Oliver Quick

Regulating and legislating safety: the case for candour

Public inquiries into healthcare-associated harm have a depressing sense of deja vu. The past 12 years have seen (among others) exhaustive and expensive inquiries into the failures of paediatric heart surgery,1 systems for obtaining informed consent,2 the killings of Harold Shipman,3 and now the story of neglect and maladministration at Mid Staffordshire NHS Trust,4 where mortality rates were persistently higher than expected over the period 2005–2009. Indeed, the vast three-volume Francis Report echoes the findings of the first major NHS public inquiry into events at Ely Hospital as far back as 1967.5 While these different events have their own histories and causes, they tell similar stories of ineffective regulation and weak safety cultures. The Francis report is reminiscent of the Kennedy inquiry report into Bristol6 in observing closed hierarchical systems, fear of blame and punishment, toleration of bad practices, and a failure to learn from patient and staff feedback. Robert Francis QC is clear (and surely correct) that the fundamental problem lies in the prevailing culture of healthcare organisations. However, the report tends to gloss over some of the complexities of culture.7 Thus, whilst heavy on detailed recommendations (there are an unmanageable 290), only four are specifically made in relation to culture.8 Instead, the report gives much detail of—and places much faith in—the capacity of law and regulation to improve the safety of patients. This short paper evaluates the recommendations made in relation to reforming the legal and regulatory landscape around patient safety, and focuses on the potential that a legal duty of candour has for contributing to an improved safety culture in healthcare. Mid Staffordshire is a story of regulatory failure. This should be surprising given the seemingly robust structures in the ‘pluralistic regulatory landscape’9 that surrounds healthcare. Professional regulators, such …

Lacey, Wells and Quick Reconstructing Criminal Law Text and Materials

Since the publication of the first edition, this textbook has offered one of the most distinctive and innovative approaches to the study of criminal law. Looking at both traditional and emerging areas, such as public order offences and corporate manslaughter, it offers a broad and thorough perspective on the subject. Material is organised thematically and is clearly signposted at the beginning of each section to allow the student to navigate successfully through the different fields. This new edition looks at topical issues such as policing, the Serious Crime Act 2007, and reform of the Fraud Act 2006. Relevant case law and extracts from the most topical and engaging debates give the subject immediacy. The book is essential for both undergraduate and postgraduate study of criminal law and justice.

Partial reform of partial defences: Developments in England and Wales

The offences of murder and manslaughter have been the subject of several Law Commission reviews in England and Wales but no wholesale reform. The two major difficulties with the law of murder have been the continuing commitment to the mandatory penalty and the impossibility of capturing culpability in a nuanced way through the mechanics of the mental element of ‘intention to cause death or serious bodily harm’. The long accepted solution to these difficulties has been the use of partial defences of diminished responsibility and provocation to reduce murder to manslaughter in some circumstances, despite the defendant clearly having satisfied the mental element. In 2006, the Law Commission proposed a new architecture of homicide offences which would have resulted in partial defence killings being in the second of three categories of killing. This would have located them in the same bracket as killings accompanied by either intention to cause serious injury or an intention to cause injury coupled with a serious risk of causing death. Rather than adopt this new scheme, the government fast tracked reform of partial defences but retained the current bifurcation between murder and manslaughter. While diminished responsibility was retained, albeit cast in slightly different terms, provocation was replaced by a defence of ‘loss of control’. In this article we analyse these changes, consider the statutory consolidation of the law of self-defence, and point up the continuing incoherence and confusion in this area.

Leaving patients to their own devices? Smart technology, safety and therapeutic relationships

BackgroundThis debate article explores how smart technologies may create a double-edged sword for patient safety and effective therapeutic relationships. Increasing utilization of health monitoring devices by patients will likely become an important aspect of self-care and preventive medicine. It may also help to enhance accurate symptom reports, diagnoses, and prompt referral to specialist care where appropriate. However, the development, marketing, and use of such technology raise significant ethical implications for therapeutic relationships and patient safety.Main textDrawing on lessons learned from other direct-to-consumer health products such as genetic testing, this article explores how smart technology can also pose regulatory challenges and encourage overutilization of healthcare services. In order for smart technology to promote safer care and effective therapeutic encounters, the technology and its utilization must be safe.ConclusionThis article argues for unified regulatory guidelines and better education for both healthcare providers and patients regarding the benefits and risks of these devices.

Clinical–insurer engagement to improve maternity safety in the UK, Ireland, Sweden and Australia:

Objective To explore different models of clinical–insurer engagement around maternity safety and to understand how state insurers could and should engage with clinical staff to improve outcomes and reduce harm. Design Semi-structured interviews and focus groups were conducted with senior representatives from state insurers. Transcripts were analysed to identify different models of engagement. Themes were also elicited from the transcripts. A further one-day focus group allowed for clarification and elaboration of these themes. Participants Senior representatives from state insurers in England, Scotland, Wales, Republic of Ireland, Sweden and Victoria, Australia. Results A variety of clinical engagement activities were undertaken by the insurers. These included training on claims and risk management, hospital site visits, facilitating multi-professional network meetings and working with clinical experts to develop best practice recommendations. Some insurers engaged with frontline clinical staff through collaborative patient safety programmes. The themes (identity and size, data and research, incentivising improvement and system integration) were important for considering the role of state insurers within health systems and how insurers could engage with clinical teams. Conclusions This study identified different examples of clinical–insurer engagement. Whilst this was encouraging, the relationships between insurers and clinical teams could be developed further. Insurers and clinical staff could still collaborate more closely and work together in improving patient outcomes. Whilst not specifically their domain, insurers do have a role in patient safety. Closer clinical collaboration may strengthen this contribution.

Lacey, Wells and Quick Reconstructing Criminal Law by Celia Wells

Since the publication of the first edition, this textbook has offered one of the most distinctive and innovative approaches to the study of criminal law. Looking at both traditional and emerging areas, such as public order offences and corporate manslaughter, it offers a broad and thorough perspective on the subject. Material is organised thematically and is clearly signposted at the beginning of each section to allow the student to navigate successfully through the different fields. This new edition looks at topical issues such as policing, the Serious Crime Act 2007, and reform of the Fraud Act 2006. Relevant case law and extracts from the most topical and engaging debates give the subject immediacy. The book is essential for both undergraduate and postgraduate study of criminal law and justice.

Lacey, Wells and Quick Reconstructing Criminal Law Text and Materials: Table of statutes

Since the publication of the first edition, this textbook has offered one of the most distinctive and innovative approaches to the study of criminal law. Looking at both traditional and emerging areas, such as public order offences and corporate manslaughter, it offers a broad and thorough perspective on the subject. Material is organised thematically and is clearly signposted at the beginning of each section to allow the student to navigate successfully through the different fields. This new edition looks at topical issues such as policing, the Serious Crime Act 2007, and reform of the Fraud Act 2006. Relevant case law and extracts from the most topical and engaging debates give the subject immediacy. The book is essential for both undergraduate and postgraduate study of criminal law and justice.

Lacey, Wells and Quick Reconstructing Criminal Law Text and Materials: Law, Order and Security

Since the publication of the first edition, this textbook has offered one of the most distinctive and innovative approaches to the study of criminal law. Looking at both traditional and emerging areas, such as public order offences and corporate manslaughter, it offers a broad and thorough perspective on the subject. Material is organised thematically and is clearly signposted at the beginning of each section to allow the student to navigate successfully through the different fields. This new edition looks at topical issues such as policing, the Serious Crime Act 2007, and reform of the Fraud Act 2006. Relevant case law and extracts from the most topical and engaging debates give the subject immediacy. The book is essential for both undergraduate and postgraduate study of criminal law and justice.

Images of Criminal Law

Images of criminal law infuse our everyday lives. From newspapers and television news programmes reporting incidents or trials, to detective novels, films and television series such as The Bill , Law and Order , Silent Witness and The Wire , crime and the control of crime pour into our individual and collective consciousness. The images produced are complex and contradictory: heroic detectives compete for our attention with ‘bent’ police; wily criminals and informers jostle with the inadequate, the psychopath, the wife-batterer and even, on occasion, the offender with whom we are invited to sympathise; the dramatic appeal of racial injustice vies with the cultural resonance of racist stereotypes. For many people who are neither practising lawyers nor legal scholars, criminal law represents the dominant image of what it is to have a legal system. In thinking carefully about the nature of criminal law, however, this familiarity can be an intellectual barrier. Most peoples image of crime is dominated by crimes of violence or serious crimes against property, proceeded against through trial by jury. But in fact violent and sexual offences make up only a fifth of offences (and only half of violent offences involve injury). The reality of the criminal justice system is dominated by the processing of road traffic offences, minor public order and low-level property offences. Many never reach a court, having been diverted via fixed penalty notices or cautions (Young 2008).

Lacey, Wells and Quick Reconstructing Criminal Law Text and Materials: Foundations of Criminal Law

Due process and human rights We suggested in Chapter 1 that modern criminal law is best understood in relation to a distinctive set of procedures. This focus on ‘due process’ has been driven over the last 150 years both by the expansion of criminal laws scope and by liberal ideas about the rights of individuals vis-a-vis the state. More recently, the salience of due process has been thrown into relief by the incorporation of the European Convention of Human Rights (ECHR) into domestic law through the Human Rights Act 1998 (HRA). Under this legislation, the courts must, wherever possible, interpret domestic law in a way which conforms to the standards embodied in the Convention: where they are unable to do so, they must make a declaration of incompatibility. At this point, the onus shifts to Parliament to decide how to respond. The Human Rights Act provides a distinctive foothold for internal critique of criminal law, by introducing within criminal law standards which were previously external to it. In the other chapters of this book, we shall consider the various ways in which human rights standards may affect the substantive criminal law. Here we are concerned with the implications of the Human Rights Act for criminal procedure and for the ideals of due process which are central to the legitimation of modern criminal law.