Integration – A rights based approach compels us to keep our collective foot on the pedal

Written by: Cathy Asante, Legal Officer, Scottish Human Rights Commission

Published: 08/01/2019

Cathy discusses how human rights can be translated from the strong words of policy intention into practice.

The Commission welcomed health and social care integration as an opportunity to make a significant cultural shift away from a focus on needs to a focus on rights, recognising the person at the centre of services and the impact those services have on their human rights. Two years on, how far has this shift been achieved?

One of the fundamental distinctions of a human rights based approach is the recognition that a vast array of public services impact on people’s human rights where they are felt most – in hospitals, care homes, in services provided in our own homes – and that accordingly people are entitled, as of right, to certain expectations. That is, to be treated with dignity and respect (reflected in the Integration Planning and Delivery Principles), and to enjoy services which allow them to lead their lives in the best possible health, as part of their communities, with choice and control. These are rights-based principles and a specific binding human rights obligation can be identified for each of them. But people in the health and social care sector in Scotland will also be familiar with them as the ethos that increasingly underpins the sector.

The range of human rights intertwined with health and social care is wide, from civil and political rights, like liberty and privacy and life, to broader economic, social and cultural rights, like the right to health and to independent living. These broader rights set for us, as a nation, the goals towards which we must work towards e.g. services that are available, accessible, acceptable and of good quality, and, importantly, the forward steps we must take to get there.

More and more, since integration (although not necessarily because of it), we hear conversations about health and social care delivery framed in terms of human rights.  However, often gaps in human rights protection appear when it is difficult to track how human rights have been translated from the strong words of policy intention into actual practice.  If you cannot see human rights, you cannot check their progress.  Professor Paul Hunt, former Special Rapporteur on the Right to Health, explains why human rights cannot be merely implicit in what we do.

“This self-serving argument masks [social] rights and drains power away from rights holders to those in authority.  It means that only those in authority know whether and when a [social] right is being taken into account and, if it is, how it is interpreted and applied.  Such arbitrariness is inconsistent with the essence of human rights.  Framing something as a human right matters: without the status of a human right, it is shorn of transformative and emancipatory promise”[1]

The new Health and Social Care Standards are one example where the bold step was taken of explicitly taking a rights based approach and, while, still in their infancy, we hope that they will contribute to a genuine shift in people’s experience of care, which will be capable of being tracked and monitored.

So it does seem as if the conversation has shifted to embrace an understanding of rights.  The next challenge, and it is not a small one, is every day, practical implementation.  How to “do rights” on a daily basis.  It is worth recognising, first off, that a human rights based approach is not a reinvention of the delivery of health and social care.  Of course, those involved in health and social care are the experts, so human rights only serves to enhance that picture, to underpin and to invigorate practice in a way that works for everyone.  If, however, human rights are to be realised on an everyday level, in health and social care partnerships or anywhere else, people need tools that translate ideals into practice.

Many such tools exist and the Commission continues to add to them.  Much of this work centres around putting into practice the PANEL principles (Participation, Accountability, Non-discrimination, Empowerment and Legality), which are a framework forming the basis of a human rights based approach.  The Commission has just produced a self-assessment tool to help organisations use the PANEL principles to assess their work and identify priorities towards embedding a human rights based approach, as one step towards bringing the work to life[2].

In 2018, the Commission ran a project to help Scotland’s public authorities put human rights at the heart of their budget planning[3].  The main aim of the project has been to give budget holders the tools they need to ensure that their budget decisions have a positive impact on people’s rights. It has also helped start a programme of ongoing work to develop tools to help scrutinise public spending decisions through a human rights lens. After all, the budget “reflects the values of a country – who it values, whose work it values and who it rewards … and who and what and whose work it doesn’t” [4].

One of the core principles of economic and social rights is that they are to be “progressively realised”.  That is to say, they don’t have to be achieved overnight.  It is recognised they take time and money.  But the important thing is that they do have to be achieved.  A human rights based approach therefore compels us to keep our collective foot on the pedal.

[1] Social Rights are Human Rights, Paul Hunt (Centre for Welfare Reform, 2017) (this link will take you away from our website)
[2] Human Rights Based Approach – A Self-Assessment Tool (this link will take you away from our website)
[3] Scottish Human Rights Commission page on Human Rights Budgeting (this link will take you away from our website)
[4] Foreword to the First South African Women’s Budget 1996

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