- The Care Quality Commission sees ‘clear evidence’ of a link between quality of care and whether service users feel their human rights are respected.
- Fairness, respect, equality, dignity and autonomy should be at the heart of all good care.
- Improving the quality of care by tackling equality and human rights issues makes good business sense.
- The CQC concludes that diverse teams that feel valued and respected perform better and provide better care.
The CQC has published a new good practice resource to help health and social care providers focus on equality and human rights issues.
What is included within the resource and how can it benefit both service users and providers?
The new CQC resource, Equally Outstanding, was published in September 2017 as a good practice tool to help providers put equality and human rights at the heart of their improvement work. It has been developed in collaboration with a number of partners, including Care England, Healthwatch, the NHS Confederation, the Social Care Institute for Excellence, and the Race Equality Foundation.
Equally Outstanding is aimed at managers in health and social care services, as well as quality improvement and organisational development staff, frontline staff with an interest in equality and human rights, regulators, commissioners and policymakers, and people who use services and their representative organisations. It can be used in a number of ways, principally to support service development and improvement programmes, but also to inform quality assurance systems and as a training resource.
In launching the guide, the CQC stated that the human rights principles of fairness, respect, equality, dignity and autonomy should be at the heart of all good care provision. It claims there is clear evidence of a link between the quality of care and whether people who use services feel their human rights are respected and they are treated equally. It also believes there is a link between the quality of care and whether staff feel that they themselves are treated equally and with respect.
Equally Outstanding includes sections on:
- the ethical, business, economic and legal cases for a focus on equality and human rights
- overcoming challenges
- empowering people and communities.
The resource includes detailed case studies from the NHS and from adult social care. These case studies reveal how services that are rated as ‘outstanding’ by CQC inspectors have prioritised equality and human rights.
The ethical case
The resource states that the importance of equality and human rights has long been recognised as a key ethical duty in national health and social care policy. It refers to the ‘FREDA principles’ of fairness, respect, equality, dignity and autonomy, and states that paying attention to equality and human rights improves care because it gives people the outcomes they want.
Person-centred care approaches support the ethical case for equality. This is because such approaches are based on respect, autonomy and individual needs, including needs arising from people's equality characteristics, such as disability, culture, language, gender, religion and sexual orientation. Person-centred care also includes tackling barriers to equality faced by individuals.
Case studies in the resource include an example of challenging the discrimination, prejudice, misunderstanding or ignorance that can affect lesbian, gay, bisexual, transgender and intersex people.
The business case
CQC says that, as well as being ethically right, improving the quality of care by tackling equality and diversity issues makes good business sense and enhances the reputation of a service. For example, research from NHS staff and inpatient surveys identify correlations between equality for staff and the quality of care provided. CQC points out that where black and minority ethnic (BME) staff have experienced discrimination there tended to be lower levels of patient satisfaction.
While CQC admits that less work in this area has been done in adult social care, it says that the same principles apply. For example, an analysis of CQC quality ratings suggests there is a link between quality of care and levels of staff discrimination. Staff in organisations with higher ratings are less likely to say they have experienced discrimination, bullying or harassment.
The resource sets out the benefits of having a diverse workforce and removing employment barriers to equality. These include:
- having a wider pool of staff talent available to providers to recruit from
- enabling the diversity of the workforce to better reflect the profile of the community they serve.
Simply put, the CQC concludes that diverse teams who feel valued and respected perform better and provide better care.
The economic case
The guide points out that increasing staff equality will save money for providers by reducing:
- staff turnover and absenteeism
- unnecessary disciplinary actions.
In addition to saving money for providers, a focus on equality and human rights can save money for the whole health and social care system as well. This is through preventing ill health, or a deterioration in people’s health, by tackling health inequalities and barriers to accessing health and social care services.
Examples of such inequalities provided in the resource include:
- disabled people being more likely to be on low incomes than non-disabled people
- BME people experiencing mental ill health having different outcomes from white people, such as higher levels of compulsory detention
- lesbian, gay and bisexual older people being more reluctant to approach health and social care services than others due to fear of discrimination.
The legal case
The resource lists the range of equality legislation that adult social care providers must comply with, including the Equality Act 2010 and the Human Rights Act 1998.
Additional legislation based on the Human Rights Act includes:
- the Health and Social Care Act regulations used by the Care Quality Commission
- the Mental Health Act 1983 and its Code of Practice
- the Mental Capacity Act 2005 and its Code of Practice.
Public sector organisations must also comply with the Public Sector Equality Duty.
The case studies
The case studies in the resource range from small care homes to large NHS trusts. From these, the CQC identifies a number of common factors shared by providers that are most successful in using equality and human rights approaches.
These nine characteristics of high-performing organisations are:
- having a leadership committed to equality and human rights
- equality and human rights principles running as a thread through the organisation, from organisational values, through leadership behaviours and actions, to frontline staff and their work
- a culture of equality and human rights for staff as a basis for quality improvement
- equality and human rights thinking applied to improvement issues
- staff being included as ‘improvement partners’ in thinking about, planning and delivering equality and human rights interventions to improve the quality of care
- people who use services being placed at the centre of care
- being open and transparent and benchmarking to other organisations
- being ‘courageous and bold’ and not being afraid of tackling difficult issues
- being willing to learn from mistakes and to continuously improve.
The resource includes links between these nine common factors in the case studies and the CQC ‘key lines of enquiry’ guidance that inspectors use when making judgements about quality.
Equally Outstanding, CQC, September 2017: https://tinyurl.com/CQCEquallyOutstanding
Use the following items in the Toolkit to put the ideas in the article into practice:
- Policy - Service user equal opportunities (domiciliary care).doc63.50 KB
- Policy - Service user equal opportunities (care homes and nursing homes).doc64.50 KB
About the author
Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care.