Would legislating through a Human Rights Lens promote a fair and effective long term care system?

Problem

The system for long term care in England is inequitable and unfit for purpose. Long term care charging is a complex, confusing and fragmented mix of funding streams, with various statutory bodies commissioning services from multiple providers. This analysis piece aims to explore the flaws in the current long term care system and also examines whether legislating for a ‘human right to health’ would promote the development of a fair and effective long term care system.

Approach

This analysis describes the history of long term care in the UK, then examines data from a number of reports including from the Office of National Statistics, National Audit Office, Care Quality Commission, Department for Work and Pensions and the Kings Fund, using this to identify problems in the current system. We especially scrutinised data related to funding, workforce factors and quality of care. Research from the US was also included to show the effects of marketisation on long term care.

Findings

An examination of the history of long term care in the UK shows how gradual divergence from the NHS led to the current, fragmented system. The extent of market involvement and privatisation in today’s system and inadequate funding and poor working conditions have clearly had a negative effect. As local authority funding has fallen from 2010 to 2017, the workforce has continued to shift away from local authority jobs toward independent sector jobs. Reduced funding has been accompanied by tightening of eligibility criteria for long term care, delays in assessing eligibility and inconsistent and inequitable application of criteria. 24% of the workforce is on zero hour contracts, with many paid the National Living Wage or less. Data on quality of care is scarce, with little information available about the quality of accommodation or the extent to which needs are met.

Consequences

Our findings suggest that a human rights approach could counter many of the problems we have identified in the current long term care system. A national strategy for long term care would be required, devised through a participatory and transparent process, giving particular attention to vulnerable groups. The legally mandated system would integrate funding and require the creation of unified statutory bodies with clear duties to avoid unnecessary fragmentation. Data collection would be routine to ensure accountability and transparency. This approach would lead to the reorientation of services away from the profit driven market towards participator model consistent with progressive human rights obligations. It would also make regression in funding and delivery of services challengeable in the courts.