What is transformation in health and social care?

On International Human Rights Day read the first blog in our series of ‘What is transformation in health and social care?’. In this instalment, from an anonymous blogger, the concepts of person centredness, compassion and the ‘patient’ as the expert, in a human rights based context are explored. human-rights-day


With International Human Rights Day on 10 December and a continuing focus on health and social care integration, this seems a good time to find my voice on a subject that has been bothering me for some time.

That subject is the extent to which the current health policy landscape in Scotland is awash with concepts such as Person Centredness, Compassion and the ‘Patient’ as the Expert.

I completely understand the intent behind these concepts as shifting the power in care from the clinician/service giver to person accessing services. I believe that intent is very genuine.

However, I do not believe that for all their intent they are or will achieve the outcome intended. The reason is this: most policies/most intents are qualified by the context in which they are applied.  Being person-centred can be compromised by a lack of resource, or a lack of time. Being compassionate can be compromised by a strain in the care giver because of lack of time or other stressors. The expertise of people accessing services in their own needs and wants may need to be qualified by the care giver because of clinical expediency, resource constraints, etc.

So, concepts such as Person-Centredness, Compassion and the ‘Patient’ as the Expert can all be qualified by the context in which they are enacted. The problem for me is that I see them being espoused and promoted as if they are not. And what that masks is that the power to decide when to withhold an element of compassion, or be less person-centred or to not go with the expert opinion of the person accessing services still rests with the care giver or the decision/policy maker in the background. So, do these concepts really lead to an equal sharing of power? And how do we hold people to account when it is not?

So, I would like us to stop offering these concepts as the underpinning concepts of care. I just want us to talk about rights.

Human rights have stood the test of time for longer than all these other concepts. They are internationally accepted.  And there is a key difference. The difference is not that human rights are not unqualifiable. Most human rights are absolutely qualifiable. The key difference between rights and these other concepts is that there is no unilateral position. In person centredness, by putting one person ‘in the centre’ you are instantly putting the other parties somewhere else. By describing one person as the expert, you are again by default assigning a different role to other parties. What is that role? It is never fully defined and therefore the power behind that role is not fully understood or visible, but it may well still be there.

With a rights based approach, the basis of everyone’s role is equal because it is based on one role for everyone – that role being one of a human being.  Care givers have a right to be there, to have knowledge, to have it listened to, to have it valued, to be understood as human beings who may have worries and pressures that affect how they act. People accessing services have a right to be there (whoever they are), to be listened to, to be valued wherever they are, to have choices.

If all of that is recognised then the default is to negotiate in the moment of what is wanted, what is possible, what is sustainable and what capacities each party has. I think that is true power sharing.

We shouldn’t be afraid of a human rights based approach to care. We also shouldn’t delude ourselves that other approaches offer the same thing. They don’t, because they don’t shift the balance of power openly and right into the centre so that all parties can see it, use it and negotiate around it openly. It is about basing care on the rights of all, not the needs of the needy.

Academy Secret Bloggers

The Health and Social Care Academy aims to bring to the fore the voices of people with lived experience of accessing health and social care services and others who are involved with or interested in the field, to drive transformational change and spread innovative ideas.

To support this, the Academy is recruiting ‘Secret Bloggers’. We want you to share your views and experiences honestly and anonymously, without restriction or fear of repercussions, regardless of how controversial or challenging your opinions are. These will be shared with a wide audience through the  Academy’s blog and social media channels to provoke conversation and debate on the future of health and social care.

If you would like to be involved, or to find out more, please email academy@alliance-scotland.org.uk