The findings of the Gosport Independent Panel Report are truly disconcerting. The Panel was set up to address concerns which had been raised about the care and subsequent deaths of older people at Gosport War Memorial Hospital. As has been widely reported, the Panel discovered that patients at the hospital were being prescribed unusually high levels of opioids, in particular diamorphine (heroin), often without demonstrating appropriate clinical indicators, and often in combination with other powerful opioids. These were administered via a syringe driver: this meant that the patients were given a continuous feed of the drugs.

 

What happened?

 

In a sample group of patients who were treated with the syringe driver, 56% of people died within two days of beginning the treatment. 75% of those lacked any appropriate clinical indications. Out of those who were treated with a combination of three opioids, 71% were dead in 2 days or less, and half on the same day as treatment began.

 

These chilling findings are accompanied by the revelation that when staff on the wards raised concerns about the use of these drugs, those concerns were not taken seriously – moreover, the manner in which the concerns were dealt with had a silencing effect on staff. Similarly, the views of patients’ family members were often disregarded or given improper weight.

 

There is no doubt a great deal which needs to be done to address the report’s findings, which reveal systemic failings in substantive decision-making, as well as in the process of that decision-making and in the way in which concerns were handled. When it comes to guarding against similar situations elsewhere, however, human rights have an important role to play.

 

Why human rights?

 

In the health and care setting, human rights law provides a framework for decision-making. Decisions about care and treatment, especially those involving people in vulnerable situations or those with reduced mental capacity, can be fraught. A balance, often difficult in practice, needs to be struck between the patient’s interests, their views and desires, those of their families and loved ones, and the views of the practitioners who are treating them.

 

There is never a one-size-fits-all answer. That’s why having a structured way to make decisions is so important: it means that, at the very least, decisions are transparent and accountable. A crucial aspect of this framework is that the patient must remain at the centre of that decision-making. Their views must be sought wherever possible, and given due weight. If a decision is taken that they do not have the capacity to be involved in that process, then that decision itself also has to be taken within a legal framework.

 

Too often at Gosport, as the report makes clear, decisions were taken without any (or any adequate) reference to this legal framework. As the report notes:

 

“The Panel found a lack of patient-centred care, in both planning and responding to changes in the condition of patients in the nurses’ care. The standard of assessment was inadequate, scanty and missed key information that ought to have been reflected in individual care plans.”

 

How can we work towards making sure that what happened at Gosport does not happen (and is not happening) elsewhere? At BIHR we’ve helped transform services by providing practitioners with practical support about how to use human rights in their work, supporting them to understand and have confidence to use human rights frameworks when making decisions about care that respect people’s dignity, whilst also giving them the vocabulary required to challenge poor practice when they see it. We’ve also found that empowering people who use health and care services, and their families and carers, about their human rights and what they mean for their care can be a powerful lever for them to advocate for better treatment.

 

Practitioners who have worked with BIHR have spoken about the difference our support has made to them and to their organisations:

 

“The project has helped build in our organisation a culture that is rights respecting. We now tell people about their rights, even if that means people challenge our decisions. The language is being weaved into our day to day work as an organisation.”

 

“Understanding that people have rights including a right to autonomy has changed the way we have discussions – it has now become part of how we make decisions. We have added it into our format for how we discuss complex cases. This project has made us reflect and think about the rights people have.”

 

“People tend to be very risk averse which can lead to a closed mind-set. Human rights helps open this out by giving us an ethical basis for decision making which takes personal opinions out of the equation.”

 

Human rights also provide a language for challenging decisions which is non-confrontational. By framing concerns in relation to legal requirements and decision-making structures, situations can de-escalate. This helps avoid the defensiveness and blame culture that too often cause complaints to be silenced. As one health advocate put it:

 

“Using a human rights based approach has helped us de-escalate differences of opinion”

 

Change is needed now

 

A number of important issues arise from the Gosport report. Not least will be the question of accountability for those involved in the decision-making that appears to have led to a number of unnecessary deaths, raising real issues about people’s right to life. Beyond this, however, the report raises the question of how to ensure there is real change in order to prevent cases like this in the future. Putting human rights back at the centre of decision-making in health and care is essential to secure that change.

 

Find out more:

Do you want more information about putting human rights into practice?

  • Find out about our human rights training and consultancy: [email protected]
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