Understanding a rights based approach

This involves a move away from a paternalistic clinical model of “the professional knows best”, to a person centred model; a model where the patient is provided with a range of information to facilitate their own decision-making. Decisions are based on what is best for them as an individual, relevant to their personal values, beliefs, wishes and feelings.

The last years have seen the publication of investigation reports, outcomes of inquests, journal articles, and books that detail poor care, negligent care, and the powerlessness of patients and families in a situation where something goes wrong. Investigation findings have identified systemic and systematic lack of acknowledgement of any deficiencies by the myriad of professionals and organisations responsible for providing care and services.

Some of these situations were historical, in that the actual “incident” happened quite a number of years ago; the investigations took some time to complete with subsequent reports and recommendations published within the last six months. Other cases happened within the more recent past. As I write this, the Muckamore Abbey Hospital Inquiry is still in progress.

Most professionals are very troubled by the detailed findings of the investigations; the extent of the neglectful care, and the apparent continual inability to accept individual and organisational failings. Some might believe that these incidences of negligent care and treatment with devastating outcomes will continue to perpetuate. But let’s not ruminate and blame and rant – the outcomes and recommendations of the investigation reports will follow their own course. Let’s actually learn and improve, so that those in our care do actually receive the most compassionate, safe and evidence based therapeutic care and treatment available.

The investigation reports and findings have identified the lack of an under-pinning rights based approach to care and treatment within organisational service delivery. At times this has also been absent from an individual health and social care professional’s care delivery. In the current context of what must be learnt and what must improve following the various recent inquiries and reports, understanding, promoting and implementing a rights based approach has never been more important.  

Implementing a rights based approach means ensuring that professionals understand what human rights means and how human rights are supported by core values that shape practice and service delivery. A rights based approach identifies “rights-holders” and their entitlements, and corresponding “duty-bearers” and their obligations.

A rights based approach is two-fold.

Human rights are enshrined in the European Convention on Human Rights which was incorporated into UK law by the Human Rights Act (1998). Human rights are the rights that we as human beings are entitled to, rights that allow us to live our lives as equal citizens. They apply to all groups at all times, and are not “given to us” by others; we are entitled to claim our rights or have them fulfilled. Human rights are about our basic needs as human beings. They capture the core rights we are all entitled to so that we may develop our potential and live our lives in dignity and respect. 

The Human Rights Act puts legal duties on public authorities (national and local) to respect human rights in their decisions and actions. This helps public officials deliver better services, and empowers every person to ensure they are treated fairly, and if necessary, to hold officials to account.

There are however some differences in how the Human Rights articles operate.

Some rights are known as absolute rights, for example Article 2, (right to life), and Article 3, (freedom from torture and inhumane or degrading treatment). Everyone is entitled to the full operation of these rights and they cannot be interfered with under any circumstances.

Limited rights are rights that can be interfered with in certain circumstances, for example Article 5, (right not to be deprived of liberty, except in certain legal circumstances).

There are also some articles known as qualified rights, where interference may be justified in order to protect the rights of others or wider public interest. These rights include Article 8, (right to private and family life) and Article 9 (freedom of thought, conscience and religion).

Secondly when we talk about a rights based approach, we mean core principles which should shape practice and services. These core principles put individuals at the centre of the delivery of health and social care. 

The core principles and values which form a rights based approach and underpin all the articles of the Human Rights Act are commonly and collectively known as FREDA - Fairness, Respect, Equality, Dignity and Autonomy. 

The FREDA principles are the basis of good health and social care which should be used individually and mutually to inform decision making.  They are a useful guide to ensure that everyone for whom care, treatment, support and/or services is provided:

• is treated with dignity and respect;
• is provided with care which best suits their individual needs;
• is able to live free from abuse, neglect or discrimination;
• is able to lead as fulfilling a life as possible; and,
• is able to participate in the choices and decisions made about their lives.

It is vital that registered nurses understand what a rights-based approach to service delivery means. All health and social care staff should receive training in human rights, the implications for their service and how they impact on the needs of those in their care. A rights based approach must be embedded in everyday service delivery and rights based language must be an every day, every situation occurrence. For registered nurses, operating within the legal and ethical aspects of delivering a rights based service is also a professional accountability requirement (The Code: Professional standards of practice and behaviour for nurses and midwives (NMC, 2018)). Respecting and upholding people’s human rights will provide registered nurses with a sound value base to model the values and principles of the Code, and provide holistic, person-centred care.