We have conducted this inquiry to find out whether the human rights of older people wanting or receiving care in their own homes in England are fully promoted and protected. The inquiry was launched in November 2010 to identify in particular the extent to which public authorities are effective in protecting and promoting the human rights of older people, including those paying for their own services, in the initial and ongoing assessment of their needs, commissioning home-based care and support and subsequent contract management.
Local authorities play an essential part in protecting the human rights of older people, particularly when commissioning home care from private and voluntary sector organisations. In 2008, an estimated, 4.1 million hours of home care were purchased or provided by local authorities. It is estimated that 80 per cent of the home care provided by the independent sector is commissioned by local authorities, who spent just over £2.1 billion on home care for older people in 2009-10.
The Commission’s Human Rights Inquiry found that, if a human rights approach is properly understood and applied, it can help to transform the way services are planned and delivered, driving up standards and providing a code of behaviour for organisations. A human rights approach provides an ethical framework for 'person-centred' decision-making by ensuring that rights are only restricted where proportionate and necessary. It can also provide guidance on how to balance competing rights and duties in situations where they conflict.
We have drawn some excellent examples of good practice from different public authorities, Commissioners and the Department of Health.
The Department of Health’s Dignity in Care campaign is one such example of how focusing on the individual is making a difference to the service user, using 'life stories'. A range of information is pulled together about an older person's life such as their key relationships and history enabling the care worker to build a picture of who their service user is. This approach demonstrates how putting human rights at the heart of health and social care services can deliver better outcomes for service users and staff alike.
Local authorities have positive obligations to carry out their functions in a way that promotes and protects the rights in the European Convention on Human Rights. This applies to every aspect of their day-to-day work. However, our findings reveal that local authorities may not have a comprehensive grasp of their human rights obligations as they relate to home care and as a result may incorporate human rights into their commissioning in a superficial way.
There are major opportunities for local authorities to promote and protect older people's human rights in:
- the way they commission home care
- the way they procure and monitor home care contracts.
They also have a role, more directly with older people, in:
- assessing older people's needs
- reviewing older people's ongoing needs and the care they are receiving
- providing information to people in need of home care.
Our findings indicate that – for a variety of reasons – commissioning bodies are not making the most effective use of the scope they have for protecting and promoting human rights. As a result, there are concerns that they are not fully meeting their own obligations as public authorities under the Human Rights Act (HRA). This seems to stem primarily from a lack of awareness about the full extent of their HRA duties, including complying with positive obligations to promote and protect human rights.
We found that practice on commissioning varied a great deal. Some local authorities adopted a quality-driven approach, incorporating human rights principles at all stages of the commissioning process, while others appeared to focus on price above all other considerations – an approach which is likely to reduce the quality of services. However, very few are consistently adopting commissioning principles that are firmly underpinned by an understanding of human rights.
- A small number of local authorities have attempted to incorporate human rights into their practices in a meaningful way throughout their commissioning, procurement and contract management – human rights was sometimes one of the specific factors considered when assessing providers’ performance.
- Some local authorities have adopted the Dignity Challenge as a framework for commissioning older people’s services – with a clear understanding that this approach is underpinned by legal obligations under the HRA. This is a welcome development, one which we hope other local authorities will follow.
Other local authority interviewees pointed out that care packages for older people were less likely to include support to allow them to take part in their local community than those for most younger adults.
Recommendations for care services providers
We recognise that there is a complex web of transactions involved in delivering home care from commissioning to service delivery and monitoring. However we believe that a human rights based approach, is the best option to ensure carers, home care providers and service users are happy with the quality of service.
Read our full recommendations
2013 Review of our recommendations
The Commission has published a Review of our initial inquiry report 'Close to home', which offers an assessment of what local authorities, Government, the Care Quality Commission and the Local Government Ombudsman have done in response to recommendations directed at them.
You can read the full Review findings
Last updated: 08 Jul 2016