Happy New Year from HEAL!

Having had a much needed break, things are starting to kick off again at HEAL. There are plenty of plans unfolding, both in the shorter and longer term. Whilst a month’s extension on the holiday would have been welcome, there’s a lot to be pleased to come back into work for.

There are various things happening in January. We are delighted to be playing host to Malcolm Oswald on the 8th, when we’ll hear his paper “Drawing the line between identifiable and anonymised health data: dilemmas for a conscientious public servant”. As is so often the case with questions in health policy, it will put some important matters under the spotlight with little by way of promise for helpful guidance from law itself.

The following week, both John Coggon and A.M. Viens are off to Germany for a meeting at the Center for Interdisciplinary Research at Universitat Bielefeld, on “Individual Liberty and Problems of Justice in Public Health Ethics”. It will be a fantastic chance for them to showcase some research on conceptual and normative problems at the intersection of ethics, law, and politics in health policy.

At the end of the month, when semester two starts, Natasha Hammond-Browning is picking up the Health Care Law teaching (to include a cameo from Caroline Jones!). The semester two teaching will be much more issue-led, as contrasted with the more foundational work on law and ethics in semester one. Natasha’s half of the semester will focus on beginning of life matters; questions central to her research interests. Towards the end of term, John will take over and speak to issues concerning the end of life, and public and global health.

We are pleased to announce too that John is becoming the new Editor-in-Chief of Health Care Analysis in January, and that A.M. Viens has joined the editorial board. It is great that this journal, with its strong focus on philosophy and health policy, now has a firm base in HEAL.

Looking a bit further forward, we’re very excited that two of HEAL’s PhD students, Alex Chrysanthou and Emma Nottingham , were successful in 2013 in leading a bid to host the Annual Postgraduate Bioethics Conference in Southampton. The conference theme is going to be “Health Law and Bioethics at the Frontiers of Innovation.” It promises to include some excellent keynotes and top quality papers on a range of bioethical questions.

The next hidden lawmakers event, on ‘Test Case Biographies’, funded by the British Academy and The Leverhulme Trust and run by Caroline, Hazel Biggs, and Jonathan Montgomery, is on the horizon this semester, as is a meeting organised by John along with Jurgen de Wispelaere on the theme: “Towards a Republic of Health? Freedom and Solidarity in Public Health and Health Policy.” A.M. Viens is also co-organising two events in the spring. The first is a workshop on Disaster Justice, co-hosted by European Cooperation in Science and Technology (COST) and the University of Copenhagen. The second is a symposium on the Ethics of Antimicrobial Resistance, hosted by the Brocher Foundation in Geneva.

We’re also between us looking forward to hosting more visitors, making more research visits , and to participating in further public consultation responses.

There’s a lot to look forward to in 2014!

Criminal Law and Public Health – Working at Cross-Purposes?

According to recent news reports, the city of Edinburgh is getting tough on those who seek sensual pleasures outside of the confines of their own homes.  The police have asked that condoms be banned from saunas as a way of trying to prevent sexual activity on the premises, and city Councillors have been asked to stop issuing licenses for saunas and massage parlours.

Besides being a naïve and impractical way to prevent people from having sex, there has been, unsurprisingly, a strong condemnation of such a move on the grounds of its potential negative effect on public health.  The charity Scot-pep, for instance, has warned that implementing the police proposal on condoms could lead a HIV epidemic, as well as the proposal to limit establishments where sex workers can meet clients puts them at greater risk from some of the inherent hazards of plying their trade outdoors.

There has been a long history in the United Kingdom of a connection between the criminal justice system and public health.  In some cases, it has been a beneficial relationship in which everything from firearms restrictions, requirements for seat belts, motorcycle helmets and child safety seats and restrictions on intoxicating substances, provide examples where the criminal justice system has been used to mitigate or prevent behaviours that are harmful to individual and population health.  Nevertheless, not all intersections of criminal justice and public health are mutually beneficial.  What is most notable is the distinct progression that has been made from a so-called “policing model of public health”, that often focused on ideas of moral hygiene and legal moralism, which remained influential in Britain into the 19^th century, towards more social models of public health that focus on health promotion, harm reduction and social justice.

The recent proposals in Edinburgh reveal a conflict that can arise when approaching a social problem through a criminal justice lens rather than one of public health.  Even with a greater focus on individual and population health that shies away from ideas of moral hygiene and legal moralism, there remain important tensions between criminal justice and public health concerns – especially in cases where it concerns sex and sexuality.  What is needed is an approach in which the criminal law – as well as other areas of law – is used as a public health tool that seeks to promote health and well-being, as opposed to being used to punish individuals’ choices we find distasteful or undesirable. 

HEAL has a strong interest in public health ethics and law.  Two of its core members (A.M. Viens and John Coggon) were editors of a volume that was published this month by Cambridge University Press entitled, Criminal Law, Philosophy and Public Health Practice.  Bringing together international experts from a variety of disciplines, including law, criminology, public health, philosophy and health policy, it explores the theoretical and practical implications of how the use of criminal law may promote or hinder public health goals.

A.M. Viens

Discussing Case Narratives: UCL Social Values Workshop

On 1 November 2013, Professor Jonathan Montgomery (UCL, formerly Southampton) and Dr Caroline Jones presented their initial ideas on a case narrative methodology, in a paper entitled ‘A Tale of Two Citadels: competing narratives in a case biography’, at the UCL Social Values Workshop. This research was supported by the British Academy and Leverhulme Trust small grant scheme, and Alex Chrysanthou (Southampton) provided the research assistance.

 Abstract:  This paper considers how clashes of social values in litigation over NHS funding decisions manifest themselves in the ‘biography’ of a case. It argues that the issues in AC v Berkshire West PCT [2010] EWHC 1162 (Admin) and (on appeal) [2011] EWCA Civ 247 can be seen in terms of two competing narratives; one about discrimination and transgender individuals, the other concerning bureaucratic rationality and prioritisation processes. Each narrative can be conceptualised as a siege on a well defended citadel. The first seeks to break down the barriers excluding transgendered people from full recognition in English law and society. The second tries to wrestle resource allocation from professional and managerial discretion into rights-based scrutiny. 

These competing narratives appear in the selection of legal teams, the overlapping but distinct networks in which cases are connected, and interpretive judgments by lawyers in and out of court. Choice between narratives provides significant framing effects for the assessment of social values, a feature that may be normal rather than unusual in contested legal cases.

[nb. The latest protocol on access to gender identity services from NHS England can be found at: http://www.england.nhs.uk/2013/10/28/gender-protocol/]

Caroline Jones

Injecting contraception in schools?

This is a guest post by Emma Nottingham.

The Daily Telegraph has conducted a survey which revealed that contraceptive injections are being offered in a range of schools across the UK in including Bristol, Northumbria, Peterborough, CountyDurham, the West Midlands and Berkshire. The front page story has expressed concern that school girls as young as thirteen are being given the contraceptive injection at school, without their parents’ knowledge. Statistics revealed that school nurses have given the contraceptive jab or implant to girls between the ages of 13 and 16 more than 900 times in the last two years. The medical profession, including school nurses are bound by rules on confidentiality.

Outrage was expressed by parents in Southampton earlier this year after finding out that children were being given the contraceptive implant in schools without their consent, as part of a wider government initiative to reduce the number of teenage pregnancies. The contraceptive implant works to prevent pregnancy by releasing the hormone progesterone into the bloodstream from a 4cm rod which is inserted into the arm and is effective for up to three years. The contraceptive injection is effective for three months.

The issue of under-16 year olds’ competency to consent to contraceptive advice and treatment without parental consent was settled in the case of Gillick v Wisbech and West Norfolk Health Authority and another [1985] 3 All ER 402, after Victoria Gillick took legal action against the Department of Health and Social Security in response to their 1980 circular on family planning which endorsed confidential contraceptive advice and treatment for under-16 year olds.

Despite the legal settlement of this issue 27 years ago, under-16 year olds’ access to contraceptive treatment without parental consent remains controversial, particularly in light of the advancement in medical technology which offers a wider variety of treatments to females, such as the implant and contraceptive injection, which were not available at the time of Gillick.

 

World first: Podiatrists & Physiotherapists ‘set to gain prescribing powers’

Today, Ministers have announced their approval to lay amendments to medicines legislation before parliament that will allow independent prescribing responsibilities to be extended to appropriately qualified physiotherapists and podiatrists. According to the DH press release (available on-line), this is a novel breakthrough: “Once suitably trained, physiotherapists and podiatrists in the UK would be the first in the world to be able to independently prescribe medicines where clinically appropriate.”

HEAL responded to both public consultations in 2011, and we are delighted to see we have been cited in both summary reports of the responses (physio & podiatrist). First,  in the Podiatrists Report [page 15], in the summary of responses to Q 1 on the ‘preferred option[s] for introducing independent prescribing (IP) by podiatrists’:  [ Option 1  was ‘independent prescribing for any condition from a full formulary’]

“Option 1 provides good opportunities to ensure and enhance responsiveness to patient need, widen patient choice, and enhance accessibility to medicines in terms of location as well as provider. It will also further support role flexibility and workforce redesign, ensuring better use of GP time and more collaborative inter-professional working. In addition, there is evidence to suggest that independent prescribing by nurses and pharmacists is operating safely and patients are satisfied (Latter et al, 2010; http://eprints.soton.ac.uk/184777/).”  Health, Ethics and Law network, University of Southampton 

Second, in the Physiotherapists Report [p36] in the section on ‘comments relating to practice guidance’:

“The Health Ethics and Law network acknowledges that the professional guidance documents for both podiatry and physiotherapy offer clear guidance to both NHS and private practice practitioners, and offers a relevant governance structure for prescribing. It is comparable in the structure and content to other NMP professional and regulatory body guidance documents (such as that provided by the Nursing and Midwifery Council, and the College of Optometrists) for professions currently with Independent Prescriber members/registrants.”
Health, Ethics and Law network, University of Southampton

According to the press release “physiotherapists and podiatrists who have successfully completed Health Professions Council (HPC) approved education programmes and are annotated on theHPCregister could be prescribing independently in 2014.”

Howard League Commission on Sex in Prisons

HEAL member Roger Ingham is to be a member of an independent Commission on Sex in Prison launched by the Howard League for Penal Reform 

The Commission  will focus on three broad themes:

• consensual sex in prisons
• coercive sex in prisons
• healthy sexual development among young people in prison.

It will undertake the first ever review of sex inside prison where it is unlawful to have sex because prison cells are deemed to be public places.  There is currently little reliable evidence available on both consensual and coercive sexual activity in prisons. It is not known to what extent men and women who identify as heterosexual may have sex with other prisoners while in prison. The Commission will also consider coercive sex which could involve rape, harassment, intimidation, assault or bribery.

The purpose of the Commission is to understand the nature and the scale of the issues and problems, making a series of recommendations with a view to making prisons safer. It will also examine how the situation in England and Wales differs from other international contexts, looking for best practice.

The Commission on Sex in Prison will undertake primary research, conduct visits and hear evidence from experts. It is expected to publish briefings on interim findings and produce a final report at the end of the two year investigation

Jonathan Montgomery appointed to chair Health Research Authority

The Secretary of State for Health has appointed HEAL member Professor Jonathan Montgomery to chair the Health Research Authority, describing him as ‘a leading expert in healthcare law, genetics and bioethics, and in addition he has an in-depth knowledge of the NHS gained from working on two NHS Trusts, a Primary Care Trust and a Strategic Health Authority. His depth of knowledge and breadth of experience will be vital in helping the Health Research Authority to safeguard the interests of patients whilst streamlining health research regulations.’

Jonathan says “I feel privileged to be appointed to chair the Health Research Authority. My first public service role was on a local research ethics committee and I know how important they are to safeguard the interests of participants. We can be proud of our country’s contribution to health research. Even so, some of our NHS approval processes delay high quality projects, especially those involving a number of different centres. We will continue to work to ensure that it is easy to carry out ethical research so that we make our contribution to ensuring that the highest levels of human knowledge and skill can be brought to bear to save lives and improve health as the NHS Constitution promises.”

The appointment was noted in a House of Lords debate on the Health Research Authority (Amendment) Regulations 2012 and will be followed shortly by the appointment of a chief executive and non executive directors.

Jonathan will withdraw from his local NHS roles once handover arrangements have been agreed  and so will maintain his current work at the University of Southampton and his chairmanship of the Nuffield Council on Bioethics.

 

Ethics in a complex world

The HEAL team members (Hazel, Jonathan and Caroline)  are excited to be involved in a new Curriculum Innovation Programme module to be offered in 2012/13: ‘Ethics in a complex world’, enthusiastically led by Dr Julie Wintrup from Health Sciences, and joined by Prof Roger Ingham, Dr Angela Fenwick, Dr Alex Furr and Fiona Harvey – with news of further colleagues joining the team to be confirmed later this year!

         

For more information check us out here & on YouTube.   

Donor conception: interesting times

In the late 1990s the wisdom of choosing sperm donation/donor conception as the focus of my research was something that I was questioned about more than once. It was seen as a ‘dated’ subject; after all it wasn’t about the latest technological developments or indicative of where science or policy might go next. But, those concerns fell by the wayside in the early 2000s when this field hit centre stage once again, and it shows no signs of letting up a decade or so later. A cursory glance at the news in the last week or so gives rise to a range of stories:

• From the ‘world first’ recommendation, in Australia, from the Victorian Parliament’s Law Reform Committee that all donor conceived people should have access to donor information, and where needed anonymity should be revoked retrospectively; further commentary and links are available on Bionews.

 

• ‘Children of sperm donors should be told’ read one headline in The Independent (02 April, 2012; ie they should be informed about the mode of their conception – it does not seem that those interviewed were asked questions about the donor’s identity per se). 

 

• The Nuffield Council on Bioethics is seeking written submissions of evidence by 15 May 2012 on ‘information disclosure’.

 

• The HFEA launched its drive to increase the numbers of egg and sperm donors, seeking members for a new National Donation Strategy Group (applications by 1 May 2012).

 

• And last, but not least, ‘British sperm donor “fathered 600 children” was the lead headline for the Sunday Times (08 April, 2012); on 10 April 2012 this was ranked the ‘most read’ article in The Sunday Times on-line. This story later appeared in The Telegraph: ‘British man “fathered 600 children” at own fertility clinic’.  

Sometimes the ‘old’ questions or supposedly ‘settled’ issues give rise to the most interesting conundrums, in health care policy and law and beyond.

New Chair for NHS Commissioning Board

Former Southampton law lecturer, Malcolm Grant, has been announced as  the preferred candidate to Chair the NHS Commissioning Board and will appear before the Health Select Committee this morning prior to his appointment being confirmed.

The Commissioning Board will be at the centre of the NHS, and Malcolm’s appointment is a crucial one. The Commissioning Board will establish the strategy for the NHS under the reforms to be introduced by the Health and Social Care Bill currently before Parliament and oversee its operation. We already know that Sir David Nicholson will be the first chief executive of the Board, ultimately to be known by the modest name of NHS England. That provides continuity with the current system. The Chair needs to respect the learning of the past, but also be bold in shaping a better future.

It is easy to see why Malcolm was an attractive candidate. He has an impressive record of delivery in public facing organisations with a global reputation, having built University College London (of which he is currently Provost) into a strong global brand. He is used to working in a knowledge based economy with some of the leading practitioners in the world, something the NHS aspires to (and sometimes, but sadly not always, achieves). He is familiar with the political dynamics of policy making in the public sector, having chaired the Local Government  Commission for England for five years. He is no stranger to public concern, having chaired the Independent Steering Board for the  Public Debate on Genetically Modified Foods. He can work with business and has a Prime Ministerial appointment as British Business Ambassador to show for it. All in all, well qualified for the role.

We look forward to seeing how he tackles his new NHS position.

Jonathan Montgomery declares interests as both chair of NHS Hampshire and also a former colleague of Malcolm’s when he was at Southampton’s Law School. The views expressed are, of course, his own.