Creating a fairer Britain
The inquiry has found that although many older people receive care at home which respects and enhances their human rights, this is by no means a universal experience. It uncovered areas of real concern in the treatment of some older people and significant shortcomings in the way that care is commissioned by local authorities.
Nearly 500,000 older people receive essential care in their own home paid for wholly or partly by their local authority. For too many, this care, delivered behind closed doors is not supporting the dignity, autonomy and family life which their human rights should guarantee.
Good quality home care is invaluable in providing older people with the support they need to keep their independence and control over their lives in familiar surroundings.
The inquiry, the first of its kind into this issue, has found that although many older people receive care at home which respects and enhances their human rights, this is by no means a universal experience. It uncovered areas of real concern in the treatment of some older people and significant shortcomings in the way that care is commissioned by local authorities.
It also found that the legal safeguards provided by the Human Rights Act, which should be used to guarantee respect for the human rights of older people including preventing inhuman or degrading treatment, are not as widely used as they should be.
Bare compliance with the Act is not enough; public authorities also have 'positive obligations'; to promote and protect human rights. There is also a significant legal loophole which means that the majority of older people who receive care at home - that is, if they pay for all or part of it themselves or if it is delivered by a private or voluntary sector organisation - are not protected by the Act.
Around half of the older people, friends and family members who gave evidence to the inquiry expressed real satisfaction with their home care. At the same time the evidence revealed many instances of care that raised real concerns such as:
Many of these incidents amount to human rights breaches. The cumulative impact on older people can be profoundly depressing and stressful: tears, frustration, expressions of a desire to die and feelings of being stripped of self-worth and dignity – much of which was avoidable. Many affronts to dignity stemmed from easily rectifiable issues, such as not covering somebody with a towel while washing them. The underlying causes of these practices are largely due to systemic problems rather than the fault of individual care workers and are caused by a failure to apply a human rights approach to home care provision.
Many of these problems could be resolved if local authorities made more of the opportunities they have to promote and protect older people's human rights in:
It appears that commissioning is not being consistently used to protect human rights effectively. Indeed some commissioning practices make the experiences that older people described more likely to happen. Although practices varied a great deal, very few seemed to be consistently underpinned by local authorities' awareness of their duties under the Human Rights Act, including their positive obligations to promote and protect human rights. Local authorities appear to have a patchy understanding of these obligations, as reflected in their commissioning documents.
We found that:
A number of other interlinked factors are contributing to the human rights risks identified in our findings. Our evidence points to:
Many difficulties older people are experiencing with their home care go undiscovered and unresolved. It was striking how reluctant older people are to make complaints. They did not want to get their care workers in trouble, feared being put into residential care and did not want to ‘make a fuss’. The vast majority want low-level, informal methods of resolving issues without making a formal complaint. Whilst some local authorities and care providers have taken steps to create a regular dialogue between providers and older people, we found that the current ways for older people to raise issues about their home care service are either insufficient or not working effectively for these reasons:
This inquiry has been undertaken at an important point for social care, when the funding and delivery of care faces fundamental reform. This presents a good opportunity to make the changes we recommend. Our full report makes a number of detailed recommendations which fall into the following three categories:
The gaps in the current legal system need to be closed so that older people receive better protection. In particular, the loophole in the Human Rights Act needs to be closed so that home care is covered in the same way as residential care. The Commission will be working to secure support for these essential changes.
Local authorities need to do more to incorporate human rights into the ways in which they commission care services and need to overcome the barriers which many older people face when raising concerns or making complaints. Problems in care delivery do not come to light quickly enough. The Commission will support local councils in understanding what they need to do and what is best practice.
Older people and their families need to have access to better information when making choices about care provision and also need to know more about how their human rights should be protected when care is delivered. The Commission will work with private providers and the voluntary sector to provide accessible guidance on human rights for older people receiving care.
Clearer guidance on human rights obligations should be provided to local authorities for use in the commissioning process. The Commission will work with partners to produce this guidance.
A copy of the full inquiry findings report which includes recommendations for change is available separately on our website, together with supplementary reports which were obtained or prepared in the process of our evidence collection.