Research on the Defence of Diminished Responsibility

Research Proposal

Provocation, diminished responsibility and the reasonable (wo)man; the implications of the Law Reform Commission’s recommendations.

Introduction

The crime of murder is one defined by the common law as the intention to unlawfully kill another human being with malice afore thought. Currently, in England and Wales the legal system does not differentiate between different ‘types’ of murder, such as first and second degree.[1] There are however, defences available to defendants, which could enable either an acquittal (some general defences), or a conviction of some lesser offence (specific defences). Under the Homicide Act 1957 an individual can plead the defences of provocation, diminished responsibility or claim that he or she was involved in a suicide pact. If such defences are successful, this will have the result of bringing a charge of murder down to one of manslaughter and thus, termed ‘voluntary manslaughter’. The first of the two defences have developed a considerable amount of case law and many of these decisions have related to abusive relationships where the abused has killed the alleged abuser.

The law relating to the defence of provocation has held that an individual must have been provoked (by either words or actions), resulting in a total loss of self control,[2] and that a reasonable person in the same situation would have acted in the same manner. The first two aspects of the defence have been referred to as the ‘subjective’ elements and the third part as ‘objective’. The so-called objective element has become more and more subjective in nature. In R v Camplin, Lord Diplock acknowledged that the test was not ‘wholly objective’[3] and in the case of R v Smith (Morgan James)[4] it was asserted that the characteristics of the defendant should be attributed to the ‘reasonable person’ and this includes not only characteristics that had bearing on the actual provocation, but also on the ability of an individual to maintain his or her self control. In context of the so-called ‘battered wife’ cases, the judiciary have also applied this principle.[5]

The specific defences outlined above are justified on the basis that in some circumstances, the law should recognise that there are reasons as to why an individual should not be convicted of the more serious offence of murder and thus, subject to a mandatory life sentence. The issue with the provocation defence relating to an individual who has suffered long-term abuse, is that such individuals will not always be able to rely on it as there may be some aspect of pre-meditation. The law has also recognised that such individuals suffering from some ‘abnormality of mind’ may not be fully responsible for his or her conduct and therefore should be convicted of manslaughter instead of murder. The effect of abuse on an individual’s mental state can in certain circumstances, amount to an ‘abnormality of mind’ and thus satisfy the defence of diminished responsibility.[6]

The purpose of the proposed research is to examine the current state of the law and look at the way in which abused women are dealt with when charged with murder. In line with the Law Commission’s proposals to reform the law of homicide, the research will also examine the extent to which the proposed change in the law will impact on this area. It is submitted that the current state of the law is not adequate in dealing with such individuals and it remains to be answered as to whether the proposals will make any real difference.

The Law Commission’s Consultation Paper proposes to maintain the defence of diminished responsibility and comments that there are no grounds for abolishing the defence based upon arguments that it gender discriminatory. The paper comments at one point:

“Was the abnormality of mental functioning really a substantial cause of the defendant’s conduct if other factors were at work? Or, were the other factors, jealousy, anger, a desire to dominate or punish, the real or predominant explanation, with the abnormality of mind being a minor background factor of inadequate moral significance to affect the verdict?”[7]

The research will examine the defence of provocation and the so-called objective element in order to determine how this fits with the nature of a long term build up of abuse suffered by some women. Is there a true ‘loss of control’ in such circumstances and is it appropriate to attribute the full characteristics of such people to the reasonable (wo)man? Furthermore, by also enabling such individuals to plead the defence of diminished responsibility, as the above quote would seem to suggest, is the law simply ‘categorising’ these people to as their conduct is not viewed quite as seriously as a person who commits murder? Thus, the term ‘abnormality of mind’ is not one used in psychiatric terminology and the courts have been left to establish exactly what the phrase means on a case-by-case basis. It seems doubtful as to whether this is a sufficient approach for the law to take.

Objectives

Analyse the current law relating to the defences of provocation and diminished responsibility and establish how these apply to women in long-term abusive relationships.
Present the justifications for the defences and apply them in context of the proposed research theme.
Establish the proposed reforms in the area.
Critically analyse the proposed reforms in line with the research topic in order to determine whether they are sufficient.

Value of the Research

Add to the current academic debate in this field.
Establish the appropriateness of the Law Commission’s reforms.
Personal interest to the researcher.

Theoretical research based on literature search and critical analysis.

Sources:

Domestic legislation, cases in domestic and international jurisdictions
Books and periodical articles.
Law Commission Reports.
Statistics from the Home Office (relating to domestic violence/fatal offences from domestic relationships).
Preliminary Plan (Chapters)
Abstract
Introduction and overview of the topic
Analysis of the existing law on provocation/diminished responsibility
Analysis of the Law Commission’s proposals for reform
Conclusion (including any further suggestions for the direction the law should take for the future).

Essential Reading:

(As well as the most current academic text books on the subject)

Legislation:

Homicide Act 1957

Family Law Act 1996 – see Part IV relating to domestic violence provisions

Protection From Harassment Act 1997

See also the Law Reform’s paper: The Law Commission Consultation Paper No 177, A New Homicide Act For England And Wales?

At http://www.lawcom.gov.uk/docs/cp177_web.pdf

Cases:

Jersey v Holley [2005] UKPC 23 R v Mohammed [2005] EWCA Crim 180 R v Ahluwalia (1992) 4 All.E.R 889 R v Bedder (1954) 2All.E.R. 801 DPP v Camplin (1978) A.C. 705 R v Duffy [1949] 1 All.E.R 932 R v Newell (1980) 71 Cr.App.R. 331 R v Roberts [1990] Crim.L.R 122 R v Thornton (No.2) (1996) 2 All.E.R 1023 R v Richens (1993) 4 All.E.R 877 R v Humphreys (1995) 4 All E.R 1008 R v Morhall (1995) 3 All E.R 659 R v Luc Thiet Thuan (1996) 2 All E.R 1033 R v Smith (Morgan James) (2000) 4 All. E.R. 289 R v Keaveney (2004) LTL 22.04.04 Extempore – unreported – find it on Lawtel

Journals:

Toczek, ‘The action of the reasonable man’, (1996) N.L.J. 146, 835 Toczek, ‘Self-control and the Reasonable Man’ (2000) NLJ 150, 1222 Oliver, ‘Provocation and non-violent homosexual advances’ (1999) J.Crim.L. 63(6) 586-592 Thomas, ‘Sentencing: manslaughter – manslaughter by reason of provocation – manslaughter of spouse of partner’ (2003) Crim.L.R. June 414-417 Neal & Bagaric, ‘Provocation: the ongoing subservience of principle to tradition’, (2003) J.Crim.L 67(3) 237-256 Gardner, ‘The mark of responsibility’ (2003) O.J.L.S 23(2) 157-171

{N.B – Some psychology literature may be relevant on this topic – search the online journals for killing stemming from domestic violence.

Further research will also be needed to obtain further literature – search www.ingenta.com and your university library should be able to order any articles of relevance that they do not have on site/access to online journal. Also search for any recent reviews of the Law Commission’s proposals

You may also need to add to this proposal and include a timescale and any further information you wish to add – such as the length of the research (this is obviously information not available)}

1

Acupuncture for Chronic Headache in Primary Care

Research Critique

Introduction

Research involves the use of systematic procedures to answer an inquiry. It involves data collection, synthesis and analysis in the light of the question or inquiry; and formulation of conclusions and recommendations, (Badke, 2004). General types of research include experimental studies which “are used to test the effect of a treatment or intervention”, (Peat, 2001, p. 16). Clinical trails fall under the broad category of experimental trials. Clinical trials are controlled experiments with patients, which range from “studies to prevent, detect, diagnose, control and treat health problems to studies of the psychological impact of a health problem and ways to improve people’s health, comfort, functioning, and quality of life”, (Brooten, 2006, p.86). Generally, clinical trials can be categorised into either randomised trials or non-randomised trials.

This paper will try to evaluate the scientific research conducted by Vickers and colleagues (2004), entitled: Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial, which was published on 15 March 2004 at the British Medical Journal. This particular topic was selected due to its relevance to this field of study. Numerous insights from this field of study and valuable best practice information in quantitative research methods can be gained from undertaking this critiquing task. This critique will be carried out using the research framework for critiquing health research formulated by Caldwell and co-workers (2005), which provides a comprehensive set of criteria against which the elements of the research article by Vickers and colleagues (2004) can be appropriately measured. This paper will first evaluate the overview of the study, including the abstract, literature review and the methodology used. Next, it will critically analyse issues concerning research ethics, data protection and research funding. Then, it will evaluate the reliability, validity of the research results, including the sampling methods employed. It will then identify the specific strengths and weaknesses of the research article. Finally, the concluding judgement about the research article will be presented.

Below are the definitions of selected important terms used in the research article:

Acupuncture – pertains to the “technique of traditional Chinese medicine, in which a number of very fine metal needles are inserted into the skin at specially designated points”, (“Acupuncture”, 2007).
ANCOVA – stands for ‘analysis of covariance’ which is a statistical treatment that combines analysis of variance (ANOVA) and regression; whereby “the predictable component of the individual differences can be removed with regression analysis”, (Anderson, 2001, p. 283).
Chronic – “all impairments or deviations from normal that have one or more of the following characteristics: are permanent; leave residual disability; are caused by nonreversible pathological alteration; require special training of the patient for rehabilitation; or may be expected to require a long period of supervision, observation or care”, (Sidell, 1997, p. 1)
Negative binomial regression – “is one of a class of mixed Poisson models that mix a second source of variance with the Poisson variance to account for overdispersion”, (Cohen, et al., 2003, p. 531).
Outcome measures – “reflect patient health status at either the individual or the aggregate (population) level”, (Stommel & Wills, 2004, p. 234).
Randomised trial – A randomised trial is a clinical trial that pertains to “an experiment in which therapies under investigation are allocated by a chance mechanism”, (Brooten, 2006, p.86).
Sham Treatment – is the experimental treatment that “has no effect and which subjects cannot distinguish from the active treatment “(Peat, 2001, p. 20).

Critical Analysis

In March 15, 2004, the BMJ Publishing Group Ltd, a wholly owned subsidiary of the British Medical Association, published the research article in its medical journal, the British Medical Journal (BMJ). Its “print BMJ has been published continuously since 1840, and now appears in four weekly editions, varying only in their advertising content. Together, their circulation totals about 122 000 copies, of which 10 000 are distributed outside Britain”, (BMJ, undated). Its website provides “the full text of everything published in the print journal since 1994, as well as much material unique to the web”, (BMJ, undated).These make the BMJ Publishing Group Ltd. an influential and authoritative source of medical articles.

The authors are recognized medical practitioners with different fields of specialisations. Andrew Vickers is an assistant attending research methodologist at the Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center in New York; Rebecca Rees is a research officer at the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit in London; Catherine E Zollman is a general medical practitioner from Montpelier Health Centre in Bristol; Rob McCarney is a research officer at the Department of Psychological Medicine, Imperial College in London; Nadia Ellis is lecturer Department of Health and Social Sciences, Coventry University in Coventry; and both Peter Fisher, who is the director of research and Robbert Van Haselen who works as the deputy director of research are from Royal London Homeopathic Hospital. Thus, based on their qualifications, the authors have the credibility, needed knowledge and expertise to engage in an extensive scientific study such as the article being evaluated.

The article is appropriately titled as Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial, since it essentially focussed on the effectiveness of the use of acupuncture to relieve chronic headache. Moreover, the title expressly implies that the methodology utilizes a large sample in the randomised trial. The abstract appears to be concise and complete. In a few paragraphs, the essential research components were summarised in the abstract, namely: (1) the research objective; (2) setting; (3) participants; (4) interventions; (5) main outcome measures; (6) results; and (7) conclusions. The abstract provides the complete key information that the readers need to fully understand the article. The introduction explained the health costs related to headache, which is the main topic of the article, including the need to apply other approaches in its treatment, particularly, acupuncture. The introduction also provides the main aim or rationale of the study, which was: “to estimate the effects of acupuncture in practice” in general; and “to determine the effects of a policy of ‘use acupuncture’ on headache, health status, days off sick, and use of resources in patients with chronic headache compared with a policy of “avoid acupuncture”, in particular, (Vickers et al., 2004). However, the literature review was limited to only one source of published work – the Cochrane review of 26 randomised trials. This would be very insufficient in terms of the extent of evaluating available sources of information related to the topic of the study. Moreover, it does not provide a comprehensive evaluation of scholarly work from which the rationale of the study could be based.

The study is a quantitative research, since the data obtained are represented in the form of numbers and statistical treatment was employed to interpret the data gathered (Grinnell & Unrau, 2005, p. 62). Despite the lack of implicit statement of the hypothesis, the audience or reader can obtain a general notion or idea of what is being tested (the effectiveness of acupuncture in the treatment of chronic headache). However, the variables were not clearly defined. Nevertheless, the procedures employed in the methodology were intricate and systematic. The participants were clearly identified and adequately described in the study. In the accrual of patients, several stages were established to facilitate the flow and recruitment of participants. Figure 1 in the appendix illustrates the flow of participants in the study. Moreover, ethical principles were upheld during the conduct of participant recruitment. Since most legal instruments expressly prohibit the use of human subjects for medical research, the researchers obtained written informed consent from the participants.

The researchers implemented a system to ensure randomization of the study through a ‘password protected database’, thereby eliminating the potential for bias and subsequently improving the quality of the results. As Peat (2001, p. 28), explains: “ in randomised controlled trials, the quality of the evidence is improved if measurement bias, such as observer or reporting bias, is reduced by using objective outcome measurements and if observers are blinded to the group status of the subjects. The method of data collection proves to be valid and reliable, as evidenced by the relatively high number of treatments (12 treatments) employed over a sufficient length of time (3 months). Moreover, a follow-up procedure was implemented to generate “a global estimate of current and baseline headache severity”, (Vickers, et al., 2004). This further enhanced the validity of the results. The large sample size helped ensure the reliability of the results. Additionally, the use of measurable outcomes such as the Likert scale of headache severity helped eliminate bias by extending common measurement criteria for the respondents. The article correlated its results with the findings in “prior literature on acupuncture”, (Vickers, et al., 2004), suggesting a high degree of validity of results generated.

The presentation of results was systematic and at the same time, clear and comprehensive. The results portion explained the process of participant recruitment including the flow of participants through the trial, patient compliance and dropout rate and their characteristics. It also provided a clear explanation of data that were obtained with accompanying tables and graphs. Thus, the audience can easily comprehend the results obtained. In the discussion, the results generated were translated into the main findings of the study which were stated in a clear, yet simple manner. Moreover, the strengths and the limitations were identified and discussed clearly.

The strengths of the research article are anchored on its methodology, such as in the recruitment of participants with a large sample size, the implementation of a system to conceal the randomization and the meticulous follow-up procedure one year after the experiment. Such procedures helped ensure that the research findings are reliable and valid. On the other hand, one of the limitations of the study is the absence of sham acupuncture for the participants, thereby failing to consider the potential placebo effects. Additionally, the participants were not blinded in the study; thereby raising the possibility of bias in terms of the participants’ assessments of their headache scores. In terms of the literature review, the article failed to provide an objective evaluation of a sufficient body of literature related to the topic of the research. Thus, it failed to address the gaps in knowledge related to acupuncture and chronic headache due to the lack of an extensive evaluation of available literature.

Conclusion

In the final analysis, the research article serves as an additional source of authoritative and credible information regarding the use of acupuncture for the relief of chronic headache. The findings of the study strongly support available scientific evidence. The weaknesses of the research article discussed above can serve as important considerations for researchers who are planning to engage in a similar undertaking – they must evaluate a substantial body of literature to gain insight into the currently available information and subsequently identify knowledge gaps. Moreover, future randomised clinical studies in acupuncture should include a sham treatment to be able to consider potential placebo effects; and blinding of participants must be observed to eliminate bias.

Bibliography

Acupuncture. (2007). In The Columbia Encyclopedia (6th ed.). New York: Columbia University Press.
Anderson, N.H., 2001. Empirical Direction in Design and Analysis. Mahwah, NJ: Lawrence Erlbaum Associates.
Badke, W.B., 2004. Research strategies: Finding your way through the information fog. (Second Edition). New York: iUniverse, Inc.
British Medical Journal. Undated. Available from: http://resources.bmj.com/bmj/about-bmj. [Accessed: 18 April, 2008].
Brooten, D., 2006. Clinical Trails. In: Encyclopedia of Nursing Research (Second Edition). Joyce Fitzpatrick and Wallace, J.J., (Eds). New York: Springer Publishing Company.
Caldwell, K., Henshaw, L., Taylor, G., 2005. Developing a framework for critiquing health research. Journal of Health, Social and Environmental Issues, 6(1), 45-54.
Cohen, J., Cohen, P., West, S.G. and Aiken, L.S., 2003. Applied Multiple Regression / Correlation Analysis for the Behavioral Sciences. Hillsdale, NJ: Erlbaum.
Grinnell, R. M., Unrau, Y. A., (Eds.), 2005. Social Work Research and Evaluation: Quantitative and Qualitative Approaches (7th ed.). New York: Oxford University Press.
Peat, J. K. (Ed.), 2001. Health Science Research: A Handbook of Quantitative Methods. Crows Nest, N.S.W.: Allen & Unwin.
Sidell, N. L. , 1997. Adult Adjustment to Chronic Illness: A Review of the Literature. Health and Social Work, 22(1), 5+.
Stommels, M., Wills, C.E., 2004. Clinical Research: Concepts and Principles for Advanced Practice Nurses. Philadelphia: Lippincott Williams and Wilkins
Vickers, A.J., Rees, R., Zollman, C.E., McCarney, R., Smith, C.M., Ellis, N., Fisher, P., 2004. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. Available from: http://www.bmj.com/cgi/content/full/328/7442/744. [Accessed: 15 April 2008].

Appendix

Figure 1Flow of Participants Through the Trial

Source: Vickers, et al., 2004

Analysis of the Public and Private Sports Industry

Public, private and voluntary sectors in the sports industry, advantages and disadvantages of the leisure centre being in the public sector, how the local leisure centre can meet the aim of getting more local clubs to use its facilities.

Introduction

“Since the opportunity to participate in sport or recreation requires facilities, the central task of organisations, and associated individuals, is to provide a service which focuses on people and which satisfies that need.”[1]

The sports industry has changed beyond all recognition since the beginning of the 1990’s in each of the public, private and voluntary sectors. The impetus has come from top level government policy with the creation of the UK Sports Council and the formation of the chief sporting bodies such as Sport England offering both funding and structure to the previously ad hoc nature of leisure and recreation in modern Britain. Moreover, the lure of professional sport has also irrevocably changed in tandem with the structural changes in amateur sport with the result that there is, at the dawn of the twenty first century, more people are taking an active part in sport, which has further increased the pressure on local services such as leisure centres. There are though vast differences between the way that the public and private sector sports providers are run and funded as shall now become apparent.

The Private Sector

With regards to the sports industry, the private sector refers to those leisure services that are funded by private capital and open only to private membership. This can mean anything from specialist professional sports clubs to health and fitness clubs to local sports teams that have been established and sponsored by local and national businesses alike. The advantages of this kind of sporting industry are predominantly economic with the funding of private sports clubs historically far outstripping the economic resources available to equivalent public sector sports services. Certainly in the 1970’s and 1980’s, private sector sports industries were far more popular and productive than their public sector counterparts mirrored in the elevated sporting achievements of private school sporting institutions as opposed to the relative failings of the same public (comprehensive) school sports bodies. There are, however, inherent disadvantages to sports and leisure services that rely exclusively on the private sector for funding. First and foremost, there are no guarantees that the source of that funding will remain constant for any fixed length of time. Benefactors are subject to the ups and downs of the free market economy, which can result in sharp reductions – as well as rises – in the level of funding provided. In addition, any leisure service that is inexorably tied to the private sector also inevitably suffers from the lack of community spirit that can only be adequately garnered through association with the local public authorities. Thus, while the advantages to sports services in the private sector appear on the surface to be all encompassing, the reality is that the lack of stability that characterises all facets of the private sector economy hampers the sustained growth and popularity.

The Public Sector

“We know that sport can make a positive contribution to national morale, health and the economy. We believe that it can enhance community spirit, equality of opportunity, personal development and social integration.”[2]

As the above quotation from the UK Sports Council in 1992 attests, the government has radically altered the way in which it views sport and the national leisure industry. The leisure industry is no longer seen as a vehicle through which to achieve solely sporting success; rather, sport – within the corridors of power in Westminster – is now seen as a way of combating such issues as obesity, social exclusion and perceived self?competence.

“Sports are vehicles of identity, providing people with a sense of difference and a way of classifying themselves and others.”[3]

As a direct result, funding within the public sector has seen a sharp, unprecedented rise since the early 1990’s with the government acting as the focal point behind this increase in official spending. An investment of ?1.5 billion over the next five years by way of state sponsored assistance has been promised by Westminster to further increase the organisational structures and performance levels of adult and child athletes who train and practice within the public sector. This money, bolstered by funding generated from institutions such as the National Lottery, is delegated to local sports authorities within Sport England, Sport Wales, Sport Scotland or Sport Northern Ireland and injected into the local community. Furthermore, local government spends approximately ?1 billion per year on sport and leisure, which is more than 50% of the total resources available to sport. This financial injection is far beyond any investment proposed by private capital; in fact, because of this large economic discrepancy, the private sector has increasingly sought to form a partnership with the public sector in order to be associated with the vast increase in interest in sport as witnessed in recent years.

Moreover, public sector sports services also get to reap the rewards of the government’s efforts at placing the country on the international sporting map. The 2002 Commonwealth Games in Manchester and, more significantly, the 2012 Olympic Games to be held in London will prove to be long term sources of investment for all those with an active interest in public sector sporting services. Not only has funding vastly increased (with the cost to the government estimated to be in excess of ?1 billion for the 2012 Games), the facilities that have been and are being constructed are open to the public after the completion of the official competition. In Manchester this has served to open up a city centre swimming pool, an athletics track and a football stadium for use within the public sector. The results for London are likely to be much more wholesale than in Manchester. Moreover, as the new facilities and funding increase, so the burgeoning association between national identity, local and central government and sport is further cemented. This has helped to push people into participating in public as opposed to private sports services, representing a significant turnaround from previous decades.

Like private sector sporting institutions, public sector services are similarly riddled with pros and cons. The most obvious advantage at the present time is the aforementioned increase in public authority funding and facilities open to the public sector, exacerbated by a media that constantly underlines the partnership taking place between local government and sport. This is, however, a double edged sword as the major disadvantage to public sector sports services concerns the very nature of government. Ultimately, just because it has suited New Labour to promote participation in recreation and sport is not to state that the Tories would necessarily feel the same. Thus, public sector sports are subject to the same ups and down and insecurities that beset the private sector.

The Voluntary Sector

Voluntary organisations rely heavily upon both the community and private enterprises for funding; they therefore straddle the boundaries that have traditionally separated the public and private sectors. Once more, though, it is the unprecedented rise in government funding that has been the voluntary sector’s greatest asset. The revamped Department for Culture, Media and Sport set up the Community Club Development Programme (CCDP) specifically to deal with the funding problems regarding the facilities and personnel required for the successful operation of volunteer sports clubs. The CCDP will provide ?100 million to National Sports Governing Bodies by March 2008 for the construction and continuation of community based sports clubs. Advantages to this kind of sporting authority centre upon the lack of reliance solely upon the public or the private sector, while conversely, at the same time, the lack of constant source of funding makes the voluntary sector the most vulnerable within the current social and political climate.

Conclusion

There are vast disparities between the public and private sectors with the local voluntary leisure centre enjoying the benefits of both worlds. For as long as the current climate favours the sports and recreation industry, the community leisure centre will continue to reap the rewards of a society renewing a relationship with exercise that had previously become stale. At present there is an excess of people interested in taking part in leisure and sport that is wholly to the benefit of local leisure centres that are able to charge admission fees that are significantly less than those on offer in the private sector. In addition, excessive government funding signals that the economic means at the public and voluntary sectors are currently vastly superior to those of the private sector. However, in the final analysis, one should not presume that the imbalance in favour of the public sector will remain as it is indefinitely. Should leisure and sport once again find themselves on the periphery of popular culture, we would surely see a reversal of contemporary trends with the balance tipped heavily in the private sector’s favour as is the case with health and education services. Politics, like economics, is subject to sweeping changes in a very short space of time.

References

Biddle, S., Sallis, J. and Cavill, N. (Eds.) (1998), Young and Active? Young People and Health Enhancing Physical Activity: Evidence and Implications London: Health Education Authority

Elvin, I.T. (1990), Sport and Physical Recreation London: Longman

Horne, J., Tomlinson, A. and Whannel, G. (2000), Understanding Sport: An Introduction to the Sociological and Cultural Analysis of Sport London: E & FN SPON

Hylton, K. (Ed.) (2001) Sports Development: Policy, Process and Practice London: Routledge

MacClancey, J. (1996) Sport, Identity and Ethnicity Oxford: Berg

Sport in the Nineties – New Horizons: a Draft Consultation (1992) London: UK Sports Council

‘Promissory estoppel is now a mature doctrine

“Promissory estoppel is now a mature doctrine. Its role is to mitigate some of the harshness of the doctrine of consideration by protecting those who reasonably rely on promises. Its full potential can only be reached if the court permits its use not merely as a shield, but as a sword, where appropriate. The decision of the Court of Appeal in Baird Textile Holdings Ltd v Marks and Spencer plc [2001] therefore represents a missed opportunity to clarify and modernise the law.”

Promissory estoppel is an important tool in equity to create fairness within contract law. It deals specifically with consideration, which as a doctrine holds the parties that have entered into a contract to which they both intend to be bound. Therefore the parties must have the capacity to be bound to the contract; as well as the intention to be bound by the contract. There must be a value to amount to consideration, which does not necessarily have to be monetary[1]. Consideration can be a right, interest, service, benefit to one party and sufficient detriment to the other party. [2] Consideration does not have to be equal on both sides; one party may only leave a nominal amount of consideration[3] As long as there is sufficient intention and the terms are not vague then the law will not get involved in business dealings; therefore the courts will infer intention[4]; as long as the consideration for that particular business dealing illustrates that there is sufficient consideration.[5] Insufficient consideration is any act where the duty is already imposed by law or a valid contractual duty. However, there are exceptions to the rules, because consideration at times can be deemed as far too harsh.

The case of Williams v Roffey Bros[6] held that consideration could be inferred in a pre-existing contractual duty if there was further consideration that could be inferred. For example this case recognized that the contractor would be subject to a significant late charge, if he did not re-negotiate his contract with the subcontractor to finish on time. Therefore the renegotiation of the pre-existing duty saved the contractor a loss of money, which the courts held as sufficient consideration. However, in the case of paying a partial debt there can never be consideration. The rule in Pinnel’s Case[7] was confirmed in the case of Foakes v Beer[8] where it was held that part payment of a debt could be held as consideration because there was an existing contractual duty. The rule in Pinnel’s Case is that promissory estoppel is an invalid action when it comes to the part payment of debt, unless it is paid in full and benefits both parties. The reasoning behind this is that part payment of debt is inequitable because the person who is supposed to benefit from the consideration is put at a detriment and therefore defeats on of the central tenants of consideration, which one party is at a sufficient benefit whilst the other party is at a sufficient detriment. There are circumstances where promissory estoppel is possible in regards to a reduced payment of a price or fee. The case of Central London Property Trust v High Trees House Ltd[9] is such a case, because the political and social environment was drastically changed. The two parties where a property owner and a business tenant, who then leased the property as flats to other individuals residentially. An agreed business tenancy price came into question during WWII, because of the bombings in London the situation made it impossible for the renter to pay the whole rent due to the bombing and lack of tenants. Here equity stepped and promissory estoppel was used, because it would be unfair to make the renter pay the whole rental amount due to the circumstances. In addition the agreement by the property owner to accept less due to the WWII inferred intention, because otherwise the landlord would receive no rent because the renter would have vacated the premises; and no other businesses would have taken up the tenancy during the war. This is a very specific scenario, where WWII could have amounted to frustration of the contract, because the war would have made it impossible for the renter to satisfy the contract and an act of war is outside his ambit of control. After the High Trees case the courts extended the doctrine of promissory estoppel in the case partial full partial payment of a debt; however if it were revealed that the re-negotiation was due was an action of duress that forced the creditor to agree to the new credit agreement then equity could not step in with the doctrine of promissory estoppel. One such case that illustrates that equity will only aid those with clean hands is the case of D & C Builders v Rees[10] where Rees discerned that the building company was in financial distress and tried to use this to her advantage by offering a smaller payment in full or nothing. This amounted to duress, because the knowledge that Rees had of the problems that D & C Builders were facing was used as a sword against a fair and equitable outcome. The key factor that surrounds the doctrine of Promissory Estoppel is that it originates out of equity and aims to create a just outcome, as in the High Trees Case. In the case of D & C Builders the use of Promissory Estoppel was for unjust purposes and equity could not aid Rees, because an injustice would occur.

High Trees is the case that the modern doctrine of Promissory Estoppel has developed from; however it was the Hughes Case that the doctrine originated from, where a landlord’s actions gave the tenant contrary belief in the events surrounding a notice to repair. Tool Metal Manufacturing Co Ltd v Tungsten Electric Co Ltd[11] case allows for suspension of payment to be reverted back to active payment as long as reasonable notice is given. This also means with the reasonable notice that the creditor can also receive compensation for the suspended payments; therefore ensuring that there is not a case of part payment of debt, because the interest can keep running. The only exception to this is an agreement of an early settlement, with a lump sum that is considered reasonable by both parties.

The Tool Metal Case and the Hughes Case point to the doctrine of promissory estoppel being a shield and not a sword of equitable justice, because it believes that consideration plays an essential part of contract law. To eradicate the harshness of consideration may allow individual like Rees in the D & C Builders Case to use Promissory Estoppel for unfair and unjust purposes. However, the High Trees Case that is the key case for the modern doctrine of Promissory Estoppel seems to be pointing in a different direction, i.e. that the doctrine is a sword against the harshness of consideration. In this case WWII made it impossible for the original contract to be kept to, hence the parties re-negotiated during this period. The case of Coombe v Coombe[12] argued that the doctrine in High Trees could not be identified as a sword against the doctrine of consideration; rather it can only be used as a defense to an action and in the interests of justice. The cases of Re Wyven Developments[13] and Evenden v Guildford City AFC[14] argued that Coombe v Coombe was incorrect and that the doctrine of Promissory Estoppel could be used as a sword; as well as a shield if justice and equity dictated.

The Coombe approach makes sense by ensuring that the rules surrounding contract law are upheld and ensuring that certainty in contracts remain; otherwise there would be a mass confusion where courts could get too involved in business contracts. English law is based on a laissez faire system, where business dealings should be free from the ministrations of parliament and the courts; as long as just and both parties were capable to enter the contract. As Mitchell argues, parties enter a contract with specific expectations and to turn these upside down would be a breach a fundamental principle of contract law:

While we could dismiss this as assimilating reasonable expectation with contractual rights, and therefore making the appeal to reasonable expectation redundant, it is clear that many appeals to reasonable expectation rely upon an institutional or contract law-based source for such expectations. Reiter and Swan, for example, write that ‘[t]he assumption is that the fundamental purpose of contract law is the protection and promotion of expectations reasonably created by contract’. If ‘contract’ here is taken in a legal, rather than a social sense, then the utility of reasonable expectations as a counter-contractual reference point is in danger of disappearing.[15]

Therefore in the light of the essential principles of contract law and the doctrine of consideration the decision of Baird v M&S[16] would have been the correct decision, otherwise there would be a free for all for parties to argue that the contract is unjust and flagrant actions of Promissory Estoppel would occur. However, Promissory Estoppel would still remain as a defense in cases where the situation dictated that there would be an unjust outcome if the contract was upheld in its present form. The case of Baird v M & S, Baird used Promissory Estoppel as an action to enforce what Baird classed as an unwritten contract. In other words Baird was arguing that the long term relationship between the two created a reasonable expectation that there was an ongoing business relationship, which could only be altered or terminated with reasonable notice; as per the Tool Metal Case. The Court of Appeal however decided against this approach, because the reason that M & S did not enter a written contractual agreement was for flexibility and the option of changing suppliers if market forces dictated this route. Also the Court of Appeal stated that the lack of a (legal) contract was determinative for the court. The estoppel claim was also thought likely to fail, since estoppel cannot be used to create a cause of action. It was remarked that, despite the close relationship between the parties, ‘businessmen must be taken to be aware that, without specific contractual protection, their business may suffer in consequence.[17] However, this argument seems to be very one-sided, because as with the High Trees Case the situation in Baird v M & S does indicate that there was intention to create some form of business and contractual relationship that benefited both parties. In fact the long history of Baird supplying the goods could be inferred as terms and conditions of the contract; however the lack of a written contract seems to be an excuse for the Court of Appeal to open up Promissory Estoppel as an action; as opposed to just a defense. Therefore, as Mitchell argues the decision in Baird v M & S could be taken either way because both sides were arguing certainty of contracts and reasonable expectation; however the determining factor not to find a contract was because of public policy reasons NOT to make Promissory Estoppel a cause of action (a Sword) and open the floodgates to further actions:

One can see how a ‘reasonable expectations’ argument can be used to support Baird or M & S, but each relies on a different basis for the reasonable expectation. Baird will have non-contractual reasonable expectations concerning the parties’ mutual obligations, based upon their experience of the previous thirty years. M & S, on the other hand, have reasonable expectations based on their strict legal rights, and supported in the judgement, that there is no contract and hence the relationship can be terminated at will-an institutional interpretation of reasonable expectation… This result does not support the attempt to make contract law more sensitive to the social dimension of agreement-making, but undermines it by privileging the legal framework in the resolution of the dispute.[18]

Bibliography:

J. Beatson (2002) Anson’s Law of Contract 28th Edition, Oxford University Press

Hooley (1991) Consideration and Existing Duty JBL 19-35

David Kelly, Ann Holmes & Ruth Hayward (2002) Business Law 4th Edition, Cavendish

Ewan McIntyre, (2004) Business Law, Longman

McKendrick, 2005, Contract law, text, cases and materials, second edition, Oxford University Press

Mitchell, 2003, Leading a Life of its own? The Roles of Reasonable Expectation in Contract Law, OJLS 23 639

Stallworthy (1994) Case Comment: Variation of Contracts, ICCR 5(7)

Chris Turner (2004) Unlocking Contract Law, Hodder Arnold

Procedural Fairness in Unfair Dismissal

Repeal of the Employment Act 2002 (Dispute Resolution) Regulations 2004: A report

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In October 2004 the government introduced a statutory minimum disciplinary and grievance procedure dealing with disputes in the workplace. These procedures and related rules are set out in the Employment Act 2002 (Dispute Resolution) Regulations 2004 and state that employers must follow a minimum dismissal and disciplinary procedure in the workplace or otherwise dismissal will be automatically unfair. When bringing a claim at the Employment Tribunal for unfair dismissal, employees are also entitled to additional compensation if these disciplinary and dismissal procedures are not adhered to. Although the aim of the Regulations was to encourage informal resolution of disputes, many employers felt that they were too complicated and did not achieve the desired aim. Gibbons (2007 pg.24)[1] sums up this view,

‘The procedures are seen as a prelude to employment tribunals, rather than a way of resolving problems in the workplace’

The Employment Bill 2007 therefore recommends a repeal of the Regulations for what is hoped will be a more straightforward regime likely to come into force in April 2009.

The Regulations

A standard dismissal procedure as per the Regulations involves the following three steps. The first is a letter which must be sent to the employee setting out the reason for dismissal and inviting them to a meeting at a convenient time and place. The employee must be given time in which to consider the letter and then has a duty having done so to take all reasonable steps to attend the meeting. The second step involves the actual meeting which has to be conducted in a manner which enables both employer and the employee to explain their case. After the meeting the employee must be notified of the decision and provided a right of appeal. The third step would be the appeal process and if the employee wishes to appeal, they must inform the employer who will then invite them to an appeal meeting. The onus is on the employee to take all reasonable steps to attend this appeal meeting and as far as is practicable a more senior manager from the organisation should attend the appeal meeting.

The appeal meeting must be conducted in the manner in which enables both the employer and the employee to explain their case. After the meeting the employee must be notified of the final decision. During every meeting in the process, the employee has a right to be accompanied by a work colleague or a trade union official. This companion may address the hearing, confer with the employee during the hearing and may also sum up the employees case but must not answer questions on behalf of the employee.

In the case of a grievance against an employer the same steps must be followed with the letter sent from employee to employer stating the nature of the grievance and asking for a meeting to be held. Where the employee has already left employment the Regulations provide for a modified procedure that does not require the Step 2 meeting.

The problems created by the Regulations

When the Regulations came into force on the 1st October 2004 the government resolved to revisit them after two years. The Department of Trade and Industry confirmed this in its Success at Work Report (2007 pg. 8)[2]

‘This is a key part of DTI’s work to simplify regulation, by removing compliance costs and complexity, and addressing irritants for business and others affected by employment law, while ensuring that employee rights are protected.’

The government then commissioned an independent report on the 12th December 2006 written by Michael Gibbons who was asked to assess all employment dispute resolution procedures including suggestions for adapting the Regulations if he found them not to be fit for purpose. He interviewed over 60 employers, employees and intermediaries involved in dispute resolution. Gibbons in his report entitled Better Dispute Resolution (2007 pg.5) states[3],

‘In conducting the Review I was struck by the overwhelming consensus that the intentions of the 2004 Regulations were sound and that there had been a genuine attempt to keep them simple, and yet …as formal legislation they have failed to produce the desired policy outcome. This is perhaps a classic case of good policy, but inappropriately inflexible and prescriptive regulation.’

It became apparent that the regulations did not state clearly what a written grievance was or what it was to contain. With no specific guidance on this, parties called for procedural hearings at the ET to establish whether the claimant actually put their grievance in writing and whether all of the claims that were found in their Claim Form had previously been evidenced in the grievance letter. The respondents were claiming that this was not the case and therefore there was no case to answer. Therefore although the procedures were clear as to the steps to follow in bringing a dispute insufficient guidance was given about each stage leaving Tribunals with an increase in the number and length of proceedings. Gibbons explains the difficulty with identifying what constitutes a grievance letter (2007 pg.8),

‘…comments in resignation letters and in 360-degree feedback forms have been held to meet the requirements, so some employers feel it is necessary to check closely and investigate any written communication that might be construed as a grievance’

Although the intention of the regulations was for early informal resolution of disputes, the drafting of the Step 1 letter and consequent meetings in practice escalate many issues taking up management time and proving stressful for employees. Also the three step process as outlined above was not always adequate in all circumstances. Small businesses in particular have complained about the formal, ‘one size fits all’ approach of the regulations. Gibbons explains (2007 pg. 8),

‘…the appeal stage is an unnecessary burden, especially for small businesses. The appeal will often be to the same person who made the original decision. It can also be difficult in cases where employees have left the workplace. One business felt it necessary to follow the three-step procedures for each of their Christmas temporary staff before they left –

a process which added no value.’

The main thrust of the opposition to the current regime is that it has created an unhealthy overlap between the resolution of disputes and the litigation procedure which should as far as possible be kept separate. For example the regulations stipulate that before a claim is lodged at the Employment Tribunal (ET) a grievance letter must be sent to the employer within three months of the alleged dismissal or conduct. Any breach of the procedure would allow the Tribunal to grant up to 50% increase if the fault was that of the employer or 50% reduction in the award depending on whether the fault was that of the employee. Of course apart from the fact that it is not always easy to ascertain whose fault led to a breach of procedure such stipulations and penalties mean that litigation has to be considered at an early stage when resolution of the dispute should be paramount. Gibbon states (2007 pg.25),

‘Both large and small businesses have reported that the number of formal disputes has risen. The Review has heard that 30 to 40% increases have been typical in the retail sector.’

Further complications arise where there are multiple claims for example in an equal pay case and the three step process has to be repeated many times creating an unnecessary administrative burden. The same burden is also felt where and employer seeks to follow the disciplinary steps and at the same time the employee also seeks to pursue a grievance.

‘It is not always clear how the two strands of the Regulations should operate in such circumstances, and employers can feel compelled to hold excessive numbers of meetings and write excessive numbers of formal letters to be sure of fulfilling the procedural requirements’[4]

The proposed reforms

As a result of the Gibbons Review, the Government held a consultation and the responses received formed the basis of the present reform proposals published in the Employment Bill 2007 which has received royal assent and is now the Employment Act 2008.

The first major reform is for the Regulations to be repealed in their entirety in April 2009 and replaced with a revised ACAS Code of Practice (the Code) which has been agreed in draft form. There will also be non statutory guidance also provided by ACAS. ACAS stands for the Advisory Conciliation and Arbitration Service and currently offers employees an arbitration service as an alternative to resorting to proceedings. Also it has always provided a Code for resolving disputes but it is only now being adapted and incorporated into statute. In actual fact the revised ACAS code provides for the same three step procedure but does not incorporate the same penalties and conditions as the Regulations. There have also been some additional requirements which seem to lean towards ensuring that employees behave ‘reasonably’. The draft Code is designed to provide basic practical guidance for disciplinary and grievance procedures but is limited as it will not apply to dismissals as a result of redundancy[5] or expiration of a fixed term contract.The Code describes the remit it covers[6],

‘Disciplinary situations include misconduct and/or poor performance…Grievances are concerns, problems or complaints that employees raise with their Employers’

It suggests in the Foreword of the Code[7] that employers and employees should try to resolve disputes between them. However if they cannot, they should seek the help of an independent third party inside or outside the organisation. The Code provides that where the Employment Tribunal must ascertain compliance with the Code it will do this on a case by case basis taking into account the size and resources of the employer. Therefore unlike the Regulations there is no expectation that all business will comply with every provision in the Code providing greater flexibility for employers.

In relation to disciplinary procedures the first step is to establish the facts of each case by collating evidence and holding an investigatory meeting if necessary. The Code then states[8],

‘If it is decided that there is a disciplinary case to answer, the employee should be notified of this in writing. This notification should contain sufficient information about the alleged misconduct or poor performance and its possible consequences to enable the employee to prepare to answer the case at a disciplinary meeting’

New provisions provide for evidence collated including witness statements to be provided by the employer with the letter requesting a disciplinary meeting. Also an employee may call their own witnesses. The statutory right to be accompanied to this meeting still stands however the Code’s emphasis on ‘reasonableness’ is evidenced where it states[9],

‘However, it would not normally be reasonable for workers to insist on being accompanied by a companion whose presence would not prejudice the hearing nor would it be reasonable for a worker to ask to be accompanied by a companion from a remote geographical location if someone suitable and willing was available on site.’

The dispute Regulations had provided that on appeal the employer only had to make one attempt to reconvene the meeting however under the Code the employer has to show that the employee has persistently been unable or unwilling to attend before a decision can be made in their absence.[10] If the employee decides to appeal, grounds of appeal in writing must be submitted to the employer.[11] This requirement was not found in the Regulations and the idea behind it is to ensure that further time is not spent discussing issues that have already been covered in the first meeting.

In a case of a grievance for example instead of the emphasis on a Step 1 grievance letter, the revised Code states[12],

‘If it is not possible to resolve a grievance informally employees should raise the matter formally and without unreasonable delay’

The employee should inform the employer of the grievance preferably in writing and the letter should be addressed to the line manager. Unlike the Regulations, a claim would not be barred in absence of a grievance letter although a failure to send this letter would be a breach of the Code and may lead to a reduction in the award.

The Code states that a meeting must be heard pursuant to the letter and that the employee must have the right to be accompanied by a colleague or trade union official. As with the disciplinary procedure, the requirement here is that the right to be accompanied is reasonable. During the meeting the employer can ask for an adjournment in order to carry out an investigation. There is also a right of appeal and subsequently the employee can decide to take the matter further and pursue the case in the Employment Tribunal.

The new regime will not hold a dismissal to be automatically unfair if there has been a breach in procedure. Employment Tribunals will have to decide cases on what is fair and reasonable and will have discretionary powers to adjust awards of up to 25% if either employer or employee has not followed the ACAS code. In relation to this provision the government report Resolving Disputes in the Workplace Consultation (May 2008 pg.16) it states,

‘This will be a power rather than a duty in order to allow the employment tribunals discretion to apply it in the interests of justice and equity’

It is hoped that these reforms will give a higher level of flexibility in resolving work place disputes and various businesses can tailor the new regime to their specific needs. The Government has also agreed as part of the reform to invest ?37M into the ACAS helpline system in order to provide early mediation for workplace disputes that would otherwise result in tribunal claims. Resolving Disputes in the Workplace Consultation (May 2008 pg.16)[13] states,

‘The government considers the way forward should be a short non prescriptive Statutory Code setting out the principles of what and employer and employee must do supported by fuller statutory guidance’

The idea is that the new statutory code will provide guidance for employment tribunals and the non statutory guidance will be used by employers and employees. Where a grievance arises during a disciplinary process, the disciplinary may be suspended or both can be dealt with concurrently if related. The Code does not cover collective grievances which must be dealt with under the agreed collective grievances procedures agreed with trade unions.

The likely effect of these reforms on employers and employees

It is unlikely that the Code will have a major change on the dispute resolution process in the work place. The code incorporates the same three steps that were found in the Regulations. There is still a penalty of an increase or decrease in the award up to 25% depending on whether the employer or employee is at fault.

Because the employee is likely to suffer a reduction in compensation of up to 25 % the pressure to ensure a grievance letter is sent still remains. Although unlike the Regulations, the claim is not barred due to failure to lodge a grievance, the number of grievances brought by employees is not likely to be reduced for so long as there remains a penalty, albeit the employee at the grievance stage may not have considered litigation. So arguably there may not necessarily be reduction of time spent on hearing and processing grievances in the workplace.

Also with the repeal of the Regulations there is no automatically unfair dismissal because of non compliance. Many have argued that this places fewer restrictions on unscrupulous employers therefore increasing the likelihood of litigation. There would need to be clear communication by the government and business to their employees as to how the new regime will work and arrangements need to be put in place for the transition between the old and new procedures.

As far as practical points flowing from the provisions of the ACAS Code, the following would ensure that employers are taking the right steps to ensure compliance although there still remains areas of uncertainty that will only be made clear once the Code is put into practice.

Mediation training should be provided for Human Resources staff to act as internal mediators and consider compiling a list of good mediators outside the organisation.
In the Introduction of the Code, it states that employees should be involved where appropriate in the development of rules and procedures so to this end it would be prudent if employers hold consultation meetings with employees and their Trade Union Representatives during the transition period between the Regulations and the Code.
Guidelines should be provided as to how to provide a ‘reasonable opportunity’ to call witnesses (Clause 12) and establish in policy that that the right to be accompanied is subject to considerations as to reasonableness (Clause 15). These issues are clearly subjective and would vary on a case by case basis and are therefore likely to prove controversial or even problematic
Guidelines should be drafted as to when and under what circumstances the employee has shown inability or unwillingness to attend a disciplinary meeting without good cause.
Different people should oversee the investigatory and later the disciplinary process.

In order to facilitate early resolution of disputes as well as implementing the Code the government also intends for ACAS to provide a helpline where simple disputes can be dealt with over the phone or by internet. This extends the existing right to mitigation that parties must be notified of in any dispute. However the issue is ensuring that ACS has the necessary funds and staff to successfully fulfil this role. Staff must be well trained in providing employment advice and negotiating settlement between parties. Another proposal is that the Employment Tribunal Application process should happen via the helpline giving claimants access to advice on their claim and alternatives to litigation.

Not all involved in the dispute resolution process favour these reforms. In the government report Resolving Disputes in the Workplace Consultation[14] it states

‘Opponents of repeal included a number of Trade Unions, representatives of vulnerable workers and individuals. Many cited the benefits of having a standard required procedure in all workplaces which operated to the benefit of workers in all types of organisations and encouraged good practice.’

From the point of view of an employee, the fear is that the new regime and its emphasis on ‘reasonableness’ leaves too much to the discretion of the employer. This coupled with the removal of the automatically unfair provision has left the issue of unfairness to the Employment Tribunal who will access the situation based on many factors other than breaches in the code including the size and resources of the employer. There is therefore an element of uncertainty in the new provisions certainly for the employee but for the employer as well. In the Legal Action Group’s response to the government consultation (June 2007) it states,[15]

‘Repeal of the Employment Act 2002 (Dispute Resolution) Regulations 2004 (the ‘regulations’), will not improve the poor position of the many, low paid, non-unionised, workers in the labour market. The government should act to protect the most vulnerable by encouraging trade union organisation and by other legislative measures.’

The concern of the Group is that the government’s emphasis on mediation could lead to vulnerable employees losing their right to a formal hearing to resolve disputes. In order for alternatives to litigation to be properly considered good quality advice needs to be available to all however only a third of the working population are trade union members. A lack of access to legal aid will mean that non members will not have proper recourse to legal advice. It seems unlikely that the ACAS helpline proposal will cater for all workplace disputes.

The Code has also been seen as unfair towards employees as it does not take into account that in reality there is rarely a balance of power between employer and employee. Employers have more resources and employees tend to already feel intimidated when bringing a grievance. A simple dispute could still have as its underlying cause a long term abusive policy against workers which of course cannot be resolved through a telephone conversation with an ACAS mediator. Indeed there are many categories of workers including the elderly and disabled or those with language difficulties who would need face to face advice. The LAG report states,[16]

‘We have to question whether the DTI is taking an even-handed approach to the resolution of work-related disputes or whether it has bowed to pressure from the powerful employers lobby.’

The overall view therefore of those acting for employees is that although the Regulations were unnecessarily complex they could have been simplified without being repealed as they provided minimum protection for all workers, whether or not they were trade union members. The principal reason for issuing the Regulations was because it was found that many employers did not have any procedures in place for resolving dispute and a repeal of the regulations could mean a return to this situation. There are also potential problems with the right of employees to bring claims being infringed where it is proposed that the Tribunal application system should also be processed through the ACAS helpline. LAG notes[17],

‘It would be inappropriate for a service point that had an aim of providing advice and guidance to also act in a ‘gatekeeping’ role for potential ET claims. Combined with the suggestion that the new advice service should be able to over-ride or contradict the advice given by a representative11, this would damage any integrity generated for

such a service.’

Conclusion

Clearly the repeal of the Dispute Resolution Regulations 2004 and the implementation of the ACAS Code due to take effect in April 2009 is not without its difficulties. The Government’s aim is to reduce the amount of claims being taken to the Tribunal although it recognises that dispute resolution is in itself only one strand. The other is revising the law in relation to unfair dismissal and making the Tribunal processes itself more efficient.

The Code is similar to the Regulations in that it mirrors a three step process. However the onus is often put on the employer to determine what is reasonable which has the effect of the Tribunal later claiming breach of the regulations or the employee claiming that their rights have been infringed. The employer therefore has a burden to act reasonably and the vagueness of this term although creates more flexibility to employers will produce greater uncertainty. Only time will tell whether the Code will in fact encourage a ‘conflict resolution culture’ and reduce the administrative burden on employers as its drafters intended.

BIBLIOGRAPHY

ACAS: Draft for Consultation: Draft Code of Practice on Discipline and Grievance (Nov 2008) http://www.acas.org.uk/CHttpHandler.ashx?id=961&p=0
BERR -Resolving Disputes in the Workplace Consultation Government Response (May 2008)
DTI-Better Dispute Resolution: A Review of Employment Dispute Resolution in Great Britain- Michael Gibbons (March 2007)-http://www.berr.gov.uk/files/file38516.pdf
DTI-Success at work resolving disputes in the workplace: A consultation- (March 2007)
DTI-Success at work resolving disputes in the workplace: A consultation- Response of the Legal Action Group (2007)
Is it the end of the road for Statutory Minimum Dispute resolution Procedures– Nick Hine May 2008)http://www.tcii.co.uk/images/upload/guest_article_pdfs/11ganick_hine2ddpdf_2173.pdf
United Kingdom: New Acas Code Of Practice on Disciplinary And Grievances Article by Val Dougan Dundas and Wilson Solicitors 28 November 2008
www.personneltoday.com

1

Privity of Contract Reform

“It is important to emphasise that, while our proposed reforms will give some third parties the right to enforce contracts, there will remain many contracts where a third party stands to benefit and yet will not have a right of enforceability”

In 1996, the Law Commission published Privity of Contract: Contract for the Benefit of Third Parties. The proposals set out in this report were later legislated on the basis of, in the Contracts (Rights of Third Parties) Act 1999. The aim of this legislation was fundamentally to alter the law in relation to the concept of privity of contract, in order to grant third parties who were not parties to the original contract certain rights. The doctrine of privity of contract will be considered, and the effect on this of the C(RTP)A will be analysed. Finally, some consideration will be given to the question of whether the legislation has gone far enough in reforming the law of privity.

It has historically been a fundamental and central principle of contract law in England and Wales that only the actual parties to a contract can have either contractual rights or duties conferred upon them. This was established at common law in the case of Tweddle v Atkinson (1861). The doctrine was confirmed in the early twentieth century in the case of Dunlop Pneumatic Tyre Co Ltd v Selfridge and Co Ltd (1915). It is important at the outset to distinguish the doctrine of privity of contract from the possibility of a third party enforcing a collateral contract. These are quite distinct scenarios. Under the first (historically), the third party had no right to claim rights, nor to be held liable for the performance of contractual duties. In the second scenario, as was established at common law in the case of Shanklin Pier v Detel Products Ltd (1951), an actual contract might be found to exist between the third party and one of the parties to the contract. It is the former of the two situations with which the C(RTP)A 1999 is concerned. The two interests (as defined by McKendrick) which a third party can have in a contract to which he is not a party are both whether or not he can acquire rights under that contract, and whether or not the contract in question can impose any liabilities or obligations on him.[1] The most significant impact on this area was that of the C(RTP)A, which Trietel describes as ‘the most significant doctrinal development in English contract law in the twentieth century.’[2]

What, then, is the purpose of privity of contract? It is, rather obviously, to do with the perceived injustice of imposing rights or obligations as between two parties who have had no dealing, at least no contractual dealing. It is clear that if X and Y enter a contractually binding agreement, Y has not made any agreement with Z, and therefore there is no rationale for entitling Z to take enforcement action against Y. The justification for the doctrine flows from the fact that contractual obligations, unlike tortious ones, are voluntary.[3] As Ibbetson states, the ‘rule that a third party could not enforce rights arising under a contract has been a feature of English law since at least the thirteenth century.’[4] The distinction between the acquisition of third party rights and obligations in contracts and other exceptions to privity of contract has already been mentioned. These exceptions can be expanded beyond collateral contracts (as seen in Shanklin Pier v Detel Products Ltd (1951)), to include a trust of a contractual right, whereby a ‘right may be transferred by way of property, as, for example, under a trust’[5]; the assignment of contractual rights to a third party (as in, for example, Linden Gardens Trust Ltd v Lenesta Sludge Disposals Ltd (1994)); in cases of agency, where the agent is acting on his principal’s behalf, with the full authority of that principle, and concludes a contract (following Wakefield v Duckworth (1915), where the agent was operating within his authority, he ‘drops out of the picture and the contract is between the principal and the other contracting party); and cases where a claimant who is a third party suffers loss because of the negligent performance of the contract by a contracting party, as in the classic case Donoghue v Stevenson (1932).

The doctrine of privity, then, was a foundational principle of English contract law until the advent of the Law Commission’s report in 1996. The opening quotation, taken from that report, explicitly seeks to limit the implications of the reforms that would later find their way into the C(RTP)A 1999, and the consideration above of the centrality of the doctrine of privity to contract law generally, shows why these limitations were considered necessary. What is the impact on this doctrine of the C(RTP)A, and does this do enough to reform the law on privity?

The C(RTP)A states that ‘subject to the provisions of this Act, a person who is not a party to a contract may in his own right enforce a term of the contract if the contract expressly provides that he may … or the term purports to confer a benefit on him.’ Furthermore, ‘the third party must be expressly identified in the contract by name, of a member of a class or as answering to a particular description but need not be in existence when the contract is entered into.’[6] There are, then, two separate tests for enforceability. The first test is described by Burrows as the ‘simplest’, and so it is; it is a simple question of fact whether the contract expresses the third party may enforce a term of it.[7] An example of this explicit authorisation of the third party to enforce a term of the contract is where the contract states ‘X [the third party] shall have the right to enforce the following terms of the contract…’ The provision under this section is less restrictive than it might be because of the implications of section 1(3) which complements it, stating that the third party does not need to be named; it is sufficient for the third party to be the member of an identified class.

The second test of enforceability under the Act is, again in the words of Burrows, is concerned with the ‘implied’ conferral of rights on third parties (as opposed to the express conferral discussed above).[8] The reasoning behind including this second test for enforceability can be broken down into 3 key areas. The first concerns the issue of implied rights in contracts, brought into the contract by implied terms. It is considered that to limit third party rights is akin to restricting implied terms. In other words, the parties’ intentions are not always their express intentions. The same can apply to third parties. The second area of justification for implied third party rights revolves around the uselessness of a reform confined to an express conferral of rights, unless the contracting parties included some ‘magic formula’ in the agreement so as to fall within the scope of the first test.[9] Cases where third parties would be unaffected by the C(RTP)A 1999 if the reform was confined to expressly mentioned third parties include Beswick v Beswick (1968), in which A contracted with B to pay money to C; and Trident General Insurance Co Ltd v McNiece Bro (1988), in which liability insurance was taken out to protect third parties to the contract. Finally, the implied conferral of rights on third parties has been justified by the fact that the aforementioned ‘magic formula’ will only be used in informed, well drafted contracts, which many will not be, particularly in the consumer sphere where good legal advice is not affordable.

Do these two tests reflect the spirit of the opening quotation? It can certainly be seen how these two tests of enforceability have altered the doctrine of privity substantially, and in particular the second test of enforceability relating to implied third party rights. The Law Commission’s statement, however, suggests a balance, between maintaining privity for many contracts, and allowing third party rights in others. This balance can be seen to be aimed for by the existence of a rebuttable presumption of intention inherent in the second test of enforceability. This rebuttable presumption attains a further balance, between a sufficient degree of certainty between contracting parties, and sufficient flexibility. This flexibility was required in order for the C(RTP)A 1999 to apply to the potentially huge range of contracts for which it was intended. The presumption is set up by asking the question ‘when are the parties likely to have intended to confer a right on a third party to confer a term?’ If the answer is ‘where the term purports to confer a benefit on the expressly identified third party’, then the presumption is raised.[10] This, of course, can be rebutted by the ordinary contractual interpretation of an indication that the parties did not intend this. The balance can be seen to have been aimed for, at least, in the two tests of enforceability in the C(RTP)A 1999.

An illustration of how the tests would be applied to decided cases is offered by Trietel, who identifies the case of Jackson v Horizon Holidays (1975) as falling within the scope of the second test under section 1(1)(b). He observes that ‘if the person making the booking [for a holiday on behalf of a third party] supplied the names of the other members of the family when the contract was made, those other members would probably acquire rights under subsection 1(1).; but no such rights are likely to be acquired if a person simply rented a holiday cottage without giving any information as to the number or names of the persons with whom he proposed to share the accommodation.’[11] This, then, can be seen to be a limitation to the effect of the reform legislation. It is suggested by McKendrick that section 1 simply gives the contracting parties an incentive to make their intention clear, which, again, returns to the issue mentioned above about the need for well-drafted contracts.[12]

The C(RTP)A 1999 is a highly significant piece of reform legislation, which fundamentally alters a central doctrine of English contract law. It can be seen to represent the superiority of the doctrine of freedom of contract over that of privity of contract. The significance of the Act is that while it maintains the previous exceptions to privity of contract, contracting parties will probably make increasing use of the Act rather than these, as a matter of certainty. The effect of the Act is somewhat limited, however, by the continuing requirement of clarity in the construction of the contract, whereby a presumption of an intention to confer rights on a third party can be rebutted. The effect of this, however, is simply to encourage a clarity of intention on the part of the contracting parties.

BIBLIOGRAPHY

Statutes

Contracts (Rights of Third Parties) Act 1999

Cases

Beswick v Beswick [1968] AC 58

Donoghue v Stevenson [1932] AC 562

Dunlop Pneumatic Tyre Co Ltd v Selfridge and Co Ltd [1915] AC 847

Jackson v Horizon Holidays [1975] 1 WLR 1468

Linden Gardens Trust Ltd v Lenesta Sludge Disposals Ltd [1994] 1 AC 85

Shanklin Pier v Detel Products Ltd [1951] 2 All ER 471

Trident General Insurance Co Ltd v McNiece Bro (1988) 165 CLR 107

Tweddle v Atkinson [1861 – 1873] All ER Rep 369

Wakefield v Duckworth [1915] 1 KB 218

Secondary sources

Burrows, A. (2000) ‘The Contracts (Rights of Third Parties) Act and its Implications for Commercial Contracts (LMCLQ 540)

Ibbetson, D. (1999) A Historical Introduction to the Law of Obligations (Oxford: OUP)

Law Commission (1996) Privity of Contract: Contract for the Benefit of Third Parties (Law Comm 242)

McKendrick, E. (2003) Contract Law: Text, Cases and Materials (Oxford: OUP)

Smith, S.A. (1997) ‘Contracts for the Benefit of Third Parties: In Defence of the Third-Party Rule’, 7 OJLS 643

Trietel, G.H. (1999) The Law of Contract, 10th Edition (London: Sweet & Maxwell)

Trietel, G.H. (2002) Some Landmarks of Twentieth Century Contract Law (Oxford: OUP)

Predicting Individual differences in Mindfulness

Predicting Individual differences in Mindfulness: The role of Trait Anxiety, Openness and Parental Nurturance

­­­­

Abstract

Mindfulness is a way of paying attention, intentionally and without judgement to the present moment. Mindfulness training has shown impressive outcomes in a number of areas such as depression and pain reduction; however, the literature has failed to account for natural, individual differences in levels of mindfulness. This research provides an exploration of the variables: Trait Anxiety, Openness to Experience and Parental Nurturance and their ability to predict individual differences in Mindfulness. 123 participants each completed four questionnaires: The State-Trait Anxiety Inventory (STAI) was used to assess Trait Anxiety, the NEO-FFI was used to measure Openness to Experience, the Parental Nurturance Inventory was used to measure Parental Nurturance, and Mindfulness was assessed using the Freiburg Mindfulness Inventory (FMI). Partially consistent with the predictions, Trait Anxiety was shown to negatively predict Mindfulness, Openness to Experience and Parental Nurturance where not as strong predictors of Mindfulness.

Key Terms: Mindfulness, Trait Anxiety, Openness, Parental Nurturance.

Introduction

Mindfulness is a way of paying attention, intentionally and without judgement to the present moment. The practice of Mindfulness originated in East India and is at the heart of Buddhist meditation. According to Kabat-Zinn (1994, 4) ‘This kind of attention nurtures greater awareness, clarity, and acceptance of present-moment reality’. A lack of or reduced awareness to the present-moment, however, has the opposite affect which results in fear driven ‘unconscious and automatic actions and behaviours’. Continuing in this pattern of diminished awareness results in erosion to ones confidence and hinders the possibility of a life of satisfaction, health and happiness (Kabat-Zinn, 1994). Traditionally, Mindfulness was viewed as a spiritual practice, heavily steeped in Buddhism; however, more recently this practice has been widely encouraged in the western society (Baer, 2003).

According to Baer (2003) there are two main Mindfulness training programmes namely the Mindfulness-Based Stress Reduction Programme and Mindfulness-Based Cognitive Therapy. Other therapies such as Dialectical Behaviour Therapy, Acceptance and Commitment Therapy and Relapse Prevention incorporate principles of Mindfulness into the programme. Most Mindfulness training programmes run for a serious of 8-10 weeks, with a one day a week group meeting which is held for approximately 2 hours. Clients are also required to do homework session including 45 minutes per day, 6 days a week.

Evidence suggests that Mindfulness-based training intervention is effective. Research indicates that Mindfulness-based training is effective in working with borderline personality disorder, mood disorders, pain, generalised anxiety disorder, stress, alcohol and substance abuse, and eating disorders (Baer, 2003; Roemer, 2002; Williams, Teasdale, Segal, & Soulsby, 2000; Witkiewitz, Marlatt, & Walker, 2005; Woodman, Noyes, Black, Schlosser, & Yagia, 1999; Zettle & Rains, 1989).

Without any way of accurately, and objectively measuring levels of Mindfulness, positive findings were attributed to the training alone. Brown and Ryan (2003), however, proposed that individual differences may account for differences in levels of Mindfulness. The introduction of a measure for Mindfulness has made room for researchers to explore this proposal in greater depth. The present study attempts to explore a question: to what extent do individual differences influence levels of Mindfulness. The literature highlights three such individual differences that may be of interest: Trait Anxiety, Openness to Experience and Parental Nurturance.

The experience of anxiety is one that is familiar to most people; and Kaplan and Sadock (1998) describe the related symptoms as including an uneasy feeling followed by automatic responses such as headaches, perspiring and tightness in the chest. Trait anxiety, as apposed to state anxiety, is a persistent and does not wane in less stressful times. These researchers identify anxiety as having two components, namely awareness to the physiological sensations and awareness to being afraid. These experiences often lead to feelings of embarrassment, and in order to feel justified for the anxiety, people tend to focus on certain, conforming aspects of the environment and overlooking others. As a result of this bias to attention, a person is unable to experience the presence as a whole. Trait Anxiety is therefore expected to have an inverse relationship with Mindfulness.

Openness to Experience is one of the five main personality domains and is described by McCrae and John (1992) as encompassing such things as imagination, aesthetic sensitivity, awareness of inner feelings, an inclination towards variety, and intellectual curiosity. Individuals who score high on this scale tend to be motivated to discover their environment, ask questions and have a readiness to question authority. As such, it is hypothesized that a high level of Openness to Experience would be a positive predictor of Mindfulness, since these individuals approach their environment with awareness, which is not clouded by judgment.

The manner in which a parent responds to their child in the first years of his or her life has a far reaching impact on their adult life, affecting their relationships, both intimate, social and professional, how they interpret information given to them from the environment and whether or not they view the world as a safe place, and whether or not people are trust worthy (Fonagy, Gergely, Jurist, & Target, 2005). According to this theory of attachment, Parental Nurturance is also an important factor in determining an individual’s ability to contain his or her own emotions. From this, it is hypothesised that positive Parental Nurturance will be a good predictor of Mindfulness as individuals are able to be present in their environment in a trusting, non-judgmental way.

The present study explores the predictive value of these variables for increased levels of Mindfulness. In light of the literature, it is thought that a low level of Trait Anxiety will have an inverse relationship with Mindfulness, and that Openness to Experience and Parental Nurturance will be positive predictors of Mindfulness.

Method
Design and Measures

For the purpose of the present research study, a cross-sectional, correlational design was adopted. Information was thereby elicited from people in a number of different conditions, namely Trait Anxiety, Openness to Experience and Parental Nurturance (independent variables), and the dependent variable of Mindfulness. The following measures where used:

Spielberger’s (1983) State-Trait Anxiety Inventory (STAI) was used to assess Trait component of Anxiety. The STAI is designed to measure and distinguish between anxiety as a trait or as a state. Trait anxiety is a relatively stable personality trait and is marked by feelings of apprehension and tension, which is heightened in times of perceived threat. State anxiety, however, fluctuates and is heightened at times of stress and low in less stressful periods. This is a self-report, four-point rating scale, including 20 statements that ask people to describe how they feel at a particular moment. A high score is indicative of a high level of Trait Anxiety.

Costa and McCrae’s (1991) NEO-FFI was used to assess Openness to Experience. This is a 60-item version of the NEO PI-R, which measures only the five factors of adult personality, however for the purpose of this study, only the twelve-item scale assessing Openness was employed. This is measure makes use of a five-point rating scale, where participants demonstrated the degree of agreement with given statements. A high score on this scale is indicative of a high level of Openness.

Buri’s (1989) Parental Nurturance scale was used to assess this component of the study. This is a self-report, five-point Likert scale, where participants are required to describe positive and negative aspects of the parental nurturance they received. This is repeated twice, once for information pertaining to the mother and the second time for information relating to the father’s nurturance. An average of these combined scores is used as a final result, with a high score indicative of elevated levels of Parental Nurturance.

Mindfulness was measured using the FMI (Walach, Buchheld, Buttenmuller, Kleinknecht, & Schmidt, 2006). This is a short scale, 14-item, self-report measure, requiring participants to indicate their degree of agreement with a given, mindfulness direct statement. A high score on this measure is indicative of elevated levels of Mindfulness.

Procedures, Participants and Ethics

Participants were purposively sampled and personally invited by written invitation to participate in this study. Of the initial 153 participants, 123 were included in the present study. A detailed outline of the nature and details of the study, including a description of what would be required of them was provided in the initial invitation. Participants were assigned to one of three separated testing groups. On receiving consent, participants were handed a package of four questionnaires (STAI, NEO-FFI, Parental-Nurturance Inventory, FMI). Each questionnaire was marked with separate instructions for completion. Each participant completed the pack of questionnaires in the same order.

Results
Reliability of Measures

A reliability analysis of the questionnaires was conducted, yielding satisfactory results indicating that the participants responded in a consistent manner to the questionnaires. The reliability coefficients were as follows: Mindfulness (? = .78); Trait Anxiety (? = .88); Openness (? = .73); Parental Nurturance – mother (? = .96); Parental Nurturance – father (? = .96).

Descriptive Statistics

A descriptive analysis of the data obtained across the variables of Mindfulness, Trait Anxiety, Openness and Parental Nurturance is given in Table 1. As shown, the mean score for openness was 3.62, with a standard deviation (SD) of .55. The total results on the measure of Trait Anxiety yielded a mean score of 2.19, with a SD of .59. The mean score for Parental Nurturance was 3.71, with a SD of .79, and the Mindfulness mean is indicated at 2.69, with a SD of .46.

Table 1: Presentation of Mean Scores and Standard Deviations from the Measures Employed to assess Openness to Experience, Trait Anxiety, Parental Nurturance and Mindfulness.

N

Minimum

Maximum

Mean

Std. Deviation

Openness mean

123

2.25

4.75

3.62

.55

Trait Anxiety mean

123

1.10

3.60

2.19

.59

Parental Nurturance mean

123

1.29

5.00

3.71

.79

Mindfulness mean

123

1.71

3.79

2.69

.46

Valid N (listwise)

123

Inferential Statistics

The correlational analysis undertaken to explore the relationship between the dependent variable, Mindfulness, and the independent variables, Openness, Trait Anxiety and Parental Nurturance. These results are presented in Table 2. A significant, positive correlation was found between Mindfulness and Openness (r = .02, df = 3, p<.05). A negative relationship was found between Trait Anxiety and Mindfulness (r = -.56, df = 3). No significant, positive relationship was found between Parental Nurturance and Mindfulness (r = .14, df = 3, p<.05), however, it may be interesting to note that this correlation borders on significant.

Table 2. Correlational Analysis Presenting the Relationship between Mindfulness and the Variables: Openness, Trait Anxiety and Parental Nurturance.

Mindfulness mean

Openness mean

Trait Anxiety mean

Parental Nurturance mean

Mindfulness mean

Pearson Correlation

1

.19

-.56

.140

Sig. (1-tailed)

.

.02

.00

.06

N

123

123

123

123

Openness mean

Pearson Correlation

.19

1

-.11

-.04

Sig. (1-tailed)

.02*

.

.11

.350

N

123

123

123

123

Trait Anxiety mean

Pearson Correlation

-.56

-.11

1

-.33

Sig. (1-tailed)

.000

.11

.

.000

N

123

123

123

123

Parental Nurturance mean

Pearson Correlation

.14

-.04

-.33

1

Sig. (1-tailed)

.06

.35

.00

.

N

123

123

123

123

* Correlation is significant at the 0.05 level (1-tailed).

** Correlation is significant at the 0.01 level (1-tailed).

An analysis of the degree of variance (ANOVA) yielded F=19.496, which is indicative of a statistically insignificant effect. Therefore, there is no relationship between the constant and the independent variables as a group. With this information in hand, a regression was undertaken to see what differences exist in each group. These results are given in Table 3.

Table 3. Presentation of the Individual Differences between Variables.

Unstandardized Coefficients

Standardized Coefficients

T

Sig.

Model

B

Std. Error

Beta

1

(Constant)

3.4

.37

9.12

.00

Openness mean

.11

.06

.13

1.66

.10

Trait Anxiety mean

-.44

.06

-.56

-6.94

.00

Parental Nurturance mean

-2.274E-02

.05

-.04

-.49

.63

From this it is clear that Trait Anxiety has the strongest, inverse relationship with Mindfulness, which is a negative relationship. Therefore, lower levels of Trait Anxiety are a strong predictor for Mindfulness. Openness is shown to be an insignificant predictor of Mindfulness, and Parental Nurturance is approaching significance.

4. Discussion

The results of this study partially meet the predictions made. Openness to Experience and Parental Nurturance were not demonstrated as positive predictors of Mindfulness, although Parental Nurturance bordered on significance. Trait Anxiety was found to be a negative predictor of Mindfulness, where the lower the level of Trait Anxiety, the higher the level of Mindfulness. These results can be explained in terms of awareness to the environment. Individuals having a high level of Trait Anxiety are unable to be present in the moment since they are subject to cognitive bias, which inhibits the information they are able to process. According to Harvey, Watkins, Mansell and Shafran (2004) individuals with high levels of anxiety have explicit memory bias for concern-relative information. These authors make further reference to the Cognitive Avoidance Theory of Worry, and describe how people who worry excessively have, as a result reduced their awareness of aversive imagery, as well as physiological and emotional responses, which inhibits emotional processes. Since individuals with high levels of Trait Anxiety are working hard at suppressing unpleasant experiences in terms of physiological, emotional and psychological responses, they are reducing their ability to be Mindful. A key component of Mindfulness is the ability to absorb the environment as a whole, without judgement and being completely present in the moment. Individuals with low levels of Trait Anxiety are able to process their environment without bias, they are not fearful and ashamed, and are not required to be vigilant and suspicious of the environment and others. The qualities are similar to those describe in the description of Mindfulness, and should therefore yield similar outcomes of ‘greater awareness, clarity, and acceptance of present-moment reality’ Kabat-Zinn (1994, 4).

From this study, it can be said that the variable of Trait Anxiety is a good predictor of the individual differences in Mindfulness. Further research into the predictive value of other personality variables may aid in the understanding of this phenomenon.

Bibliography

Baer, R.A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143.

Brown, K.W. & Ryan, R.M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848.

Buri, J. R. (1989). Self-esteem and appraisals of parental behavior. Journal of Adolescent Research, 4, 33-49.

** Costa, P. & McCrae, R. (1991). The NEO-Five Factor Inventory – Form S. Odessa, Florida: Psychological Assessment Resources.

Fonagy, P., Gergely, G., Jurist, E.L. & Targer, M. (2005). Affect Regulation, Mentalization, and the Development of the Self. London: Karnac.

Harvey, A., Watkins, E., Mansell, W. & Shafran, R. (2004). Cognitive Behavioural Processes Across Psychological Disorders: A transdiagnostic approach to research and treatment. Oxford University Press.

Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness meditation for everyday life. NY: Piatkus.

McCrae, R.R. & John, O.P. (1992). An introduction to the five-factor model and its implications. Journal of Personality, 60, 175-215.

Roemer, L. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9(1), 54-68.

** Spielberger, C. (1983). State-Trait Anxiety Inventory for adults. Redwood City, California: Mind Garden

Walach, H., Buchheld, N., Buttenmuller V., Kleinknecht, N. & Schmidt, S. (2006). Measuring mindfulness – the Freiburg Mindfulness Inventory (FMI). Personality and Individual Differences, 40, 1543-1555.

Williams, J.M.G., Teasdale, J.D., Segal, Z.V. & Soulsby, J. (2000). Mindfulness-based cognitive therapy reduces over-general autobiographical memory in formerly depressed patients. Journal of Abnormal Psychology, 109, 150-155.

Witkiewitz, K., Marlatt, G.A. & Walker, D. (2005). Mindfulness-Based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy: An International Quarterly, 19(3), 211-228.

Woodman, C.L., Noyes, R., Black, D.W., Schlosser, S. & Yagia, S.J. (1999). A five year follow-up study of generalized anxiety disorder and panic disorder. Journal of Nervous and Mental Disease, 187, 3-9.

Zeattle, R.D. & Rains, J.C. (1989). Group cognitive and contextual therapies in treatment for depression. Journal of Clinical Psychology, 45, 436-445.

** References borrowed from given notes.

One of the principle aims of the Children Act

One of the principle aims of the Children Act 1989 was to ensure that more attention was paid to the child’s voice.

Critically examine to extent to which this aim has been achieved.

Introduction:

Bridgeman and Monk argue that the development of child law is becoming progressively more distinct from family law. In their view this development can be understood as a reflection of the influence of children’s rights and feminist views of the law that have encouraged a child centred focus where children are not simply seen as family persons but as individuals in their own right (Bridgeman and Monk, 2000, p. 1), a point reiterated by Muncie et al. who point to the recognition of rights of children as now being considered as distinct from the rights of the family as a whole (Muncie at al., 2005).

The Children Act 1989 which came in to force on 14th October 1991 was heralded as the most important legislation pertaining to children in living memory. Lord Mackay called it:

“the most comprehensive and far reaching form of child law which has come before Parliament in living memory.”

Prior to the Act the law relating to children in the UK had been driven by a plethora of different pieces of legislation, leading to considerable complexity and inconsistency. Although European law has come to an increasing level of prominence in domestic law, in practice the Children Act remains the single document most referred to (Prest and Wildblood, 2005, p. 311).

The strength and scope of the Act have been reflected by the considerable body of case law that evolved in a relatively short period of time.

The Act fulfilled two functions as highlighted by Allen:

It brought together all the existing law under the umbrella of one piece of legislation;
The Act acknowledged the limits of the law in family relations. While it was seen as a land mark piece of legislation, it did not contain a magic formula to deal with family problems.

(Allen, 2005, p.1).

The main thrust of the Act was to enable all those involved with the care of children to further their best interests whether living with their families, in local authority care or in respect of protection from abuse.

Private and Public Law:

The private legislation relating to children’s law does not concern public bodies. It refers to issues that are between individuals, usually family members.

The public law relating to children concerns legislation pertaining to intervention by public authorities. This encompasses voluntary agencies as well as social services. The State is typically a party to proceedings.

Purpose of the Act:

It was also hoped that through the Act children would become more central to proceedings concerning their welfare and would be given a considerably stronger voice. Feminist analysts have questioned the effectiveness of this, arguing that the law is often better at protecting the interests of adults than children.

Common Law Before the Act:

Historically, in common law parental rights were traditionally with the father in the case of legitimate children. It was not until 1886 that mothers were given guardianship under the Guardianship of Infants Act and the welfare of the child was to be taken into account when hearing any claim.

Developments in this area of the law saw an increasingly important regard given to the welfare of the child. This evolved into the modern idea of paramnountcy, enshrined in the 1989 Act.

The Law Leading to the Act:

Before the Act there were a number of different aspects of children’s law, described by Allen as chaotic in its nature (Allen, 2005, p.3). The law relating to children had evolved in a somewhat haphazard way, and was becoming increasingly difficult for professionals to interpret. In 1984 a comprehensive review was undertaken in an attempt to integrate the law.

The White Paper published in 1987, The Law on Child care and Family Services, stated that government proposals would involve “ a major overhaul of child care law intended to provide a clearer and fairer framework for the provision of child care services for families and for the protection of children at risk.”[1]

Scope of the Act:

The Act covers many areas including pre-school day care, child protection, local authority provision for children, the care of children in independent schools, children involved in divorce or custody proceedings, children with disabilities, child patients in long stay hospitals and children with learning difficulties (Hendrick, 2003, p.196-107).

Intrinsic to the legislation were four main principles:

(1)The paramountcy principle – this was not really a new idea but added considerable weight to ideas about child welfare, making it clear that this was always to be paramount in any decisions. This guiding principle has, however, been criticised in some quarters because of its vagueness.

The child’s welfare is the paramount consideration in respect of:

(a)the upbringing of the child;

(b) the administration of a child’s property or any income arising from it (s 1 (1)).[2]

(2) A checklist was introduced to assist courts in applying the welfare principle when considering certain categories of order.

(3)The delay principle which states that proceedings should be expedited with minimum delay as any such delay is regarded as being to the child’s disadvantage unless proven otherwise (s 1 (2))[3].

(4) Intervention by the State in the life of the child or the child’s family should only occur when it could be shown that “on balance the bringing of proceedings is likely to be in the best interest of children.” This is the no order principle where no order shall be made unless it is considered to be better for the child than making no order at all.[4]

Some new concepts were introduced. One of the main ones was “parental responsibility”. This emphasised the rights of parents in the context of their parental responsibility. If parents exercise their responsibility with the necessary level of diligence, certain rights in law are afforded, in effect promoting parents as authority figures. The Act also saw something of a swing back in emphasis to parents as opposed to the state being responsible for their children. Parents could only relinquish their responsibility to their children through formal, legal adoption. The term “accommodation” replaced “voluntary care” meaning, in effect that local authorities would care for children on their parents’ behalf only until such times as they could resume their proper role (Eekelaar and Dingwall, 1989, p.26).

Parental Responsibilities:

The Children Act gave courts wide ranging and flexible powers to regulate the exercise of parental responsibility, introducing some sweeping changes in this area.

The Child’s Wishes:

One of the central ideas was that the child’s wishes be taken into consideration, to a degree which was appropriate in any proceedings. The issue has arisen in relation to care proceedings, medical treatment and so on. In the case of local authority accommodation, there is a clear distinction in law between children over and under sixteen years old. The Children Act provides that neither the parental right of objection not the parental right of removal applies where a child of sixteen agrees to being provided with accommodation.[5]

This was tested in Re T (Accomodation by Local Authority)[6]. A seventeen year old girl had been informally accommodated by friends, an arrangement which she sought to formalise so that both parties would be eligible for benefits under section 24 of the Act which would stop when she reached age 18 otherwise. The director of social services refused this request taking the view that her welfare was not likely to be seriously prejudiced if she were not accommodated. This decision was quashed at court, the judge taking the view that social services had no way of ascertaining her future needs and there was no way of establishing whether the local authority would continue to exert the discretionary power it had done up to this point.

The issue of the child’s wishes is a much more contentious area when younger children are involved. Some very emotive case law, particularly in respect of medical arrangements and treatments, has developed in this area.

The child’s age should be taken into consideration when making any decision, but this is dependent on the individual child concerned . It is well recognised that children have the capacity to engage in acts and make decisions which can be dependent on chronological age or the attainment of a level of maturity beyond the chronological age. Precedent concerning a child’s age was first established in the land mark case of Gillick v. West Norfolk and Wisbech Health Authority[7].

The Gillick Case:

In 1980 The Department of Health and Social Security asserted that, while it would be most unusual, it would be lawful in some circumstances for a doctor to give contraceptive advice to a girl under sixteen without prior consultation with her parents. Victoria Gillick, a parent with strongly held religious views, sought assurances that none of her daughters would receive such advice.

Her claim was eventually rejected by the House of Lords, the decision coming to be known as ‘Gillick competence’. Lord Scarman proposed that a high level of understanding would be required, extending beyond the medical issues.

Lord Scarman noted:

“It is not enough that she should understand the nature of the advice which she is being given: she must have sufficient maturity to understand what is involved.”

Critical was the question in respect of whether, once a child has reached a certain level of maturity, whether in chronological or maturational terms, the rights of the patents to be involved, should be terminated or should co-exist with the child’s.

The Gillick decision was contrary to popular opinion and controversial. When faced with the dilemma of Gillick competence again, the courts adopted a somewhat different view. Later case law served to muddy the waters and adolescents were not given clear advice over their right to reach decisions for themselves in the event of family disputes or other issues.

Re R[8] concerned the competence of adolescents to refuse medical treatment.

R was a fifteen year old girl who had been suffering from mental illness which had caused her to be hospitalised under the Mental Health Act. At various times during the course of her treatment she was regarded as being a suicide risk. The unit in which she was hospitalised used sedatives as a last resort as part of the treatment regime. The hospital said that they would not retain R in hospital unless she were prepared to engage in treatment, including taking sedatives.

They put this to the local authority who had parental responsibility for R. The local authority initially agreed to the hospital’s request but, following conversation between R. and a social worker, withdrew its consent. R indicated to the social worker that the hospital were trying to give her drugs which she neither wanted nor needed. The social worker’s opinion was that R. was lucid and rational during the conversation, an assessment subsequently confirmed by psychiatric evaluation. The authority made R. a ward of court to resolve the argument. This is demonstrative of the responsibility to make the child’s voice heard, through the consultation process, a responsibility placed on local authorities by the Act.

The solicitor acting as guardian ad litem argued that, where a child has capacity to withhold consent to treatment based on sufficient understanding, any parental right to give or withdraw consent terminated.

Lord Donaldson reopened the whole discussion in respect of the relationship between a competent minor’s capacity and a parent’s right to consent on a minor’s behalf.

The Court of Appeal upheld the decision of Waite J., that R. failed the test of competence and that, in her best interests, the treatment should be authorised.

The most significant issue was whether the court had the power to over rule the decision of a competent minor. The court held that such an ability existed because the Gillick principles did not have effect in wardship proceedings. It was argued that the court had wider powers than those of normal parents, being derived from the Crown. The court saw no reason not to override the wishes of a competent minor if it believed that to be in the child’s best interests.

The judgement demonstrated that the application of the ‘welfare’ and the ‘Gillick’ tests could lead to different results.

The court’s power to override the decision of a minor were again illustrated in Re M. (Medical Treatment : Consent)[9]. A fifteen year old girl needed a heart transplant to save her life but refused to give her consent. Her reasoning was that she did not want to have some one else’s heart and did not want to have to take medication for the rest of her life.

In the solicitors notes taken at interview, it could be clearly seen that she had considered carefully her decision:

“Death is final – I know I can’t change my mind. I don’t want to die but I would rather die than have the transplant and have someone else’s heart, I would rather die with fifteen years of my own heart.”

While acknowledging the gravity of overriding M.’s decision, and the associated health risks, the operation was authorised.

Children in Court:

English law has not traditionally given minors right of representation in legal proceedings, but this was one of the main issues that the Children Act 1989 sought to address. The usual procedure has been for courts to require welfare reports in respect of children rather than to elicit the views of children themselves or of other interested parties or representatives.

The Children Act considerably changed that nature of representation for children in public proceedings in court. In care proceedings the Act created the presumption of the appointment of a guardian ad litem (Children’s guardian). The child will also automatically be party to the proceedings.

Children’s guardians are individuals who are required to have a thorough knowledge of both social work and child law. Their role is to ensure ‘that the court is fully informed of the relevant facts which relate to the child’s welfare and that the wishes and feelings of the child are clearly established.[10] Their role is to be proactive in its nature and ensure that the wishes of the child are given their due weight in the proceedings.

The issue in respect of private law is markedly different with children rarely being represented in this context. These are generally in relation to divorce and while welfare reports are submitted on occasion, this is not often the case, simply because of the volume of these types of proceedings.

Harm to children:

One of the main purposes of the Children Act was to ensure that children be protected from harm.

Newham London Borough Council v. AG[11]. reflects the difficult choice with which the courts are often faced regarding whether it is better for a child to stay with members of his/ her extended family or other, outside carers. In Newham the Court of Appeal held that placing the child with grandparents would be unsatisfactory as they would be unable to protect the child from the serious risk that was posed by the child’s mother who suffered from severe schizophrenia which manifested itself in her inability to look after the child and to neglect her.

The test case for the risk of significant harm is Re M. (A minor)(Care Order: Threshold Conditions).[12] A father had murdered the children’s mother in front of them, after which they were taken into emergency protection. The father was convicted of the mother’s murder and was sentenced to life imprisonment with a recommendation that he be deported to Nigeria, his home country, on release. Three of the four children were placed with Mrs W., the mother’s cousin, but she felt unable to cope with the youngest child, M. who was placed with a temporary foster mother. Eventually Mrs W. wanted to offer M. a home with his siblings. The father sought to influence the decision from prison, as he was M.’s biological father. The local authority, the guardian ad litem for M., and the father all wanted a care order to be made for M. outside the extended birth family.

Bracewell J. made the care order in the first instance but the Court of Appeal favoured Mrs W., substituting a care order in her favour. The question for the courts was whether, in considering if a child ‘is suffering from significant harm’, is it permissible to consider the situation when protective measures were introduced, or does this test have to be satisfied at the time of the hearing at which the application is being considered. At the time of the hearing M. was no longer suffering, nor was he likely to suffer ‘significant harm because, by this time, he was being properly looked after and the danger had passed.

The House of Lords held that there was jurisdiction to make a care order in these circumstances. Lord Mackay argued that the court was entitled to have regard to the full length from the protection to the disposal of the case. Brackwell had been entitled to, and indeed correct, to look back to the time when the emergency protection was taken. She had been entitled to infer that, at that time, M. had been permanently deprived of the love and care of his mother which constituted significant harm. The care given by the father was not what could reasonably have been expected from a parent, although it could reasonably be argued that the anger and violence was directed to the mother rather than M. The only limitation in the process of looking back was that the initial protective arrangements had remained continuously in place. Lords Templeman and Nolan pointed out that to restrict evidence to that which was available at the hearing could mean that any temporary measures which removed the risk could preclude the court from making a final care order which could not have been Parliament’s intention.

Separated Families:

Contact:

A great deal of case law relates to families where divorce or separation is a factor. Section 8 of the Act deals with the contact order:

“an order requiring the person with whom a child lives, or is to live, to allow the child to visit or stay with the person named in the order, or for that person and the child otherwise to have contact with each other.”[13]

The contact order has become very important in the sphere of children’s law as it is the most common type of order made. Men, who tend not to be the residential parent in cases of divorce, are increasingly applying for contact orders with their children.

Payne v. Payne is one of the leading cases in respect of contact. The mother, originally from New Zealand wanted to return there with the couple’s four year old child following her divorce. Mr Payne argued that, to allow the mother to remove the child from the country, would infringe his right to contact, and that this infringement would be contrary to the principles of the Children Act 1989. The Court of Appeal argued that the child’s happiness was bound up in the happiness of the mother , the primary carer, and any move to separate them might be that her “unhappiness, sense of isolation and depression would be exacerbated to a degree that could well be damaging to the child.”

The judgement in Payne v. Payne was not a denial that the father had a right to contact. It was a demonstration of the application of the welfare principle, protecting the best interests of the child which were, in the courts opinion, inextricably linked to the mother. The decision makes clear that contact is a qualified right which will always be superseded by the welfare of the child.

Paternity:

The paramountcy principle has been criticised as being too limited in its scope. Where the issue of paternity has come before the courts it has been held that this only has an indirect impact upon the child’s upbringing and so falls outside the scope of the test. Freeman has argued that since maternity is rarely in doubt, this stance in respect of paternity allows men to shirk to some degree their paternity in the English Legal system (Freeman, 2000, p.33).

Foster Parents:

While the law relating to children has always had scope in respect of biological families, this is clearly extended to foster parents by the Children Act. The term ‘foster parents’ covers a variety of care arrangements, but is most usually thought of as parents who look after children to whom they are not related. The main distinctions in foster care arrangements are in private or local authority arrangements and short and long term fostering arrangements.

Arrangements and case law have shown that foster carers will not automatically be afforded parental responsibility, legal steps must be taken before this can happen.

In Gloucestershire County Council v. P[14] the child’s guardian ad litem persuaded the court that a residence order in favour of the foster parents, rather than an order freeing the child for adoption or residence order in favour of the extended family, would be appropriate. A majority of the Court of Appeal held that the Court did, in fact, have the power to do this even though the foster parents had cared for the child for less than three years.

More than one child:

Problems with the paramountcy principle have occurred when there is more than one child and their interests appear to be at odds. In Birmingham CC v. H[15] the case concerned a mother, herself a minor, and her child. It was believed to be in the mother’s best interests to maintain some contact with her baby as she may self harm otherwise. It was not held to be in the best interests of her baby. The law said that the interests of both was paramount. The House of Lords held that it was necessary to identify the child who was the subject of the application and make their welfare paramount, in this case the baby. This logic has been applied in subsequent cases on this matter when the interests of siblings have been thought to be in conflict.

Conclusion:

It is generally agreed that the Children Act represents a consensus among interested parties, except of course for children, who were not consulted (Hendrick, 2003, p.198). The concept of welfare or best interests of children reflects a desire to protect children. Some theorists have argued that because the input of children into changes in the law has been neglected, the law may be ineffective in protecting them from harm which may be very different from the harm and pain felt by adults (Bridgeman and Monk, 2000, p.7).

Some aspects of the Act have been problematic. The paramountcy principle has been very difficult in both a practical and an ethical respect. There is considerable tension between a child’s welfare and a child’s voice. The weight of the law is given to the former but many argue that the child’s opinion and wishes should carry more weight than they do at the moment. There are also, as has been seen, questions concerning when the child’s wishes should supersede those of his/ her parents and be respected as valid in their own right.

The law in relation to children has seen more change in recent years but the Children Act still has considerable force in practice. While there has been increasing emphasis placed on children’s individualism, autonomy, capacity and competence (Hallett, 2000, p.389), it has been seen that it is often the case that no matter how lucid or mature a child appears to be, the courts have been reluctant to allow the child to have a full voice in issues of a serious and life changing nature. The complex nature of families and their increasingly diverse nature in society means that these difficult issues will probably become more, rather than less complex in their nature and present themselves with a greater degree of frequency.

References:

Allen, N. (2005) Making Sense of the Children Act 1989. Chichester: John Wiley and Sons.

Bainham, A. (1990) Children : The New Law. Bristol: Jordan Publishing Ltd.

Bainham, A. (2005) Children: The Modern Law. Bristol: Jordan Publishing Ltd.

Bainham, A., Day-Sclater, S. & Richards, M. (Eds)(1999) What is a Parent? A Socio-Legal Analysis. Oxford: Oxford University Press.

Bridgeman, J. & Monk, D. (2000) Reflection on the relationship between feminism and child law in J. Bridgeman & D. Monk (Eds) Feminist Perspective on Child Law. London: Cavendish Publishing.

Corby, B. (2002) Child Abuse and Child Protection in B. Goldson, M. Lavalette and E. McKenchie (Eds) Children, Welfare and the State. London: Sage.

Eekelaar, J. (1991) Parental Responsibility: State of nature or nature of state? Journal of Welfare and Family Law, 1, 37-50.

Eekelaar, J. and Dingwall, R. (1989) The Reform of Child Care Law: A practical Guide to the Children Act. London: Routledge.

Farson, R. (1978) Birthrights. London: Penguin.

Fortin, J. (2003) Children’s Rights and the Developing Law. London: Reed Elsevier.

Freeman, M. (2000) Feminism and Child Law in J. Bridgeman & D. Monk (Eds) Feminist Perspective on Child Law. London: Cavendish Publishing.

Gibson, C., Grice, J., James, R. & Mulholland, S. (2001) The Children Act Explained. London: The Stationery Office.

Hallett, C. (2000) Children’s Rights: Child Abuse Review, 9, 389-393.

Harris, P.M. & Scanlan, D.E. (1991) Children Act 1989: A Procedural Handbook. London: Butterworths.

Hendrick, H. (2003) Child Welfare: Historical Dimensions, Contemporary Debate. Bristol. The Policy Press.

Herring, J. (2004) Family Law. London: Pearson.

Hoggett, B.M. (1987) Parents and Children: The Law of Parental Responsibility. London: Sweet and Maxwell.

Horwarth, J. (Ed)(2001) The Child’s World: Assessing Children in Need. London: Jessica Kingsley Publishers.

Masson, J. (1990) The Children Act 1989: Current Law Statutes Annotated. London: Sweet and Maxwell.

Muncie, J. Wetherall, M., Dallos, R. & Cochrane, A. (Eds)(1995) Understanding the Family. London: Sage.

Prest, C. & Wildblood, S. (2005) Children Law: An Interdisciplinary Approach. Bristol: Jordan Publishing Ltd.

White, R., Carr, P. & Lowe, N. (1995) The Children Act in Practice. London: Butterworths.

Wyld, N. (2000) The Human Rights Act and the Law Relating to Children. Legal Action, September, 17-18.

1

Nurse-led Clinics in Respiratory Care: a Literature Review

INTRODUCTION

1. What is a nurse-led clinic?

As the coined term suggests, a nurse-led clinic is a health care centre in which nurses are involved in high level specialist procedures and assessments. In such centres, nurses are the critical decision makers, being involved in patient care at the micro-, meso-, and macro-levels. While the role of the physician in the provision of health care is undisputable, the deity-like status that medical practitioners typically have in the mind of patients, coupled with the limited time available for individual patient consultations, make it hard for these group of health care professionals to tackle the ‘softer’ side of patient care. Nurses, on the other hand, defined by the Oxford Medical Dictionary as health care professionals that are trained and experienced in nursing matters and entrusted with the care of the sick and the carrying out of medical and surgical routines, are better placed to provide this essential follow-up, especially in the care of patients with chronic diseases.

According to Hatchett (2003), a nurse-led clinic is a clinic in which nurses have their own patient case loads of whom they take complete charge. Hatchett broadly describes the components of such a clinic. There would be an increase in autonomy associated with the nursing role in the nurse-led clinic, with the power to admit, discharge or refer patients, as appropriate. In Hatchett’s own words, the roles which nurses adopt in these revolutionary settings can be broadly classified as follows (Hatchett, 2003):

Education
Psychological support
Patient monitoring

The initiation of nurse-led initiatives probably owes its origins to the rise in nursing specialties in the United Kingdom. Throughout primary and secondary care, nurses are taking senior positions in health care institutions, such as nurse specialists, nurse practitioners, nurse consultants, nurse prescribers, etc, leading to a marked change in service delivery and the profile of the nursing profession. In addition to the usual registered nurse training, nurses working at higher levels of practice receive training to acquire a range of other medical skills such as physical examination and medical history taking in order to recognise abnormal clinical findings.

In a two-phase exploratory study to evaluate the domains of structure, process and outcome of nurse-led clinics in supporting intermediate care after the acute phase of disease, Wong et al (2006) interviewed nurses from 34 clinics and 16 physicians and observed 162 nurse-led clinic sessions. Their findings demonstrated the high level of skill and experience of the nurses who ran the clinics. Their work involved skills such as adjusting medications and initiating therapies, and diagnostic tests according to protocols. Interventions included assessments and evaluations, and health counselling. All patients studied showed improvement after the nurse clinic consultation, with the best rates reported in wound and continence clinics; satisfaction scores for both nurses and clients were high. However, although physicians valued their partnership in care with the nurses, they were concerned about possible legal liability resulting from the advanced roles assumed by these nurses.

Ultimately, nurse-led clinics provide an integral and invaluable patient-centred approach to the management of chronic disease which build upon skills such as counselling, teaching and health promotion which are key to contemporary nursing practice, as well as newly acquired medical skills. The advent if nurse-led clinics provides an opportunity for nurses to develop enhanced roles in which they can achieve more autonomy in their practice. This can be made a reality if adequate training and education, as well as effective leadership are in place (Wiles et al, 2001).

2. The general roles of nurses in chronic care management

The chief nursing officer, Sarah Mullally has proposed ten key roles for nurses in autonomous patient care. These are outlined below as cited by Hatchett (2003):

Order diagnostic interventions: just like a medical practitioner would, the present-day nurse is able to ask for laboratory or clinical diagnostic tests to aid the process of diagnosis. Furthermore, a well-trained nurse will also be able to read and interpret laboratory results effectively
Make and receive referrals directly: while the all-important roles of nurses are recognised, the need for a multidisciplinary approach to patient care remains key in order to optimise patient outcomes. Accordingly, nurses should be able to recognise the patients’ needs and refer them to the appropriate health care service as required. Similarly, nurses should be ready to accept referrals from other health care disciplines as necessary.
Admit and discharge patients for specified conditions, within agreed protocols: in order to make the best use of the often limited hospital resources, a nurse should have the power to recommend patients for hospital admission and subsequent discharge
Manage patient case loads: in nurse-led clinics, nurses are also responsible for managing their individual case loads. It is important to delegate patient cases to other members of the team, when necessary to ensure that patients receive the best care possible.
Run clinics: the autonomous role of the nurse in a nurse-led clinic includes all aspects of the management and day-to-day running of the clinic.
Prescribe medications and treatments: nurse prescribers are able to advise patients on appropriate treatment, based on diagnosis of ailment and individual characteristics and laboratory findings.
Carry out a wide range of resuscitation procedures, including defribillation
Perform minor surgery and outpatient procedures: especially in injury clinics. While nurses are probably not equipped to carry out full-fledged surgical operations alone, they are trained to conduct emergency processes as appropriate.
Triage patients, using the latest information technology, to the most appropriate health care professional
Take a lead in the way local health services are organised and in the way they are run

Nurses have always been considered as a supplement to the fundamental care provided by medical doctors. In fact, in some geographical regions, nursing roles are limited to menial tasks such as changing bedpans etc. In the new age, the nursing role as we know it is becoming increasingly important with nurses taking on infinitely more clinical roles. This has led to controversial debates with critics arguing that nurses cannot replace doctors in the provision of health care services. As Richard Hatchett very astutely pointed out (2003), the increased autonomy being acquired by nurses is not a bid to compete with medical doctors. Instead, “it is a case of considering who can provide the most appropriate service to the patient” (Hatchett, 2003).

Thus, it is clear that the roles of nurses in chronic care management is very diverse and can be integrated into any nurse-led clinic intervention to the utmost benefit of the patient and all stakeholders. There have been numerous studies on the role of nurses in the care of patients with chronic diseases. In addition, and more specifically, the feasibility and benefits of implementing nurse-led clinics in practice have also been investigated to some extent. In the subsequent sections, we will review the evidence to support these innovative nursing interventions in an attempt to make the best use of health care resources.

3. Nurse-led clinics in the management of chronic care diseases: the evidence

The World Health Organization (2002) defines chronic diseases as health care problems that require ongoing management over a period of years or decades. The nature of these disease conditions make it necessary to provide long term care and follow-up for the afflicted patients. Nurse-led interventions have been investigated a wide range of chronic diseases. It could be a logical, user-friendly, cost-effective and practical approach to improving long-term patient outcomes and should be explored fully to maximise the contributions of nurses to the chronic care management.

Although this review aims to analyse the effectiveness of nurse-led clinics in the treatment of respiratory diseases, a prior look at the role of these interventions in the management of other chronic care diseases will provide an insight to the general contributory roles of nurses and will serve as a foundation for complete understanding of this state of the art intervention.

3.1 Nurse-led interventions in the management of diabetes

Numerous studies have evaluated the benefits and practicalities of nurse-led clinics in the long-term management of diabetes. The renal diabetic nurse specialist is described as an “essential player” in organising the management of, and to meet, all aspects of need of this group of patients (Marchant, 2002). An unintended benefit of a nurse-led clinic to reduce cardiovascular risk is improved glycaemic control, HbA1c (Woodward et al, 2005). In particular, nurse-led diabetic clinics have been shown to benefit specific ethnic groups. Matthias et al (1998) identified the needs of diabetic patients from minority ethnic groups, such as blacks and Asians and postulated that nurse-led clinics were of particular benefit in this patient group. As epidemiological data show that diabetes is most common in minority ethnic groups (Carter et al, 1996), the importance of these innovative interventions is further emphasised.

3.2 Nurse-led interventions in the management of cardiovascular disease

Care of patients with cardiovascular diseases is broad and involves many aspects, from risk factor management (non pharmacological interventions), primary and secondary prevention of clinical events, pharmacological therapy, surgical procedures, etc. Through a large well-designed randomised controlled trial in Scotland, Campbell et al (1998) showed that nurse-led clinics were practical to implement general practice and led to an significant increase in various aspects of the secondary prevention of coronary heart disease. Significant improvements were noted in aspirin management, blood pressure management, lipid profile management, diet and physical activity, regardless of the individual patient’s baseline cardio performance or status. However, surprisingly, there was no recorded improvement on smoking cessation, which would have been a beneficial intervention in most acute and chronic disease states, including respiratory diseases.

In addition to the apparent effectiveness of the nurse-led clinics in the long-term primary and secondary prevention of coronary heart disease, the optimal use of nurses in the care of these patients has been shown to be cost-effective in terms of quality adjusted life years (QALYs) (Raftery et al, 2005). In this large cost-effectiveness analysis, although the cost of the nurse-led clinic intervention was ?136 higher per patient, the differences in other National Health Service (NHS) costs was not statistically significant. Furthermore, there were 28 more deaths in the non-intervention group leading to a gain, in the intervention group, in mean life-years per patient of 0.110 and of 0.124 QALYs.

3.3 Nurse-led interventions in rheumatology

The role of clinical specialist medical doctors in the care of their patients is unquestionable; however, the role of nurses in the therapy area of rheumatology (i.e. in patients with rheumatoid arthritis) is also well documented. Hill and colleagues (1994) clearly demonstrated the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic. Although this was a small study with a sample size that only included 70 patients, the statistical significance of the findings of this randomised controlled trial cannot be ignored. In patients managed in the Rheumatology Nurse Practitioner clinic, pain, morning stiffness, psychological status, patient management and satisfaction all improved significantly (p = 0.001; p = 0.028; p = 0.0005; p<0.0001; p<0.0001, respectively). It is worthy of note that these improvements were not mirrored by patients who were managed in the Consultant Rheumatologist clinic.

In addition, patient satisfaction is frequently higher in patients who are allocated to nurse care than those allocated to standard medical care (Hill, 1997). In yet another study by Dr Jackie Hill, a registered nurse at the Academic and Clinical Unit for Musculoskeletal Nursing in the Chapel Allerton Hospital in Leeds, the researchers concluded that a nurse-led clinic is effective and safe and is associated with additional benefits, such as greater symptom control and enhanced patient self-care, compared with standard outpatient care.

3.4 Nurse-led interventions in cancer care

The effectiveness of nurse-led care in different common cancer afflictions has been researched variously. An extensive review article by Loftus and Weston (2001) discussed the patient needs that could be met by nurses working in nurse-led clinics and highlighted the experience and skills of advanced nursing practice that make such innovative care a reality.

The types of nurse-led interventions are as varied as the different types of cancers for which they are used. These range from nurse-led telephone clinics in patients with malignant glioma (Sardell et al, 2001); nurse-led follow up in patients receiving therapy for breast cancer (Koinberg et al, 2004); and nurse-led screening programmes in Hong Kong Chinese women with cervical cancer (Twinn and Cheung, 1999).

In a randomised controlled trial in a specialist cancer hospital and three cancer units in southeastern England, Moore et al (2002) assessed the effectiveness of nurse-led follow-up in the management of patients with lung cancer. The findings of the study showed high levels (75%) of patient acceptability. This negates the possibility of patients’ reduced confidence in nurses’ ability and preference for standard medical doctor care. Clinical outcomes were also greatly improved as shown by less severe dyspnoea at three months (p=0.03), better scores for emotional functioning (p=0.03), and less peripheral neuropathy at 12 months (p=0.05).

3.5 Nurse-led interventions in the management of HIV infection

Using a rigorous model of comprehensive care nurse-led clinic in genitourinary medicine to compare nurse-led and doctor-led clinics at a central London medicine clinic, Miles and colleagues (2003) reported reliable and valid results to support the use of the nurse-led variety as an acceptable alternative to the existing doctor-led clinics. More specifically, the British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) advocate the benefits that can be accrued from a nurse-led educational intervention in the care of patients with HIV infection (Poppa et al, 2003). A small pilot study that investigated the effects of a 6-month nurse-led educational programme reported that improved virological responses were seen in treatment-experienced patients (Alexander et al, 2001).

While a majority of the studies on nurse-led clinics in other chronic diseases can be broadly applied to nurse-led care in patients with respiratory diseases, differences in the nature of these diseases and the necessary care pathways mean that the extent to which these tested interventions can be applied to other therapy areas is, in actual fact, limited. Government policies that advocate the clinical and economic effectiveness of nurse-led interventions frequently pool together evidence from all therapeutic areas. Indeed, it can be hypothesised that, if nursing interventions are shown be practical alternatives for medical care in complex diseases with poor prognoses, such as cancer, HIV and coronary heart diseases, care of patients with respiratory diseases which generally have better prognoses should be easily, effectively and safely undertaken by qualified and well-trained nurses.

Nevertheless, these findings of the effectiveness of nurse-led interventions in the numerous chronic diseases explored in previous sections, should be applied to the different patient population with respiratory diseases. As much as possible, research findings from similar patient groups should be applied in clinical practice in order to ensure that evidence-based practice in this case is relevant.

4. Government policies influencing the establishment of nurse-led clinics

Government health policies in the United Kingdom actively support the extension of nurses’ skills into areas such as nurse prescribing and the development of nurse practitioner posts (NHS Plan 2000; Department of Health). Government initiatives that that strive to reduce consultation waiting times and optimise the use of medical practitioners indirectly support the establishment of nurse-led clinics. The Government has endorsed the implementation of nurse-led clinics as a means of increasing access to specialist health care and treatment more quickly and also as an effective way to manage chronic conditions (Hatchett, 2003).

In the Department of Health (1999) document, ‘Making a difference’, government plans for strengthening nursing contribution to health care is presented. The Government has launched an ambitious programme of measures to improve the National Health Service and the health of the public, and the role of the nursing profession in this initiative cannot be overemphasised.

The key nurse-related points of the document are outlined below:

To extend the roles of nurses, midwives and health visitors to make better use of their knowledge an skills – including making it easier for them to prescribe
To modernise the roles of school nurses and health visitors in supporting the new health strategy and other policies
To see more nurse-led primary care services to improve accessibility and responsiveness

The document highlights numerous nurse-led initiatives that have been effectively implemented all around the United Kingdom. A nurse-led minor injury service in rural Cornwall has provided patients with a number of benefits: easier accessibility, reduced waiting times, reduced need for on-site medical; attendance, increased patient satisfaction and reduced need for transfers to local Accident and Emergency departments. Similarly, a nurse-led rapid response team in Peterborough responds to acute crisis cases and allows patients to be nursed at home. Evaluation has shown that 71% of patients referred to this ‘hospital at home’ service would have been admitted to hospital if the service did not exist. Other effective live nurse-led services include a nurse-led rheumatology service in Merseyside and a nurse-led intermediate care unit in Liverpool.

Furthermore, several nurse interventions are advocated in the document for contributing to the management of cardiovascular disease. Several of these are also applicable to respiratory diseases; these include:

Smoking cessation clinics using national smoking cessation guidelines
Healthy lifestyle clinics in collaboration with other health professionals to address factors such as diet, nutrition and exercise, thus improving overall health
Care for patients with congestive cardiac failure under ‘home-based’ initiatives
Nurse-led chest pain clinics or risk factor screening and reduction clinics
Nurse-led blood pressure clinics to identify and help manage blood pressure disorders and medication adherence

5. Review objectives

The objectives of this review are:

To briefly summarise various studies on effectiveness and cost-effectiveness of nurse-led interventions in common respiratory diseases
To critically appraise the methods employed by these studies
To evaluate, interpret, and where possible, compare the findings of the various studies
To explore the applicability and generalisability of the results to practice in the appropriate patient population
To make suggestions for future studies in this area.

METHODS

Literature search

A search of two major databases, MEDLINE and EMBASE, was conducted to identify articles published from 1990 through 2008. Search terms that were used include nurse, nurse-led clinic, nurse-led interventions, respiratory diseases, asthma, chronic obstructive pulmonary disease, bronchiectasis, tuberculosis, cystic fibrosis, cost-effectiveness analysis, cost-benefit analysis, and economics. A secondary search of the reference lists was then conducted to identify relevant articles, editorials, and other unoriginal reports that may have been missed in the primary search.

Some studies were excluded based on the following criteria:

They were not conducted in patient populations with respiratory diseases
Independent nurse-led interventions were not investigated
The study populations being investigated were mixed in terms of diagnosis, which would affect the integrity of the study findings for respiratory diseases
The methodology and/ or statistical analysis methods were not clearly elucidated

6. Nurse-led clinics in the management of respiratory diseases: a review of the evidence

The role of the specialist respiratory nurse has evolved since the early 1980’s with the support of the Royal College of Physicians (RCP 1981). The possible complexity of respiratory patients’ regimens necessitates support with various aspects of their care plans, such as:

Supervising nebuliser and inhaler techniques
Monitoring progress, i.e. by periodical assessment of lung function and exercise capacity
Education on the specific disorder, medications, potential adverse events, etc
Counselling and education on positive lifestyle, or non-pharmacological, changes
Adherence support and monitoring

The role has developed further with nurses providing nurse-led clinics in chronic obstructive pulmonary disease (COPD) and asthma along with nurses providing early supportive discharge and ’hospital at home’ for patients with COPD (French et al, 2003). Some schools of thought argue that nurse-led clinics would culminate in the neglect of the more traditional nursing roles, as nurses focus on a more medical-focused aspect of patient care. However, research in other therapy areas, such as rheumatology (Hill et al, 1994) and mental health (Reynolds et al, 2000) shows that nurses can effectively combine the medical role with the traditional nursing approach. Nursing care strives to provide a holistic approach to care through practical management of disability, education and counselling and referral to other health care services as required (Rafferty and Elborn 2002).

6.1 Bronchiectasis

Nurse-led clinics have been evaluated, compared with regular doctor-led clinics, in a single randomised controlled trial in patients with bronchiectasis, a respiratory condition in which there is widening of the bronchi or their branches (Sharples et al, 2002). The study was a randomised controlled crossover trial including 80 patients in a bronchiectasis outpatient clinic. Patients received 1 year of nurse led care and 1 year of doctor led care in random order, and were followed up for 2 years. Various outcome indicators were used in the comparison, including lung function and exercise capacity, infective exacerbations, hospital admissions, quality of life and cost-effectiveness of the intervention. The results of this study are illustrated in Table 1 below.

Table 1: Nurse-led and doctor-led care in care of patients with bronchiectasis (Sharples et al, 2002)

Measurement outcome

Nurse-led

Doctor-led

Mean difference

(95% CI)

p-value

Forced expiratory volume in one second (FEV1) (%)

1.87

1.86

0.01 (-0.04 to 0.06)

Forced expiratory volume in one second (FEV1) (L)

69.7

69.5

0.2 (-1.6 to 2.0)

Forced vital capacity (FVC) (%)

87.6

87.6

-0.02 (-1.5 to 1.4)

12 minute walk distance (m)

765

746

18 (-13 to 48)

Infective exacerbations (patient years of follow up)

262 (79.4)

238 (77.8)

0.34

Hospital admissions attributable to patient’s bronchiectasis

43

23

0.22

As the table above clearly shows, there was no statistical difference in FEV1/FVC percent predicted or distance walked between nurse led and doctor led care in the

two treatment periods. Furthermore, 262 episodes of infective exacerbations were recorded by patients in the nurse practitioner-led care group in 79.4 patient years of follow up, compared with 238 in 77.8 years in the doctor-led care group. Thus, nurse practitioner-led care is associated with a relative rate of exacerbations of 1.09 (95% CI 0.91 to 1.30), p=0.34.

Using the St Georges Respiratory Disease questionnaire to assess differences in health-related quality of life between the two groups, there was no statistically significant differences in each of the scores for Symptoms, Control, Impact or total score. Also, the study showed that nurse-led care resulted in significantly higher costs per patient compared with doctor-led care; this was largely due to the difference in the number of hospital admissions and intravenous and nebulised antibiotic costs. The

authors concluded that nurse practitioner-led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources.

This study has several potential limitations which could invalidate the findings. As the study relied on patient report to record the prescriptions issued by general practitioners, these may have been underestimated and could grossly affect the cost analysis. Conversely, the nurse practitioner was required to record prescriptions and tests issued at the clinic, and thus these records are probably more reliable and she would be more likely to have ensured that patients left with supplies of routine treatment. Another possible drawback of this study is the use of a crossover design in the methodology. Unless a wash-out period is incorporated in the study design, there is the possibility of a carryover effect with crossover study designs, with the danger that the effects of the earlier treatment is falsely attributed to the final experimental

treatment. In this study, there was no allowance for a washout period and thus this could affect the reliability and validity of the study results. This order and time effect needs to be checked for within the analyses but it can rarely be excluded as potential biasing factors (Pocock 1983). However, as recruited patients received the interventions in random order, this may negate the carryover effect.

Despite the possible limitations of the study that could potentially hinder its applicability in practice, the findings support the implementation of a nurse-led clinic in patients with chronic cases of bronchiectasis as an alternative to the standard rigid medical care.

6.2 Asthma

Similar to the findings in the study by Sharples and colleagues (2002) in patients with bronchiectasis, Nathan et al (2006) more recently compared the effect of follow-up by a nurse specialist with follow-up by a respiratory doctor following an acute asthma admission. In a single centre prospective randomised controlled trial, 154 patients admitted with acute asthma were randomly assigned to receive an initial 30-min follow-up clinic appointment within 2 weeks of hospital discharge with either a specialist nurse or respiratory doctor. The intervention comprised a medical review, patient education, and a self-management asthma plan. Further follow-up was then arranged as was deemed appropriate by the corresponding doctor or nurse, and all patients were asked to attend a 6-month appointment.

Despite hospital outpatient follow-up, there was a significant proportion of patients in both groups who had exacerbations. However, there was no statistically significant difference between the two groups (Table 2). In the same manner, there was no statistically significant difference in quality of life assessed with two different validated questionnaires, the Asthma Questionnaire and the St George Respiratory Questionnaire. Mean change in peak flow at 6 months was similar between the two groups, probably indicating equivalence of the two tested interventions. Nathan et al (2006) concluded that follow-up care by a nurse specialist for patients admitted with acute asthma can be delivered equivocally with comparable safety and effectiveness to that traditionally provided by a doctor practitioner.

Table 2: Nurse-led and doctor-led care in follow-up care of patients admitted with acute asthma (Nathan et al, 2006)

Measurement outcome

Nurse-led

Doctor-led

Odds ratio

(95% CI)

Mean difference

(95% CI)

p-value

Change in peak flow

1.39 (-3.84 to 6.63)

0.122

Infective exacerbations (%)

45.6

49.2

0.86 (0.44 to 1.71)

0.674

Quality of life

87.6

87.6

-0.02 (-1.5 to 1.4)

Asthma Questionnaire

0.78 (-0.64 to 2.19)

0.285

St George Respiratory Questionnaire

1.08 (5.05 to 7.21)

0.891

The possible limitations associated with this study is the large amount of missing data for some outcomes, especially peak flow and quality of life

Financial Reporting Systems of Germany and the Netherlands

Nobes (1998) classifies the German financial reporting system as a ‘Type B (weak equity)’ and The Netherlands as ‘Type A (strong equity)’. Compare the financial reporting systems of Germany and The Netherlands.

National differences have all become stereotypical. Indeed the differences between countries may be vast. Influences such as family origin, or attitudes towards business culture are inherently reflected in the way businesses are run, managed and owned. There are also many reasons as to why there are differences in financial reporting. These depend on the character of the national legal system, the type of industry financing, the interrelationship between tax and finance reporting systems, the extent of accounting theory progression and even language.(Elliott, 2006)[1]

In terms of the legal system between Germany and the Netherlands, it is clear tat they both follow a civil law system which is different to the common la procedure of the United Kingdom contained within the Companies Act 1981.[2] However, for the purposes of this essay, I will focus on the comparisons between the financial supporting systems of German and the Netherlands with regards to the Nobes’ (1998) classification of Germany being a weak equity (Type B) while the Netherlands in a strong Equity (Type A).

I will consider Nobes’ theory by considering equity figures for both Germany and the Netherlands in respect of their types of equity and will briefly compare the financial reporting systems of the two countries.

Although equity is represented in many different forms, it is generally defined as “the value of a company which is the property of its ordinary shareholders (the company’s assets less its liabilities, not including the ordinary share capital)[3]

In terms of financial accounting reporting, considerations of which is the relevant way of financing a business, i.e. the information required by equity investors are different to those of load creditors. Strong equity can be defined as a high ratio between equity market capitalisation and Gross Domestic Product (GDP) whilst weak equity is a low ratio between market capitalisation and Gross Domestic Product (GDP).[4] I, Germany had the lowest equity of 5 countries which were studied. (49%). This shows that unlike America, France or presumably the Netherlands, Germany does not rely heavily on individual investors.

Specifically, Nobes (1998) develops a frameork that seek to explain the differences in international accounting. Nobes catagorises accounting systems into two types: Class A (accounting for outside shareholders) and Class B (accounting for tax and creditors). Two variables determine whether a country will have a Class A or a Class B accounting system: (1) the type of culture and (2) the strength of the equity-outsider financing system. According to the model, countries with Type A cultures have developed strong outsider-equity financing systems that have led to the development of a Class A financial reporting system. Therefore, like America and the UK, the Netherlands has relied on a Type A accounting system that is relaint on a high ratio of equity investment as oposed to loan creditors.

Conversely, countries with Type B cultures have weak outsider-equity financing (i.e. weak equity) systems that have led to the development of a Type B financial reporting system . This model is comonly known to be widespread practice within continenatl Europe including Germany.

Nobes (1998) stsudies the link between the financing system and accounting, but also believes that a Type A system in terms of equity financing is not entirely dependant on Type A accounting, but instead external or outsider equity financing is imperative.

By drawing on examples, Nobes (1998) examines Japan. Japan is a country with many listed companies as well as large equity market, but instead of the market being supported externally, most of the shares are owend by Janpanese banks or other companies, investors etc). According to the model, financial reporting in Japan should exhibit the characteristics of a Type B accounting system. Nonethelss, Nobes (1998) in explaining why Germany is substantialy different to the Netherlands claims that differences in culture, i.e. countries that have altered their culture through war will usually adopt the culture and accounting system imported from the dominating country. This explains, for example, why some post colonial African countries possess a type A system despite having very weak accounting systems.

As noted earlier, Nobes focuses his discussion on the link between financing systems and accounting. He assumes that some cultures lead to strong equity-outsider financing systems and others do not, but he leaves the examination of this assumed relationship for others. Nobes appears to assign a very broad view of culture to this variable in his model. In a simplified model presented earlier in his paper he refers to this variable as “culture, including institutional structures”[5] A brief examination of the differences betweent the culture of institutional structures is examined below.

While a Type A classification separates accounting and tax rules, Type B does not.[6] Type A in comparison to Type B also has an extensive auditing system. This is true for the Netherlands in comparison to Germany. In US, UK and Netherlands, link between taxable income and accounting income is much weaker, with separate tax accounts and financial accounts. The information is prepared with external investor information in mind thereby focusing on a large equity market (Type A). In comparison a Type B taxation system such as that of Germany tax accounts which are published financial accounts are not usually prepared for investors, but instead internal forces such as company investors, shareholders etc.

In sum, the Type A system such as that in practice in the Netherlands and as proposed by Nobes is one of dynamic accounting formulated with the external investor in mind thereby creating increased demand for external investment. On the other hand, Germany experiences the converse of this, with taxation and accounting system which is interlinked and an intention of financial reporting for internal investors rather than external investors in mind.

Bibliography

Classification based on Corporate Finance, http://www.people.ex.ac.uk/wl203/BEAM011/Materials/Lecture 10/IA1 Lecture 10.pdf

Elliott et al, Financial Accounting and Reporting, (2006 10th ed)

Dictionary of Accounting, Collin Publishing (2001)

Nobes (1998)