1. Human rights and home care Joanna Owen March 2014

2. Human rights and home care Joanna Owen March 2014
‘Close to home’ – 2011
What we did next
‘Close to home review’ – 2013
Care Bill ?????

3. Human rights and home care Joanna Owen March 2014
“Where, after all, do universal human rights begin? In small places, close to home... Unless these rights have meaning there, they have little meaning anywhere.”
Eleanor Roosevelt

4. Human rights and home care Joanna Owen March 2014
Close to home findings 1
Many older people are very happy with the home care service they receive
Both my parents have been enabled to stay independent as long as they can due to the care they have been provided with… [They] are able to enjoy a dignified life, in their communities, at little cost to the state, and remain in control and as independent as they can be.
Daughter whose parents receive home care, Midlands

5. Human rights and home care Joanna Owen March 2014
Close to home findings 2
Causes for concern included
Older people not being given adequate support to eat and drink
Neglect
Financial abuse
Disregard for older people’s privacy and dignity
Talking over older people
Little attention to older people's choices
Risks to personal security
Physical abuse

6. Human rights and home care Joanna Owen March 2014
Impact on older people
“I felt worse than a baby ... a package that was just left there. They would come in and do this and that, and go again, and then come back. I just wanted to curl up and die. I was diminished. I wasn’t me any more ... not quite a human being. My life was ... taken over.”
Woman, 76, lives with partner, direct payments from Independent Living Fund

7. Human rights and home care Joanna Owen March 2014
Effects of commissioning practices
Many of these problems could be resolved if local authorities made more of the opportunities they have to promote and protect older people’s human rights in:
the way home care is commissioned
the way home care contracts are procured and monitored.

8. Human rights and home care Joanna Owen March 2014
Commissioning practices
Quality/cost
‘Time and task’
Monitoring of contracts
Clear need for supportive senior leadership
Good practice underpinned by understanding of human rights.

9. Human rights and home care Joanna Owen March 2014
Other contributing factors
A number of other interlinked factors are contributing to the human rights risks identified in our findings:
Differential treatment related to age.
A lack of suitable information on the different processes and options for obtaining care.
Patchy or no advocacy or age-appropriate brokerage support.
A lack of investment in care workers.

10. Human rights and home care Joanna Owen March 2014
Key recommendations
Proper legal protection
More effective monitoring
Better guidance

11. Human rights and home care Joanna Owen March 2014
Proper legal protection
Our primary recommendation is that The definition of ‘public function’ should be extended to include the provision of home care by private and voluntary sector organisations, at least when this is publicly arranged.

12. Human rights and home care Joanna Owen March 2014
What we did next
Parliamentary influencing – Health and Social Care Bill (as was)
Disseminated findings nationally and internationally
Worked with and through others – e.g. CQC
Guidance for older people and family and home care and human rights
Guidance on human rights for commissioners of home care
Recommendations review

13. Human rights and home care Joanna Owen March 2014
Close to home review
Methodology (who and how)
Why the extra attention on local authorities
Published October 2013
Purpose was to measure and draw attention to what had been done to implement the Close to home recommendations.
The reccs targeted Government, regulators, local authorities and system leaders (SCIE)
Apart from LA’s our CEO wrote formal letters to Government and the others asking them to detail what they’d done making it clear that we would publish their responses in the review report – and list all non responders.
Different approach with LA’s because due to their statutory responsibility for commissioning they are in a position to make immediate improvements in human rights protection by changing how they commission and monitor home care (and assess). In depth survey and follow up interviews with some gave us a rich statistical analysis showing individual performance – e.g. Commissioning rates, service specs and contracts, NMW info etc.

14. Human rights and home care Joanna Owen March 2014
Close to home review -findings
100% response – eventually
Commissioning practices continuing to put human rights at risk
Some commissioning rates not covering actual costs of delivering care – workers on very low salaries sometimes don’t amount to National Minimum Wage
Handful of authorities demonstrating impressive human rights approach
Welcome progress by CQC
Government – mixed

15. Human rights and home care Joanna Owen March 2014
Close to home review – contract clauses
EHRC recommending and supporting LA’s to include template clauses in contracts with providers
To give home care service users legal redress if their human rights are breached
To ensure providers pay care workers at least the National Minimum Wage.
Human rights clause would have the effect of requiring the provider to act compatibly with the Human Rights Act 1998, and would give users of contracted services a direct right of redress against the provider in the event that their human rights were breached.
The minimum wage clause would make it a fundamental term of the contract that the contractor pays the National Minimum Wage to all eligible employees, and keeps records as required by the National Minimum Wage Regulations 1999.

16. Human rights and home care Joanna Owen March 2014
Care Bill – HRA loophole
Lord Low’s successful amendment in House of Lords Report Stage
Removed at Commons Committee Stage (2 hour debate)
Joint Committee on Human Rights Care Bill Scrutiny Report proposed a slightly different amendment to Lord Low
Commons Report Stage or final stages in the Lords??
CQC reviews....
Lord Low’s amendment – effect would be to clarify that all providers of regulated care were deemed to be carrying out a public function and thereby covered by HRA. Would have included self funders even when there had been no input from or assessment by LA.
JCHR amendment – slightly narrower – all providers of regulated care publically funded or arranged

17. Human rights and home care Joanna Owen March 2014
How do I find out more?
Close to home report
Guidance or older people
Guidance for commissioners
Close to home review
Elected member training materials coming .
JCHR Care Bill Scrutiny Report