“Quite simply we cannot hope to improve people’s health and wellbeing if we are not ensuring that their human rights are respected.”
Rosie Winterton [1]
“These rights – and the intentions behind them – are at the core of what good care and support should mean at a day to day level. Whilst they may sometimes appear abstract, they are really about such mundane things as eating a meal when you are hungry rather than when a service wants to provide it; having a bath in privacy and comfort; being able to play with your children or go to church or to the pub in the same way as everyone else.”
Equality and Human Rights Commission [2]
In my previous blog I discussed how our focus on ‘needs’ highlights so much of what is wrong with current practice, and suggested that we need to shift from a needs-based approach to a rights-based approach.
Flip the narrative from ‘need for’ to ‘right to’.
This is part two – a follow-up blog on ‘rights’.
So, let’s look again at the start to my previous blog…
Needs are ‘the things we must have for a satisfactory life’. There are the basic things we all need to stay alive – like food, water, air, shelter, and sleep, and to feel safe and secure. [Article 2: The right to life. Article 3: Prohibition of torture, inhuman and degrading treatment. Article 5: Right to liberty and security.]
And there are the things that give us reason to live. The need for belonging and connection. Family and friendships. Love and intimacy. Dignity and respect. Freedom. The need to be recognised, accepted, and valued. The need to have something to do, and to look forward to. To have meaning and purpose. [Article 3: Prohibition of torture, inhuman and degrading treatment. Article 5: Right to liberty and security. Article 8: The right to respect for private and family life, home and correspondence. Article 9: The right to freedom of thought, conscience and religion. Article 10: The right to freedom of expression. Article 12: The right to marry and found a family.][3]
The things we need to survive and to thrive are also the things that we all have a basic human right to.
But while references to needs dominate our narrative and our practice, the language of rights is far less pervasive.
There are 1690 references to needs in the care and support statutory guidance.
And 41 references to rights.
Wellbeing
“[I] believe it’s possible to flip our practice within the existing legal framework. It’s about starting our practice from a different place, ironically from where the Care Act also begins: wellbeing. That’s where rights should come in.”
Phil Holmes [4]
Promoting wellbeing and respecting, protecting, and promoting human rights are inextricably linked, ensuring we can all live dignified lives in a place that feels like home, be with people and things we love, do the things that matter to us, and participate as active members of communities where we all look out for one another.
Human rights are based on principles of fairness, respect, equality, dignity and autonomy, and these principles weave their way through the Care Act 2014 and the statutory guidance.
However, while the overarching wellbeing principle “is intended to cover the key components of independent living, as expressed in the UN Convention on the Rights of People with Disabilities”, the Act and the guidance avoid the use of the “relatively abstract” term ‘independent living’, and also largely avoid explicit references to rights.
While the UN Convention recognises that “persons with disabilities continue to face barriers in their participation as equal members of society and violations of their human rights in all parts of the world”, and as such there is a need to “promote and protect the human rights of all persons with disabilities”, the Care Act has nine ‘areas’ of individual wellbeing which must be promoted.
Now is it just me, or does ‘area of wellbeing’ not quite have the same authority and power as ‘right’?
Isn’t “participation in work, education, training or recreation” ‘relatively abstract’ compared to “the right of persons with disabilities to work, on an equal basis with others”, “the right of persons with disabilities to education” and “the right of persons with disabilities to take part on an equal basis with others in cultural life”?
Isn’t “domestic, family and personal relationships” ‘relatively abstract’ compared to “no person with disabilities, regardless of place of residence or living arrangements, shall be subjected to arbitrary or unlawful interference with his or her privacy, family, home or correspondence” and “the right of all persons with disabilities who are of marriageable age to marry and to found a family…”?
Isn’t “suitability of living accommodation” ‘relatively abstract’ compared to “the equal right of all persons with disabilities to live in the community, with choices equal to others [and] to choose their place of residence and where and with whom they live on an equal basis…”?
Human rights may be embedded implicitly throughout the Act and corresponding guidance – and wellbeing is (in theory) “at the heart of care and support”, but this is a blog about language, and the language of ‘needs’ is so much more explicit.
Eligibility
“…the fundamental problem with social care is that it is predicated on need rather than rights…”
Equality and Human Rights Commission [5]
It is of course possible to reframe needs as entitlements or rights – to switch from ‘need for’ to ‘right to’ – but the overall basis of our current ‘system’ is still one of eligibility rather than entitlement, and the legislation and guidance still ultimately embed a needs-led rather than a rights-led approach.
As such, eligibility dominates practice. Checking. Screening. Questioning. Box ticking – or not ticking. Forms. Processes. Panels. MDTs. DSTs. Waiting. Worrying. Arguing. Justifying. Disputing. Appealing. Defending.
“the ratio of ‘checking’ (assessments, panels, scrutiny, supervisory oversight/justification, inspection etc) to ‘doing’ (supporting, nurturing, connecting…even intervening) was roughly 2:1… Imagine if we could liberate the time and effort spent doing this to doing other things…”
Mark Adam Smith [6]
And despite the Care Act guidance emphasising the shift from providing services to meeting needs, needs are still largely interpreted as needs for a service, not a life. A need for something finite, in limited supply – which further embeds the requirement to ration and gatekeep.
Just whose needs are we meeting?
“[We tell] people they need to move to a care home when we actually mean… we don’t have the time, connections or resources to work with you and your family to knit together the creative tapestry of support you will need if you are to stay at home.”
Angela Catley [7]
Switching instead to a rights-based approach – to a focus on wellbeing and participation and good lives – opens opportunities.
Shifts the focus from services and providers and institutions to the abundance of resources in communities and how they can be nurtured and connected and shared.
Shifts from scarcity to abundance.[8]
Power and politics
The needs-led approach puts people seeking support in an inferior, disempowered position – asking for needs to be met – dependent on the assessment and judgement of ‘professionals’ to determine need and eligibility.
Help me. Please.
In contrast, a rights-based approach shifts power, with people maintaining their dignity, organisations more explicitly accountable to people for fulfilling their rights, and social workers working alongside citizens to uphold and promote rights and social justice.
The unrelenting focus on needs also keeps our attention on the personal rather than the political.
Needs-based practice locates the ‘problem’ with the person, suggesting needs are individual, blaming ‘people with care and support needs’ and avoiding any focus on systemic failings and changes.
“Rights-based practice is political. It requires advocacy and activism, and this is surely a time when our political action is needed to address the human rights violations and gaps in care and services that the coronavirus has made (even more) visible.”
Jane McPherson [9]
Social work: a human rights discipline
“Social work is a human rights discipline. It’s not just an element of it – it is the core principle.”
Ruth Stark [10]
The global definition of social work states that “principles of social justice, human rights, collective responsibility and respect for diversities are central to social work,” and the British Association of Social Work code of ethics suggests that “respect for human rights and a commitment to promoting social justice are at the core of social work practice throughout the world”.[11][12]
But care management has trapped social workers in a never-ending cycle of screen triage signpost assess plan justify refer provide place review close.
Defending budgets and policies and processes rather than human rights.
Fighting with, not for, people and families.
When I wrote my blog post about the language of social work job adverts, a number of things stood out. The endless ‘p words’ (pathways, processes, packages, placements) summing up the transactional nature of the local authority social work role. The distancing, dehumanising, and blaming ‘c words’ (customer, case, caseload, complex, challenging). And the absence of words like rights, advocacy, relationships, creativity, and hope.
Process has replaced politics.
Assessments have replaced activism.
I wrote that blog post a couple of years ago. I’ve just had a scan of thirty or so current job adverts to see if anything has changed. Most described people as vulnerable / service users / customers / clients / complex cases. Several referred to care management. Two mentioned upholding and promoting people’s rights.
Responsibilities
“Perhaps the most deep-rooted systemic barrier to older and disabled people enjoying their human rights on an equal basis with others is paternalism. Put simply, society’s prejudice that people who require some financial or practical support cannot safely take responsibility for their own lives is codified into our laws, institutions, professional qualifications, culture, practice, and public discourse.”
Neil Crowther [13]
The language of needs embeds and perpetuates the belief that people ‘with care and support needs’ are ‘needy’ and ‘vulnerable’ and ‘helpless’ and therefore must be ‘looked after’ and ‘protected’.
And in turn, the purpose of social care is largely viewed as ‘looking after the vulnerable’, and support focuses on just that. Just. That.
“Too often in the language of power we hear citizens being turned into patients, residents, service users, consumers or recipients; in other words, we turn the active into the passive, we don’t see the multiple gifts that each of us brings, instead we convert each other into an impossibly long list of needs waiting to be met.”
Simon Duffy [14]
In contrast, the language of rights recognises everyone as equal, active citizens, with shared human rights, and shared responsibilities.
It shifts the focus to purpose and participation and potential and possibility.
To doing and being and becoming.[15]
To “the contribution care and support can make to people’s equality of opportunity to participate and contribute fully in society.” [16]
And to wider conversations about roles and responsibilities – like recent ideas about a ‘National Care Covenant’ from the Archbishops’ Commission on Reimaging Care, and a National Care Service from the Fabian Society.[17][18]
Us not them and us
“To deny people their human rights is to challenge their very humanity.”
Nelson Mandela [19]
The focus on needs divides people into them and us.
‘Those with care and support needs.’
Them.
In contrast, rights are universal and apply to everyone.
Us.
However, there is currently a dangerous political narrative around human rights. As Amnesty International observe, “the consequences of “us vs them” rhetoric setting the agenda in Europe, the United States and elsewhere is fuelling a global pushback against human rights” and “instead of fighting for people’s rights, too many leaders have adopted a dehumanizing agenda for political expediency. Many are violating rights of scapegoated groups to score political points, or to distract from their own failures to ensure economic and social rights.”[20]
This divisive rhetoric – echoed in sections of the media and influencing public attitudes – could easily be seen as a reason to steer clear of the language of rights in relation to care and support.
Or as a very valid reason to firmly embed rights into our language and our practice.
We can choose to perpetuate an approach to care and support based around needs and screening and eligibility and gatekeeping and them and us.
Or we can choose instead to grow an approach based around rights and advocacy and participation and citizenship and all of us.
References
[1] Human Rights in Healthcare – A Framework for Local Action, Department of Health, 27 March 2007
[2] From safety net to springboard A new approach to care and support for all based on equality and human rights, Equality and Human Rights Commission, 2 February 2009
[4] [I] believe it’s also possible to flip our practice within the existing legal framework…, Phil Holmes, Twitter, 20 May 2023
[5] From safety net to springboard A new approach to care and support for all based on equality and human rights, Equality and Human Rights Commission, 2 February 2009
[6] Eligibility criteria – what if we just turned them off?, Mark Adam Smith, Changing Futures Northumbria, 10 August 2022
[7] Mavis and Meena – social care abundance or deficit? Angela Catley, Community Catalysts, 30 May 2023
[8] Mavis and Meena – social care abundance or deficit? Angela Catley, Community Catalysts, 30 May 2023
[9] Now Is the Time for a Rights-Based Approach to Social Work Practice, Jane McPherson, Journal of Human Rights and Social Work, 3 June 2020
[10] ‘Social work is a human rights discipline’: IFSW president speaks up for the profession, Rachel Schraer, Community Care, 23 July 2014
[11] Global definition of social work International Federation of Social Workers, July 2014
[12] BASW Code of Ethics for Social Work, The Policy, Ethics and Human Rights Committee, British Association of Social Workers, 7 July 2021
[13] With shared power comes shared responsibility, Neil Crowther, Making rights make sense, 23 April 2022
[14] The path to community, Simon Duffy, Citizen Network, 6 June 2023
[15] Welfare 5.0: Why we need a social revolution and how to make it happen, Hilary Cottam, UCL Institute for Innovation and Public Purpose, September 2020
[16] From safety net to springboard A new approach to care and support for all based on equality and human rights, Equality and Human Rights Commission, 2 February 2009
[17] Care and Support Reimagined: a National Care Covenant For England, Archbishops’ Commission on Reimaging Care, January 2023
[18] Support guaranteed: the roadmap to a national care service, Andrew Harrop and Ben Cooper, Fabian Society, 8 June 2023
[19] Nelson Mandela at a joint meeting of the United States Congress, Washington DC, 26 June 1990, – quoted by Building on the Legacy of Nelson Mandela, United Nations
[20] ‘Politics of demonization’ breeding division and fear’, Salil Shetty, Amnesty International, 22 February 2017
Rewriting social care 
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