Research
You will find a complete range of our peer-reviewed monographs, multi-authored and edited works, including original scholarly research across the social sciences and aligned disciplines. We publish long and short form research and you can browse the Bristol University Press and Policy Press archive.
Policy Press also publishes policy reviews and polemic work which aim to challenge policy and practice in certain fields. These books have a practitioner in mind and are practical, accessible in style, as well as being academically sound and referenced.
Books: Research
The conclusion aims to draw together some of the main themes and lessons from the book. In particular it reflects on the potential contribution of equality law to addressing health inequalities, and discrimination and inequality in access to health care, and identifies gaps in existing knowledge and areas for future research.
Available open access digitally under CC-BY-ND licence.
When deciding who to treat, those engaged in priority setting and resource allocation in health care need to comply with their obligations under the Equality Act 2010.
This book provides an in-depth examination of how anti-discrimination laws intersect with health care rationing in the UK. It critiques how existing legal frameworks apply to resource allocation, questioning whether and when utilitarian principles should be adjusted to incorporate anti-discrimination norms. The author offers detailed cases studies in the contexts of fertility treatment, public health, and intensive care, highlighting practical implications and real-world challenges.
This is a timely legal analysis, providing crucial policy insights in the wake of recent global health crises.
This chapter explores the complex relationship between personal characteristics protected by equality law, socio-economic inequality and patterns of health inequality in the UK, and explores the potential of equality law in addressing health inequalities. It considers the role that the Equality Act 2010 and the Human Rights Act – and especially proactive duties such as the Public Sector Equality Duty – have to play both in tackling the determinants of ill health and in shaping policy responses to it, and argues that this potential is currently limited in a number of key respects. In particular, existing law is ill equipped to address socio-economic inequality and problems of intersectionality.
This chapter assesses the impact of restrictions on access to fertility treatment (including in vitro fertilization and surrogacy services) on two groups protected by equality law in particular – older women and same-sex couples. Existing policies often contain eligibility criteria which either exclude or restrict access to funded treatment for these groups. The chapter outlines the existing policy landscape in the UK – which, as will be seen, varies significantly across different localities – and then considers whether (and if so, what) potential legal justification exists for discriminatory access criteria by assessing how the proportionality test may apply in this context. In doing so it will consider the relevance of the definitions of infertility.
This chapter looks at the scope for discrimination to arise when making decisions about who can access intensive and other forms of emergency care and the way in which the equality law framework may respond to this. In particular it will explore the concerns about age and disability discrimination that arose in the COVID-19 pandemic, as a result of policy choices about how to prioritize patients in the face of a shortage of intensive care beds or the appropriate application of ‘do not attempt cardiopulmonary resuscitation’ orders, but it will also consider the scope for such discrimination to arise in ‘ordinary’ times. It also explores, briefly, the extent to which the law requires religious belief to be accommodated in making decisions about end of life care.
This introductory chapter sets the scene for discussion of the issues raised in the book, outlining the dilemmas faced by those responsible for deciding how health care should be commissioned in the UK and the particular challenges and opportunities offered by equality and anti-discrimination law in this context. It also outlines the institutional setting and provides a brief overview of the legal framework which is then explored in more detail throughout the book.
This chapter considers the circumstances under which it will be possible to make health interventions available only to certain subgroups of patients or to individuals where they would be particularly disadvantaged, in ways related to their protected characteristics, by a policy not to fund them. It will aim to identify, as far as possible, the circumstances under which equality law will permit or require the personal characteristics of patients to be taken into account in determining whether an exception for a specific group or for an individual should be made. It will also highlight a number of challenges the equality law framework presents for commissioners and other health professionals in making decisions about how to allocate resources.
This chapter explores how policy decisions are made about which treatments to fund and what the access criteria for these treatments should be, and identifies the respects in which the policy-making framework is constrained or facilitated by equality law. It considers whether and how discrimination, and the disadvantage and inequality this may cause or reinforce, may arise in a number of aspects of policy making – in particular in relation to decisions made on the basis of cost-effectiveness, including where the methodology involves the use of Quality Adjusted Life Years; the use of characteristics such as age as proxies or markers for risk or capacity to benefit in decision making; lack of inclusion in research; and variation in local provision, often referred to as the ‘postcode lottery’.
This chapter will look at two aspects of public health policy that raise interesting questions and challenges for equality law. First, screening programmes aiming to catch serious disease at an early stage. These provide an interesting case study because public health screening is one of the few contexts in which is common to find explicit use of age limits (or occasionally sex) to determine eligibility for treatment. Second, the chapter explores aspects of the public health response to COVID-19, the way this served to disadvantage some groups, and the role of the Public Sector Equality Duty in informing the policy choices that needed to be made.
This chapter considers the role of the courts in reviewing resource allocation decisions involving potential discrimination. In relation to ‘ordinary’ judicial review of resource allocation decisions, the approach of the courts is generally one of considerable deference, with a willingness to adjudicate on procedural failures but not on the substance of decisions. The chapter will review case law which deals with discrimination in a resource allocation context (in health care and other relevant areas and including cases involving claims under Article 14 of the European Convention on Human Rights and the Equality Act 2010) and consider the coherence of the law and the implications for commissioning health care.
