Hundreds of people have died; others have been starved, dehydrated and left in appalling conditions of indignity, witnessed by their loved ones. Surely this is what Chris Grayling, Justice Secretary, had in mind when he recently cautioned to need to “concentrate on real human rights”? Yet the rights, legal accountability, and practical benefits of the Human Rights Act are rarely mentioned in discussions about the shocking failures of care such as those featured in today’s Public Inquiry Report in events at Staffordshire Hospital between 2005-2008. Sanchita Hosali, Deputy Director at the British Institute of Human Rights, shines a human rights spotlight on the issues.
When we need to use NHS services most of us will receive care and treatment which respects our basic rights to equal dignity. Sadly, for others, often at their most vulnerable, this is not the case. Today’s Francis Report from the Mid-Staffordshire Public Inquiry, the latest in a long line of similar reports into failures of care. It is unfortunate that the report provides little explict reference to human right; however with the focus on patients, on dignity, respect and safety and accountability at the day-to-day and legal levels, the Francis report is in essence calling for a system of healthcare which respects, protects and promotes people’s basic human rights. The message is clear, that when we are in the care of public services there is minimum level of treatment that we should all receive. Human rights – universal basic minimum standards based on the values of equal dignity and respect which are legally enforceable – provide the very framework that is needed.
The Francis Report into Mid-Staff presents an opportunity to reflect on why it is important to frame these about the quality of care in human rights terms. Put simply we are talking about risks to and abuse of basic human rights, so our solutions both for immediate accountability and longer-term change should include human rights.
Seeking accountability? That’s what the Human Rights Act is for
Just one of the stories from Mid-Staffs is a stark example of the serious human rights issues at stake. Following hospitalisation for a fall at home, one woman’s “care” resulted in pressure sores, dehydration and malnourishment, an array of serious infections and frequent pain due to lack of medication. After three months she died in hospital, and her body was so contagious she was denied the final dignity of a proper burial. The family argued this was so appalling it amounted to a breach of the right to be free from inhuman and degrading treatment under the Human Rights Act, and the family distress at witnessing their mother’s suffering breached their rights to physical and mental well-being. Leigh Day and Co helped this family and many others secure over 1 million pounds in out of court settlements, and perhaps more importantly a personal letter of apology from the top. It is also worth recalling that families relied on the Human Rights Act to secure the Public Inquiry in the first place, relying on the investigative duty included within the right to life and freedom from inhuman treatment.
Applying a human rights lens also raises serious questions about the time it took to respond, particularly as health practitioners and those in regulatory bodies have talked about the concerns they raised. Positive obligations under the Human Rights Act to take action can include investigating credible allegations of harm and taking preventative measures. Perhaps now is the time to consider the role of regulators and “whistle-blowing” laws in light of these positive obligations.
Beyond Mid-Staffs the Human Rights Act is now being used to challenge other care-related failings. For example, Liberty is representing two former residents of Winterborne View who suffered physical violence and humiliation. Beyond the courtrooms, BIHR works with advocacy groups to use rights language in their everyday interactions to make sure services are dignified and accountable, including for example the groups which challenged the blanket use of Do Not Resuscitate orders in hospital wards.
Re-introducing the human into healthcare
Mid-Staffs is a stark reminder of what happens when targets and financial imperatives become the focus and services lose sight of the person. A human rights approach looks at using the law in practice to design and deliver services that place patients at the heart of healthcare, seeking to respect, protect and fulfil their rights.
Our work with Mersey Care NHS Trust shows how a human rights approach helps put patient voice front and centre, transforming services and changing staffing cultures and practices. In the Learning Disability Service staff, patients and carers work together to understand their human rights and what they mean in a healthcare setting. Evaluation has shown the powerful difference this work makes to both patients and staff. More than three-quarters of service users and carers said it has a positive impact on their mental health. Over 90% of managers said this approach had positively changed them as a person, with significant numbers reporting a change in attitude and practice.
Moving forward: naming human rights abuses here at home
Clearly the Human Rights Act is not a magic wand; but when we need health services, it is not too much to expect to be treated with basic dignity and respect. Placing human rights at the heart of healthcare is an important step in making this a reality.
So will this happen? You only need to visit the pages of this blog to see the increasingly toxic nature of our domestic debates about the Human Rights Act. Sadly, this game of political and headline one-upmanship helps foster a climate which fails to identify appalling standards of care as a human rights concern, ignoring an important accountability mechanism and a means for a fresh person-centred approach.
Mid-Staffordshire should not be seen as a one-off or something from the past. As a recent report notes the climate of increased demand for services coupled with “austerity” may lead Trusts to focus more (or exclusively) on cost rather than quality of care, raising fears “that there could be another ‘Mid Staffs’. As Jeremy Hunt, Health Secretary, considers the Francis Report and the much broader need to ensure “patients must never be treated as numbers but as human beings” we should all be reminding him that the Human Rights Act should be part of the toolkit for ensuring accountable, dignified and respectful services.