NIHRC Inquiry: Terms of Reference Emergency health care in Northern Ireland 1. Introduction The Northern Ireland Human Rights Commission (the Commission) will conduct a human rights inquiry into emergency health care (the Inquiry). This inquiry is in accordance with Section 69(8) of the Northern Ireland Act 1998, under which the Commission may carry out such investigations as considered necessary or expedient in fulfilling its statutory functions. The Inquiry will examine the right to health, providing a platform for those directly affected including patients, family members, and health care staff, representatives of professional organisations, trade unions, voluntary and community organisations. For the purpose of the Inquiry, the Commission will access information from public authorities. The process will also involve witness testimonies, evidence gathering and participation from members of the public, experts and those responsible for service delivery and patient care. The Inquiry will begin in June 2014 and public hearings will take place throughout Northern Ireland in September and October 2014. The Commission will consider the evidence gathered and publish a final report in April 2015. Conclusions and recommendations for action necessary for the promotion and protection of human rights will be presented to the Northern Ireland Executive and Legislative Assembly in accordance with Section 69(1) and (3) of the Northern Ireland Act 1998. 2. Background Fulfilling each person s right to health in Northern Ireland requires the Northern Ireland Executive and other relevant public authorities to ensure that a system of health protection is in place, and that this is of good 1
quality, acceptable and accessible to all without discrimination. Good quality care that is effective in practice treats people in a manner that respects their fundamental human rights, including their right to respect for dignity. It is also requires an assurance that there are sufficient numbers, adequate training and support for health care staff. In order to exercise their right to health, people should be provided with appropriate information and enabled to participate in health related decision-making. Notably, in Northern Ireland, as elsewhere in the UK, there are proposals for significant change to the delivery of health care. 1 If implemented, these proposals will undoubtedly impact on how emergency care is provided. The State s obligation to fulfill the right to health includes the development and implementation of laws, policies and actions that give sufficient recognition to the right to health. In any change process, therefore, an examination of the potential impacts on the right to health is required. Having completed a scoping exercise in March 2014, taking into account completed 2 and ongoing work 3 in this area, the Commission has concluded that a human rights examination of emergency healthcare is necessary. It is evident that the conditions within A&E departments affect patients rights to dignity. 4 But the potential impacts on the right to health are not yet established. The extent to which the Northern Ireland Executive and other relevant public authorities are fulfilling the right to health is therefore the focus of the Commission s inquiry. 3. What does the Inquiry aim to achieve? 1 DHSSPS (2011) Transforming Your Care: A Review of Health and Social Care in Northern Ireland, December 2011. Belfast: DHSSPS. In England, a review of urgent and emergency care is also ongoing -- see NHS England (2013) Transforming Urgent and Emergency Care Services in England: End of Phase 1 Report. England: NHS 2 For example, RQIA (2014) Final Report of the Inspection of Unscheduled Care in the Belfast Health and Social Care Trust, 31 January to 3 February 2014. Belfast: RQIA. See also the Patient Client Council (2013) Care When I Need It: A Report on Urgent Care Services, March 2013. Belfast: PCC. 3 An independent review by the RQIA of unscheduled care in the Belfast Trust area and related regional matters is currently underway and due to be published in June 2014 (see Statement to the Assembly by the Minister for Health, Social Services and Public Safety: RQIA review of arrangements for management and co-ordination of unscheduled care in the Belfast HSC Trust and related regional considerations, Monday 10 February 2014 (http://www.dhsspsni.gov.uk/report-eds-statement-100214 [accessed 8 April 2014]); see also the Public Health Agency s 10,000 Voices project that aims to gather the healthcare experiences of patients and, for its first phase, has focused on unscheduled care http://www.publichealth.hscni.net/publications/10000-voicesimproving-patient-experience (accessed 24 April 2014). 4 As above 2
The Inquiry aims to: Identify the extent to which the legal, policy and regulatory framework for emergency health care respects, protects and fulfils human rights; Identify the extent to which the human rights of people seeking emergency care are respected, protected and fulfilled in practice; Increase the public s awareness of human rights generally and in the specific context of health care; Identify good practice, as well as recommendations for improvements that aim to ensure human rights are respected, protected and fulfilled; and Enable the participation of the general public. 4. Terms of Reference To investigate, through the method of a human rights inquiry, and make recommendations on the extent to which the Northern Ireland Executive and other public authorities respect, protect and fulfil the human rights of those seeking emergency care. In particular, the Inquiry will examine: i) Quality The quality of care, with a particular focus on: The right to respect for dignity; Responsiveness to need, including the most vulnerable and marginalised members of society; The provision of and support for appropriately skilled staff. ii) Information The provision of appropriate information. iii) Participation The participation of patients and their families. 5. How will we conduct the Inquiry? The inquiry will be carried out by: A review of literature and relevant human rights standards and case law; A review of legislation, policy and the domestic regulatory framework; 3
An analysis of available statistical and qualitative material on emergency care; and, A public call for evidence and analysis of data received (see below). Public call for evidence The Commission will use a human rights inquiry methodology involving a public call for evidence. The evidence will be collected through: A Freephone telephone number; Questionnaire; Written submissions; and, Public hearings (witness testimonies). Freephone telephone number and questionnaire People are invited to provide their experiences of emergency care by contacting the Commission using a Freephone telephone number. People who provide evidence might include, for example, patients, family members, and health care staff, representatives of professional organisations, trade unions, voluntary and community organisations. The evidence will be gathered for an initial period of approximately three weeks from 3 June 2014 to 20 June 2014. During this time people can also submit evidence by completing a questionnaire available on the Commission s website or by post. Submitting evidence by questionnaire will be available for a longer period of time and the closing date for this evidence is 30 June 2014. The information gathered by telephone and from the questionnaire will be analysed to: Assess areas of concern, as well as good practice that the Commission can potentially examine through its public hearings; and, Produce anonymous case studies for, and inform the findings of, the Commission s final report. Written submissions Submissions of written evidence will be sought from the Northern Ireland Executive departments and other relevant public authorities. Where appropriate professional organisations, trade unions, voluntary and community organisations will also be invited to submit written evidence. Public Hearings The public hearings will take place during September and October 2014. The Commission will hold public hearings in various locations throughout 4
Northern Ireland. Information on how to attend or provide evidence to the public hearings will be available on the Commission s website. At the public hearings the following may be invited to provide witnesses testimonies: patients, family members and carers, elected representatives, representatives of the Northern Ireland Executive departments, representatives of other relevant public authorities, representatives of professional organisations, trade unions, voluntary and community organisations. 6. Timeline The Inquiry will be launched in June 2014 with the final report published in April 2015. 5