This blog is a part of a series of expert blogs commenting on how Brexit may affect human rights in a variety of sectors. This contribution is from Dr Donald Macaskill, CEO of Scottish Care

Please note, this is a guest blog and views expressed in this blog do not necessarily reflect the views of BIHR.

As we move almost inexorably to what feels like a period of regressive instability and uncertainty sometimes it seems that Brexit has become one big reality television show where millions of viewers take positions on one side or another of the multiple arguments. The machinations, manipulations and machismo of Brexit have become the lifeblood of our 24-hour news culture and there appears to be no place to escape its reach and rhetoric.

But what about the potential impacts on some of our most vulnerable fellow citizens? What might Brexit mean to those who use and depend upon lifesaving and life-enhancing health and social care services?

It is clear from the Yellowhammer leaks that there is a particular risk to the sustainability of health and social care services and supports. These risks include threats to medicines and the need to substitute or change treatments, the impact of food and fuel shortages not least on the ability of the workforce to get to their places of work, challenges in accessing supplies from isotopes to continence products and the threat to elective non-emergency procedures. Articulating the reasonable worst-case scenarios which lie at the heart of good resilience planning does not serve to paint a picture of assurance and confidence.

So, what about human rights? Strangely enough amidst all the political and media hype human rights have played a marginal role, or at worst the debate has centred around the false presumption that leaving the EU means the end of the European Convention of Human Rights. There has been very little consideration of what a Brexit process might mean for the human rights of individuals or communities.

Human rights lie at the very core of health and social care not least because at their heart human rights have to do with relationships and belonging, with connection and being fully human. Anything that negatively impacts on these, diminishes, reduces or removes the rights of others.

My organisation, Scottish Care, has a working definition of social care as:

‘The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential and the nurturing of belonging to enable the individual person to flourish.’

If that definition rings true for health and care then its essence means that services are about enabling the fullness of life for every citizen who needs support whether on the grounds of age, disability, infirmity or health. It is about enabling independence and reducing control, encouraging self-assurance and removing restriction, maximising choice and building community.

For me health and social care have always been about human rights. It is about giving the citizen control and choice, voice and agency, decision and empowerment. These sentiments are well reflected in the international literature both on the role and purpose of health and social care.

So, Brexit and its uncertainties provide a direct challenge in so many ways to the achievement and fulfilment of the International Covenant on Economic, Social and Cultural Rights (CESCR) and what it describes as the right to health.

The right to health is the right to a universal minimum standard of health to which all individuals are entitled without discrimination. What this means in practice has been long debated but there is now a mature conviction that the right to health is not solely the right to physical and clinical health but to psychological, emotional and societal well-being.

The Brexit process potentially in its negative implementation and the preparation for it definitely constitutes a risk to the right to health. Take for instance measures to substitute medication. The physiological nature of older persons means that they will be disproportionately impacted by decisions which will have to be made should there be medicine shortage. Those in receipt of treatments which involve isotopes, those in receipt of palliative and end of life care, will be deeply impacted by restrictions to their care caused by shortages or import restrictions. Those who rely on the daily visit from a care worker will be impacted by her inability to get to them because the buses are not running or because fuel is restricted and in short supply. Perhaps more generally because social care and health services are most often utilised by those facing economic inequality, the impact of price rises on essential commodities and especially food – will have a profoundly negative impact on their health and wellbeing.

So, Brexit will not be felt equally, but disproportionately its impacts will touch and diminish the lives of those who already are restricted and in distress of one sort or another.

We may not have cases of inhumane treatment, but I very much suspect that a no-deal Brexit will result in a disproportionate impact upon those with disabilities, those who are old, homeless, amongst many others.

At the heart of all our statutes on human rights is a relational dynamic which enshrines dignity at the core of our humanity. Dignity has gone missing in Brexitland. Tolerance and respect, sensitivity in language and conciliation in conduct have been palpably missing from parliamentary exchanges. Dignity is likely to be the first casualty in a Brexitland where the individual struggles to assert his dominance over and against those who have little ability, capacity, strength or economic ability to assert themselves.

So in the midst of the diatribe and debate it is incumbent on those of us with agency and voice, to continue to advocate and struggle to ensure that the rights of those with less are defended, the voice of those marginalised to the edge of presence are heard, and that the dignity of humanity survives the struggle of Brexit individualism.