Joint Committee On Human Rights Eighteenth Report

1  Introduction

Our inquiry

1. The number of older people in the UK is growing and people are living longer than they ever did. The Government estimates that by the middle of the century, twice as many people will be aged 80 or over as there are today.[1] Older people are the main users of the NHS. Two thirds of general and acute hospital beds are occupied by people aged 65 and over.[2] A recent survey found that 72% of care home residents were immobile or reliant on assistance, 62% were confused and forgetful and 24% were confused, immobile and incontinent.[3] As older people live longer, their health care needs become more complex, and their dependency and frailty increase. These changes inevitably have consequences for the health service and the social care sector, including an increased pressure on resources (both human and financial). Older people in healthcare, especially those with complex needs, are dependent on others for many if not all of their basic needs, such as food, personal care and medication. They may have, or feel that they have, little or no control over what happens to them.

2. Whilst human rights principles apply to everybody, we chose to limit our inquiry to focus on one particular group, namely older people and their receipt of healthcare services in hospitals and care homes. Victimisation or neglect of older people within the healthcare system raises important issues of substantive human rights law under the Human Rights Act 1998 (HRA), the European Convention on Human Rights (ECHR) and other international law obligations such as the prohibition of ill-treatment, the right to respect for private and family life, physical and psychological integrity and the prohibition on discrimination (including the provision of healthcare on equal terms with the rest of the population). It is also potentially in breach of common law principles such as dignity, humanity and equality and, in particularly serious circumstances, the criminal law. At their most severe, poor treatment could lead to an infringement of the right to life.

Terms of reference

3. Our terms of reference called for evidence in particular on how human rights principles could be applied, by healthcare providers and inspectorates alike, to ensure that older people are treated with greater dignity and respect when being cared for. It sought evidence on the following questions:

4. Our inquiry does not consider palliative care, the meaning of "public authority"[4] or domiciliary care.

Structure of our report

5. In Chapter 2, we set out the evidence we received of the nature and scale of the human rights problem affecting older people in healthcare and its root causes. Chapter 3 explains our understanding of the application of human rights standards to the treatment of older people in healthcare and its benefits. In the following Chapters, we consider the role of the Department of Health (Chapter 4), providers of services (Chapter 5), health and social care inspectorates and NICE (Chapter 6) and staff in protecting human rights (Chapter 7). In Chapter 8, we consider the barriers to older people raising human rights concerns and complaints and the role that human rights have to play in overcoming these problems. Finally, in Chapter 9, we set out our principal conclusions and recommendations. An analysis of the applicable human rights standards is contained in the Annex to this Report.

Evidence and visits

6. We received written evidence from many organisations and some individuals, for all of which we are grateful. Most of this evidence is published in full in a separate volume to this Report. The transcripts of the oral evidence sessions are also published in a separate volume.

7. In May 2007, we visited hospitals and care homes in North London where we met and talked with councillors, managers, staff, residents, patients and their families. Denmark and Sweden are often cited as examples of best practice in the field of health and social care and in March 2007 we visited Copenhagen and Malmö where we had discussions with central and local government, the relevant inspectorates and visited hospitals and residential care homes. We are most grateful to all those who assisted us in the course of our inquiry.

Specialist adviser

8. We record our particular thanks to Frances Butler, our specialist adviser on this inquiry, for her assistance.

1   Communities and Local Government, Discrimination Law Review - A Framework for Fairness: Proposals for a Single Equality Bill for Great Britain, June 2007, para 9.10. Back

2   Department of Health, National Service Framework for Older People, March 2001, p 1. Back

3   Continuing Care Conference Survey of 32,000 care home residents, 2006, quoted in Age Concern, The Age Agenda in 2007, February 2007, p 32. Back

4   Ninth Report of Session 2006-07, The Meaning of Public Authority Under the Human Rights Act, HL paper 77/HC 410. Back

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