Monday, 17 October 2011

CARE4YOURRIGHTS is moving to THINKRIGHTS

Care4yourRights blog has now been almagamated with THINKRIGHTS which can be found at:
www.thinkrights.blogspot.com

Care4yourRights has also been amalgamated with THINKRIGHTS on twitter: www.twitter.com/think_rights

ThinkRights explores human rights, particularly the right to freedom of thought, conscience and religion.

Saturday, 1 October 2011

Dementia Patients Let Down

Some more about issues of restraint (follows from post on detention of patients with TB):

Laws which which were supposed to offer safeguards to the vulnerable elderly and people with learning difficulties have failed, experts have warned. The safeguards were introduced in 2009 in an attempt to stop the scandal of dementia patients being locked up and restrained in care homes and hospitals, without authority, or any checks that such measures could be justified.

Staff working with the elderly and those with learning disabilities now have to seek legal permission from special panels, if they intend to bring in measures which would reduce their freedom. The panels can only allow a "deprivation of liberty" if a formal assessment allows particular measures, finding that they are in the person's best interests. But a major study has found that the experts making such decisions cannot agree which kinds of cases require such legal protection.

The consultant psychiatrist at South London and Maudsley Hospital NHS Foundation trust said: "This legislation was introduced in order to safeguard and protect potentially vulnerable people; the problem is it is incredibly complex. If the professionals working in this field - including the expert lawyers - can't agree about what constitutes a deprivation of liberty, it is hard to have any confidence that the system is working."

The legal changes were triggered by a test case, when the European Court of Human Rights ruled in 2004 that a hospital was wrong to "informally" detain an adult patient with learning difficulties, and to deny him visits from foster parents, for fear they would take him home. In cases which are deemed to constitute a "deprivation of liberty" a hospital or care home has to have two experts formally assess a person, to judge what level of restriction is required, and the person is entitled to an independent advocate, and right of appeal.

http://www.telegraph.co.uk/news/uknews/8800989/Dementia-patients-let-down-despite-promises.html

Again this post raises the ethical problem of discerning the 'best interests' of the patient. How is it possible to decide this?

Rights: Minimally Conscious State

W (by her litigation friend, B) v M (by her litigation friend, the Official Solicitor) and others [2011] EWHC 2443 (Fam).

In the first case of its kind, the Court of Protection ruled that withdrawing artificial nutrition and hydration from a person in a minimally conscious state was not, in the circumstances, in that person’s best interests. In its determination, the Court looked at s4 of the Mental Capacity Act (MCA) and authorities such as the landmark case of Airedale NHS Trust v Bland [1993] AC 789. s4 MCA 2005 states that, in determining best interests, all relevant circumstances should be considered, including the person’s past and present wishes and feelings, and the views of those close to him.
Read more: http://ukhumanrightsblog.com/2011/09/30/what-is-a-life-worth-living-further-analysis-of-m-daniel-sokol/

Polly Toybee has expressed her opinion on this case in
http://www.guardian.co.uk/commentisfree/2011/sep/29/ms-condemned-suffer?newsfeed=true arguing that it is a 'sad reminder of the courts ability to inflict cruelty.'  But what if the evidence offered by some of the carers, that M is capable of positive experiences, was not as Toynbee suggests, 'far-fetched'? Yes, the family did not get the decision they wanted, but how can we possibly know what M wants here and now?

Detaining TB Patients

Recently in the news there was an article concerning the detention of an individual suffering from tb for public health reasons.

I have just read an interesting article on the ethics of legally detaining tb patients at http://www.nursingtimes.net/nursing-practice-clinical-research/the-ethics-of-legally-detaining-a-patient-who-has-tuberculosis/204146. The article is dated (2004) but nevertheless some of the questions raised remain important.

The case concerns a patient named Ms Green. Following investigations it was discovered that Ms Green had tb and as such was a considerable risk to other patients.

'An application was therefore made to the consultant in communicable disease control to obtain enforced isolation under section 38 of the Public Health (Control of Disease) Act 1984. The magistrate agreed to grant this for one month.

Implementing section 38
The act states that 'any officer of the hospital may do all acts necessary' to effect the order to detain an infectious person in hospital. The ethical dilemma was how to carry out this order if Ms Green decided to leave. Nurses may not wish to confuse their caring role with a custodial function.

On a previous occasion, before the introduction of the Human Rights Act 1998, a security guard had been employed to implement the order. As the isolation room has a lock we considered if this could be used.

The senior nurse had the following questions:

- Would Ms Green's rights be infringed by locking her door - especially as the ward was not a secure unit?

- Would Ms Green's confidentiality be infringed by posting a security guard at the door - especially if she or he were in uniform, as this would draw attention to Ms Green's detention?

- Would the guard be physically able to detain Ms Green if she tried to leave - considering her infectious state, frail medical condition and the local security services policy regarding hands-on restraint? (This policy regards the hands-on restraint of a patient to be a last resort).

- Would placing a lock on the door constitute a health and safety risk in the event of fire or a similar event?

In view of these concerns, the senior nurse instructed the ward to employ a nurse special to provide one-to-one supervision for Ms Green. This nurse was to encourage Ms Green to stay in her room, accept treatment and to alert other staff if she tried to leave.

Two days after starting this course of action, Ms Green left the ward when the assigned nurse was taking a break and other staff were engaged with patient care.

The senior nurse suggested an urgent meeting with the ward manager, matron, TB specialist nurses and the consultant to discuss developing a protocol for future management if Ms Green returned.

Code of professional conduct
The senior nurse was concerned that she had underestimated the legal implications of this case and questioned her professional accountability.

The Code of Professional Conduct (NMC, 2002) lists seven key values, of which the following were particularly relevant in this case:

- Respect the patient or client as an individual;

- Obtain consent before giving treatment or care;

- Protect confidential information;

- Cooperate with others in the team;

- Act to identify and minimise risk to patients and clients.

The senior nurse was concerned that she may have compromised these as a consequence of the complex nature of this case. She sought further advice from the trust's director of nursing and chief executive (CE).

Ms Green's consultant also e-mailed the CE to put forward his concerns about the hospital's ability to carry out the magistrate's order to detain the patient.

Devising a management protocol
The CE convened a meeting the next day and instructed the trust's solicitor to attend. The consultant, senior nurse, head of security, matron and a staff nurse from the ward were also present at the meeting. There was much debate about the interpretation of the Public Health (Control of Disease) Act 1984 against the Human Rights Act 1998 (Box 1).

The security team said their permanent staff accessed occupational health services, but many of their staff were employed on temporary contracts and there was no guarantee they were screened and protected against TB.

Also, a guard would be unable to restrain without a clinical 'partner' (a nursing or medical team member able to advise from a clinical perspective). This would therefore require two people to be involved in the detention.

The central theme in the discussion was one of 'proportion' - the action to restrain Ms Green must be proportionate to the risk. A protocol was developed from these discussions and agreed by the CE (Box 2).

All parties involved (including the trust's solicitor) were satisfied with these proposals. The ward staff in particular felt happier.'

In October 2007 A man from Rochdale was forcibly detained at North Manchester General Hospital to stop him spreading TB. see http://www.rochdaleonline.co.uk/news-features/2/news-headlines/2074/rochdale-man-with-tb-forcibly-detained

Detention in cases such of these is compatible with ECHR art 5. Everyone has the right to liberty and security of person. No one shall be deprived of his liberty save in the following cases and in accordance with a procedure prescribed by law:
e) the lawful detention of persons for the prevention of the spreading of infectious diseases, of persons of unsound mind, alcoholics or drug addicts or vagrants.

Each of these permissible forms of detention depends for its legitimacy on the availability of review. In other words, there must be periodic scrutiny of the legality of the detention by an independent court or tribunal.

The importance of speedy referrals for review can be seen in the case of R v Secretary of State. This case concerned the time delay in referral to the Mental Health Tribinal to review the legality of the detention of the individual held under the Mental Health Act. The Court held that the statutory scheme dealing with the referral of the case of a recalled mental patient to a mental health review tribunal was not incompatible with the patient’s rights under ECHR art 5.

'Fake' nurse

A ‘fake’ nurse who treated hundreds of patients despite allegedly not holding any medical qualifications has been arrested.

The 46-year, who worked at GP surgeries for more than four years, was responsible for checking hundreds of women for cervical cancer and administering jabs to children.

She had previously worked as a healthcare assistant – a role which does not require any nursing training or even a GCSE. But she managed to pose as a nurse in four surgeries in Chatham and Gillingham, Kent, and one in Essex over more than four years.

Letters have since gone out to more than 1,400 patients within Kent and Medway Primary Care Trust who are thought to have been seen by the woman. This includes more than 300 women who had smear tests to check for cervical cancer as well as 500 children who were given routine jabs for TB, polio, measles, mumps and rubella.

Monday, 26 September 2011

Medic’s Poetry Contest

‘Poetry contest reminds trainee medics that patients are people, not machines’

 An absolutely brilliant idea...

 The "brutalising" effect of medical training, with its heavy focus on hard science, has long concerned John Martin.

 Now, the professor of cardiovascular medicine at University College London has done something to tackle the problem, which he argues can leave medics "thinking about people as molecular machines rather than as whole human beings with 'souls'".

"The humanities can help doctors understand that they are not engineers but have both a scientific and a human function in relation to their patients," he explained.

 Some of the poems submitted can be read at: http://www.timeshighereducation.co.uk/story.asp?sectioncode=26&storycode=417480&c=1

Sunday, 25 September 2011

Hospital Chaplains

I was looking at a hospital chaplaincy board yesterday; all three Chaplains were Christian (two CofE and one Catholic). I have thought about this Christian weighting before but have not really considered it in any depth. Who can patients (and their families/ friends) turn to if they are not Christian? What if they are atheist/ humanist for instance? Do people feel offended or left out?

I have done a little reading on this topic this morning and have found that Humanist Chaplains (which seems an oxymoron at first) are becoming more popular particularly in University settings (both Harvard University and the University of Glasgow have Humanist Chaplains). It does seem  to me to be sensible and worthwhile to have an individual who can talk to and support patients who hold no particular faith. In 2006 E. Davidson was appointed as a humanist hospital chaplain in Leicestershire. A really interesting interview can be found at: http://www.humanism.org.uk/_uploads/documents/chaplaincy-for-web.pdf

The right to health is not only the right to the highest possible physical health but also mental health. Belief and well being can sometimes be strongly interlinked and it must be recognised that it is not only people with faith who need support in a hospital or care home setting, those without faith have many of the same needs. I read through the list on the wall, which is intended to give individuals an idea of instances in which they may like to talk to a chaplain. Apart from administering sacraments, all of the other instances could be addressed just as well by a atheist/humanist chaplain.

It is also important to remember that whilst human right and anti-discrimination legislation protect the  right of individuals to to hold religious beliefs, it also protects the right of indidividuals to other philosophical beliefs similar to a religion and the right to have no religion or belief. I believe that those who fall into the latter two categories should not be deprived, as they currently are, of access to an individual with whom they can discuss issues as those of faith would discuss with a Chaplain.

I'm just about to read an article I have found in the Freethinker (2009) on this very topic....http://freethinker.co.uk/features/spiritual-care-on-the-nhs-chaplains-or-charlatans/

Wednesday, 14 September 2011

Lord Justice Jackson: Legal Aid

Lord Justice Jackson has said recently that Legal Aid should remain for clinical negligence.

See article: http://ukhumanrightsblog.com/2011/09/13/lord-justice-jackson-legal-aid-should-remain-for-clinical-negligence/#more-10487

BBC Radio Shropshire: Disability

Yesterday, BBC Radio Shropshire (Jim Hawkins' Programme) gave air time to an individual who held extremely prejudiced and discriminatory views towards disabled people. Of course, freedom of expression is crucial to a democratic society, but some forms of extreme expression, particularly that which  incites intolerance between groups should, I think, be curtailed.

It saddens me that a reputable station could encourage this type of (what I consider to be totally unacceptable) participation, especially given the recent case of the horrific torture and murder of Gemma Hayter. Disabled people can be vulnerable and it is important that they have advocates who can fight for their rights to be protected. It did not seem to be appreciated yesterday that disability includes not only physically disabled but also anyone with, sensory impairment, learning disability or mental health problems, and thus the airing of such prejudice could cause great harm. What is more, the target audience of Radio Shropshire is specifically 50 years and older; a cohort which includes many vulnerable and disabled people.

Friday, 9 September 2011

Human Rights of Older Persons

Some good news...

"After a long time of neglect, there is an increasing awareness and recognition of the human rights of older persons within the international human rights community. Several stakeholders have issued a call for a ‘UN Convention on the Rights of Older Persons’. In a recent article in the Human Rights Law Review, entitled ‘The Human Rights of Older Persons: A Growing Challenge’, Frédéric Mégret does an excellent job assessing these developments. Mégret shows that the rights of older persons should be approached through a human rights framework and that this is an issue which human rights lawyers cannot afford to ignore any longer.

So far, the European Court of Human Rights has not exactly produced a rich case law on the human rights of older persons. Perhaps this is not surprising, given that the European Convention and its Protocols are silent on the issue of rights for the elderly (in contrast to the European Social Charter (see article 23) and the Charter on Fundamental Rights of the European Union (article 21 and 25)). However, this might be changing. There is definitely potential in the Court’s legal analysis to mainstream the rights of older persons. This blog post focuses on that potential through the lens of two cases that were handed down in July: Heinisch v. Germany and Georgel and Georgeta Stoicescu v. Romania." From: http://strasbourgobservers.com/2011/09/05/mainstreaming-the-human-rights-of-older-persons/

The case of Heinisch v Germany  is terrifically important as it concerns an instance of whistleblowing (which has been discussed in a previous post) in a care home. The judgement states:
In societies with an ever growing part of their elderly population being subject to institutional care, and taking into account the particular vulnerability of the patients concerned, who often may not be in a position to draw attention to shortcomings in the care rendered on their own initiative, the dissemination of information about the quality or deficiencies of such care is of vital importance with a view to preventing abuse.” (par 71)

This is important because it not only draws attention to the fact that elderly patients may be vulnerable but also recognises that they may not (for various reasons) be at liberty to make a complaint themselves.

For a much fuller discussion please see: http://strasbourgobservers.com/2011/09/05/mainstreaming-the-human-rights-of-older-persons/

Haiti: Healthcare

A new Human Rights Watch Report has been released this week. It focuses on the inadequate healthcare care for women and girls in particular, in Haiti.

More than a year after Haiti's devastating earthquake, women and girls are still facing gaps in access to healthcare needed to stop preventable maternal and infant deaths, the report says.

It calls for the government to do more when it comes to protecting women and girls from violence, and ensure that they receive all the information they need. "Attention to human rights should be an essential part of Haiti's recovery plan," Roth said.

Read more: http://www.guardian.co.uk/global-development/2011/sep/01/haiti-healthcare-miseries-women-girls

Wednesday, 31 August 2011

Phillip Davies' Comment

I was shocked and appalled to hear about the comment Phillip Davies MP made during a Parliamentary debate earlier this year. The following is from the recent newsletter of the Equality and Human Rights Commission:

Mr Davies had argued that disabled people 'could' be paid less than the minimum wage.

In the debate, Mr Davies contended that that employers often chose non-disabled people over disabled people when recruiting, since they were forced to pay the minimum wage to all potential employees and therefore would not take on a disabled candidate who 'cannot, by definition be as productive in their work' as a non-disabled candidate who would be 'more productive and less of a risk'.

He went on to argue that disabled people should therefore be able to offer to work for less than the minimum wage if it would help them get a job.
Read more at: http://www.equalityhumanrights.com/

What do you think?

Convention for the Rights of Disabled People


Equality and Human Rights Commission Update:
The Commission is carrying out a range of activities across Britain to fulfil its role as one of the designated independent bodies which promote, protect and monitor the implementation of the Convention in the UK. We have produced a briefing document to communicate our work and to encourage participation and involvement.

Health Authorities Need to Advance Equality

From the Equality and Human Rights Commission:

New health commissioning bodies should learn from the mistakes of their predecessors and take steps to meet their obligations under equality legislation to make a real difference to health outcomes according to the Equality and Human Rights Commission.

The Commission undertook a study assessing the performance of a sample of Strategic Health Authorities and Primary Care Trusts in England with regard to the race, gender and disability equality duties. It found that many bodies were not taking sufficient action to address the diverse needs of people in Britain and to protect the rights of disadvantaged groups.

The Commission concluded that without a major re-think by new health bodies on how they tackle discrimination and advance equality some groups will continue to experience poorer health. For example:
  • Men are less likely to report health conditions than women, leading to worse implications for their health;
  • Infant mortality is higher than average among Black Caribbean and Pakistani groups;
  • Muslim people tend to report worse health than average; and
  • Women report higher incidences of mental health conditions.
The Commission’s recommendations include a requirement that health authorities collect data to ensure they have the right evidence base on which to make decisions, and provide guidance to the people making decisions about commissioning.

Until April 2011, health bodies in England were subject to equality duties regarding race, disability and gender. This meant that public authorities had to take steps to tackle discrimination and promote equality amongst the people they serve. The duties were replaced by the public sector equality duty in April 2011 which covers a wider range of groups such as age, religion or belief and sexual orientation.

Andrea Murray, Director of Policy at the Equality and Human Rights Commission, said:
“The introduction of the new equality duty and the reorganisation of the NHS is a good time for health bodies to re-think their approach to equality. Our research shows that many health organisations see equality as a box ticking exercise, and few were able to show they have used the duties to make a real difference to the health outcomes of particular groups.

“Acting upon the equality duty will help health organisations to develop effective services that meet patients’ needs, improve the health of the population and tackle disadvantage faced by particular groups.”

http://www.equalityhumanrights.com/news/2011/july/new-health-authorities-need-to-advance-equality/

Tuesday, 30 August 2011

Cameron's Social Policy Review

David Cameron has chaired the first meeting of the social policy review launched in the wake of the riots earlier this month. The prime minister announced in the aftermath of the disturbances that an internal review of every government policy would take place to ensure they were bold enough to fix a "broken society".

Ministers from the Home Office, the work and pensions department and the communities and local government department are taking part in the review, which is expected to last until October.
A Downing Street spokeswoman said it would look at whether current government plans and programmes are "big enough and bold enough to deliver the change the country now wants to see".

The spokeswoman said the policy review would "see whether it addresses the demands that were made by the public in the wake of the public disorder. It's to do that check on where we are in terms of existing policy development and whether it continues to meet the demands that have been made."
The meeting set out the process of the review, which will look at the wide range of issues around what the government terms the "broken society".

The spokeswoman added: "It looks at the whole set of issues regarding broken society; it could be schools, family policy, parenting, communities, human rights, health and safety, cultural, legal, bureaucratic problems, services the government provides and how they are delivered and the signals that government sends about the kind of behaviours that are encouraged and rewarded."

http://www.guardian.co.uk/uk/2011/aug/30/uk-riots-david-cameron-policy-review

Resuscitation Orders

There is a worrying article in the Guardian: Patient Concern demands national policy on 'do not resuscitate' orders http://www.guardian.co.uk/society/2011/aug/29/do-not-resuscitate-regulation-janet-tracey

Patchy Healthcare Adds to Miseries of Women and Girls

A Human Rights Watch report, "Nobody Remembers Us: Failure to Protect Women's and Girls' Right to Health and Security in Post-Earthquake Haiti," documents the lack of access to reproductive and maternal care in the aftermath of the catastrophe.

According to Klasing, the government should adopt a strong gender policy across ministries and programmes to ensure women's rights are considered in all matters.

"It also should take steps to make sure women and girls at public facilities understand what programmes and services are available for free and necessary to continue treatment," she said.

"With almost 260 million dollars earmarked for health care, no woman should have to give birth on the street," Roth said. "Women and girls have a right to life-saving care, including in adverse circumstances."

Read more: http://ipsnews.net/news.asp?idnews=104930

Friday, 26 August 2011

Human Rights in Healthcare Conference

I have just discovered a recent conference report (May 2011) on Human Rights and Healthcare held by the Mersey Care NHS Trust (Liverpool). The Trust has recently set up a Human Rights in Healthcare website as part of their Human Rights in Healthcare programme. According to their webpage, their aim is to 'promote a human rights based approach in health and social care.'

The conference report can be found at: http://www.humanrightsinhealthcare.nhs.uk/Library/advice_and_support/events/conference_report_may_2011.pdf

The slides used for the background presentation are also available:
http://www.humanrightsinhealthcare.nhs.uk/AdviceAndSupport/events_archive.aspx

Sunday, 21 August 2011

Single Sex Wards

Some positive news! It appears progress is being made...

Further falls in the number of patients kept on mixed-sex wards has prompted ministers to suggest single-sex accommodation is now the norm in the NHS in England. In July there were 1,126 breaches - a drop of 90% since December 2010. More than two thirds of hospitals reported zero breaches with the north east becoming the first region to report no breaches at all.
Health Secretary Andrew Lansley said: "The NHS has done a fantastic job getting to grips with this. Single-sex accommodation is what people can now expect."  They apply to all trusts from acute hospitals to mental health units. Only intensive care and A&E are excused. Read more: http://www.bbc.co.uk/news/health-14573155


I remember the Health Minister, back in 2008, stating that 'single sex wards were not possible.'  I've found the 2008 article at http://news.bbc.co.uk/1/hi/health/7213836.stm. Here is an extract:

"The only way we're going to have single-sex wards within the NHS is to build the whole of the NHS into single rooms. That is an aspiration that cannot be met."

In the article, Kate Jopling, of the charity Help the Aged, said:

"Dignity in care should be paramount, and privacy goes hand in hand with this. Sharing mixed sex wards remains an ongoing concern for many older people who may find the experience distressing and an inappropriate infringement of their privacy, and therefore dignity.

Of course, as Ms Jopling is speaking for Help the Aged, her focus is on older people, but the points she makes about the importance of dignity and privacy, and the distress mixed wards have caused (and continue to cause in some areas) extend to all age groups. I am, therefore, pleased by this news (even if it has taken the government far too long to implement it...)

---------

N.B. For all its failings, the Daily Mail has consistently fought to bring to an end the NHS practice of mixing men and women patients.

CEDAW: Brazil

In the first-ever maternal death case to be decided by an international human rights body, the United Nations Committee on the Elimination of Discrimination against Women established that governments have a human rights obligation to guarantee that all women in their countries—regardless of income or racial background—have access to timely, non-discriminatory, and appropriate maternal health services. Even when governments outsource health services to private institutions, the committee found, they remain directly responsible for their actions and have a duty to regulate and monitor said institutions.

Today’s decision is a groundbreaking victory that will benefit women worldwide, says Center for Reproductive Rights, a global legal advocacy organization that filed the case with the United Nations.
Read more at: http://www.trust.org/trustlaw/news/historic-un-ruling-finds-brazil-violates-womans-human-rights

Monday, 15 August 2011

UK Bill of Human Rights

There is an intersting article on the proposed Bill of Rights on the UK Human Rights Blog and some thought-provoking comments in response to Adam Wagner's article in the Guardian on this topic: http://www.guardian.co.uk/law/2011/aug/08/british-bill-rights-consultation-complicated

It seems to me that much of this concern about the 'dangers' of the Human Rights Act 1998 is unfounded.

The Act was defined as inter alia giving further effect to rights and freedoms guaranteed under the European Convention on Human Rights (ECHR) BUT it is subject to limitations and controls:

-          Does not grant the courts the power to strike down domestic legislation that is inconsistent with the Convention
-          Parliament is free, if it chooses, to enact legislation that is not compatible with the Convention
-          Act is not entrenched against appeal.

This extract from the conclusion of R v Mental Health Tribunal (2001) gets to the point:

“The United Kingdom has of course been signatory to the European Convention since its outset in 1951. Since 1966, it has granted the right of individual access, and there have been a considerable number of cases against the United Kingdom before the court. We now have incorporated the Convention into our law by the Human Rights Act of 1998. But, as it seems to me, the view that that makes a sea-change is an erroneous one. We have had, over the years since 1951, to comply with the terms of the Convention. Sometimes, as decisions of the court have made plain, we have not succeeded in doing so. But for the most part, the practices and procedures carried out in this country do comply with the terms of the Convention, and it is wrong to approach the matter with a view that there may be a breach. Rather, as it seems to me, the approach should be that the court will not accept a breach unless persuaded and satisfied that there is one.”

There is, generally within the UK, overriding compliance with Convention rights. Therefore, whilst the HRA assists access to these rights (at least procedurally) it is actually a fairly superfluous piece of legislation. As long as we are party to the ECHR, the rights we have protected now will remain protected, whether through a British instrument (the HRA or the proposed Bill of Rights), through the judicary or the court in Strasbourg.

Tom Condliff: PCT U Turn

Heard on the news this evening that, despite the court rejecting Tom Condliff's appeal (see previous posts), the NHS IS now funding the necessary surgery. This is due, so it appears, to a recent change in his medical situation. In a statement, the PCT said: "The request and the new supporting medical evidence was thoroughly examined by our clinically led panel and Mr Condliff's clinical circumstances were found to be exceptional as outlined in our policy." http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-14525854

Maternal Health: Africa

During the past week or so the spotlight has been placed on the state of maternal health in South Africa. There has also been lots of coverage on Twitter helping to raise awareness of this important issue.

The most recent Human Rights Watch newsletter  ran an item entitled 'South Africa's Failing Maternity Care' (http://www.hrw.org/).  The experience of Abeba, and other women interviewed by HRW, makes for extremely disturbing reading. According to teh recent HRW report the ratio of death from childbirth are four times more likely than ten years ago. This is a shocking statistic, especially considering that one of the UN Millennium Development Goals is the improvement of maternal health. There is so hope, however, as HRW suggests that measure to improve oversight and accountability in public hospitals and among health workers could reverse this trend.

This item has also been covered by Times Online, 'Healthcare system fails pregnant mothers'. http://www.timeslive.co.za/world/2011/08/08/healthcare-system-fails-pregnant-women It makes the important point that:
"Women do not know their rights, and often don't know that they can complain because of that the health system doesn't benefit from this information."

Health Minister Aaron Motsoaledi said that plans to overhaul the healthcare system were passed last week and new posts had been created:
"We need health workers that respect the basic rights of patients, and these new posts will provide competent people who will be responsible and accountable for instances of abuse."

Thursday, 11 August 2011

Thank you

Thank you to everyone who has sent supportive emails and to those who are now following my blog and twitter feed.

Please do get involved in the discussion!

Whistleblowers

I mentioned the brilliant item on the One Show re whistleblowers in a previous post. The gentleman interviewed by the presenters made some important points concerning the safeguarding of patients. He argued that:
- doctors and nurses have an ethical duty to act if they think their patients are being harmed
- managers should not ignore whistleblowers
I completely agree. He also provided some guidance as to where concerns should be taken:
- feedback to the hospital
- contact the care quality Commission
- contact the patients association

This is all well and good. But do we not just return again to the question: what about the people raising the concerns? Will they have to worry about their job security? 'The Small Places' has raised an other interesting point on Twitter:

"Another perverse effect of closing Rose Villa may be to discourage whistleblowers: all staff would lose their jobs when services are closed."

The whole idea of a 'need' for 'whistleblowing' at all seems wrong to me; something is wrong at a fundamental level. What do you think?

Thursday, 4 August 2011

Winterborne View: Article 8

There is an excellent post on UK Human Rights Blog which discusses the potential of Article 8 (esp. privacy and autonomy) in cases in which individuals have been mistreated/abused in healthcare settings.
Link: http://ukhumanrightsblog.com/2011/08/01/after-winterbourne-view-the-untapped-potential-of-article-8-lucy-series/#more-10036

Saturday, 30 July 2011

BLOG LAUNCH ON TWITTER

I'm launching my blog today on twitter!

Welcome to anyone who has followed the link!

Friday, 29 July 2011

McDonald Overnight Care Case

This post follows my tweet earlier this month regarding the case of Ms McDonald. After having her case heard in the Supreme Court on 6th July 2011, Ms McDonald lost her battle against Kensington and Chelsea Council to provide overnight care. Earlier this month, John Wadham, Group Director, Legal, at the Equality and Human Rights Commission, said:

'We are disappointed with [the] ruling which is a significant setback for people who receive care in their home. Ms McDonald is not incontinent, however this judgment means she will be treated as such...Local authorities will now have greater discretion in deciding how to meet a person's home care needs and will find it easier to justify withdrawing care. This means that older people's human rights to privacy, autonomy and dignity will often be put at serious risk.

Indeed, I agree that it is crucial to ensure that basic human rights to privacy, autonomy and dignity are protected, particularly with respect to elderly and vulnerable groups. It is totally unacceptable for anyone to have to, as Ms McDonald puts it, 'lie in urine for hours' when they are continent and could easily be assisted to use a commode. Age UK are correct in pointing out the "extremely adverse and devastating consequences for many thousands of older people if other councils take similar decisions to save money". (http://www.guardian.co.uk/society/2011/jul/06/care-battle-ballerina-supreme-court)

However, (to play the devil's advocate for a moment), given the governmental resource constraints is it reasonable to expect a local authority to provide overnight care for all who need it in their catchment area? Could or should alternative arrangements be made?? (We are all aware of the care homes crisis!) How do/should local authorities balance the needs of individuals with the broader needs of society as a whole? These are difficult questions. I would like to hear your thoughts...

Health Sector: New Report

The Equality and Human Rights Commission (EHRC) has recently released a new report, entitled 'The Performance of the Health Sector in Meeting Public Sector Equality Duties.' This report examines performance on the former race, disability and gender equality duties by Strategic Health Authorities and Primary Care Trusts in England. These duties were replaced by the new public sector equality duty in April 2011.

The research found that although progress was made on delivering the race, disability and gender equality duties, significant work still needs to be done by health bodies to ensure that their efforts lead to identifiable changes to health outcomes for different groups.

The report is accompanied by a policy paper with recommendations as to how health bodies can meet their obligations under the new equality duty. Effective implementation of the new duty can assist healthcare providers in reducing health inequalities, creating a more effective workforce, and improving the life chances and wellbeing of millions of people in the UK.

Taken from: http://www.equalityhumanrights.com/advice-and-guidance/public-sector-equality-duty/research-and-policy-papers-on-the-duty/#The_performance_of_the_health_sector_in_meeting_the_Public_Sector_Equality_Duties

Thursday, 28 July 2011

Interconnectedness

I have just read a good article in The Lancet which, though not strictly related to human rights in healthcare, might be of interest. It looks at the correlation between suicide rates and unemployment, thus highlighting the way in which (mental) health issues and employment are closely related.
The article is entitled 'The effects of the 2008 recession on health' and can be found at:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961079-9/fulltext

I thought I would make a note of this here as it links into a particular interest I have concerning the interconnectedness of human rights. Many human rights are mutually dependent; they are contingent on one another. I have already mentioned on the 'Right to Health' page that the right to healthcare must be understood in the wider context of the right to health itself. As this right is an inclusive right (covering access to safe food and housing, for instance) it has close links with many other social and economic rights such as the right to employment. Therefore the right to health should, where possible, be understood in this wider context. It is especially important for policy developers to acknowledge this broader context because it is difficult to address many rights, including the right to healthcare, in isolation.

Gastric Surgery: Appeal Lost

I posted on this case earlier this month (under the title 'Gastric Surgery: A Human Right'). Today, news has been released that Mr Condliff has lost his appeal against North Staffordshire Primary Care Trust. The Court of Appeal decided that the Primary Care Trust did NOT have an obligation under Article 8 of the European Convention on Human Rights to consider social / non-clinical factors when deciding whether to grant a request for exceptional funding.

It is interesting to ask (given the trend that is emerging) whether this is another decision influenced by the general reluctance of the judiciary to intervene in cases which concern the allocation of limited public resources. Adam Wagner, of the UK Human Rights Blogs, certainly suggests so.
For a detailed discussion of the ruling please see: 'Public Purse stays closed for Morbidly Obese Man' http://ukhumanrightsblog.com/2011/07/28/public-purse-stays-closed-for-morbidly-obese-man/#more-9995

Saturday, 23 July 2011

Tied to Chairs, Sedated or Locked Up: Dementia Sufferers

This story ran on Thursday in the DM. The article opened with:

"Thousands of restraining orders are being taken out on dementia patients and the alarming practice appears to be increasing, official figures have revealed....This can include locking residents in their rooms overnight, sedating them or even tying them to chairs – all of which, critics said, denies them their basic human rights."

I agree with the critics. Such treatment is indeed an infringement of human rights and I am appalled by the extent of such practices. While some may protest against this, arguing that it can be extremely difficult to look after patients with dementia (and somehow attempt to justify such approaches), it is important to stress that the right to be free from inhuman or degrading treatment or punishment is an absolute right which means that it cannot, under any circumstances, be justified. Precisely because of the difficulties and complications in caring for people with dementia, is is extremely important to ensure that they are treated with dignity and their right to autonomy is respected. This blog has noted in the past that under staffing in care homes is often a root cause of poor care provision but we must continue to stress that it is absolutely unacceptable that patients/residents should suffer due to failings in the system.

http://www.dailymail.co.uk/news/article-2017079/Hospital-staff-tie-sedate-2-700-frail-patients-alarming-restraining-order-rise.html#ixzz1Sv76ikRZ

The DM, (despite its lack of support for the HRA), has actually been doing some good work to highlight the widespread neglect and maltreatment of the elderly in hospitals and care homes through its Dignity for Elderly Campaign (See link above for more info).

It is also worth mentioning an article in today's Telegraph which links directly into the above story, entitled, 'five dementia sufferers die everyday from 'chemical cosh' drugs. According to Beckford, the Health Correspondent, "[m]any more hospital patients and care home residents suffer strokes triggered by the antipsychotic medications they are given to keep them sedated." The data used in this report is from 2009; I wonder if statistics are higher today given the recent rapid decline in the care system...

 Full story can be read at: http://www.telegraph.co.uk/health/healthnews/8652593/Five-dementia-sufferers-die-every-day-from-chemical-cosh-drugs.html

Wednesday, 20 July 2011

NHS Reforms

http://www.guardian.co.uk/society/2011/jul/13/nhs-reforms-local-solutions

Health Tourism

An article in the Daily Mail highlights an interesting phenomenon they call 'health tourism'. Earlier this month they ran a story on a Nigerian mother who flew to Britain when she learned she was pregnant and had quintuplets which cost taxpayers an estimated £200,000. More recently they have run a similar story in which they ask:
When the NHS is hard pushed to pay for chemotherapy for cancer patients and is struggling to provide decent maternity services, why on earth should it have to ...deliver the babies of mothers with no connection with this country?

I would be interested to know the opinion of the DM on the UN  Millenium Development Goal 5, to improve maternal health. Every year more than half a million women die due to complications in pregnancy and childbirth - 99% of which are in developing countries. In light of this, I wonder whether they would still object to the delivery of this Nigerian woman's quintuplets in the UK?

Tuesday, 19 July 2011

Hidden Human Rights Crisis of Medical Pain

It appears some extremely commendable research into the hidden human rights crisis of medical pain has been undertaken by student of journalism in the University of British Columbia. Graduate students travelled to India, Ukraine and Uganda to investigate how countries around the world deal with suffering patients. Their findings show that "more than half the countries in the world have little to no access to morphine, the gold standard for treating medical pain." What is more, they have discovered that  "[u]nlike so many global health problems, pain treatment is not about money or a lack of drugs, since morphine costs pennies per dose and is readily available." Rather it is due to "bureaucratic hurdles, and the chilling effect of the global war on drugs" which are the main impediments to access to morphine.
The full story can be read at http://www.publicaffairs.ubc.ca/2011/07/18/ubc-documentary-shows-hidden-human-rights-crisis-of-medical-pain/
More information about the film "Freedom from Pain" produced by the UBC can be found at http://www.internationalreporting.org/blog/2011/07/07/the-pain-project/

Incidentally, Human Rights Watch produced an article on this issue at almost exactly the same time last year, entitled, "Pain Relief: A Human Right." Lots of useful information along with reports on the state of pallative care in various countries is available from HRW at http://www.hrw.org/en/news/2010/07/26/pain-relief-human-right

Saturday, 16 July 2011

Pets As Therapy

Amidst all of the depressing news stories this week, it is wonderful to hear something positive in this field. Today, in Ysbyty Glan Clwyd in North Wales, another 'Pets As Therapy' initiative has been launched. The Pets As Therapy (PAT) charity does some really tremendous work. Primarily, it organises visits by volunteer pet owners and their animals to people who are residents in hospitals, hospices, residential homes, nursing homes, day car centres, and special needs schools.

The launch today in Ysbyty Glan Clwyd follows the introduction this initiative in the mental health Ablett Unit at Glan Clwyd hospital twelve months ago. A spokesperson has said that the dogs have been a huge success in this unit and the "feedback from the patients has been extremely positive." According to BBC news, the launch at Glan Clwyd means that the service will now be available at other hospitals inj North Wales too. http://www.bbc.co.uk/news/uk-wales-north-east-wales-14173175

Incidentally, a similar story featured in today's Los Angeles Times - 'Therapy Dogs make the rounds in more healthcare settings', showing this is not a pratice confined to the UK. The LAT reports that "across the country, more than 10,000 trained person-plus-pet teams are registered in Pet Partners, a program established in 1990 by the Delta Society, a nonprofit organization that believes positive interactions with animals can improve people's health and well-being." http://www.latimes.com/health/la-he-therapy-dogs-20110718,0,4456307.story

It is widely known that many people experience profound health benefits from spending time with dogs and cats. Animals encourage interaction in patients who wouldn’t usually get involved in social activity thus boosting their confidence and can have a very positive effect upon people with communication difficulties enabling them to particpate in the life of the community.

The question I would like to raise is: does the fact that pets can help people in such a way mean that access to pets could, whilst in a healthcare setting at least, be part of our human rights? Indeed this seems far fetched at first but it is possible to make some links. What about the right to companionship, for instanc? Or the right to particpate in community life (Art 29 (i) of the ICESCR)? Can we go even further?  Dr. Edward Creagan, interviewed as part of the LAT article , believes that pets are embedded in the soul of our humanity. Is he right? It is certainly something to think on...

Stepping Hill Hospital

It is extremely disturbing to hear the news that three people have died possibly as a result of saline medication being tampered with in Stepping Hill Hospital in Stockport. Understandably, the news reports are still a little vague as investigations remain underway. According to the Telegraph:
"Detectives believe the insulin was deliberately injected into the saline containers which were used by at least two wards but they say the deaths remain unexplained as they await post-mortem results." Read the full story at: http://www.telegraph.co.uk/news/uknews/crime/8641983/Hospital-poisoning-police-to-interview-surviving-patients-after-three-die-in-Stockport.html
Channel 4 news reports that a hotline has now been set up for concerned patients and relatives. I wonder, where else people can find support?

Friday, 15 July 2011

Care, Consultation and Human Rights

The outcome of the recent case R (on the application of Tiller) v Secretary of State for the Home Department highlights the importance of correct consultation procedures where there is a possiblity that the human rights of those being care for may be breached. This case concerns a local authority's decision to replace the 24-hour care provided to tenants of a sheltered housing scheme (due to financial constraints) with an on-site service during week-day office hours and an on-call remote service at other times (the most vulnerable tenants were offered accommodation at nearby facilities that offered greater levels of care).

The claimant, however, argued that throughout the process the local authority had failed to give any conscious thought to its duty under the Disability Discrimination Act 1995 (DDA), now the Equality Act, and stressed the failure of the local authority to mention the duty or the Act in any documents relating to its decision. Nevertheless, this argument was too weak to stand up in court. It was ruled that the local authority's consultation process and assessment of tenants needs were adequate and, whilst the court recognised that the DDA had not been mentioned, it made it clear that the local authority had discharged its legal obligations.

This was in fact quite a straightforward case. What it does show, however, is that it is becoming increasingly difficult to change care arrangements as legal challenges to such changes are becoming increasingly common. This is surely a good thing. While the landlords had acted properly in this instance, it is essential that proper consultation takes place before changes are made and the human rights of those being care for are protected.

To read more: http://www.bllaw.co.uk/sectors/social_housing/news_and_updates/human_rights.aspx?lang=en

Indonesia's Human Rights Violations

I have just read an interesting news article in the Telegraph entitled, 'Indonesia's Human Rights Violations Deeply Entrenched'. Indonesia is the world's largest democratic Muslim country but conditions there seem to be appalling . The article reports that "[e]veryday acts – such as complaining about treatment received at a hospital or asking a local official about a land assessment – can result in a defamation prosecution and a prison sentence."

Thursday, 14 July 2011

Gastric Surgery: A Human Right?

It will be interesting to hear the decision of the Appeal Judges in the sad case of Tom Condliff. In April the High Court refused to quash its decision not to provide the surgey he requires. Will this be overruled by the Appeal Court? Will the argument that the Staffordshire PCT, by not providing the necessary surgery, has breached Mr Condliff's right to respect for private and family life, hold up?

Care at Home

Much has been written this week about the adequacy (or rather the inadequacy) of care at home. Findings in a recent report by the Equality and Human Rights Commission are indeed shocking:

"Researchers...found that visits by carers are often so short and infrequent that there is not enough time to carry out even the most basic tasks. That means overstretched home helps often have to make a choice between which essential needs to address, frequently foregoing mealtimes, for example, for washing and dressing." (R. Alleyne, http://www.telegraph.co.uk/health/healthnews/8585086/Home-help-so-poor-for-elderly-it-threatens-most-basic-human-rights-claims-report.html)

Just yesterday the mail reported that an 85yo bedridden widow was left lying in her home without food or water for three days because of a care visit blunder. http://www.dailymail.co.uk/news/article-2014232/Bed-ridden-widow-85-left-lying-home-food-water-THREE-DAYS-care-visit-blunder.html?ito=feeds-newsxml

Of course, this exceeding limited level of care is putting basic human rights, such as the right to life and the right to live free of inhuman and degrading treatment, in danger. What is particularly concerning is the fact that "one in five older people who responded to the call for evidence said that they would not complain because they didn't know how to, or for fear of repercussions." (Alleyne).

Rose Villa Care Home Abuse

It is disturbing to hear that allegations of abuse have surfaced at another of Castlebeck's care homes, Rose Villa, which cares for those with learning difficulties in Bristol. So far four staff have been suspended and an inquiry is underway. Winterborne View, also operated by Castlebeck, closed earlier this month as a direct result of the BBC Panorama's exposure of the terrible abuses perpetrated there.
http://www.telegraph.co.uk/health/healthnews/8633763/Castlebeck-workers-suspended-over-new-abuse-claims-at-care-home.html

Abuse and Neglect in Care Homes

There is an interesting and very moving article in the Daily Mail about the work Eileen Chubb has been doing to expose the neglect and abuse in various care homes around the country.  The full article can be read at: http://www.dailymail.co.uk/femail/article-2014129/A-humble-crusader-One-womans-journey-dark-heart-Britains-care-system.html It is interesting to note that this story has not (as far as I can see) been covered by any other newspapers.

Eileen Chubb runs the charity Compassion in Care.http://www.compassionincare.com/

Tuesday, 12 July 2011

The Right To Health

For information on rights to health please look at 'The Right to Health - Human Rights Instruments' page which can be located at the top of this blog.