Issue 14 - December 2016


By Lucy Mulvagh, Director of Policy and Communications and Ian Welsh, Chief Executive - Health and Social Care Alliance Scotland

We live in challenging and uncertain times and it’s easy to feel as though there is more to separate and divide us, rather than unite. Inequalities continue to grow in health, wellbeing and household incomes; food and fuel poverty are on the rise; and stigma and discrimination persist against people with disabilities, long term conditions, and those who access social security.

Nevertheless, in Scotland there is a growing consensus that things must change. A steadily growing number of people believe the answer lies in human rights and that a rights-based approach in law, policy and practice will help achieve the Scottish Government’s vision of a fairer and healthier nation. The unifying factor of rights is that we are all born equal and they are inherent to all human beings, irrespective of nationality, race, gender, religion, disability or any other status.

The ALLIANCE has been promoting, supporting and endorsing human rights and the rights-based approach for several years

The need for fundamental change is particularly acute in health and social care, where current crises have been recently highlighted in Audit Scotland’s 2016 reports on the NHS, social work, and changing models of care. These indicate that, while some improvements have been made, much more is needed to realise the transformational change required to fundamentally improve people’s lives.

Although human rights are sometimes (negatively) associated with courts, lawyers and legal action, they are also standards to help shape positive and progressive policy, programmes and practice. A human rights framework – for example using the ‘PANEL’ Principles (see box) – can underpin action at all stages, including (economic) design, delivery, monitoring and review. A number of tools to support the rights-based approach already exist, such as those developed by the United Nations and World Health Organisation, and several case studies demonstrate how rights are already operationalised in Scotland.

The five 'PANEL' principles offer a way to put rights into practice:

  • Participation - people have a voice and take an equal part in decision-making
  • Accountability - organisations and people are accountable for realising rights
  • Non-discrimination - everyone has the same rights, regardless of their status
  • Empowerment - people have the power to know and claim their rights
  • Legality - all decisions answer to human rights legal standards 

Human rights add to Scotland’s values based approach by ensuring that people are empowered and lead decision-making and we are all accountable for our actions. Scottish Government plans are increasingly framed around rights and a growing number of national health and care policies contain the language of rights. For example, the current programme of work is peppered throughout with commitments to help Scottish citizens realise their rights; the principles underpinning the delivery of health and social care Integration explicitly includes the “respect of the rights of service users”; and the statement of values and principles related to self-directed support is explicitly “based on a human rights approach.” Other recent examples include the 2016 vision for a new mental health strategy and the draft National Care Standards currently out for consultation.

The PANEL Principle of legality is evident in Scotland’s Patient’s Rights Act and associated Charter of Patient Rights and Responsibilities. Our civil society plays a key role in raising the profile of human rights legal standards, for example in the Charter of Rights for People with Dementia and their Carers, the Rights for Life Declaration and Change Agenda and the Charter for Involvement.

Many other health and care methodologies currently in vogue in Scotland demonstrate the human rights values of choice, control and empowerment in action, for example person-centeredness, personal outcomes approaches, assets/strengths, and other initiatives like co-design, community empowerment and participatory budgeting.

The ALLIANCE has been promoting, supporting and endorsing human rights and the rights-based approach for several years. As co-convenors of the Health and Social Care Action Group of Scotland’s National Action Plan for Human Rights we work with partners, including NHS Health Scotland and the Scottish Human Rights Commission, to help enhance respect, protection and fulfilment of human rights to achieve high quality health and social care. As champions of rights we welcomed the First Minister’s announcement in May 2016 that the Scottish Government will be working with civil society on “a new set of social and economic rights for all”.

Many other health and care methodologies currently in vogue in Scotland demonstrate the human rights values of choice, control and empowerment in action…

The rights-based approach guarantees that people are at the centre and play a leading role in decision-making. Our People Powered Health and Wellbeing programme is working to embed co-production approaches in health and social care, while the Third Sector Support Team champions the active involvement of organisations working with and for people with lived experience in Integration, alongside the statutory sector. Reinforcing support for the time and patience required to shift the balance of power is central to the work of the Health and Social Care Academy, which uses a cross-sectoral approach to support the change agenda.

Many other ALLIANCE work streams are specifically designed to enhance, empower and engage the voice of lived experience, including Dementia Carer Voices, Our Voice, the Neurological and Transforming Care After Treatment (TCAT) programmes, and Prescription for Excellence. The Welfare Advocacy Support Project, a joint initiative with the Scottish Independent Advocacy Alliance, highlighted the crucial role that access to independent advocacy – the right to supported decision-making in action – plays in the lives of people accessing the social security system.

The right to participation requires access to freely available, independent information, tailored to the recipient’s requirements. Here, the digital world offers a wealth of opportunity, and ALISS and Our GP are two of our initiatives that aim to put people in control of information about health, care and other resources, as well as their own personal data.

Self management is another rights-based approach that helps put people in charge of their lives. The 15 new projects financed under the ALLIANCE’s Transforming Self Management in Scotland Fund demonstrate how funding can be allocated to innovative work on prevention, person-centeredness and co-production. Scotland’s House of Care, which also promotes self management, places people’s empowerment and participation at the centre of their experiences of care.

Despite the many positive and progressive standards in national health and social care policy, there is an acknowledged and unacceptable gap that persists – indeed is growing – between these principles and the reality of people’s everyday experiences of services and support. While we become increasingly good at addressing participation and empowerment, we can no longer afford to overlook the principles of non-discrimination, legality and accountability if we want to achieve better lives. 

Although Scots can currently rely on the European Convention on Human Rights in domestic courts (through a combination of the Human Rights Act and Scotland Act), other international human rights treaties – including the International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of Persons with Disabilities – are not yet incorporated into law. Mainstreaming international human rights into domestic law would strengthen accountability mechanisms and give people in Scotland opportunities for effective redress when their rights are infringed. This will lead to transformational change and far better outcomes in areas like health, social protection, employment and independent living.

The double threat of a possible repeal of the HRA and a further retraction of rights caused by Brexit gives even more impetus to incorporating international standards. In the meantime, however, the Scotland Act empowers Scottish Ministers to observe and implement all the UK’s international human rights obligations. The Scottish Government could therefore use these powers to progress the realisation of international human rights without waiting for legislative incorporation. The current national policy agenda provides a range of opportunities to do this, such as the development of a new mental health strategy, the devolution of social security powers, and the national review of targets. The First Minister has committed to “do even more, even better on incorporating human rights in Scotland”. The ALLIANCE and our partners will continue to advocate strongly for human rights and watch with interest as these initiatives develop.

Lucy Mulvagh is Director of Policy and Communications
Ian Welsh is Chief Executive
at the Health and Social Care Alliance Scotland (the ALLIANCE)

By Lucy Mulvagh, Director of Policy and Communications and Ian Welsh, Chief Executive - Health and Social Care Alliance Scotland

Issue 14 - December 2016


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