Equality and Human Rights Commission

Care about Rights is a flexible, interactive training and awareness raising programme which gives practical advice about how to apply human rights principles in the delivery of home care and residential care for older people. The materials are intended to be used by older people, carers, care workers, managers, inspectors, policy makers and commissioners of care. Care about Rights explains the benefits of applying human rights principles to everyday situations, by means of practical scenarios with accompanying guidance and explanatory material. The training may be completed in stages, by individuals or as a group, and aims to increase understanding and awareness about:

• what human rights are and how they are applicable in care settings
• the relationship between human rights and other legislation and standards
• how human rights can help to balance risks and rights in decision making
• how human rights can support the delivery of person centred care
• how human rights can help resolve conflict and improve communication with people using services, their families and others.

• Many daily decisions that care staff make - such as staffing levels, the use of medication, physical restraint, personal care and end of life decisions - carry human rights implications.
• Sometimes a service provider or care worker might try to avoid risk by limiting the freedoms of people using services in order to preserve the safety of those individuals or others. Human rights can assist in putting the individual’s rights at the centre of these difficult decisions and balancing the rights of the individual to have their wishes and rights respected against the risks to the safety of the individual or the rights of others.
• The role of a human rights based approach is to ensure that the dignity of the individual is at the centre of policy- and decision-making. Where it is applied, everyone affected will have an opportunity to help think through how human rights can best be realised in the delivery of care and support services.
   

How to use this resource

This training and awareness raising programme comprises:

• 10 written case studies and three film scenarios with accompanying guidance, and
• a downloadable information pack.

The materials may be delivered as part of a facilitated training event or a more informal discussion session; for example, in a care setting. Alternatively they may be used by individuals with an interest in human rights and the care and support of older people. The material has a linear format which is easy to navigate, and may be worked through in stages.

The information pack contains detailed guidance for facilitators. This includes plans for sessions lasting one hour; two hours; half a day and a full day. It also includes stand-alone activities, including ‘ice breakers’ and a ‘rounding up’ exercise, together with guidance on the case studies and film scenarios.

It also provides detailed information tailored to each of three audiences:

• people who use services, their families and carers
• care providers and care workers, and
• others involved in policy and practice issues of older people’s care and support, e.g. care policy makers, commissioners of care, the regulators of care and care assessors.

The pack explains the legal framework and considers the importance of the key articles of the European Convention on Human Rights and international human rights laws relevant for a care setting. It also shows how human rights connect to the principles and provisions of the following:

• Adult Support and Protection (Scotland) Act 2007
• Adults with Incapacity (Scotland) Act 2000
• Mental Health (Care and Treatment) (Scotland) Act 2003
• Regulation of Care Act (Scotland) 2001
• Equality Act 2010
• National Care Standards
• Inspection Focus Areas of the Care Commission
• National Occupational Standards and the vocational qualifications for health and social care which arise from them, as well as the Scottish Social Services Council Codes of Practice for Social Service Workers and Employers of Social Service Workers.

While the pack contains information on laws and standards which are specific to Scotland, it also contains much generic material and guidance about the Human Rights Act 1998 and international human rights treaties, which are relevant across the UK.

Applying human rights in practice

The three film scenarios and 10 written case studies address a range of situations and dilemmas. They provide guidance about how everyone affected might use human rights to analyse the situation and make decisions.

It is important to note that many of the issues raised in both the film scenarios and written case studies are unlikely to reach a threshold of being classified as a
human rights violation in the legal sense. Nevertheless, the resource explains how applying human rights principles and standards can help to resolve the issues in a way in which respects the dignity, autonomy and rights of the individuals involved, as well as avoiding potential problems escalating to the point where human rights violations become more likely.

At the heart of the resource is the ‘FAIR’ approach, which was developed by the Scottish Human Rights Commission to support public authorities to apply human rights in practice.

The basic steps of the FAIR approach are:

• Facts: What is the experience of the individuals involved and what are the important facts to understand?
• Analyse rights: Develop an analysis of the human rights at stake; whether the right/s can be restricted and whether any proposed restriction is proportionate
• Identify shared responsibilities: Identify what needs to be done and who is responsible for doing it
• Review actions: Make recommendations for action and later recall and evaluate what has happened as a result.

Film scenarios

The film scenarios are each in two parts: the first sets out the scenario and the second shows how problems could be addressed. In between, the viewer is prompted to use the FAIR approach to examine the human rights issues involved and consider what they would do in each case.

Example: Sheila’s story
Sheila is in her mid-70s and has been diagnosed with dementia. Sheila is fascinated with plants and loved her garden. She now lives in a care home. The film shows Sheila looking outside at the sensory garden and struggling to try to open the door, which is locked. Sheila’s support worker tells her it is not possible for her to go out for her own safety. Sheila gets increasingly frustrated and distressed. The care staff are later seen discussing the incident. They recall that Sheila’s care plan notes the beneficial effects that being outdoors has on her.

The potential human rights at stake are:

• the right to respect for private and family life: for a meaningful home life, Sheila requires access to activities and the ability to participate in decisions about her care, and
• the right to liberty and security: Sheila is locked into the home and unable to leave.

These rights can be restricted for the safety of Sheila or the safety of others. The justification in this instance is that the restriction is for Sheila’s own safety.

The guidance suggests, however, that not allowing Sheila outside is a disproportionate restriction and there may be other ways to resolve the issue that are less restrictive of her rights. For example, she can be accompanied outside and plants can be put inside for her for times when she can’t go out.

The scenario concludes with a series of prompts to identify shared responsibilities and review the actions that are required.

Written case studies

The written case studies also employ the FAIR approach.

Example: Clive and Adrian’s story
Clive and Adrian are a gay couple being supported in their own home. Ben, their care worker, has openly voiced his disapproval of their relationship based on his religious views. Clive and Adrian are likely to feel offended by Ben’s views and that their right to live as they choose in their own home is being challenged. Ben, on the other hand, feels that he has the right to express his views and have them respected.

The potential human rights at stake here are:

• the right to freedom of religion and belief: Ben’s religious views condemn homosexuality
• the right to freedom of expression: Ben feels that he is unable to express his views and that his personal beliefs have not been taken into account by the care provider in placing him with Clive and Adrian
• freedom from discrimination: Clive and Adrian may feel that they are being discriminated against because of their sexuality, in that the care provided to them is likely to be negatively affected by the Ben’s religious belief
• Clive and Adrian’s right to respect for private and family life.

The guidance explains that none of these rights are absolute and so the rights of one person are not necessarily upheld over another’s. Ben’s right to hold and express his religious beliefs can be restricted by balancing against Clive and Adrian’s right to respect for their private life and their right to be free from discrimination.

The guidance notes that the facts in this situation do not appear to take into account Clive and Adrian’s right to have their privacy and home life respected. It should be considered whether Ben has breached the care provider policies. It should also be made clear to Ben and all staff that all people using care services should be treated with dignity and respect at all times.

Evaluation of this resource

The Care about Rights training and awareness raising programme was independently evaluated in 2011. This involved baseline and follow-up surveys of 800 people in Scotland prior to their participating in the Care about Rights training.

The evaluation found that the structure and content of Care about Rights and the supporting materials are considered to be of a ‘very high quality’. The scenarios are particularly useful as they ‘recognise the complexity and subtlety of human rights issues and help to reduce fear and confusion about human rights’.

The evaluation found that understanding of human rights and their application – and confidence to communicate about human rights with colleagues – increased markedly after the training.

It also found considerable evidence that Care about Rights, particularly the FAIR framework, has the potential to assist care workers in using a human rights approach to balance risk in decision-making: 93 per cent of respondents to the follow-up survey reported this as a potential benefit of a human rights approach. Eighty six per cent felt that a human rights approach could help resolve conflict between the needs of different service users.

There was also anecdotal evidence of additional benefits for care providers and workers as a result of Care about Rights. These are improved staff morale (as a result of increased confidence and a sense of empowerment) and a positive impact on care home inspection reports and scoring. Anecdotal evidence shows that where the resources have been brought to the attention of inspection officers they have been viewed as a positive addition to the processes and procedures in place and a resource to provide evidence about the ‘value base’ of the care home.

Older people reported very similar benefits to care workers. The majority reported that they learned something new about human rights and how they relate to care for older people. Advocacy workers and volunteers considered it very important that they know and can clearly articulate human rights information.

The evaluation noted that, while it would take time for momentum to build, impacts increased over time and some participants are now using their human rights knowledge to influence policy through community work and to challenge service providers.

Related equality messages

The guidance explains the key principles and provisions of the Equality Act 2010 and how these connect to human rights. It observes that the advancement of equality and the prohibition and elimination of discrimination, on any ground, are fundamental to human rights and a central element of human rights law.

In particular the Equality Act gives further effect to the principles of Article 14 of the European Convention: the right not to be discriminated against in the enjoyment of Convention rights. An important additional aspect to Article 14 is that the protection from direct discrimination applies on the basis of a broad range of grounds beyond the protected characteristics in the Equality Act.

Date of review

March 2012

• GEN, The University of Bedfordshire and Queen Margaret University (2011) Care about Rights: Phase 2 Report to the Scottish Human Rights Commission.
  http://www.scottishhumanrights.com/application/resources/documents/CaRfullevaluationfinalOct2011.pdf
• Scottish Government and Convention of Scottish Local Authorities (2010) Procurement of care and support services.
  http://www.jitscotland.org.uk/action-areas/commissioning/procurement/

We hope that you found the resource helpful and easy to use. Please let us know about other guidance or references that you think we should include. Send us your feedback.