Many social care professionals have not received legal training or information about upholding human rights or using emergency powers during the Covid-19 pandemic, new research suggests.
The British Institute of Human Rights (BIHR), which carried out the research, said the findings were “very concerning” because of the significant changes to law and working practices during the coronavirus crisis. The organisation surveyed 230 health and social care staff, representatives from advocacy groups and charities, and people with care and support needs and their carers, and the research also drew upon the BIHR’s work during the pandemic with 950 staff and 400 people using services.
Over three-quarters (77%) of staff surveyed said they had not received training or information on upholding human rights law and 79% had not in relation to emergency powers under the Coronavirus Act 2020. The act, which was passed at great speed in March before the peak of the pandemic, allows local authorities to suspend key duties under the Care Act and its equivalent Welsh legislation. Currently no English local authorities are suspending Care Act duties though eight did so previously.
Staff ‘not supported’ to prevent rights breaches
BIHR director Sanchita Hosali said the scale and speed of the legal changes made the lack of training concerning.
“All of a sudden staff were told: ‘all of the processes you’ve used previously can now be suspended’, but with no training on how they’re supposed to make it human rights compliant, it was quite surprising in the context where the Coronavirus Act specifically says don’t breach human rights, yet they weren’t supported to do that,” Hosali said.
Hosali sounded alarm over the 60% of those surveyed with care and support needs who reported they were not told under what legal basis changes to their care and support was made during Covid-19. A Mencap survey published last month found care packages had at least halved for most adults with learning disabilities, as the lockdown led to day services being shut and reductions in social support and home care.
One respondent to the BIHR survey said they had been receiving psychological support in another part of the country, then without warning received an email explaining the criteria for accessing the support had now changed.
“I no longer meet the criteria and cannot continue my psychological therapy there. I was not involved in the decision, it was a decision made at meetings at the psychology department and NHS Trust. Patients were not part of that meeting, it has been devastating and it is worse to start the treatment and have it taken away in a way that seems quite arbitrary,” they wrote.
Hosali said the incident was not an isolated one.
“We have people who, in order to keep themselves safe, are relying on care and support and then it’s changed or withdrawn and they have no idea how to challenge it or even any idea how to have a conversation about what basis the decisions were made.
“That’s worrying during the lockdown period because there’s so much emergency law being implemented, we’re told so many things we can and can’t do, there are so many grey areas on what’s law and what’s guidance,” Hosali added.
Lack of balance on care home visits ban
Hosali also raised concerns about the impact of visitor restrictions on care home residents. Non-essential care home visits were banned in March but this was lifted in July, with providers able to allow visits in line with guidance from their local director of public health.
“There’s a real lack of balance in how that’s being approached, when you’re looking at the balancing of these rights from a human rights approach, one of the key principles is proportionality. You must weigh it up and look at what you can do to make sure human rights still exist.”
Hosali said “it’s just been doors shut, end of the conversation”.
“From both staff and people we’ve heard it isn’t just a case of putting on Facetime but for some people that really doesn’t work as a communication method, so what other alternatives we can put in place?
“Some of that is happening now, but in the height of lockdown it wasn’t,” she said.
DNR orders imposed without involving person
Hosali said the pandemic had “shone a stark spotlight” on the issue of do not resuscitate (DNR) orders – otherwise known as do not attempt cardiopulmonary resuscitation (DNACPR) orders – with 34% of health and social care staff reporting experiencing pressure to put an order in place without involving the person in the decision.
Of those with care and support needs surveyed, 9% reported a DNACPR order was made without them being involved in the decision.
“Anecdotally we’ve had many distressing conversations with both staff and people over the period, where staff were being told these orders have been put in place and they don’t know how to challenge it,” Hosali said.
According to Resuscitation Council UK, policies and individual decisions about CPR and DNACPRs must comply with the Human Rights Act 1998. An individual has to be involved in the decision-making process, the decision must be non-discriminatory and the implementation of an order must not lead to withholding of other elements of treatment.
The government has agreed to issue new guidance on DNACPR orders in response to concerns over their use during the pandemic.