Equality and Human Rights Commission

This tool is designed to assess how human rights are being incorporated into the lives of people supported by 'complex care pathways'. It can be used to evaluate the extent to which a human rights based approach is taken by the services they use, regardless of whether these services are being provided by health, local authorities, or private and voluntary sector organisations. It assesses the incorporation of human rights in relation to eight different areas, such as risk assessment, health, physical intervention, daily living and housing. The tool is intended to be completed on an annual basis for most areas. The manual may be copied for use within NHS organisations if suitably credited. It can be used in conjunction with other human rights tools produced by Mersey Care NHS Trust.

• The Human Rights Act means that all public authorities - including NHS Trusts and social services - have an obligation to ensure that people's rights are respected in all that they do.
• Meaningful involvement and participation of service users in decisions about their lives is particularly important.
• The right to private and family life is applicable to a range of issues that are relevant to service users' daily lives, including relationships, independent living, visits, diet, cultural and religious practices. It is important that service users' choices and wishes are reflected in these areas.

Legal and policy context

This is one of a set of unique human rights tools designed by Mersey Care NHS Trust for social workers and clinicians working with learning disabled people with complex care packages.

It explains that employing a 'human rights based approach' promotes 'a shared sense of entitlement, encourages personal responsibility and upholds respect for the rights of others; whilst accounting for issues of equality and diversity'.

It is underpinned by the human rights values known as FREDA:

• fairness
• respect
• equality
• dignity
• autonomy

These principles find their expression in human rights laws, such as the Human Rights Act (HRA) 1998 which gives domestic effect to most of the rights in the European Convention on Human Rights.

The Act means that all public authorities - including NHS Trusts and social services - have an obligation to ensure that people's rights are respected in all that they do.

Using this tool

The tool can be used to assess how human rights are implemented in eight areas:

1. Risk assessment (see also another Mersey Care tool, the Human Rights Joint Risk Assessment and Management Plan)
2. Physical Intervention
3. Staffing
4. Health
5. Involvement and confidentiality
6. Essential lifestyle plan and daily living
7. Activities and employment
8. Housing (quality and appropriateness of existing housing)
9. Choice of housing when moving to new accommodation

For each area, the tool explains the human rights that are of most relevance and how they come into play in real life settings.

Example: Physical intervention

Physical intervention should be treated with caution as there is a very real risk of breaching a service user's human rights. Particularly relevant articles in terms of restraint include:

Right to private and family life
An important aspect of this right is psychological and physical integrity. Restraint has the potential to breach this right if the service user's human rights are not considered. It must be ensured that any action of restraint is balanced and proportionate to the risk. The least restrictive option must be used at all times and the service user should be treated with fairness, respect and dignity in the case of restraint). This right could be breached easily if, for example, the service user is not asked about their preference regarding physical intervention.

Right not to be tortured or treated in an inhuman or degrading way
If restraint was very severe and used with excessive force (i.e. not proportionate to the risk), it could potentially be considered inhuman or degrading treatment. If this is suspected, action should cease immediately because this is an absolute right that
should not be compromised under any circumstances.
Source: Mersey Care NHS Trust (2011) Benchmarking Tool, p.6

In each area, there are around eight to ten questions. Each can be scored as either '0', '1' or '2', and clear guidance is provided as to how to decide on scoring. Acceptable scores vary between sections.

There are also key questions (highlighted in red) for which a score of '0' will always require immediate attention, regardless of the overall score for the section.

The document expresses the hope that services will use the results of this tool to highlight areas in which they can improve.

Related equality messages

The tool explains that the European Convention contains the right not to be discriminated against in relation to any other Convention right. For example, If a service user is denied the opportunity to participate in the community or gain suitable employment because of the fact that they have a learning disability, the right not to be discriminated against could be compromised alongside the right to respect for private and family life.

Date of review

April 2011

• Ministry of Justice, A Guide to the Human Rights Act: a booklet for people with learning disabilities
  http://www.justice.gov.uk/guidance/docs/human-rights-act-learning-disabilities.pdf
• Dr Beth Greenhill et al (2011) Human Rights Joint Risk Assessment and Management Plan (HR-JRAMP) (Mersey Care NHS Trust)
• Jenna Vyas et al (2011) Keeping Me Safe and Well Assessment Manual (Mersey Care NHS Trust)
  

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.