How to make rights accessible
to older people
270. Despite concerns about terminology, witnesses
have nevertheless told us that they see great benefits to older
people and their carers or advocates of equipping them with information
about human rights principles and their practical application
to them. As Age Concern explained, it would be one way
of addressing the power imbalance and overcoming the powerlessness
that older people complain of when trying to challenge poor treatment.
It would also provide them with a new language to help them
to "advocate more strongly for themselves".
However, the BIHR sounded a note of caution:
The responsibility for making sure that people's
rights are respected should never fall on one frail individual
in a residential care home but, at the same time, that frail individual
should at least have the opportunity to know what their rights
are and for those rights to be respected.
271. Race on the Agenda agreed that consumers of
public services need to have enough knowledge to enable them to
challenge the system when the service is poor, that they should
be consulted to "identify the best methodologies in using
the principles underlying the Human Rights Act" but that
such a process "should not over-burden individuals".
272. It is important that older people and their
advocates or carers have sufficient information about their rights,
to ensure that they can claim them from service providers if they
wish to do so. However, this should be a matter of last
resort. Given the power imbalance between older people
and service providers, and their resulting reluctance to complain,
we do not consider that it is either realistic or appropriate
to expect older people to shoulder the burden for ensuring that
service providers treat them with respect for their human rights.
The primary responsibility for the protection of human rights,
as we have repeatedly said in this Report, falls on providers
of public services. We have already recommended in Chapters
4, 5 and 6 what the Department of Health, providers of healthcare
services, inspectorates and other healthcare agencies should be
doing to ensure that older people's human rights are protected
in hospitals and care homes.
273. Witnesses agreed that, in addition to better
education of the general public, specific targeted information
aimed at older people, their carers and advocates was required.
Information needs to be "accessible and meaningful",
and staff should be trained to support people in accessing this
information. Help the Aged noted the need for independent
quality advocacy services to ensure that older people are informed
and involved and that "access to qualified legal advice is
274. Some witnesses commented on the role of voluntary
and community organisations in communicating the message of human
rights to the public,
and they recommended that the new Commission for Equality and
Human Rights produce similar general and targeted information.
The BIHR told us this about their guide on human rights for
We produced a plain English guide for older people
about human rights and it has flown off our shelves. It
has been the most popular guide of the four guides we produce.
I think it shows there is an appetite there for information.
275. The National Pensioners Convention told us about
their leaflet, Older People and the Human Rights Act.
However, Action on Elder Abuse felt that the emphasis should
be on changing institutional culture:
In our opinion, the strategy to move this situation
forward is less about producing leaflets or posters telling older
people about their human rights, but is more about influencing
the institutions that provide health and social care so that a
human rights culture is "mainstreamed" into the thinking,
planning and delivery; but also to make human rights accessible
through mechanisms other than the judicial system.
276. We consider that a dual approach is required:
firstly, older people need information about their human rights;
and secondly, institutions need to mainstream human rights within
their work. We recommend that the Department of Health,
the inspectorates, healthcare policy-makers and every provider
of healthcare services make a public commitment to: (a) embed
a human rights approach in hospitals and care homes across the
country and (b) make sure that accessible information on human
rights and how to use them are provided to patients, care home
residents, relatives, carers and advocates, and the public as
277. In addition, we recommend that the Commission
for Equality and Human Rights, in partnership with organisations
representing older people, assesses the quality of the information
available to older people, their families and carers on the application
of human rights principles to their lives and makes sure that
the best information is widely disseminated. Independent
advocates and advisors have a crucial role to play in assisting
people to understand and apply these concepts.
278. During the evidence session with the Healthcare
Commission, it was revealed that although the care standards require
hospitals "to respect human rights", this requirement
is not made clear to patients:
Chairman: You do not say to patients
and relatives, "Do you realise that human rights include
X, Y and Z?"?
Ms Walker: No, we do not do that. That
would be another way of coming at it. Our relationship
with the patient fora is in its infancy in the sense that we introduced
the annual health check for the first time last year.
279. Under the National Minimum Standards, care homes
are required to make the following information available to residents:
The registered person produces and makes available
to service users an up-to date statement of purpose setting out
the aims, objectives, philosophy of care, services and facilities,
and terms and conditions of the home; and provides a service users'
guide to the home for current and prospective residents.
Each service user is provided with a statement
of terms and conditions at the point of moving into the home (or
contract if purchasing their care privately).
280. A number of witnesses, including providers,
recommended that older people should be informed about their rights
and responsibilities, as well as what the service provider was
and was not able to do, when entering the hospital or care home.
The Royal College of Nursing suggested that there was work
to be done in putting together:
] something very simple for patients and
for healthcare staff so that they understand what that actually
means, so that patients understand what they have a right to expect
and so that healthcare staff also have the right in understanding
what they have a right to expect and what they should do if they
cannot meet those expectations. 
281. On our visit to a North London hospital, we
were given copies of leaflets provided to patients on admission
about the services that they could expect. These included
information on care and treatment, how to make a complaint and
what happens on discharge. In one of them, Our promise
to you, the NHS Trust states "we will deliver our services
in a way which is fair and safe, recognising the individual needs
of our patients and the potential of our staff".
282. There is no reference to the fact that patients
have "rights" as well as "needs" or that the
providers have a legal duty under the Human Rights Act. It
was thought by those present, however, that a bald reference to
"human rights" could be "off-putting" for
patients. We recommend that information on human rights
be presented by the NHS in an appropriate way to older people.
283. For care homes, information could be provided
as part of the information that homes are required, under the
national minimum standards, to make available to residents.
284. The Minister agreed that individuals should
be informed of their rights and responsibilities when entering
healthcare and that ideally this should be done not by giving
the older person a document, but by having a conversation with
285. Some witnesses advocated a bill of rights for
older people in healthcare.
This is supported by a survey by the Patients' Association.
The British Geriatrics Society suggested that:
Older persons receiving treatment in hospital or
in residential care could be better informed about human rights
] This could be achieved by a public information
campaign and/or a Bill of Rights for older frail persons entering
hospital or a care home.
286. As part of its evidence, the British Geriatrics
Society appended, as a good practice example, US Federal law requirements
for nursing homes which state that "Federal law requires
a nursing home to care for its residents in a way that promotes
their quality of life."
287. The listed rights under US law are comparable
in content to those contained in the Department of Health's national
minimum standards but the difference is that they are contained
in primary legislation.
288. We recommend that information on the human
rights of older people and the duties of service providers as
"public authorities" under the HRA be provided to older
people, in an accessible form, on entry to the care home or hospital.
The applicable care standards for hospitals and care homes
should be revised to require that service providers make specific
reference to an individual's human rights and the avenue for making