We are also issuing an invitation to the public – to use the information provided by CQC or by professionals who help you, to make decisions about your care and the care of your loved ones. Where you don’t have a choice of care, then become more demanding of those who should be acting in your interests. They should be putting you at the heart of good quality care. It is your right.

The State of Care Report 2013 - 2014 released this week by the Care Quality Commission has a lot to say about how rights are protected in health and social care. Most importantly, it issues a challenge to both care providers and care receivers - be proactive about care standards. Challenge bad practice and stand up for your right to make decisions about your own care.

The report is flags examples of outstanding care - and some very bad ones – both of which are drawn from dementia themed review, and highlights the CQC’s commitment for personal choice and dignity within health and social care.

The Good

We saw how supporting dementia was built into each care plan. For example, the night time care plan for one person reminded staff that the person had little concept of night and day, and needed to be reminded it was night time. It showed that if the person said they were ‘hungry’ at night it usually meant they needed to use the commode. The manager told us … staff might put dressing gowns on themselves to help people connect wearing a dressing gown with night time and going to bed.

The Poor

Some rooms had little décor or pictures and no information to assist in getting to know the person. Other rooms, however, were warm and cosy and personalised. We found that the rooms with little or no personalised effects belonged to people in the later stages of dementia. This suggested that people with higher needs, or in the later stages of dementia, did not have their dignity maintained in the same way as people who were able to make choices and express their own needs.

In this poor example, the dignity of the later stage dementia patient was ignored on the basis of an assumption made by staff about that person’s quality of life. At BIHR our work in health and social care often comes across examples of assumptions about a person which colours the quality of care they receive. Our work to put human rights at the heart of services focuses on placing the person back at the centre of their own care, regardless of their ability. Our work shows this is an approach which can help restore dignity and choice to health and social care setting, something which is reinforced by the CQC’s report:
People will only receive safe, effective, caring and responsive services if providers address issues of equality and human rights. We have developed a human rights approach to regulation which uses human rights principles to help us look at care from the perspective of people using the service.
The examples of good care that respects dignity and choice suggests that the CQC human rights based approach is working, but there is still some way to go. In particular the report suggests that women, particularly older women, lesbian woman, BME women and women with mental health problems are less likely to feel as though they have been treated with respect and dignity within care.

"Don’t wait for a CQC inspection to get to grips with what ‘good’ care looks like."

This is the challenge issued by the CQC; and a call to arms for all health and social care providers to integrate a human rights approach into their services. In a report released earlier this year, Monitoring the Mental Health Act 2012 - 2013, the CQC recommended all detaining authorities and advocacy services received copies of BIHR's Mental Health Advocacy and Human Rights Guide. With its practical focus, our Guide shows how and why human rights are crucial to ensuring good decision-making which improves the experience of care for both receivers and providers.
We welcome the publication of the British Institute of Human Rights guide to mental health advocacy and human rights. This is designed to help both patients and advocates to understand and apply human rights in an advocacy context. We recommend advocacy services and detaining authorities circulate it widely.

BIHR’s Mental Health Advocacy and Human Rights Guide is just one of the many outcomes from BIHR’s work on human rights in health and social care over the last decade. This work has been captured in The Difference it Makes: Putting human rights at the heart of health and care, a seminal resource which explains the importance of a human rights approach and what this looks like through the real life experiences of the patients and services we work to support. Rather than waiting for the findings of  inspections, a human rights approach helps care staff and advocates to understand how services can meet their human rights and equalities obligations under the law and translate this into better care. Integrating a human rights approach doesn’t have to be difficult, it’s practical, it’s necessary, and, as our work shows, it can change lives, and sometimes even save lives.