A non-exhaustive list of issues raised during the development of SNAP 2 includes:
- Many people do not fully enjoy their right to the highest attainable standard of physical and mental health, or the right to a healthy environment, and the rights of some people are particularly at risk. For each action, delivery stakeholders should ensure that the people whose rights are most at risk are identified and prioritised before activity begins.
- Although there is substantial research and evidence on life expectancy and mortality rates, improvements are needed to ensure that robust disaggregated equality and human rights data is gathered and analysed in order to better understand these as human rights issues and the experiences of people whose rights are most at risk.
- Evidence shows that some people experience systematic and growing levels of violence and abuse, and a range of national strategies and delivery programmes have been created to address the issues faced by different equality groups. However, while there is some evidence of connections between these, more work is needed to overcome silos and ensure a coordinated, rights-based approach.
- There is a serious, ongoing disconnect between rights-based policy ambitions in health and social care and financial decision-making, and much more is needed to align the two. To demonstrate that this is achievable, a first step should be to carry out human rights budget analysis at the local level. This would inform and influence further rights-based budget setting at the local level, and human rights budget work nationally, into the future.
- Despite the existence of several shared decision-making projects in healthcare settings, there is a lack of consistent and universal good practice and some people continue to experience infringements of their right to participate in decisions about their care and support. More work is needed to systematically map and identify the projects that take a rights-based approach, to inform and help improve practice in services across the country.
- Online bullying and harassment affects multiple groups in Scottish society, but it is not well understood as a human rights issue, and therefore rights-based measures to tackle it are being overlooked.
- People who experience mental ill-health face numerous human rights issues. This includes – but is not limited to – stigma and discrimination, unemployment and underemployment, rising rates of detention, over-use of medication, a lack of decision-making power, and barriers to accessing health and social care services that are available, accessible, acceptable and good quality.
- There is an ongoing tension between rights-based policy in social care and commissioning and procurement processes. Neither the Independent Review of Adult Social Care nor the National Care Service (NCS) proposals strongly align human rights with commissioning and procurement (Feeley references ‘commissioning for social good’, and the NCS proposals refer to ‘ethical commissioning’). More work is needed to inform and help improve rights-based policy and practice in social care commissioning and procurement. In future, this could be applied to commissioning and procurement across a wider range of public service provision.
- The right to health for some women is particularly at risk. Although women’s health is a growing policy priority, action is needed to ensure all women across Scotland equally enjoy their right to available, accessible, acceptable and quality healthcare, including – but not limited to – reproductive and maternal healthcare services. There is a lack of investment in research and gender-competent, evidence-led policy related to women’s health, and gaps in disaggregated equality and human rights data and analysis.
- Scotland must urgently prioritise environmental protection from a human rights perspective and tackle environmental damage and the disproportionate impact it has on areas of high disadvantage, and people whose rights are most at risk.
- Carry out a human rights review of current evidence on healthy life expectancy and adverse mortality rates in Scotland. Particular focus on population groups that experience shorter healthy life expectancy and the most adverse mortality rates, including care experienced people, people living in poverty, disabled people including people with learning disabilities and autistic people, people with mental health conditions, people with lived experience of substance use, minority ethnic people and transgender people.
- Carry out a human rights review of current national strategies and delivery programmes in Scotland in order to better understand, reduce and prevent infringements of people’s right to be free from violence and abuse. Particular focus on population groups who experience the greatest infringement of this right, including disabled people, care experienced people, LGBTQIA+ people, minority ethnic people, women and girls.
- Pilot a human rights budget analysis of allocation and spend on health and social care in at least one Scottish region. The analysis will cover two budgetary cycles – one pre-COVID 19 and one during the pandemic period, after restrictions were lifted. Suggested budget cycles are 2018-2019 and 2022-2023. Use findings to inform and implement human rights budget work across all public sector budgets in Scotland.
- To help reduce inequalities and tackle discrimination, carry out a mapping exercise to identify good practice examples of rights-based decision-making in healthcare settings with people whose rights are most at risk. Use the findings and good practice examples to inform, improve and support the implementation of rights-based policy and practice across healthcare in Scotland.
- To support the progressive realisation of women’s right to health: (a) increase investment in research and evidence-led policy; (b) improve rights-based intersectional data collection and analysis; and (c) develop national standards and gender-competent, rights-based professional development. Particular focus on women whose rights to available, accessible, acceptable and quality healthcare services are most at risk.
- Carry out a human rights review of online bullying, harassment and abuse in Scotland to better understand, mitigate and prevent the negative impact on people’s rights. Particular focus on those whose rights are most at risk, including children and young people, disabled people including people with learning disabilities and autistic people, LGBTQIA+ people, minority ethnic people, older people, and women.
- Carry out a human rights review of collated baseline data on air, land and water pollution impacts and severe weather events. To address the disproportionate impact of environmental harms on marginalised places and people whose rights are most at risk, prioritise focus on: (a) areas of highest deprivation and/or at higher risk; (b) the impact of environmental hazards on health outcomes; and (c) the extent to which mitigation and adaptation measures are prioritised for areas of highest deprivation. Use findings to inform national decision-making to help better realise the right to a healthy environment.
- Carry out a human rights review of commissioning and procurement in the social care sector. Use the findings and recommendations to inform, improve and support the implementation of rights-based practice across all public services in Scotland.
- As part of its work to review and develop actions, the SNAP Leadership Panel considered possible actions related to mental health, in addition to those included in this Plan. At the time of developing SNAP 2, extensive work in the area of mental health and human rights was underway. This included the Scottish Mental Health Law Review (SMHLR), the development of a new national mental health strategy, and the proposed incorporation of ICESCR and CRPD. In light of these developments, the Panel commits to keeping this issue under continuous review, in particular as the Scottish Government responds to the SMHLR, and new actions could be introduced in the future if required.
- As part of its work to review and develop actions, the SNAP Leadership Panel considered actions related to social care, in addition to those included in this Plan. At the time of developing the plan, a process to develop a National Care Service, following from the Independent Review of Adult Social Care, was in progress. As this process was subject to an ongoing co-design process, and a Bill was undergoing its passage through the Scottish Parliament, it was not clear at the time of development to what extent this process would advance human rights. In light of these developments, the Panel will continue to review this area for future consideration, once the outcome of this process is complete.
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