Examination of Witnesses (Questions 400-419)|
LEWIS MP, MR
4 JUNE 2007
Q400 Baroness Stern: I get the impression
from what you have said that this is fairly recent. Is that right?
Mr Lewis: The activity has been,
let us say, stepped up in recent times.
Q401 Baroness Stern: It did not start
seven years ago?
Mr Lewis: Not that I am aware
of, if I am frank.
Q402 Baroness Stern: Last December
your department published a guide for NHS managers on equality
and human rights which declared, and this is good, "Equality
and human rights is core business for the NHS". We recently
visited a hospital in north London where we were told that human
rights are peripheral to mainstream business, largely because
of a lack of guidance from your department. Do you have plans,
concrete, specific, laid-out plans, to try and move this agenda
from the periphery into the mainstream that you could tell us
Mr Lewis: I have tried to say
that we only published Human Rights and Healthcare -
A Framework for Local Action in March, so essentially the
challenge is to make sure that in every locality this document
is being debated, discussed and implemented, not just at chief
executive and middle management level but also in terms of engaging
with front-line staff. I do not believe that that will happen
overnight. It will happen over a period of time. It would disturb
me if an organisation were to describe it as peripheral in terms
of their approach. I do not who said that. There was no attribution,
whether it was the chief executive or somebody senior. I am not
clear who made that comment.
Q403 Chairman: I think it was the
general view of the professions we met that it was seen very much
as a tick-box exercise on the lawyers' side. Although they were
very committed to providing the core standard, the good practice
side of it, it was not because of the Human Rights Act or anything
like that, and I think the issue really came home not so much
at the hospital but at the community hospital we visited afterwards
where a patient we met had been discharged to that and treated
with care there, and where one of the issues it particularly raised
was the treatment of that elderly patient in the discharge lounge
by non-clinical staff. The focus has been very much on the clinical
staff and far less on non-clinical staff who can simply not accept
or understand the continuing need to treat patients in a non-clinical
way properly in accordance with their human rights.
Mr Lewis: You said there has been
no guidance from our department but you yourself quoted the guidance
that we have issued and I have produced this document today.
Q404 Baroness Stern: No, I did not
Mr Lewis: Not you said, but a
person said, which is a source to consider. Just to quote from
Rosie Winterton's foreword to this document, "Too often human
rights are seen as an issue for other countries or a relic of
the past century, not anything we need be concerned with in health
and social care. This is not the case. Quite simply, we cannot
help to improve people's health and wellbeing if we are not ensuring
their human rights or respect. Human rights are not just about
avoiding getting it wrong. They are an opportunity to make real
improvements to people's lives. Human rights can provide a practical
way of making the common-sense principles that we have as a society
Q405 Baroness Stern: Documents are
lovely things to have and lovely documents are lovely things to
have, but I would be really interested to hear you say something
about the plan, if there is a plan, for turning the document into
changes in behaviour in the discharge lounge in this hospital
and in the old people's home somewhere else.
Mr Lewis: What we have at the
moment is a pilot running with the British Institute of Human
Rights. It is operating in five trusts. To try and say to you
today that we have got robust evaluation evidence from these pilots
which will then help us to inform policyI have to say that
we have not got that yet. We are hoping to use this partnership
pilot to inform where we need to go next; that is the truth. The
reason we have introduced the pilot is to try and learn lessons
as to how we can make this mainstream and how we can move it from
Q406 Baroness Stern: Are you happy
that so far your department has really done its best to implement
the Human Rights Act?
Mr Lewis: Standard one of the
NSF for Older People absolutely makes it clear that rooting out
age discrimination in the way that the NHS behaves has to be one
of its top priorities. I think if you look at the history of the
NHS and the way it has treated older people we have a pretty patchy
record. Do I believe that since the NSF was developed and all
of the work that has happened as a consequence of that there has
been real progress? I do not want to bore the Committee but I
could probably point to a whole series of very tangible outcomes
which are about older people's human rights that have occurred
as a result of the NSF. Yes, I think we have made significant
progress. Can I just say that I am conscious of the limitations
of documents and national frameworks. You have to use those as
a lever, a tool, to change behaviour at a local level. We all
know that the whole challenge for government is the gap between
rhetoric and reality, the gap between the finest intentions of
legislation, of resources, of policy and the reality in terms
of people's experiences in the real world and on the ground. I
also believe that this is not just about the state; I think it
is also about the awareness and the confidence of citizens and
communities to assert their rights. I think that is why the Government
increasingly understands that reforming public services is not
just about changing structures; it is also about empowering those
people who use services and, more broadly than that, communities
Q407 Baroness Stern: What do you
think of the idea of a positive statutory duty on health and social
care organisations to respect the rights of the people they are
helping under the Human Rights Act?
Mr Lewis: Would it add value?
Would it make a difference?
Q408 Baroness Stern: I am asking
you that. You are the witness.
Mr Lewis: I do not know. The difficulty
I have with this is that we have the NSF, we have this document
and we have got this specific work we are doing trying to put
dignity and respect at the heart of care services. I think there
comes a point when you have to reflect on all of that and decide
how many advances you have made, how much progress you have made
and whether there is a requirement for any further legislation.
I would say the jury is out.
Q409 Baroness Stern: Finally, you
did mention the British Institute of Human Rights pilot with the
five NHS trusts which is now over. What factors are you looking
at in evaluating that when deciding whether to roll it out nationally?
Mr Lewis: As far as I know it
is continuing; it is not completed. What factors will we look
at? I think the factors we need to look at are: what are the ingredients
that have begun to change the culture in those organisations to
have a far greater rights-based approach than they have had historically?
What are the ingredients? What are the characteristics? What were
the change agents? Once you have identified what they are then
you can clearly seek to mainstream those within every organisation
because for me it is also about strengthening the belief that
healthcare and social care need to be provided very differently
than they have been provided historically in terms of the relative
power of professionals vis-a"-vis patients and users of services.
Q410 Chairman: When will the pilots
Mr Sharma: I do not think there
is a timescale in terms of completion because it is ongoing work.
I think it is the learning that we can pick up from the pilots
in terms of what that means for other organisations.
Q411 Chairman: But you must have
an idea. If you pay the BIHR you must have a contract with them
for how long they are going to do it for.
Mr Sharma: But the pilots that
we commissioned were with the British Institute and now we are
continuing that work ourselves with those areas.
Q412 Chairman: But there must come
a time when you say, "Okay, that is the pilot. Evaluate it,
roll it out". Otherwise it just becomes an excuse for not
doing anything else.
Mr Lewis: Yes; we cannot have
perpetual pilots, although we tend to. I think the answer is at
present is that we do not know when they will be complete today.
We will write to you with that information.
Q413 Chairman: Otherwise you set
up an automatic pilot. It just keeps going. One point I was going
to come back to was when I talked about non-clinical staff, because
it has been about clinical staff more than anything else, whether
in care homes or in hospitals. Will this evaluation look at non-clinical
staff, for example, reception arrangements, booking appointments,
which are particularly serious for elderly people trying to do
it by phone? I do not want to see or hear of the sort of complaint
we had of an old lady sitting in her night clothes in the discharge
lounge for four or five hours with her underwear in a plastic
bag in her lap, no food, no tea, no nothing, and completely ignored
by the staff.
Mr Lewis: Why?
Q414 Chairman: Because they did not
know any better.
Mr Lewis: How can I defend that?
Q415 Chairman: Exactly. The point
I am making is, will these pilots be looking much beyond what
the focus has always been, which is how people are treated on
the wards, and into the wider aspect of the hospital service?
Mr Lewis: I suppose I can point
you at Birmingham Teaching Primary Care Trust who are looking
across their organisation, so it is very much across their organisation
as a whole. Mersey Care NHS Trust are looking at all of their
learning disability services. Tees, Esk and Wear Valleys NHS Trust
are looking at the whole approach to care planning. There should
be some evidence emerging from these pilots which are about organisational
issues, not just about clinical issues. In terms of the story
about that lady, there has to be a real question mark back: is
that anything to do with human rights legislation or is that about
basic minimum standards?
Q416 Chairman: The point is that
that was raised with me by the daughter-in-law in the human rights
context, "My mother-in-law has got her human rights and they
are being infringed in the way she was treated", which is
absolutely right in my view. The point was that if people were
more aware of what their rights were they could say, "Look:
this is not how people should be treated". Yes, it is below
the basic care standards, but the point is that this is not in
a clinical context and most of the effort we have been looking
at, most of the information we have had, have been about the clinical
context, not that non-clinical context, and I think that is potentially
the killer in all the work that has been done.
Mr Lewis: I am certainly not going
to get involved in mothers-in-law. No: the point you make is obviously
a valid point. It is in every part of the pathway in terms of
a patient or a user's experience of the service and the way that
they are treated.
Q417 Earl of Onslow: But surely in
that case the person was not doing their job properly? That is
simply bad officering, if somebody leaves a patient like that.
Whether they are a clerk, whether they are a bootshine boy, whatever
they are, they should not do that.
Mr Lewis: I am not sure how many
bootshine boys are operating now.
Earl of Onslow: I was using that as an
Q418 Chairman: I do not know if there
are any human rights about shining shoes.
Mr Lewis: The response to your
question, and I think the Chairman was suggesting this, is to
do with the source of redress. Is your redress through the grievance
or complaints procedure or is it to say, "You have broken
the law"? There is a significant difference between the two,
is there not? The bit that is different is the way that you seek
Q419 Earl of Onslow: It is the other
side of the coin.
Mr Lewis: I will be very clear,
just in case the Daily Mail is listening to this, that
if that happened I would hope that the way we would resolve this
would be for the relative or the patient or both to complain to
the relevant manager who could resolve it within the organisation.
I certainly personallyand this is where I think there are
issues about the Human Rights Actdo not want to see an
explosion of litigation in areas where litigation is not desirable.
Chairman: You will never achieve human
rights through suing people, generally speaking I would agree
with that, but the point is that we can use it as a lever now.
It will be too late for that old lady but hopefully, through filing
this complaint, which I am doing, we will then see improvements
so it does not happen to anybody else.