This thesis explores the London Market Excess of Loss Spiral (“LMX Spiral”), a phenomenon based upon excess of loss reinsurance contracts that developed within the London reinsurance market of the 1980s. The unwinding of the LMX Spiral was a key factor in the crisis the Lloyd’s insurance market had to face in the early 1990s. However, whilst the crisis resulted in a wave of litigation in the English courts, there is no legal appraisal of the additional element of risk brought by the LMX Spiral itself. The case law instead focuses on the duties of the underwriters and various agents that fuelled its development. This situation is unsatisfactory for two reasons. Firstly, reinsurance spirals are a potential side-effect of XL reinsurance markets and therefore other spirals may develop in the future. Secondly, this thesis shows that once a reinsurance spiral reaches a certain point, it becomes unsustainable, generating instability within the relevant reinsurance market. This thesis provides a detailed legal appraisal of reinsurance spirals and a new analysis of excess of loss reinsurance contracts. The first part sets out the relevant legal principles and describes the LMX Spiral and its impact; listing, for the first time, the “Spiral Effects” identified through reports and actuarial models. The second part reviews the case law and assesses the legal nature of the excess of loss “Spiral Contracts” at the core of any reinsurance spiral, concluding that the Spiral Effects can distort the Spiral Contracts to the point where they become simple contracts of indemnity. The third part explores the nature of excess of loss reinsurance in light of the review of the Spiral Contracts, submitting that excess of loss reinsurance contracts cover both the liability of the reinsured and the relevant insured peril.

Fraud is always a concern when an insurer issues a policy to an assured. An assured can take out numerous policies and claim indemnity under all the policies, which would result in the assured receiving more than he is entitled to. Is the fear of fraud justifiable and are such exclusions or limitations in insurance contracts preventing recovery where there is other insurance effective? Further, is there sufficient protection for insurers by way of contribution from other insurers. It is beneficial to look at the history and development of the law of insurance, to understand how the law relating to double insurance has developed and the factors the courts may take into account when deciding such issues. The courts in many jurisdictions have tried to deal with the problems which have arisen as a result of such clauses. The courts have also dealt with the question of whether the assured is or should be given any protection when double insurance arises, and if so, whether the insurer has to pay out under the insurance policy. However, where there are rateable proportion clauses with other types of clauses, the solution is not that clear. It is quite common for judges, when dealing with such cases, to conclude that the case before it is not a case of double insurance. In some cases, even though the trial judge may hold that the case before him, on the facts, were sufficient to give rise to double insurance, on appeal, the appeal courts have come to the conclusion that the facts of the case do not give rise to one of double insurance. This clearly shows what a difficult concept double insurance is. This has resulted in the courts not actually being able, even till now, to provide any real solid rules or guidelines on double insurance . Further, even though an assured has taken out insurance with numerous insurers he will not be able to recover more than the loss he has actually suffered. This is the general principle of indemnity. The next problem for an assured is then, from which insurer the assured can seek recovery from. Is there a particular order when seeking recovery or can he recover from whichever insurer he chooses? At the moment, the law on this is also unclear.

This thesis explores the newly established role of midwife practitioner (MP) and its impact on midwives and obstetricians in a maternity unit in Wales. MPs manage the care of women at high obstetric risk and carry out aspects of care, such as assessment, diagnosis and the development of management plans, which in the past were predominantly performed by obstetricians. This qualitative study employs a focused ethnographic approach and uses a purposive sample. Phase one consisted of seven focus groups, which were held between May and August 2004, with midwives (n=48) from maternity units in Mid and South Wales. In Phase two, participant observation was undertaken with MPs (n=3) over a two-week period encompassing eight 12-hour night shifts, during November and December 2004. For Phase three, semi-structured interviews were conducted with midwives (n=10), clients (n=10) and obstetricians (n=7), between July and December 2005. Phases two and three were carried out in a maternity unit in South Wales. The key findings of this study demonstrate that the lack of planning for the MP role inadvertently resulted in the creation of a distinct health care role, which encompasses positive aspects of both midwives' and obstetricians' work to provide safe and acceptable care for clients. The MPs in this study are committed to providing holistic care that takes into consideration the emotional and social needs of women and their families. In addition, these MPs are developing confidence and analytical skills, normally demonstrated by medical staff. However, further initiatives such as allowing MPs to prescribe, or to refer to other specialties, have not yet been adapted to support these new roles. It is too early to see the full impact of this role, but it is argued that it will have no significant effect on the work of the other midwives. MPs, however, do have the potential to impact upon the work of the obstetricians. This study contributes to the current body of knowledge concerning policy and practice for maternity care by examining a new role early in its genesis. This study makes a number of recommendations, including extending the number of MPs employed in Wales, the need for careful planning of future extensions to the midwives' role and further research into the safety and effectiveness of the MP role.

Study one explored the service user experience of treatment for anorexia nervosa in the Welsh healthcare service. Factors such as treatment expectations, satisfaction, therapeutic alliance, motivation to change and engaging in treatment were considered by conducting indepth interviews with participants who had a diagnosis of anorexia nervosa and were receiving secondary care. Qualitative data were analysed using thematic framework analysis revealing six main concepts: service user description of anorexia; expectations of treatment for anorexia; the journey through the health service for anorexia; therapeutic alliance during treatment for anorexia; satisfaction with the health service; and service user recommendations to improve the health service. Mapping and interpretation of the concepts drawn from the interviews resulted in a model exploring the relationship between expectations and satisfaction of treatment for patients with anorexia nervosa, and the effect upon motivation to engage in treatment and recover. Another model describing factors that affect therapeutic alliance was developed. The results are described with particular reference to the Self-Determination Theory (Ryan & Deci, 2000). Study two used a four-stage, mixed-methods approach to develop and evaluate an anorexia nervosa awareness campaign for healthcare professionals. The campaign was developed using an integrative social marketing approach (NSMC: 2013): including formative research, process evaluation and outcome evaluation. Formative research included audience research (interviews and focus groups with healthcare professionals and healthcare professionals in training) in combination with theories of social cognition and persuasion to develop four posters. Process evaluation included campaign evaluation by healthcare professionals using questionnaires (open and closed ended questions). Appropriate modifications to the posters were made following the process evaluation, and two posters were chosen as the final intervention. Outcome evaluation of the campaign was conducted by using a brief, four-item evaluation questionnaire completed by healthcare professionals (General Practitioners and nurses). Results from all phases indicated that the use of posters as the medium of the anorexia Study three included development of a comprehensive audio-visual intervention to increase nursing students’ self-effcacy regarding initial management of patients with anorexia nervosa. The intervention was developed and underpinned using the Transtheoretical Model Framework (Levesque et al., 2001), and then evaluated using a pre-post-test design. The intervention was successful in significantly increasing nursing students’ self-efficacy regarding the initial management of anorexia nervosa. Furthermore, the nursing students’ self-efficacy was high prior to the intervention, indicating that nursing students already feel confident to manage patients with the disorder. The methodological and theoretical implications are discussed. nervosa awareness campaign did not sufficiently raise awareness of anorexia nervosa, and therefore the limitations of the second study were considered.

No description available.

The end of World War II was the beginning of an era of promises being made for the protection of human rights. Since then, the international community has established a variety of legal instruments that aim to achieve this protection. These legal instruments at the international level provide certain standards for states to fulfil, such as the right to a fair trial and prohibition of arbitrary detention. Despite the growing international human rights network including several official and non-official actors, non-compliance with international protection standards by states is still a serious challenge within the system. The ever-enlarging literature on international law compliance theories persistently seeks to find ways to overcome this problem. Immigration detention of children, one of the human rights issues on which the international network has provided guidance to states, has been practiced by Turkish and British immigration authorities for a considerable period of time. This practice has been justified on the grounds of efficient immigration control. Nevertheless, these two countries recently took legislative steps towards compliance with international human rights standards regarding immigration detention of minors. This research investigated these processes in Turkey and the UK to find out whether there were any actors that influenced the decision to change legislation by applying a selected compliance theory that focuses on socialisation between various actors such as courts and international monitoring bodies and the state. It was clear that these two very different countries reached the same conclusions via distinct routes, in reference to different reasons and motivations. While the theory’s predictive value showed only limited success in the UK’s case due to its reliance on socialisation and international law, it had high explanatory power for Turkey’s case. Nonetheless, it still demonstrated the importance of identifying actors capable of influencing decisionmaking of states to further strengthen the system of protection of human rights.

Background: In a part of Wales where over 50% of the population were bilingual, one community physical rehabilitation services had no Welsh speaking therapists. This research attempts to find whether Welsh speakers had the same access to health and social care services and whether their outcomes were similar to non-Welsh speaking patients; and what the service users' opinion were on Welsh language services. Methodology: 1 - Therapy inputs and outcomes of service users who spoke Welsh were compared to service users who did not speak Welsh with a rehabilitation team where no therapists spoke Welsh. 2 - The ratio of Welsh speakers referred to the rehabilitation services and accepted for services were compared with the ratio of Welsh speakers in the general population. 3 - 201 service users were asked for their opinion on services and their language choice, and the possible effect on their ability to effectively receive a rehabilitation service. Results: Significantly fewer Welsh speakers were referred to the rehabilitation service than the anticipated percentage (p < 0.001). Wales' social services do not document individuals' language preference consistently. A significant difference was found in the therapy outcomes measured by outcome measures according to the patients' language if the practitioners could not speak Welsh. Welsh speaking patients had significantly lower results following rehabilitation than non-Welsh speakers (p < 0.05). The vast majority of Welsh speaking patients who were asked believed they would have preferred receiving services in Welsh. Conclusion: Awareness raising training for practitioners and carers, as well as language training, including 'little words' training, would support availability of Welsh language services. Consideration should be given to creating a specialist national agency to maintain a database of Welsh speaking practitioners, from which health boards and local authorities could buy their services when appropriate.

The major concern of this thesis is about the current professional standard of care under Saudi Arabian medical law, regarding doctors’ duty to disclose information and risks to competent adult patients about a proposed medical treatment. Additionally, the thesis has highlighted other legal deficiencies that occur as a result of applying the professional standard in Saudi Arabia and considered how reforms can be introduced, based on English law experience in a way that is in harmony with Islamic Sharia. The thesis has undertaken a novel approach by critically studying and comparing the current practice in Saudi Arabian medical law to the comparative English law approach. The reason for this is to provide a comprehensive legal literature review based on the extremely well- developed English law experiences in the same matters. Realising the significance of the principle of the respect for autonomy, the thesis has placed a noticeable emphasis on this principle by arguing that considering and respecting autonomy would lead the law to protect the patient’s autonomy and self-determination in a medical context. The thesis has argued that both Western and Islamic Sharia medical ethics have considered the notion of the respect for patients’ autonomy, but that consideration has been approached differently, as the thesis has shown. Further, the thesis has critically discussed how the English law standard of care has been developed in the last three decades, in order to move from the professional standard of care to a new standard that protects patients’ autonomy and self-determination. These developments and years of experience have provided sufficient arguments and supports for the thesis’s motion to recommend and suggest that Saudi Arabian medical law departs from the professional standard and adopts the prudent patient standard to protect patients’ autonomy in compliance with Islamic Sharia. In addition to proposing a legal formula for the prudent patient standard that can be adopted by Saudi Arabian medical law, this thesis has also proposed other formulas as solutions for other legal deficiencies, based on English law experience and in accordance with Islamic Sharia.

A popular metaphor used by judges and journalists, the ‘chilling effect’ is used to describe the undesirable deterrence of legitimate free expression, although it is widely and loosely interpreted and rarely interrogated through methodical empirical research. This research examines the perceived chilling effect on freedom of expression in relation to defamation and privacy law and digital journalistic practice in England and Wales, over a five year period (2008-13). It examines media law in practice through interviews with legal specialists in defamation and privacy, close monitoring of online content, examination of court and policy documents, and surveys among journalists and online writers, and considers how decisions to publish or abandon stories are made in the contemporary networked news environment. The thesis finds that lawyers play an under-recognised but pivotal social role in the editorial gatekeeping process, enabling as well as restricting publication. Their absence in ill-resourced environments has a paradoxically constraining and liberating effect: a lack of legal advice and knowledge may lead to unnecessary censorship of particular stories, but at the same time small-scale operations without legal support and training may be less reactive to potential libel and privacy risks. Despite a popular perception of runaway privacy law, the findings indicate that libel was still a predominant concern for research participants and generated more threats and claims. The impact of defamation and privacy law on journalism, which is implied by the chilling effect metaphor, cannot be understood in isolation and a socio-legal approach based on empirical evidence is required to more fully expose the two-way interaction between law and journalism. Editorial decisions are subject to a complex web of competing factors; the collective or individual avoidance of stories can only be explained by looking at legal influences in their social context. In this way, hyperlocal bloggers may steer clear of particular topics for fear of social implications in local communities and national journalists can neglect stories as a result of organisational commercial pressures, or because such stories would damage their access to sources. The chilling effect descriptor is generally used to help direct policy and decisions that enhance freedom of expression in the public interest but debate is severely hampered by the lack of systematic research and data collection, as this thesis will show. Given the social complexity and ambiguity around perceived chilling effects, the thesis argues that this exercise would be informed by more detailed monitoring and analysis of specific contributory factors, such as individuals’ access to legal resources, legal knowledge and experience of direct or indirect threats of legal action. A more precise understanding of these elements in their wider social context would help the design of proportionate legal dispute mechanisms and the development of public legal education initiatives.

Shareholder protection has been a focal point of the Greek legislator's agenda for years. Despite a series of reforms towards the direction of shareholder empowerment, the adequacy of the existing framework remains questionable. The thesis conveys the argument that the remedies for maladministration under Greek company law remain dysfunctional and need to be reformed in order to establish an effective and competitive legal framework for shareholder protection. It is argued that such initiatives are important in order to boost investor confidence and provide an effective monitoring mechanism of corporate governance. In order to assess whether and to what extent the Greek shareholder law attains these objectives, it is examined on a comparative basis with jurisdictions which recently reformed their shareholder law; namely the United Kingdom and Germany. The thesis analyses the imperfections of Greek law. The latter is devoid of a genuine derivative action and the existing functionally equivalent mechanism is unsuitable to overcome the challenges of shareholder litigation. The relevant law is exclusionary and rather biased against individual shareholders. It deters meritorious litigation and does little to ensure that proceedings do not run contrary to the company’s interests. Much of corporate misfeasance escapes the scope and content of the existing provisions and, effectively, corporate wrongdoing is left uncompensated for and undeterred. Furthermore, the broader legal framework cannot compensate for the absence of an appropriate mechanism to enforce directors’ duties and pursue corporate claims via shareholder-initiated litigation. However, the examination of the strategies followed by the UK and Germany provides useful insights for the way forward. The rationale for and the experience from the recently introduced provisions thereto are invaluable in the thesis’ attempt to construct and propose a modern and functioning model of derivative actions for Greece.