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1.1 Law Centre (NI) is a public interest law non-governmental organisation. We work to promote social justice and provide specialist legal services to advice organisations and disadvantaged individuals through our advice line and our casework services from our two regional offices in Northern Ireland. It provides a specialist legal service (advice, representation, training, information and policy comment) in five areas of law: immigration, social security, community care, mental health and employment.

1.2 The work of the Department of Health, Social Services and Public Safety is of particular relevance to our mental health and community care services. The community care legal representation service deals with personal and support services for a range of people including those who are elderly, ill, disabled, incapacitated and carers. Our community care advice line operates from both our offices and our community care legal representation service provides training for trusts and social services. The mental health legal representation service offers legal representation for issues around admission to hospital for assessment, capacity, treatment, discharge delay, community services and other mental health related legal issues.

1.3 Our services are provided to almost 500 member agencies. Members include local Citizen Advice Bureaux, independent advice agencies, local solicitors, trade unions, social services, probation offices, constituency associations of local political parties, libraries and other civic organisations.

1.4 We support a rights-based approach to health and social services in Northern Ireland. Under a rights-based approach to health, human rights should be used as a framework for health development and the human rights implications of any health policy, programme or legislation should be assessed and addressed prior to implementation. The Strategy seems to support this approach and its desire to promote equality, good relations and human rights is a step forward in ensuring that the right to the highest attainable standard of health[1] is more firmly established in Northern Ireland.

1.5 Given current discussions regarding the development of a Northern Ireland Bill of Rights, it is a key time for the Department to contribute to discussions regarding the inclusion of a right to health within a Bill of Rights. We would fully support the inclusion of a right to health within a Northern Ireland Bill of Rights and believe it would be appropriate for the Department to contribute to this timely and important debate. Such action would further confirm the Department’s commitment to a right-based approach to health in Northern Ireland.

1.6 The Strategy and Action Plan to Promote Equality, Good Relations and Human Rights (the Strategy) is welcome, although we have some concerns regarding the document as it currently stands and we look forward to receiving further information on how the proposed actions will be implemented in practice. We welcome the opportunity to contribute further to the ongoing development of the Strategy and are open to further participation in the consultation process. We look forward to the provision of more detailed information regarding how DHSSPS will apply and administer the Strategy to ensure that its vision will become reality.

1.7 We welcome the opportunity to respond to this consultation document. We have made some general comments in response and address some of the questions which were posed for consultation.

2.1 We welcome the recognition within the Strategy that significant health inequalities still exist in Northern Ireland and that access to services is still a considerable problem for many groups and communities.

2.2 We support the Department’s aim to deliver a health and social care service that is characterised by openness, integrity and fair treatment for all and the desire to improve the responsiveness of services taking into account societal inequalities, and ensuring the continued respect and promotion of human rights. We note, however, the Strategy does not refer to the targeting of financial resources to reduce existing health inequalities or other social-economic inequalities that impact on the health of people in Northern Ireland. We would welcome further comment on the resource implications of the Strategy and whether funding will be ring-fenced for any of the strategies outlined within the Strategy.

2.3 It is important that this very broad Strategy is implemented effectively and that positive developments result. We are aware of a plethora of documents and policies that refer to the need to promote equality and human rights within health and social services to combat inequality. While considerable advances have been made within the sector to target inequality, this is a continuous process and there is still some way to go. To ensure quantifiable success the Strategy needs to include more definitive time-scales with measurable targets. It is important that the Strategy generates public confidence and that clear processes for ongoing monitoring and annual reviews of its outcomes are put in place.

2.4 We note the statement that the Strategy is a ‘living document capable of being adapted and refreshed to take account of changes and other factors.’ If the Strategy’s purpose is merely to provide a goal for attainment then it goes some way to meeting its aim. However, much of the content of the Strategy has been previously documented in other reports and action plans and we are concerned that the Strategy does not outline any new or innovative models for the successful reduction of health inequalities or a radical means of promoting human rights or good relations within the health sector. As such, we are concerned that the level of resources and input put into the production of this Strategy may have been better placed in resourcing staff training and actual services to meet the gaps in services that have been previously highlighted in similar reports, such as Investing for Health or the recent Anti-Poverty Strategy.

2.5 Significant responsibility will be placed on Trusts and other health and social services agencies to ensure that the Strategy is used as the guiding framework for decision-making and for securing support for equality, good relations and human rights initiatives. Considerable training will need to be available to Trusts governing boards and staff prior to any roll out of the Strategy to ensure that they are aware of their obligations. Consideration needs to be given to the allocation of resources for this purpose and training should be informed and/or delivered by service users.

3.1 We note the Department’s commitment to consultation throughout the development of the Strategy and trust that this will continue as the Strategy continues to develop through implementation and ongoing monitoring of compliance with the Strategy.

3.2 We note that there are a number of existing and developing strategies, policies and initiatives that will influence and complement those proposed within the Strategy. The list of other strategies and frameworks confirm the increased recognition given to human rights and equality within the health sector in Northern Ireland. However, with the quantity of documents comes the need to ensure that these strategies are coordinated and complementary. Further care needs to be taken to ensure that the principle of human rights and equality for all within the various documents is not lost by the sheer quantity of documents produced. We recommend that a consolidated document is produced which draws together key priorities with appropriate reference to other strategies.

3.3 We welcome the various projects described within this chapter and are encouraged by the Departments early intervention in the areas identified as requiring immediate attention.

3.4 We note the reference to the development of a booklet in nine different languages on HPSS services as part of the Accessible Formats project. This publication will be extremely useful to those members of ethnic communities for whom English is not their first language. We would welcome further information regarding the timeframe for this publication and where it will be available to the public.

3.5 We welcome the references within the Strategy to the needs of people with disabilities. The widespread recognition of the rights of people with disabilities to equal protection and access is long overdue and we are encouraged by the significant changes in legislation and policy that have occurred over the last few years. The need for this recognition is nowhere more evident than in Northern Ireland where more than one in five (over 300,000) people has a disability, higher than in the rest of the United Kingdom. Indeed over one quarter of all families in Northern Ireland are affected to some degree by disability.[2]

3.6 The Departments decision to engage Disability Action to review the action taken by the HPSS and to advise on what further action is necessary to meet the obligations of the Disability Discrimination Act 1995 (the DDA) shows a commitment to ensure that recommendations are informed by service users and their representatives. We look forward to further information regarding how these recommendations will be put into practice.

3.7 The creation of the Equality and Human Rights Steering Group, extending the Equality Steering Group to cover human rights is welcome as this further demonstrates the move towards a rights based approach to health in Northern Ireland, which we strongly encourage.

4.1 We welcome the strategic priorities in this chapter. We have concerns, however, about some of the strategic objectives outlined to achieve these priorities.

4.2 Strategic Priority 1 to improve people’s experiences and access to information and services: We welcome the Department’s commitment to ‘take steps to identify and address access issues’ and to ‘pay particular attention to identifying and addressing any equality, good relations or human rights problem’. Further information would be useful on what steps it will take and how it will identify and address problems to ensure that people’s experiences of the health sector are more positive.

4.3 Strategic Priority 2 to mainstream equality and human rights: The focus on consultation and continuous engagement with service users/stakeholders as part of this Strategic Priority is welcome. Mainstreaming equality and human rights should enable better decision-making and lead to better informed policy-making. We support the desire to promote a culture of engagement with those likely to be affected by decisions, policies, and practices affecting their lives. Again, we look forward to further information on how the Department and its agencies will ensure that full and transparent consultation and engagement with service users and stakeholders occurs and how this will be monitored and enforced.

4.4 Strategic Priority 3 to promote an equality and human rights culture across the HPSS: While we are encouraged by the aim of the Strategy to promote equality, good relations and human rights and reduce inequalities in access to health and social services much of the success of the Strategy will rest on whether staff support and are committed to this aim. Many people’s experiences of health and social services are influenced to a high degree by the staff they meet. Therefore, the Strategic Priority to promote an equality and human rights culture across the HPSS by training staff is of the utmost importance. Staff need to be made aware of their statutory equality and human rights legal obligations.

4.5 Key Indicators: The key indicators are a welcome practical element to the Strategy and we endorse them as helpful focus points for monitoring the commitment to equality, good relations and human rights. Again, however, we are concerned that while the aim and rhetoric of the Strategy is commendable, the practical reality remains that vast inequalities still exist in access to health and social care. A senior management presence at equality awareness seminars and training events is to be encouraged. However, without a commitment to increased resourcing and practical commitment to provide services to meet the needs of those who do not have equal access, little may change on the ground where it matters.

5.1 Notwithstanding our reservations regarding the practical outworking of the Strategy we welcome the Action Plan and the detail provided within it to confirm the ongoing commitment by the Department to recognise and promote equality, good relations and human rights. Again, we note the comment that the Action Plan is a working document capable of being adapted to take account of changes and other factors.

5.2 We note the reference to the Review of Public Administration (RPA) and the major organisational change within the HPSS that has occurred as a result. We are concerned that ongoing implications of the RPA may have an undue effect on the implementation of the Strategy. Therefore, we would welcome further information from the Department regarding the safeguards that will be put in place to ensure that this does not occur and confirmation that the requirements as detailed within the Guide will not be unduly affected by any changes as a result of the RPA.

5.3 We welcome the commitment to produce a general and introductory information booklet on entitlements and access for migrant workers and minority language communities. The aim to achieve equality of access to health and social care services and to deliver the highest quality care, for those members of black and minority ethnic communities, migrant workers, asylum seekers and refugees is commendable.

5.4 The focus within the Action Plan on the need to take forward the future development and maintenance of high-quality, appropriate interpreting services is welcome, as is the plan to maintain and develop effective high quality translation services for documentation. The availability of interpreters and written materials in other languages will greatly assist those in Northern Ireland for whom English is not a first language.

5.5 We have a particular interest in the rights and access to services for migrant workers and asylum seekers. Asylum seekers experience similar health problems as the rest of the population. In addition, they are also liable to suffer from a range of particular, physical, mental and emotional health problems, caused by the conditions they have fled from, the abuse and poverty they have suffered and the conditions they have experienced while fleeing and encountered when reaching the UK. Our concerns, focus on the lack of adequate health care, often associated with a delay in accessing health care; the particular problems experienced by asylum seekers presenting with mental health needs; the lack of health services to failed asylum seekers; the impact of removal and detention on the health of asylum seekers and the potential impact on the health of asylum seekers arising from the threat of deportation.

5.6 We consider there to be a pressing need for increased awareness among service providers of the specific issues asylum seekers present with; the targeting of services to match the needs of asylum seekers e.g. counselling services, and greater allocation of resources to frontline services. (For example, we are aware of only one counsellor currently providing services to asylum seekers in Northern Ireland and we understand that this service is provided on a voluntary basis.) We recommend that priority should be given to providing training and information for health care providers; improving access to support services such as interpreters and better treatment, including counselling, for the specific issues faced by asylum seekers. We further recommend that the Department consults with the Medical Foundation for the Care of Victims of Torture on the implementation of measures to support asylum seekers (www.torturecare.org.uk). Such measures would significantly improve the experience of asylum seekers in Northern Ireland.

5.7 As previously referred to at point 3.6, we are encouraged by the undertaking within the Action Plan to respond to Disability Action’s survey findings and recommendations on how well the HPSS is meeting the Disability Discrimination Act 1995 (DDA) access requirements. Ensuring that public access areas are accessible to people with disabilities is vital and we welcome the commitment by the Department to assess these areas to ensure that legislation is being complied with. We would welcome further information regarding how the Department will respond to the survey findings and how compliance with the DDA will be monitored and enforced on a regular basis.

5.8 We also welcome the commitment to establish implementation groups to take forward agreed recommendations following analysis of the consultation responses.

6.1 Law Centre (NI) welcomes the opportunity to respond to this consultation document. We trust you will find our comments helpful. If there is any further way in which we could contribute to this process we would welcome the opportunity to do so.

[1] As reflected in Article 12 of the International Covenant on Economic, Social and Cultural Rights

[2] Disability Action, “Agenda for Change,” 2003, pg. 1