---

Older People's Rights (Health Care)

I hear what the hon. Gentleman says, and I think that that came out in the evidence. Returning to the point, more subtle forms of discrimination are still endemic. The NHS's national director for older people's services told us that there are still"““deep-rooted, negative attitudes and behaviour towards older people””" in the NHS. Examples include making decisions on whether to refer or to treat people on the basis of those "““deep-seated underlying attitudes and beliefs about older people.””" For example, elderly people are less likely to be offered ““talking therapy”” for mental health problems. Financial arrangements can also discriminate against older people. We were told that local authorities frequently have lower budgets for their teams dealing with older people than for those dealing with younger people. We are not convinced that the existing legislation does enough to protect and promote the rights of older people in health care. In addition to our recommendations relating to the Human Rights Act 1998, which I will come on to shortly, we made two recommendations to address that problem. We called for a positive duty to be placed on the providers of health and residential care to promote equality for older people. We also recommended that the current prohibition on age discrimination in the workplace should be extended to the provision of goods, facilities and services so that it would include health care, among other things. The Government told us that they would consider the suggestion in the context of the review of discrimination law. Perhaps the Minister can tell us what his view is, and also say what progress is being made. What do human rights offer beyond what should be good practice, common sense, and good old fashioned manners? That was considered by one of the Lords on our Committee when we started looking at the issue. The NHS is good at curing, but what about caring in the wider sense of the word? Human rights are based on dignity, respect, equality and fairness. We can all agree that those concepts are particularly relevant to vulnerable groups, such as older people in health care. The Human Rights Act is best seen as a tool that can and should be used in law, policy and practice to ensure that those social justice goals are achieved. It is a lever to help drive up improvements in service. It is not merely that there a duty on the NHS and its staff to provide services properly; the patient has an enforceable right to receive such services, too. The Human Rights Act can help put patients, and not finance systems or staff, at the heart of the NHS. The organisation Action on Elder Abuse told us:"““Debates in both the health and social care sector have ignored the Human Rights Act and have instead been focused upon costs, rather than quality of care provision. We are addressing a 'mass production' approach toward older people, rather than a 'quality approach'””." By giving legal force to concepts such as dignity, respect, equality and fairness, the Human Rights Act empowers patients and carers to demand better quality treatment. Patients in vulnerable circumstances can be powerless in the face of unresponsive systems. The Act also empowers individual members of staff and their teams to improve the ways in which they work. The Royal College of Nursing told us that human rights"““legitimise speaking out when things are not right.””" The human rights legislation gives nurses and care workers ammunition to pressurise management to change bad practice or improve resources because the rights of their patients are being infringed. Of course, good quality patient-focused treatment is to be found in parts of the NHS, but best practice is not universal throughout the service. The Human Rights Act provides a framework to encourage best practice in health care and, because it has the force of law, it also acts as a backstop to ensure that a positive approach to respecting the human rights of patients becomes the norm. We have all seen the signs that say, ““Our staff are entitled to be treated with dignity and respect,”” or ““We will prosecute those who assault or abuse our staff.”” Where are the ones that say, ““You, the patient and the relatives, are entitled to dignity and respect. We will take action against those who assault or abuse you””? I have yet to see them myself. In practice, it is important to look at how the Human Rights Act can work. The British Institute of Human Rights, with the Department of Health and five NHS trusts, has completed a pilot programme to demonstrate how a human rights approach can be mainstreamed in the NHS. For example, upholding human rights is one of the strategic objectives of the Mersey Care NHS Trust, which is participating in the pilot, and there is board-level leadership on the issue. We were told:"““People have traditionally had things done to them rather than being actively involved. Now that service users and carers are involved...they say it makes a difference for them, they feel valued, they have interesting things to do.””" Users and carers also say that involvement makes a difference to staff attitudes, clinical practice and the kinds of services that are provided. The pilot programme provides welcome evidence of the kind of institutional respect for human rights for which we have long been calling. It integrates not just the elderly, but other vulnerable people, such as adults with learning disabilities and those at risk of discrimination on the grounds of race and gender. However, such practice is the exception rather than the rule. In 2003, the Audit Commission found that 60 per cent. of health bodies had not yet adopted a strategy for human rights from the Human Rights Act. We have seen no evidence that the position has improved. Will my hon. Friend the Minister bring us up to date on the BIHR pilot? When does he expect to evaluate its impact? We would certainly like to see the human rights approach piloted by that project implemented across the health care sector. We hope that the Minister supports that, and will explain how it is going to be developed. The Human Rights Act provides a legal underpinning for dignity, respect, equality and fairness in health care and elsewhere. Respecting human rights is not a question of take-it-or-leave-it best practice; it is a legal duty on public bodies. Public bodies have a positive duty to take active steps to protect and respect the human rights of the people with whom they deal. In our view, an understanding of that legal obligation in the public sector is very limited. As a result, there is infrequent compliance. We call for the positive duty that is implicit in the Human Rights Act to be spelled out explicitly in primary legislation. That could kick-start the institutional changes that are needed in public authorities to put the human rights of their users at the centre of their work. The Government's response to that recommendation missed the point entirely. It merely referred to the terms of the Human Rights Act and the role of the Equality and Human Rights Commission in encouraging public bodies to comply. Our argument is that the existence of that positive duty is not contained in the Act, so understanding of it and compliance are poor. Will my hon. Friend the Minister explain to the House why the positive duty should not be spelled out explicitly in primary legislation? If not, how does he intend to ensure that the NHS bodies act on that duty?