National health and wellbeing outcomes framework

Guidance framework on the national health and wellbeing outcomes which apply to integrated health and social care.

9. Embedding a human rights based approach

The national health and wellbeing outcomes, together with the integration planning and delivery principles[10], are grounded in a human rights based approach. Human rights based on the principle that people should be equal and free to participate as full and active members of society. They belong to us all and are the basic rights and freedoms that we have as human beings, which allow us to live with dignity, and participate in our communities equally.

A human rights based approach is a way of empowering people to know and claim their rights. It increases the ability and accountability of individuals, organisations and the relevant professionals who are responsible for respecting, protecting and fulfilling rights. This means giving people greater opportunities to participate in shaping the decisions that impact on their human rights.

Human rights are closely aligned to the national health and wellbeing outcomes, for example, we have developed the national health and wellbeing outcomes to reflect the desire for people to have the highest possible standard of health and to reflect the principle that everyone should have a right to independent living. A human rights based approach can offer a practical framework to help people to work together to achieve the national health and wellbeing outcomes.

The Scottish National Action Plan (SNAP) on Human Rights recognises that human rights impact on all of us through a basic assumption of humane, dignified, fair and equal treatment in our homes, schools, workplaces and communities. As part of its commitment to SNAP, the Scottish Government, with others, will design and lead a programme of work to ensure that human rights is put at the heart of the integration of health and social care including in outcome measures and guidance.

SNAP advocates the use of the PANEL and FAIR approaches. There are some underlying principles which are important in applying a human rights-based approach in practice, known as the PANEL Principles.

9.1 PANEL principles

If these principles are used in planning and delivery, services and support should uphold the rights of everyone, be person-centred, and demonstrate that they aim to ensure good decision-making, improvement in institutional culture and relationships, legal compliance and best practice.

PANEL Principles


Everyone has the right to participate in decisions which affect them. Participation must be active, free, and meaningful and give attention to issues of accessibility, including access to information in a form and a language which can be understood.


Accountability requires effective monitoring of human rights standards. For accountability to be effective there must be appropriate laws, policies, administrative procedures and mechanisms of redress in order to secure human rights.

Non-discrimination and equality

A human rights based approach means that all forms of discrimination must be prohibited, prevented and eliminated. It also requires the prioritisation of those in the most vulnerable situations who face the biggest barriers to realising their rights.


People should understand their rights, and be fully supported to participate in the development of policy and practices which affect their lives. People should be able to claim their rights where necessary.


The full range of legally protected human rights must be respected, protected and fulfilled. A human rights based approach requires the recognition of rights as legally enforceable entitlements, and is linked in to national and international human rights law.

9.2 FAIR approach

The Scottish Human Rights Commission has also developed the 'FAIR' approach to help apply a human rights based approach in practice. Often using the FAIR approach can be a means of reaching a balanced and just solution in difficult situations. The FAIR chart, below, outlines the steps that can be taken in more detail.

FAIR Approach


  • What is the experience of the individual?
  • Is the individual being heard and if not, do they require support to do so?
  • What are the important facts to understand?

Analysis of rights at stake

  • What are the human rights or issues at stake?
  • Is the right to life or the right not to be subjected to inhuman or degrading treatment at stake? If so, these rights are absolute and cannot be restricted.
  • Can the right be restricted? What is the justification for restricting the right?
  • Is the restriction on the right 'proportionate'? i.e. is it the minimum necessary restriction to meet the aim or is a "sledgehammer being used to crack a nut"?

Identification of shared responsibilities

  • What changes are necessary? Who has responsibilities for helping to make the necessary changes?

Review actions

  • Have the actions taken been recorded and reviewed and has the individual affected been involved?

Graham's Story

Graham is 55 years old, lives with his long-term partner and used to work with a local youth organisation. He volunteers with several charities and is involved in local planning groups for health and social care services. Graham was diagnosed with bipolar disorder when he was a teenager. He received good support from his GP and a psychiatrist, as well as his school. This helped him to go to college and get the job he wanted.

When Graham was 45 he was diagnosed with heart disease, which had a big impact on him physically and emotionally. Graham found it increasingly difficult to manage his mental health effectively, partly due to the effect of his new medication on his moods and due to the stress of his diagnosis. He started to struggle with work, finding that he could not predict how he would feel physically or mentally from one day to the next. He felt tired a lot of the time and found it difficult to stay motivated and positive about the future.

Soon after his diagnosis, Graham's GP suggested he book a double appointment so they could talk through his diagnosis, how he could manage both of his conditions and what kind of support might help. They talked about the impact on Graham's ability to work and agreed that Graham would speak to his employer about reducing his hours so that he could continue to work.

'Graham now feels that he is able to manage his conditions better and feels confident that he knows where to turn to for support when he needs it'.

The GP also referred Graham to the Practice Nurse and a Social Worker specialising in mental health. The Practice Nurse helped him understand his heart condition and how he could manage it. She also signposted him to a national organisation that ran local cardiac rehabilitation groups, along with the Citizens Advice Bureau, to help with his concerns about the financial impact of reducing his hours. Through the Social Worker, Graham was put in touch with a Peer Support Worker who helped him develop a Wellness Recovery Action Plan (WRAP).

As a result of the support he has received, Graham has been able to stay in work for several years following his diagnosis, and when he decided he needed to retire to protect his health, he continued to do voluntary work instead. He also became involved in a writing group which helped him to tell his story and share his experiences.



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