles are an easy way to make sure that all staff in adult social care are starting from the right place in their interactions with residents. More and more services use FREDA to check, in every supervision or team meeting, whether their interactions, and decisions, with or for an individual resident or user of the service, embody these principles: Fairness, Respect, Equality, Dignity, Autonomy.
These are noble aims, but they feel a bit abstract. We know that if you ask the most careless, authoritarian managers if they treat the residents with dignity, they will reply, ‘Oh yes! We knock before going into their rooms.’
Like the Human Rights Act itself these principles can feel as though they’re no use in day-to-day work – so it helps to put some practical colour onto them. For example, in FREDA, it might feel a bit as though the long word ‘autonomy’ is there just to turn the name from Fred to Freda, although many people are unsure of its meaning in a care setting. It makes much better sense, though, when we realise that a right to autonomy means the right to live, in practice, how you want to, as long as you’re not harming other people, even if others think you’re odd, or weird. So, it covers the right to be vegan or follow religious or cultural food rules that are important to you; it covers your sexual or gender identity, your political views, your choice of music … every aspect of the values and personality that makes you who you are. If you imagine for a moment being prevented from exercising your own individual choices about some of these vital parts of your identity, you will understand clearly how important human rights are.
It is worth managers using the FREDA principles in all team meetings to recognise, and record, the practical ways staff have come up with, to ensure fairness, and enable autonomy.
Simple and rewarding in practice
Person-centred human rights means enabling someone to continue seeing farm animals, or listening to opera, or punk, or whatever it might be that’s been an important part of their lives. And it really is simple: I remember a Care Quality Commission (CQC) inspector being thrilled by a care assistant explaining that Jim (not his real name), who was kicking at the front door and then banging the window, had been a postman all his working life, and given an award for never taking a day off sick. She knew that Jim just needed her to help him into his wellies and mac and then open the door, to enable his essential morning walks round the garden, whatever the weather.
Jim could so easily have been labelled as ‘challenging’; instead, his personality, his history and his autonomy were honoured. The inspector also liked it a lot that Jim’s care plan contained the explanation that he hates Rafael Nadal: Jim’s occasional shouting at the telly, especially during Wimbledon, is not seen as a mental health problem, but just accepted as part of who he is.
Age UK’s guide to human rights in practice has some great examples which show that, though this organisation is focused on older people, human rights principles apply to everyone who might need support to exercise their right to live as they choose. A group of older citizens in Stockport thought that human rights were nothing to do with their own lives, until the local council planned to close some public toilets, with very little consultation. The older residents successfully used the Human Rights Act to focus wider attention on this issue. They pointed out that the closures would have a significant impact on many other groups in the community, discriminating against certain groups unfairly.
The British Institute of Human Rights (BIHR) has excellent resources, including a series of ‘explainers’, which give the relevant information in clear plain English. I particularly recommend their guide to the Human Rights Act for use with any staff group; it uses graphics and quotes to bring out the instinctive nature of human rights. Pictures and case examples bring their importance alive, such as the harrowing discrimination because of learning disabilities that led to the avoidable death of a young man who was illegally refused the surgery he needed. All the examples given are true; they cover a range of settings and situations, and make for great learning.
CQC expects human rights compliance
The CQC good practice resource Equally Outstanding: equality and human rights is another useful tool that highlights the importance of human rights in practice. This CQC resource, with its sections on the business and economic case for human rights-based practice, is also useful for reminding senior management and commissioners that human rights-based care is not only essential for lawful practice but makes good business sense.
In the end, though, it is the importance for all the individuals who receive care services that makes CQC focus on human rights across all health and social care . The commission inspects against human rights and the empowering ethos of the Mental Capacity Act (MCA) and, as in the example of Jim, inspectors are, rightly, very impressed by practical, person-centred respect for human rights when they see it.
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