Why human rights can be transformational – Lucy Mulvagh

One of the Academy’s Five Provocations, Emphasising Humanity, is described as the need “to emphasise the humanity and human rights of the people accessing and providing support and services, to create relationships that enable people to flourish.” Here, Lucy Mulvagh explains why she thinks human rights can help achieve transformational change.

 

It was love at first sight (or should that be sound?) when I first heard about human rights. I can’t really remember a time as an adult when they haven’t figured somehow or another in my life and it’s usually a subject that’s knocking around my head on most days.

I’ve got many reasons for this passion, but primarily it’s because human rights can identify and challenge the myriad power imbalances that currently exist. I firmly believe that if we were to adopt a truly rights-based approach – as widely as possible in everyday life – then many of society’s ills and injustices could be overcome.

Using rights to support decision-making – at the individual, community, regional or national level – means it’s based on fairness, transparency, equality and proportionality instead of (political) ideology, decisions around who is ‘deserving’ or ‘undeserving’, and (unwittingly or not) prejudice, bias and stigma.

I’m thinking of decision-making that can apply anywhere and at any time: how resources and budgets are allocated and disbursed; homes and public spaces are designed, built and sustained; health and social care services; income and social protection; good quality food, heating and clothing; transport; education; employment; … you name it!

I’m very sad that there is still such a great deal of suspicion and unease about human rights in some quarters. While this is due, in part, to genuine misunderstandings about rights being purely associated with lawyers, court cases and punitive action, I’m pretty sure that some is deliberate misinterpretation and misinformation by those who are challenged by the idea of greater equality in the distribution of power.

We all have human rights, simply by virtue of being human, and it’s a bit of a personal mission of mine to help raise awareness about rights and support efforts to increase our understanding about how truly revolutionary they can be – for all of us.

I welcome the growing appreciation – and name-checking – of human rights in national policy, but there’s still a long way to go to bridge the (growing) gap between rhetoric and reality and translate rights into everyday life. In the meantime much of the focus, including in health and social care, has been on concepts like ‘person centredness’, ‘compassion’ and asking people what’s important to them.

Don’t get me wrong, of course I agree we need as much compassion, kindness, listening and understanding as we can get. But I can’t help feeling that it’s a sad indictment of how we currently relate to each other – irrespective of where our interactions take place – that these could ever be seen as transformational.  Aren’t they the basic minimum that we should expect when we relate to each other?

And what happens when, say, a service says that they listen to what’s important for people, but then they either don’t, or do but then don’t actually act on what they’ve been told?  Very often this sort of practice is deplored and decried as unacceptable, and a (public) apology may be offered, but what difference does that really make to the people and institutions involved, and are we sure there are adequate concrete measures in place to ensure it never, ever, happens again?

We can’t, and indeed shouldn’t, legislate for compassion, but we can legislate for human rights and rights-based approaches – like the right to free, meaningful and active participation in decision-making – which means that when things go wrong there will be an open and honest approach to accountability, remedy and redress.

But it’s not just about the ‘stick’ of holding people or services accountable when things go wrong. Taking a human rights-based approach to decision-making means we can start with the ‘carrot’ and conceptualise and deliver support in very different ways, nip issues in the bud at a much earlier stage, and even avoid things going wrong in the first place.

I’m committed to spreading the love about human rights – who’s with me?

@lkmulvagh

 

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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.

The Power of Prevention: “It’s time to stop being polite, and get angry”

David’s story, presented at the Academy’s event on the benefits of prevention in health and social care, inevitably invokes equal measures of sympathy, frustration and dismay. It is a story in which many professionals were ‘only doing their job’, or perhaps, no more than their job requires. Missed signs, missed connections and missed opportunities all conspired towards a man who was gravely mentally ill spending weeks in a prison cell because, during his crisis, his home had been condemned and social work, primary care and mental health services failed to respond effectively.

Read More “The Power of Prevention: “It’s time to stop being polite, and get angry””

“Citizenship is belonging”

“Citizenship is belonging”

This was the phrase that seemed to sum up our recent Academy masterclass with Professor Michael Rowe of Yale University.  It was one of the contributions from a member of the People Powered Health and Wellbeing Reference Group in an excellent short film and a theme that resonated throughout the session.

Read More ““Citizenship is belonging””