Human Rights in Healthcare

Title of guidance:

Human Rights in Healthcare - a framework for local action (2nd edition)

Author: Equality and Human Rights Group, Department of Health and British Institute of Human Rights

Human Rights in Healthcare
Year published: 2007
Length: 71 pages
Format: PDF (4Mb)
Other formats: CD available with 'further information and resources' - phone: 0151 285 2321 / email: Lyndsey.dyer@merseycare.nhs.uk
Producer/ Publisher: Department of Health
Type of organisation: Public authority

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Categories:

Health | In-house service guidance | Human Rights Act | European Convention on Human Rights | GB wide| Case studies

Audience: Service management | Front-line service personnel | Elected councillors, board members, trustees | Policy managers and directors

Topics: Human rights | equality | assessing risk | transparency and accountability | proportionality | balancing competing rights | involvement and participation | dignity | positive obligations | commissioning

Summary

This report introduces the Human Rights Act as a framework for decision-making and explains its relevance to healthcare. It examines the obligations that NHS organisations have under the HRA and explores what these mean for their everyday work. It aims to be a 'launch pad' for NHS organisations to use human rights to improve the design and delivery of services, and documents the experience of pilot projects in five NHS organisations; it is not a detailed guide or toolkit. The intended audience is primarily 'frontline' staff, including clinicians and support and administrative staff. It is also a useful introduction for directors, board members, managers and policy staff, as well as voluntary and private providers of health services and patient advocacy groups.

Key human rights messages in this guidance

  • NHS organisations are not just under a duty to refrain from breaching people's human rights. In some situations, they have a positive obligation to take proactive steps to protect people from human rights abuses even if the harm is caused by private individuals rather than directly by the authority.
  • Human rights are a practical framework for making decisions in difficult situations: for example, to ensure that staff are protected from violent or abusive patients while also having regard to the interests of the patient.

Full review of this guidance

This 'framework for local action' aims to help NHS organisations to put into practice the human rights principles of fairness, respect, equality, dignity and autonomy (known as the FREDA principles)..

Its value lies in the way it relates the FREDA principles to specific rights contained in the Human Rights Act (HRA) and, in turn, to areas of policy or practice that might need to be changed to bring those rights and principles to life.

These connections are demonstrated through the experience of five pilot projects in different NHS Trusts.

The framework will support staff and commissioned providers to fulfil their specific duties under the HRA, as well as meeting Care Quality Commission standards on human rights and patient treatment.

It also aims to help NHS organisations 'add value' to their work on wider duties and priorities such as:

  • ensuring equality
  • Dignity in Care
  • delivering patient choice
  • providing more personalised services and ensuring that people have a stronger voice
  • protecting the most vulnerable people.

The framework explains how the HRA works, with express reference to the duties and obligations that NHS organisations have as public authorities.

Types of rights

The framework sets out the nature of the rights contained in the HRA, and their implications for NHS organisations.

  • Absolute rights can never be limited or interfered with; for example, the right not to be tortured or treated in an inhuman or degrading way.
  • Limited rights can be limited only in specific and finite circumstances which are set out in the HRA; for example, the right to liberty, often of relevance in mental health or residential care facilities.
  • Qualified rights - such as the right to respect for private and family life - can be restricted when a number of general conditions are met. Any interference with a qualified right must be:
    • in pursuit of a legitimate aim that is set out in the HRA e.g. to protect the rights of others
    • prescribed by law, i.e. allowed within existing legislation
    • necessary; and
    • proportionate.

Proportionality

The framework emphasises that proportionality is an important mechanism to:

  • ensure that the infringement of rights is kept to a minimum and is always reasonable
  • allow NHS organisations to balance competing interests, e.g. the rights of individuals with those of patients, staff or the wider community.

Human rights are presented as a practical framework for making decisions in difficult situations: for example, to ensure that staff are protected from violent or abusive patients while also having regard to the interests of the patient.

Positive obligations

NHS organisations are not just under a duty to refrain from breaching people's human rights. In some situations, they have a positive obligation to take proactive steps to protect people from human rights abuses even if the harm is caused by private individuals rather than directly by the authority.

For example, if there is evidence that a patient is being abused by relatives, NHS organisations should investigate this and where necessary take steps to prevent it.

What is a 'human rights based approach'?

The framework documents the experience of the five pilot projects in that NHS that have attempted to put human rights systematically into practice.

It proposes five principles that underpin a 'human rights based approach' and illustrates these through snapshots from the pilots.

Putting human rights principles and standards at the heart of policy and planning
Mersey Care NHS Trust has integrated human rights into its patient risk assessment strategies and tools. One practical tool it has developed is the 'Keeping Me Safe and Well Risk Screen'. This is a simple questionnaire designed to help service users with learning disabilities understand their human rights, and identify the risks to themselves and others.

Ensuring accountability
Southwark Health and Social Care has developed a human rights based commissioning framework to ensure that commissioned services respect, protect and fulfil human rights. As part of this, Southwark developed a training programme to educate staff, including commissioners, and to create a baseline understanding of human rights.

Empowerment
Surrey and Borders Partnership NHS Foundation Trust has developed a human rights training module for staff. The training is provided at four levels - for new staff, work teams, management, and leadership and senior management. Training includes practical elements such as collaborating with groups of service users and carers to improve work practices.

Participation and involvement
Heart of Birmingham Teaching PCT developed an equality and human rights impact assessment tool to measure the impacts of any new or existing policy by engaging patients and service users.

Non-discrimination and attention to vulnerable groups
Tees, Esk and Wear Valleys NHS Trust worked with voluntary and community groups that represent people who may be more vulnerable to human rights breaches - among them, disabled people, asylum seekers, children and young people - to identify the rights that are relevant to them and to develop a 'business case' for services to realise those rights.

Organisational lessons

The document synthesises the organisational lessons learned by the pilot Trusts. It emphasises, among other things, the need to:

  • secure senior level commitment and engagement
  • integrate human rights into existing initiatives and processes (such as those linked to equality and diversity) rather than 'reinventing the wheel'
  • use practical human rights training that is directly relevant to people's day-to-day work, and
  • involve staff, patients and service users and ensure they have accessible information about human rights.

What difference do human rights make?

This framework makes some expansive statements about the effects of using human rights in healthcare. For example:

Put simply, a lack of understanding and respect for people's human rights is bad for their health. On the flip side, the use of [a human rights based approach] by NHS organisations can significantly improve people's health outcomes by directly supporting the delivery of more effective, better quality, 'person centred' healthcare.

However, it adds that the pilots are not presented as evidence of impact. Rather, they provide an initial snapshot of how the pilot Trusts have integrated human rights in their work, and what resources and information are needed to kick start this process. The emphasis, then, is on organisational processes rather than measurable impact.

An evaluation of the Human Rights in Healthcare programme was conducted in 2008 and is available below. A further evaluation was conducted in 2010 but as of April 2011 this has not been published.

Related equality messages (if applicable)

The framework aims to help NHS organisations to put the principle of equality into practice. The European Convention contains a right not to be discriminated against in the enjoyment of any other Convention right. This might require changes to policy or practice; for example, through a commitment to improving mental health services for people from black and minority ethnic groups, or by ensuring that people are not denied treatment solely on the basis of their age.

The framework contains case studies of NHS Trusts that have integrated human rights into existing initiatives and processes, such as those linked to equality and diversity.

Other important information

As of April 2011, funding for the Human Rights in Healthcare programme has been secured for a further two years and planned activities include a good practice web site and a small number of new projects to demonstrate practical tools for implementing human rights for different user groups.

Date of review

April 2011

  • [This is a summary version of the document reviewed here.]
    Human rights in healthcare - a short introduction
    http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/
    documents/digitalasset/dh_088971.pdf
  • Ipsos Mori (2008), Human rights in healthcare evaluation - final evaluation report
    http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/
    documents/digitalasset/dh_088980.pdf
  • Dignity Champions Action Pack: Human Rights and Dignity, Department of Health, August 2010
    http://www.dignityincare.org.uk/_library/Dignity_Champions_Action_Pack_-_Human_Rights_and_Dignity.pdf
  • Essence of Care 2010: Benchmarks for Respect and Dignity – benchmarks for the fundamental aspects of care, Department of Health, 2010
    http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/
    documents/digitalasset/dh_119978.pdf
     

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