Bringing humanity into action — our revised human rights approach to regulation
In this blog, Lucy Wilkinson, CQC’s Interim Head of equality, health inequalities and human rights, talks about the fundamental link between human rights and delivering safe, good quality care.
Human rights are about everyone. We all want the same things when we are using health and social care services. We want our views and wishes to be treated with respect. We want to be treated with dignity, even if there are barriers to expressing our views. We want as much control over our lives as possible. We want fair treatment. Some people are much less likely to experience these things, so equality is important too.
Our recent State of Care report shows the many challenges in providing good care, such as workforce pressures and long NHS waiting lists. These pressures can lead to unfair care. The causes are complex and challenging and the solutions are not simple. However, in many situations, a change of perspective towards care that respects people’s human rights (rights-respecting care) can improve people’s experiences and outcomes.
Our refreshed human rights approach is based on the FREDA principles (fairness, respect, equality, dignity and autonomy) and states clearly that there can be no good care without this rights-respecting care. It has the strapline “humanity into action”. The FREDA principles express humanity — we are asking for everyone working in health and social care to understand this and put these principles into action.
Our new human rights approach does this for CQC by taking the opportunities of our new assessment framework to advance human rights. One aspect that we emphasise is tackling epistemic injustice — when people are wronged in their capacity as a ‘knower’. Major failures in health and care are often because people have not been heard when they have spoken up about whether they have been treated with dignity, respect or fairness — as people with vital knowledge about the quality of care. The same is true for frontline staff who have tried to speak up. We also need to counter epistemic injustice in daily interactions between staff and people using care services — even in good services.
Some people are more likely to face these epistemic barriers because they are not seen as ‘credible’. Or because services have failed to communicate with people in ways that they can understand and be understood, for example because they have a cognitive impairment. We are developing our approach to epistemic justice using our people’s experience principles. We will be publishing staff experience principles too.
Rights-respecting care needs to take place on 3 levels: individual, institutional, and structural.
Firstly, individual workers in health and social care need to have a sound understanding of human rights. They need to apply this in day-to-day decision-making and conversations with colleagues and people using services. This involves staff having values aligned with the FREDA principles. Where there are more complex situations, they need to understand human rights law relevant to their role.
At an institutional level, embedding human rights principles into service delivery will help ensure that it is good or outstanding. We showed exemplars of this in Equally Outstanding. We have built human rights principles into the quality statements for our new assessment framework. We will use all our available regulatory levers to advance rights-respecting care. This includes registration, assessments and ratings, enforcement and encouraging improvement.
It is heartening to be involved in national initiatives developing evidence-based approaches that help services deliver rights-respecting care:
- The revisions to the Accessible Information Standard will advance epistemic justice for disabled people.
- The Patient and Carer Race Equality Framework uses an anti-racism approach to promote human rights for people from racialised communities using mental health services.
- We are also pleased to see the work of the Patient Safety Commissioner in developing practical solutions to epistemic injustice for everyone using inpatient acute care.
We will continue our work with the Equality and Human Rights Commission to make best use of our respective regulatory powers to improve human rights in care.
Finally, structural challenges mean human rights can be at risk if services are not resourced well enough or, if the commissioning model does not develop services that empower people to have maximum control over their care and their lives. We highlighted this last year in Out of sight? who cares — a human rights issue. We will keep using our independent voice to highlight structural barriers to human rights and to show good work by local systems that enables rights-respecting care to flourish.
None of us know when we, or our loved ones, will next need care. But we do know that we would want care that is fair, respectful, dignified and that maximises our independence. And we would want that for everyone too. This is why rights-respecting care is at the heart of good care.
Our revised approach to human rights is a significant milestone and a springboard for our work as a regulator. Everyone working in health and social care has a part to play in developing and delivering rights-respecting care. This is potentially the most rewarding challenge we have.
As underpinning principles of our new assessment framework, it is our commitment to bringing humanity into action.
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