Can candour heal healthcare harm?

by Oliver Quick, Co-Director, Centre for Health, Law and Society, University of Bristol Law School

“Patient Talking With Doctor” by NIH Clinical Centre

Healthcare harm is a global public health problem. The World Health Organisation estimates that adverse events account for more deaths than either lung cancer, diabetes or road injuriesand that around 80% are avoidable. In low- and middle- income countries, poor quality healthcare accounts for 10-15% of deaths annually. Such statistics are striking if slightly simplistic in that unsafe care combines with pre-existing health conditions and diseases, and avoidability assessments are likely based on ideal, rather than real world, conditions. However, in England alone, the additional annual financial cost oproviding further care to harmed patients would equate to employing over 2,000 salaried GPs and 3,500 hospital nursesmuch needed given the high number of vacant positions in the NHS workforce. The annual cost of compensating and managing maternity negligence cases (£2.1 billion) now exceeds the amount spent on delivering babies (£1.9 billion.) Remarkably, there remains no coherent cross-government strategy and policy to address these spiralling costs.   
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The PPE scandal shines a light on the worrying future of UK procurement law

By Professor Albert Sanchez-Graells (University of Bristol Law School).

The National Audit Office’s Report on its ‘Investigation into government procurement during the COVID-19 pandemic’ found that the relaxation of the standard procurement rules to allow for extremely urgent acquisitions, mainly of PPE, resulted in alarmingly widespread levels of procedural impropriety in the award of up to £18bn in public contracts. Most notably, the NAO report revealed the existence of a ‘VIP procurement channel’ for those with political connections, which resulted in much higher chances of obtaining very lucrative contracts than for those retained under the ‘normal’ pool of potential suppliers. This adds to (and partly explains) earlier reports of very large PPE contracts awarded to companies with no proven track record in the PPE market. (more…)

A perfect storm: Patients, psychiatrists and the pandemic

By Prof Judy Laing, Professor of Mental Health Law, Rights and Policy (University of Bristol Law School)

Mental Health Awareness week is an important time to reflect on how the Covid-19 pandemic is generating a global crisis in mental health. Earlier this month, the United Nations published a policy brief warning that:  ‘Although the Covid crisis is, in the first instance, a physical health crisis, is has the seeds of a major mental health crisis as well.

Stringent lockdown measures have increased social isolation, and for many, this is creating huge psychological distress. That is further impacted by the fear of infection, death and losing relatives and close friends to the virus. The state of the economy is creating additional anxiety and stress for those who have lost or are at risk of losing their income and livelihoods. Professor David Gunnell (a colleague at the University of Bristol who researches on suicide and self-harm) has highlighted with others in The Lancet  that the pandemic will ‘leave many people vulnerable to mental health problems and suicidal behaviour, and increased risks of suicide’. Taking action now to prevent the risk of suicide is therefore imperative. And the United Nations policy brief also urges national governments to take positive action to ensure widespread availability of mental health support, as well as building mental health services for the future to promote recovery from the pandemic. (more…)

The Commission Roadmap on Covid-19: is the EU Finding the Route or Continuing to Lose the Way?

By Prof Keith Syrett, Professor of Health Law and Policy (University of Bristol Law School)

Credit: European Union, Coronavirus Global Response, 2020

The European Union has been widely criticised for its response to the outbreak of pandemic coronavirus (COVID-19) in early 2020. Still distracted by Brexit and, more recently by the Turkish migrant crisis, EU leaders were caught off guard by the rapid spread of the virus, initially into Italy. Member states took actions into their own hands, imposing border controls, banning exports of protective equipment and, later, banning mass gatherings, closing schools, and instituting lockdowns, while the EU appeared to be a largely impotent bystander.

Perhaps the EU’s muted initial response was unsurprising, given that previous public health threats of a similar type, such as SARS, MERS and Ebola, had had little impact within the Union. However, more than a decade previously, concerns had been raised about lack of preparedness for a pandemic outbreak in Europe.[1] Notwithstanding the EU’s subsequent establishment of a firm legal basis for a response to pandemics, it now seems that the lessons presented previously had not fully been learned. (more…)

Beyond liberty: social values and public health ethics in responses to COVID-19

By Prof John Coggon, Professor of Law (University of Bristol Law School)

Legal and policy responses to COVID-19 rest on and express the balance of different basic values and principles. Earlier and current regulatory approaches bring into sharp relief how liberty must be understood and weighed against other values. This is for the sake of liberty itself, but crucially too for other compelling aspects of social justice.

Emergency powers and pandemic ethics

COVID-19 is a global problem, albeit one that governments across the world have been approaching differently. Over the past weeks we have seen fast changes in policies as different countries have sought to anticipate and respond to the extraordinary scale of the challenges that we face and which lie ahead. (more…)

A Legal Landmark in Reproductive Rights: The Abortion (Northern Ireland) Regulations 2020

By Dr Sheelagh McGuinness, Reader in Law and Dr Jane Rooney, Lecturer in Law (University of Bristol Law School)

On 31st March, 2020, The Abortion (Northern Ireland) Regulations 2020 came into force. This is a landmark in reproductive rights in Northern Ireland. Many were sceptical as to whether this day would ever arrive. The regulations represent the culmination of decades of activism across civil society, grassroots and medical organizations, legal representatives, and political actors. They constitute a huge step forward in the protection of the reproductive health of women. However, the scope of protection afforded will depend on how they are interpreted and implemented. In this blog we give an overview of the regulations and highlight some areas of on-going concern. (more…)

Mental disability and voting rights: Bridging the knowledge and uptake gap

By Prof Judy Laing, Professor of Mental Health law, Rights and Policy (University of Bristol Law School)

As the general election approaches and you consider whether to use your vote, spare a thought for the thousands of people who are detained in psychiatric hospitals or living in residential care/nursing homes, and who may not even realise that they are entitled to vote, or be given the opportunity to do so.

Government statistics suggest that there were 21,439 people reported as being subject to compulsory detention under the Mental Health Act 1983 on 31st March 2018, and over three quarters of these people were being detained in hospital in England.[1] The majority of these detained patients have the same right to vote as the general population, but they are one of the most disenfranchised groups in society.  Surveys have found that psychiatric in-patient uptake and knowledge of voting rights is generally poor. For example, a study on the general election in 2010 found that eligible psychiatric in-patients were half as likely to register as the general population; half as likely to vote if registered, and patients who had been in hospital for longer periods were particularly affected.[2] Moreover, research also suggests that knowledge of patients’ voting rights amongst mental health professionals could be improved.[3] (more…)

Abortion Law Reform in Northern Ireland

By Dr Sheelagh McGuinness, Reader in Law (University of Bristol Law School) & Professor Sir Jonathan Montgomery, Professor of Healthcare Law (UCL Laws).

Credit: Rossographer

October 22nd 2019 marked a momentous day for those who have advocated for decades for liberalisation of Northern Ireland’s restrictive abortion laws.[1] Following the implementation of Section 9 of the Northern Ireland Executive Formation Act 2019, abortion up until 24 weeks gestation is decriminalised. In addition to this, an obligation has been placed on the Secretary of State for Northern Ireland to ensure that adequate regulations are in place by the end of March 2020 to ensure a human rights compliant framework for provision of abortion care.

This is the first of a two-part blog. Here we focus on what decriminalisation of abortion means for regulation of abortion in Northern Ireland.[2] In the next part we will provide an account of what the content of human rights compliant abortion regulations should be. (more…)

Abortion in Northern Ireland: The Ewart Judicial Review Judgment

By Dr. Jane Rooney, Lecturer in Law (University of Bristol Law School)

NB: Abortion law in Northern Ireland is set to change on 22nd October 2019 if the suspended Northern Irish Assembly continues to not function on or after 21st October. This blog post contextualises and recognises the continued relevance of judicial review proceedings challenging the prohibition on abortion in Northern Ireland in cases of fatal foetal abnormality within a dynamic, multi-layered legal, political and social context.

On 3rd October 2019, the High Court of Justice in Northern Ireland decided that Northern Irish abortion law was incompatible with the Human Rights Act 1998 (HRA) insofar as it prohibited abortion in cases of fatal foetal abnormality (FFA). Justice Keegan decided to refrain from pronouncing on the remedy before hearing further submissions by the parties involved: she delayed the decision over whether to make a declaration of incompatibility (DOI) pending further submissions.[1]  This judicial review case follows a momentous year in activism, litigation, and legislative reform on abortion in Northern Ireland. The following provides context to the judgment, and a summary of the key reasoning employed. It then focuses on the DOI point which is yet to be concluded. A DOI should be made for two primary reasons. First, this remedy is warranted in the circumstances of the prohibition on abortion in cases of FFA. It can be distinguished from Nicklinson which introduced the idea that a DOI need not be made despite finding an incompatibility. Second, to proceed with refusing a DOI despite finding an incompatibility, and normalising Nicklinson, would have broader consequences for the human rights protection system in the UK. (more…)

Promoting the next generation of health law scholarship

By Prof John Coggon and Prof Judy Laing (Bristol University Law School)

In October 2017, we were proud and honoured to mark the launch of the Centre for Health, Law, and Society (CHLS) in the University of Bristol Law School. The Centre is founded on ambitious aims to push the boundaries of scholarship in health law: expand its methods and approaches; broaden its practical reach and points of focus; enhance its place in shaping education; and increase its engagement with, relevance to, and impacts on people, organisations, regulators, and policy-makers across society.

Our launch event allowed a showcase of the breadth of scholarly interest and inquiry within CHLS, as well as an opportunity to hear presentations from leading figures in health, law, and associated disciplines. We start from a basic premise that the value and significance of health requires understandings from ranging disciplinary perspectives, looking across social sectors and actors. We are interested in the roles served by law to protect and promote rights, achieve greater social justice, and to ensure that health and other fundamental values are secured fairly for all.

Since the time of our launch, CHLS has gone from strength to strength. Our community of students, academics and collaborators continues to grow. And we are delighted in March 2019 to publish a Special Issue of the Northern Ireland Legal Quarterly (NILQ), which shows well the depth, range and reach of our ambitions. The Special Issue comprises contributions from 11 of CHLS’ members, as well as from colleagues from other universities. They represent legal scholarship that engages with ethical considerations and social justice, history, human rights, philosophy, politics and social sciences. They approach questions spanning from very individualised rights, to population- and systems-level analyses. (more…)