Category: duty of care

  • Everyone cares until someone asks for a statute

    Everyone cares until someone asks for a statute

    Parliament will soon return to the question of a statutory duty of care in higher education, because the first debate did not deliver the clarity or action that was needed.

    The Post-16 education and skills white paper flags the issue – noting that a new Higher Education Student Support Champion will work to address the recommendations from the National Review into Higher Education Student Suicides.

    More than three university students in England and Wales die by suicide every week. The duty to protect students from reasonably foreseeable harm is long overdue. Voluntary measures and optional good practice are no substitute for a clear legal duty.

    The first parliamentary debate on this issue, held in 2023, left a crucial question unanswered – what does “duty of care” actually mean, and why do so many people believe universities already have one?

    Every conversation about “duty of care” in higher education eventually runs into confusion. Some say universities already have one. Others insist they don’t. Both sound right – and both can’t be wrong. The problem is that “duty of care” means very different things depending on who’s speaking.

    For families, it’s a promise of protection. For universities, it’s a matter of professional judgment. For lawyers, it’s a term of art – a legal threshold that decides whether the law even applies when harm occurs. But there’s a simple way to make sense of it – by borrowing a shape from soil science.

    So as MPs prepare to revisit the issue, here I’ve set out a way to understand the debate in visual form – through what I’ve called the Legal Duty of Care Triangle. It shows, at a glance, why legal definitions, government policy, and public expectation have drifted so far apart – and why that gap matters now more than ever.

    The concept

    A ternary diagram is a triangular graph used to represent systems with three components that sum to a constant, typically 100 per cent. While traditionally employed in the physical sciences – in chemistry, geology or soil classification – to show compositional data, it can also be a powerful conceptual model for non-scientific problems.

    By using the three corners of a triangle to represent three competing factors, we can visualise the balance between them and the resulting outcome.

    The same idea can explain the legal concept of duty of care. Imagine a triangle whose corners are labelled “making things worse,” “doing nothing,” and “making things better.” Every decision, omission or intervention made by an institution can be plotted somewhere within that space. The position tells you what kind of care – or lack of care – is at play, and whether the law of negligence currently recognises it.

    Acts, omissions and the Tindall judgment

    The distinction between acts and omissions runs through English law. Courts are willing to impose liability for acts that cause harm, but rarely for failures to act, even when the need for intervention was obvious.

    The Supreme Court reaffirmed this in Tindall v Chief Constable of Thames Valley Police [2024] UKSC 44, describing the difference between “making things worse” and “failing to make things better.” The law punishes the first but usually overlooks the second, unless a “special relationship” creates a specific obligation to act.

    That single distinction explains why so many student cases – including Abrahart v University of Bristol (Court of Appeal, 2024) – fail to establish a general duty of care. The courts accept that mistakes were made, and even that harm was foreseeable, but can decline to impose liability by characterising the university’s failings as “pure omissions”, not actions that “made things worse.”

    In the conceptual model, the three corners of the triangle represent three strategic approaches an institution might take when faced with foreseeable risk:

    • Making things better – Proactive action. Taking reasonable and timely steps to prevent foreseeable harm. This might include implementing sound procedures, addressing emerging risks, and responding appropriately when warning signs are clear.
    • Making things worse – Negligent action. Acts or decisions that foreseeably create or aggravate harm — for example, ignoring evidence, mishandling complaints, or enforcing policies that intensify vulnerability or risk.
    • Doing nothing – Passive inaction. A failure to act when an institution knows, or ought reasonably to know, that intervention is required. Courts are generally reluctant to impose broad affirmative duties, but complete inaction in the face of foreseeable harm can potentially still give rise to liability under existing legal frameworks such as negligence or equality law.

    The triangle shows how these behaviours relate to one another.

    • At the bottom left lies making things worse – acts of commission that cause harm.
    • At the bottom right, doing nothing – omissions or institutional inertia.
    • At the top, making things better – protective, preventive steps taken with reasonable care.

    The law, as it stands, occupies mainly the lower portion of the triangle. It is most comfortable along the base, where harmful acts are distinguished from mere inaction. The upper space – proactive prevention – sits largely outside the common-law field.

    Cause, not prevent

    One organisation sits in a particularly revealing place on the triangle – Universities UK (UUK).

    Unlike the Department for Education or the courts, UUK has consistently described universities as already having a common law “general duty of care.” At first glance, that sounds like agreement with campaigners – but it isn’t.

    What UUK actually means is a general duty not to cause harm through acts or omissions. It’s a subtle but crucial difference. It is referring to a reactive duty – one concerned with causation of harm, not prevention of reasonably foreseeable harm.

    For example, if an institution takes a clear and identifiable act — such as issuing incorrect information, mishandling a process, or withdrawing essential support — and that conduct foreseeably causes or worsens harm, the law may treat the situation as one of direct causation.

    If the institution then fails to correct or mitigate the error once aware of it, that omission becomes part of the same chain of causation.In such cases, the duty extends to omissions only when they form part of that chain, not where the institution simply fails to prevent a wider or unrelated risk..

    In legal terms, this remains a negative duty (to avoid causing harm), not a positive duty (to take steps to prevent it). It recognises that omissions can sometimes “cause” harm where there’s a direct link, but it doesn’t impose any obligation to foresee and prevent it.

    That distinction between cause and prevent defines UUK’s unique position. It sits within the existing boundaries of common law because it focuses on reactive duties — those that arise only when harm has already been caused.

    This is the source of much public confusion: UUK uses the language of care to describe a legal concept concerned solely with causation.

    The result is a comforting vocabulary that sounds protective but, in practice, stops at the point of legal liability.

    When UUK says that universities already have a duty of care, it means a duty not to make things worse, rather than a duty to make things better. The same words – but different worlds.

    Responsibility without liability

    The original petition did not ask for improved guidance or voluntary measures. It called for a statutory legal duty of care – a clearly defined obligation in law requiring universities to take reasonable steps to protect students from foreseeable harm.

    Yet when the government issued its 2023 petition response, it appeared to suggest that such a duty already existed. The statement claimed that universities “already have a general duty of care to not cause harm to their students” and “are expected to act reasonably to protect the health, safety and welfare of their students”. Language that sounded legal but was not.

    At that stage, the Department for Education (DfE) was describing something closer to an ethical or moral responsibility – a general expectation that institutions should act responsibly – while borrowing the vocabulary of law. It gave the public the reassurance of legal certainty without any of its substance. The explicit legal framing emerged only later.

    In response to a Parliamentary Question tabled shortly before the Westminster Hall debate, Minister Robert Halfon used the phrase “law of negligence.”

    This was the first time the Department had explicitly tied its earlier petition response to that legal doctrine, implying that it had always referred to common-law principles. From that point onward, this became the Department’s preferred line – not as clarification, but as post-hoc justification.

    Then, in early 2025, Janet Daby MP, Minister for Children, Families and Wellbeing in the Department for Education (DfE). appeared to reset the conversation. In a Parliamentary Question response she acknowledged that a duty of care may arise in certain circumstances, but that this would be a matter for the courts to determine. This was a noticeable change in tone – a more candid admission that no general legal duty exists and that the issue remains legally unsettled.

    Her statement offered welcome clarity after years of obfuscation, though it still stopped short of committing the Department to legislative reform.

    The same careful phrasing was subsequently used in a formal letter from the Department dated 16 July 2025, confirming that this “reset” had become its official position:

    A duty of care in higher education may arise in certain circumstances. Such circumstances would be a matter for the courts to decide… The common law allows flexibility, without the potential rigidity that may arise from codifying a statutory duty.

    The evolution reveals rhetorical movement but positional continuity.

    The Department has, in reality, always occupied the same place – outside the legal boundary of the triangle, in the zone of responsibility without liability. What changed was not the position itself but the language used to describe it.

    The 2023 response disguised that position through legal-sounding reassurance; the 2025 reset finally admitted what had been true all along — that no general legal duty exists and that the matter rests with the courts. In other words, DfE continues to speak of care, support and best practice, but refuses to define those commitments in law.

    When the risk is radicalisation, the government imposes a statutory Prevent Duty, but when the risk is harm to students, it hides behind the flexibility of common law.

    The real world

    Once the triangle exists, it becomes possible to plot where each actor sits – and, crucially, what that reveals about how they understand “duty of care.”

    At the bottom centre sit the courts, which define the legal floor of responsibility. Their judgments focus on causation, proximity, and foreseeability – deciding whether an act or omission was sufficiently connected to the harm suffered to give rise to a duty.

    They don’t occupy either corner of the base because they navigate between them – recognising liability for acts that make things worse, but rarely for omissions that cause or contribute to the problem, or simply fail to make things better.

    Their position therefore represents the balancing point of the common law – the threshold where duty ends and moral expectation begins.

    Along that same base lies UUK, which has translated the courts’ caution into sector orthodoxy. UUK’s “general duty not to cause harm” adopts the courts’ reasoning as a policy principle – treating the lower boundary of the triangle as the full extent of universities’ obligations. In effect, the courts define the boundary, and UUK defends it.

    Moving rightwards along the base, universities sit midway between the courts and the “doing nothing” corner, invoking autonomy and professional judgment to argue that support and intervention are matters of discretion rather than law.

    Then just outside that edge sits the Department for Education, which talks in moral terms of “responsibility” and “care” but refuses to anchor those ideas in law. It operates in the space of responsibility without liability.

    Above them all, beyond the apex marked “making things better,” lies public expectation – the belief that institutions should act to prevent foreseeable harm, not merely avoid causing it.

    This moral position sits outside the present legal framework but defines the social direction of travel.

    Between these two levels – between the courts’ current legal boundary and the moral high ground of public expectation – lies the proposed statutory duty of care.

    It would still sit along the base axis of law, midway between making things worse and doing nothing, but it would rise vertically within the triangle – recognising that the law must not only avoid harm but also act to prevent it where reasonably foreseeable, just as Parliament has already required through the Prevent Duty.

    In that sense, a statutory duty would lift the legal threshold upward, not outward – retaining the structure of the common law but extending its reach to address public expectation.

    The triangle naturally narrows as it rises. In legal terms, that tapering reflects how rarely the courts recognise proactive duties. A statutory duty of care would not alter the shape of the triangle but would raise the level at which the law operates, making what is now exceptional – acting to prevent harm – part of the ordinary standard of care.

    Drawing the line

    The Legal Duty of Care Triangle is not just a visual aid, it’s a question. Every dot on it represents a choice about where responsibility should sit – inside or outside the field of law.

    Parliament now faces that same choice. The forthcoming debate is not about whether universities should care for their students – everyone agrees they should. It is about whether that care should be accountable.

    Placing the point inside the triangle would mean recognising a statutory legal duty of care – a defined obligation that lifts the existing common-law threshold so that institutions must take reasonable steps to prevent foreseeable harm. It would introduce a clear standard of accountability, giving students and families a route to justice when that standard is not met.

    Placing the point outside the triangle leaves the status quo intact – a landscape of guidance, codes, and voluntary commitments that sound caring but lack consequence when breached. It maintains responsibility without liability – expectation without enforcement.

    That is the question before Parliament. Where should the point be placed? Inside the triangle, where care carries accountability – or outside, where it does not?

    The triangle invites everyone – not just lawyers or policymakers – to think about where they believe accountability should begin. It is less about identifying where universities are and more about asking where they should be in terms of legal accountability.

    For a university that sees its role purely as educational delivery, the point may hover near the base – within the comfort zone of “doing nothing” unless compelled. But that is the vending machine model of higher education – inputs go in, outputs come out, but no awareness or responsibility exists between the two.

    When things go wrong, the machine insists it functioned as designed – and no one accepts responsibility for the harm that results.

    For institutions that recognise their wider duty to protect students from reasonably foreseeable harm, the point moves upward, toward “making things better.”

    The purpose of our campaign is not to redraw the triangle but to raise the floor – bringing the baseline of law closer to where most people assume it already stands.

    A statutory duty of care would not expand the triangle. It would ensure that its foundation reflects modern expectations of safety, fairness, and accountability in higher education.

    What that duty would look like in practice – the mechanisms, policies, and safeguards that would follow are arguments for another day.

    The purpose here is simpler – to define the space where that conversation must take place – inside the triangle, where duty carries accountability.

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  • A review of student suicides suggests that standards are now necessary

    A review of student suicides suggests that standards are now necessary

    For years, bereaved families have fought for answers – and change – after losing their children to suicide at university.

    When life is difficult, Samaritans are here – day or night, 365 days a year. You can call them for free on 116 123, email them at [email protected], or visit http://www.samaritans.org to find your nearest branch.

    Arguably the most high-profile have been Bob and Margaret Abrahart, who led this charge after their daughter Natasha died in April 2018 at the University of Bristol.

    Despite her severe social anxiety, Natasha was required to give oral presentations that filled her with dread, and in 2022, a judge ruled that Bristol had discriminated against Natasha under the Equality Act by not making reasonable adjustments.

    But he did not find the university owed a general duty of care to avoid causing psychiatric harm – noting that:

    …if a relevant duty of care did exist… there can be no doubt that the university would have been in breach.

    That distinction prompted the Abraharts and other bereaved families to launch the “#ForThe100” campaign, named after the estimated annual student suicide toll. Their petition for a statutory duty of care gathered over 128,000 signatures and triggered a Westminster Hall debate in 2023, where MPs across parties voiced support.

    The skills minister at the time, Robert Halfon, rejected the call for statutory change. Instead, as part of a higher education mental health implementation taskforce, he announced an independent review of student suicide deaths – a “watching brief” approach that effectively deferred the question of legal responsibility while monitoring the sector.

    The review has now been published – and it reveals a catalogue of missed opportunities, systematic failures, and inadequate protections for vulnerable students.

    It also evidences the patterns identified by campaigners for years – poor monitoring of disengagement, communication silos between academic and support services, inadequate training for staff, and safety concerns in university accommodation.

    The big question now is whether the evidence will drive the legal and cultural shifts needed to protect students and prevent future deaths – or whether it will become yet another well-intentioned PDF on the ever-growing pile of guidance that relies on voluntary implementation.

    A review of student suicides

    The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) team from the University of Manchester was commissioned to conduct the review. Their approach was methodical – all higher education institutions in England were asked to submit redacted serious incident reports for suspected suicides and serious self-harm incidents occurring during the 2023-2024 academic year.

    The response was robust. Of the 115 Universities UK members, 113 (98 per cent) provided a nominated contact, and 110 (96 per cent) responded with information about serious incidents during the academic year. That does at least suggest that universities recognise the importance of addressing student suicide, even if some remain hesitant about legal frameworks for doing so.

    In total, universities reported 107 suspected suicide deaths and 62 incidents of non-fatal self-harm during the 2023-2024 academic year. Of these, 104 serious incident reports (79 for suspected suicides and 25 for self-harm) were submitted to NCISH for analysis. As such, it is the largest collection of detailed individual-level data on student suicide ever compiled in the UK.

    The team then analyzed those reports against established standards, including both the Universities UK/PAPYRUS/Samaritans guidance for conducting serious incident reviews, and NCISH’s own 10 standards for investigating serious incidents. They examined student characteristics, identified risk factors, evaluated the quality of investigations, and assessed the recommendations and action plans arising from these reviews.

    Pressure and disengagement

    In 38 per cent of cases, students were experiencing academic problems or pressures. These ranged from exam-related stress (10 per cent) to anxiety about falling behind or meeting deadlines (19 per cent).

    Nearly a third (32 per cent) of reports identified evidence of non-attendance – a critical warning sign that was often met with inadequate response, if it was noticed at all. The most common intervention was an automated email from administrators, rather than proactive personal outreach.

    The report argues that that represents a significant missed opportunity for intervention – calling for students who are struggling academically to be recognised as potentially at risk, with an enhanced focus on providing a supportive response, as well as increased awareness of support at key pressure points in the academic calendar, especially during exam periods.

    The review also found that while 21 per cent of students were or had been part of “support to study” procedures or equivalent, there were clear instances where a cause for concern had not been appropriately escalated.

    The report identifies a need for additional or more robust processes for monitoring student engagement and non-attendance, including recommendations to review attendance triggers, the development of consistent approaches to responding to non-attendance, and the implementation of earlier interventions when disengagement is identified.

    The timing of incidents reinforces the connection to academic pressure, with peaks occurring in March and May – coinciding with assessment and exam periods – and notably fewer incidents during holiday periods, suggesting that academic stressors play a significant role in student distress.

    One thing I’d add here is that it really shouldn’t be a given that students in the UK all progress and complete at the same pace – that we are the country in the OECD whose students complete the fastest and drop out the least has some obvious downsides that the LLE, and a large dose of culture change, really ought to tackle.

    The other thing worth considering is culture. In our work on student health last month, academic culture popped up a significant but often overlooked determinant of student health in survey responses, with students describing patterns of overwork, presenteeism, and a “meritocracy of difficulty” that rewards suffering over learning outcomes.

    Students’ comments revealed how unhealthy work patterns are normalized within academic environments, with concerns about overwhelming assessment deadlines, high-stakes exams disadvantaging students with health conditions, and the glorification of struggle across disciplines. Students also highlighted the disconnect between wellbeing messaging and impossible workloads, articulating a desire for intellectually challenging environments that don’t lead to burnout – as well as both personal and systems empathy.

    Their solutions included workload mapping, identifying assessment bottlenecks, flexible assessment strategies offering multiple ways to demonstrate learning, staff training on setting healthy work boundaries, health impact assessments for curriculum design, accessibility-focused policies, clear distinctions between challenging content and unnecessary stress, student workload panels with authority to flag unsustainable demands, and revised attendance policies to discourage presenteeism during illness. They are all worth considering – as are projects like the one referenced here.

    Mental health, neurodiversity and support services

    Nearly half (47 per cent) of reports identified mental health difficulties as a factor prior to the incident, with 31 per cent noting diagnosed mental health conditions. Most commonly, these were depression and anxiety disorders (20 per cent).

    Significantly, 30 per cent of reports described a diagnosis or suspected diagnosis of neurodiversity, including attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, or dyslexia. Of these neurodivergent students, only 14 described reasonable adjustments or support/inclusion plans tailored to their needs, and 12 per cent also had a mental health diagnosis. That suggests big gaps in support for students with overlapping mental health and neurodevelopmental needs.

    Especially concerning is that 70 per cent of students were known to university support services before their death, most often wellbeing services. These weren’t cases where students were suffering in silence – they had actively reached out for help within the university system. In many cases, students had multiple touchpoints with support services, but there were often gaps in follow-up, inadequate assessment of risk severity, and insufficient intensity or continuity of support.

    It’s partly the silo problem again. The report identified plenty of problems with information sharing in 24 per cent of cases, where critical details about a student’s mental health were not communicated between clinical, pastoral, and academic staff. Communication breakdowns meant that while a student might disclose suicidal thoughts to a counselor, personal/academic tutors remained unaware of the severity of their situation, continuing to apply normal academic pressures.

    Similarly, when academic staff noticed concerning changes in attendance or performance, this information wasn’t consistently shared with mental health professionals who could have intervened.

    The review specifically recommends improving information sharing internally and externally but notes that (often unfounded) concerns about confidentiality prevent effective coordination – leaving vulnerable students to navigate fragmented support systems and tell their story repeatedly to different university staff. What I’d note is that recommendations and guidance on this have been around for years now – universities clearly need to go further, and faster.

    And the realities of the funding system, the state of the sector’s finances and the resultant staff-student ratios in plenty of departments also need an honest conversation. If it’s noticing that matters, other students also need to be in the mix as well as academic staff.

    Location and transition

    Where location was known, 23 per cent of incidents occurred in university-managed accommodation – suggesting serious safety concerns in spaces directly controlled by institutions. The review specifically recommends reviewing the safety of university-managed accommodation, including physical safety, high-risk locations, the criteria for welfare checks, and signposting for support, particularly out-of-hours.

    I’d suggest that that should probably reflect, via the codes of practice the firms will be required to join to escape the regulation in the Renter’s Rights Act, standards in private halls too – although that would, of course require a modicum of coordination between DfE and the Ministry of Housing, Communities and Local Government.

    Almost three-quarters (73 per cent) of students were undergraduates, with over a quarter (27 per cent) in their first year of undergraduate studies, backing up previous research that has indicated that the first year represents a particularly vulnerable transition period – often leaving home, managing independent living, forming new relationships, and adapting to university-level academic demands.

    The review suggests these changes create a perfect storm of risk factors – first-year students often lack established campus support networks while losing daily contact with home support systems, may struggle with imposter syndrome or academic uncertainty, and frequently hesitate to seek help, believing their struggles are just “normal” adjustment issues.

    The problem is then compounded by institutional factors – with no prior academic record to contextualise changes in engagement and larger first-year class sizes, warning signs frequently go unnoticed by staff. The review specifically calls for enhanced induction processes and early intervention systems for first-years, recognising that proactive support during this critical transition period could significantly reduce suicide risk.

    I remain convinced that near-universal systems of group social mentoring found on the continent could have a major role to play here – they’re even in the legislation in Finland – but I also wonder whether the other notable OECD comparison, that (together with Belgium) we have pretty much the youngest bachelor’s entrants in the world, could also do with some significant thought.

    DfE has, of course, had a previous run at coordinating a national piece of work on transition support and standards – but the less said about that the better. We almost certainly need something more consistent, substantial and credit-bearing – I sketched out what that could look like here.

    International students

    International students accounted for nearly a quarter (24 per cent) of all submitted reports – a disproportionately high percentage given their representation in the overall student population. The overrepresentation could suggest additional challenges, including potential cultural and language barriers, social isolation, and distance from established support networks.

    In many ways, they face much of what home students face, with unfamiliar academic and cultural expectations, (often) studying in a second language, managing complex visa requirements, and coping with significant financial pressures due to higher fees and limited work rights piled on top. Many also experience intense pressure to succeed from family members who may have made substantial sacrifices to fund their education.

    The review found that cultural differences significantly impacted how international students experienced and expressed mental health difficulties. In some cases, cultural stigma around mental illness prevented students from seeking help, while in others, language barriers made it difficult to effectively communicate distress to university staff. The report also noted particular difficulties with international students who were isolated within their own cultural groups, making it harder for wider university systems to identify warning signs.

    Despite the overrepresentation of international students in suicide cases, the review found minimal evidence of culturally sensitive support services or targeted outreach. Many just applied a one-size-fits-all approach to wellbeing support that failed to account for diverse cultural understandings of mental health.

    The review specifically recommends that universities develop more culturally competent services and proactive engagement strategies for international students – particularly those from countries with significant cultural differences from the UK.

    There’s a reason why new Office for Students Condition E6 on harassment and sexual misconduct specifically requires approaches that are tailored to a provider’s specific student population, and that systems and processes to help prevent and respond to harassment and sexual misconduct are accessible to international students. It’s true on this issue too.

    Investigation quality and university response

    Following a death by suicide, the review found significant gaps in postvention support – the care provided to those affected. While 41 per cent of reports showed evidence of support for peers following a suicide, there was significantly less support for affected staff (18 per cent) and bereaved families (9 per cent).

    The review recommends that anyone affected by a student’s death by suicide should be offered or signposted to appropriate support – acknowledging that effective postvention is itself a critical component of preventing further deaths.

    The review then found wide variation in how universities investigate student deaths and respond to them. In three-quarters (76 per cent) of all reviewed cases, families were not involved in any aspect of the suicide investigation process. While 72 per cent of reports indicated that the family was contacted after the death to offer condolences, only 11 per cent of families contributed to or were offered involvement in the investigation process. And just 6 per cent of reports had been shared with the families.

    As the report notes, families provided:

    …moving accounts of feeling excluded from the process of finding out what happened to their loved ones, and some had a perception that the university was evasive and reluctant to answer important and painful questions.

    The exclusion of those who knew the student best not only denies families closure but also prevents universities from gaining valuable insights about circumstances outside the institution.

    It also raised significant questions about who conducts these investigations and their qualifications to do so. In 35 per cent of reports, information on the lead reviewer was not available. Only 13 per cent explicitly stated that the lead reviewer had no prior involvement with the student – a fundamental principle of independent investigation.

    There was also little evidence that those conducting the reviews had specific training or expertise in suicide prevention or investigation. As the report notes:

    …completing a serious incident review is an additional strategic-level responsibility, with no status of its own within someone’s job role.

    Most reviews focused narrowly on the university’s own processes and records, rarely seeking information from external sources. Despite 60 per cent of reports indicating the student had contact with other agencies (such as healthcare providers), only 6 per cent of these included contributions from those organizations in the review process.

    The gathering of information “did not generally extend to records and contributions from other agencies” such as primary care, secondary mental health care, and the criminal justice system. This was true even where the university was aware that those agencies had played a critical role in the student’s care. This inward-looking approach created significant knowledge gaps that could have been filled with input from families, health providers, and other external sources.

    The report also notes that there were examples of gaps in the chronology with little or no information between the student’s last contact with the HE provider and the incident. Without a comprehensive understanding of the student’s circumstances, universities can’t effectively identify all factors contributing to suicide risk.

    This won’t come as a surprise to anyone working in HE, but while 79 per cent of reports identified learning to help prevent future incidents (generating almost 300 recommendations in total), the implementation process was often weak. Over half (53 per cent) identified specific actions, but 18 per cent of these lacked clear owners and 40 per cent had no timescales for delivery.

    That raises questions about whether these recommendations are ever fully implemented or simply filed away. Learning points were “inconsistently assigned or scheduled,” with a lack of institutional commitment to following through on identified improvements. Without accountability mechanisms and clear follow-up processes, there’s little assurance that these recommendations will lead to meaningful change.

    Learning from tragedy

    The review makes 19 specific recommendations across four categories – safety concerns, suicide prevention within university systems, amendments to guidance, and wider system messages. They are comprehensive – but they largely represent guidance rather than enforceable standards.

    The first recommendation, for example, calls for “mental health awareness and suicide prevention training” to be available for all student-facing staff, with consideration for making such training mandatory – acknowledging the critical role staff play in identifying and responding to students in distress.

    But the report stops short of recommending that training be required – using the softer language of “consideration” for mandatory training. It’s a recommendation I’ve read hundreds of times over the years, and in the financial and redundancies state the sector is in, it would be hard to believe that it’s going to happen without a requirement that it does.

    That’ll be why OfS is now requiring it in E6 for harassment and sexual misconduct, and why that includes a line on “no saying you can’t afford it – if you can’t afford it, don’t provide HE”. Something similar should surely apply here.

    Meanwhile recommendations 3 and 4 address academic pressures, calling for students struggling academically to be “recognised as potentially at risk” and for increased support at key academic calendar points. They are a shift toward viewing academic processes not just as educational tools but as potential risk factors for mental health – a perspective that aligns with campaigners’ arguments for a duty of care that encompasses the whole student experience.

    Although as I said above, some system-structural issues relating to age and pace ought be on the list inside DfE’s reform plans for proper consideration.

    While it stops short of recommending a duty of care, it does call for “a duty of candour” to be introduced to the HE sector, setting out organisational responsibilities to be open and transparent with families after a suspected suicide. That would include a duty to provide information on what happened, at the earliest point.

    As it stands, Keir Starmer promised that such a duty, to apply to public authorities including universities, would appear by 15 April – the anniversary of the Hillsborough disaster. But it’s a deadline that was missed – with rumours that officials have been attempting to water it down and questions over whether it would apply in internal investigations as well as statutory inquiries. A decision will need to come soon.

    Mark Shanahan, on behalf of the LEARN Network, argues that universities are learning communities, but it is unclear from the research whether the learning leads to change. If nothing else, they’re supporting the idea that the exercise becomes annual:

    In some ways, it’s a vindication to see the concerns of bereaved families confirmed, when many feel so excluded when they try to find out what happened to their sons and daughters. Without families’ strength and persistence this report would not have been commissioned. We need to see it repeated annually if lessons are to be learned over the longer term.

    Given that so few University Mental Health Charter Awards have been achieved (just two in 2025), the network also argues that a legal duty of care by universities towards students, delivered by statute and/or regulation is the only way to accelerate the changes advocated in this report.

    Duty of care?

    The review comes, of course, amid ongoing confusion about what a “duty of care” would actually mean in a university context. The current government position, articulated by DfE minister Janet Daby, is that “a duty of care in HE may arise in certain circumstances” which “would be a matter for the courts to decide.”

    On BBC News, asked why a legal duty of care had not been introduced, skills minister Jacqui Smith says that “we do think that universities have a general duty of care to their students”, but that there were “some legal challenges”:

    We’ll be absolutely clear with universities that this is their responsibility. We’ve made resource available and we will continue to challenge them to deliver that.

    Being “absolutely clear” means establishing a legal duty and then asking your regulator to proactively monitor compliance with it – not a combo of endless finger wagging and a charter whose evaluation report found universities where mental health and wellbeing efforts were ad hoc, siloed, had limited proactive outreach, featured inconsistent and sometimes contradictory responses across departments, and lacked a strategic approach to mental health in curriculum design, community building and risk management.

    And “resource” probably doesn’t mean the paltry £5 per student in the grant letter.

    The position on duty of care contrasts sharply with the certainty provided in other contexts – like as the duty of care employers owe to their employees or that schools owe to their pupils – and means students enter university without clarity on what protections they can expect, while universities operate without clear standards for their responsibilities.

    As Bob Abrahart argues:

    …students and universities need instead to know where they stand.

    The review signals pretty clearly that the ambiguity has real consequences – inconsistent practices, missed warning signs, and preventable tragedies. Valuable recommendations will mean nothing if their implementation remains voluntary without a statutory framework.

    And as I’ve argued before on the site, when students have rights and know their rights, they’re better able to contribute to decent conversations about how they might be implemented practically. The rest is all “in an ideal world”, and we’re very much not in an ideal world right now.

    A more comprehensive statutory duty of care would establish clear standards for prevention, requiring universities to take reasonable steps to avoid foreseeable harm. It would not, as opponents suggest, treat students as children or make universities responsible for all aspects of student wellbeing. It would provide clarity on the reasonable expectations students can have of their institutions, and ensure consistency across the sector.

    The review has shown where the problems lie – now ministerial courage is needed to implement solutions that are universally applied. The 107 students whose deaths formed the basis of this review deserved better. Future students deserve the protection of clear, enforceable standards that their staff get.

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  • There’s nothing certain about the circumstances when a duty of care applies to students

    There’s nothing certain about the circumstances when a duty of care applies to students

    The Secretary of State for Education was recently asked in Parliament if she would meet with campaigners to discuss the “duty of care” owed by higher education providers to their students.

    Janet Daby – the Minister for Children, Families and Wellbeing in the Department for Education (DfE) responded on her behalf, and also outlined the department’s current view on the law for holding negligent institutions to account.

    At first glance, her response was unhelpful – arguing the department’s position is that a duty of care in higher education may arise in “certain circumstances”:

    Such circumstances would be a matter for the courts to decide, based on the specific facts and context of the case being considered, and will be dependent on the application by a court of accepted common law principles.

    It would be easy to argue that lawmakers, including Janet Daby and skills minister Jacqui Smith, should not simply defer to the courts on matters of law and institutional accountability.

    After all, lawmakers have the power to create laws – so overall responsibility doesn’t rest solely with judges and their judicial interpretation of common law principles.

    But perhaps Daby’s response was more helpful than it looked – because it directly confronts misleading statements that have persisted since 2023, particularly those made by former Minister Robert Halfon.

    Although some might view her answer as a cautious response, in reality, it was a breath of fresh air – a much-need step in addressing the confusion that has clouded our understanding of legal responsibilities in higher education.

    From Halfon’s Law to Daby’s Law

    To grasp the significance of Janet Daby’s correction, we must first revisit the origins of the confusion – what I’ll call here Halfon’s Law.

    Introduced by Robert Halfon in 2023, it laid the foundation for a misrepresentation of the legal duties owed by higher education providers to their students. Halfon’s Law is a belief that stemmed from a misunderstanding of online material, initially presented in a now-deleted AMOSSHE blog that was published in 2015.

    In responding to the 128,000+ registered voters who signed our parliamentary e-petition calling for a statutory duty of care, Halfon asserted his department’s belief that universities already owed their students a broad and generalised duty of care. He said:

    Higher Education providers do have a general duty of care to deliver educational and pastoral services to the standard of an ordinarily competent institution and, in carrying out these services, they are expected to act reasonably to protect the health, safety and welfare of their students. This can be summed up as providers owing a duty of care to not cause harm to their students through the university’s own actions.

    At first glance, this might sound reasonable, but in truth, it was far from accurate. By conflating a general moral and legal principle – to act in a way that avoids causing harm to others – with a formal, court recognised duty of care that only arises in specific, legally-defined circumstances and relationships, Halfon introduced a dangerous oversimplification.

    It was a distortion used to justify dismissing the petitioners’ call for a statutory duty of care, effectively silencing important conversations about the protections that students need.

    Halfon’s Law, with the documented source having now been quietly removed from its original website, was a misstep in understanding the complexities of legal responsibilities in higher education. Its fall from grace is something to be celebrated.

    Enter Daby’s Law: Janet Daby’s response marks a shift towards legal clarity. A duty of care may arise in certain specific circumstances, but ultimately, it is the courts that will determine the existence and application of any such duty on a limited case-by-case basis – should lengthy and costly litigation ever actually occur.

    As it stands therefore, nobody truly knows what protections are in place, leaving students vulnerable, and institutions at risk of being punished for failing to do the right thing. As such, Daby’s position not only corrects the errors of Halfon’s Law, but also raises significant concerns, including the urgent need for a properly codified duty that both universities and their students can understand.

    The advocacy that led to Daby’s law

    Daby’s correction of the record didn’t happen by chance. It was the direct result of relentless behind-the-scenes efforts from advocates, especially ForThe100, who recognised the need to dismantle Halfon’s contention? – since it was a significant barrier preventing meaningful progress.

    For too long, Halfon’s Law and its sweeping and factually incorrect statements had clouded the conversation around student safety and wellbeing, effectively stopping us from moving forward and pushing for the protections students desperately need. Too many policymakers thought it true – and so dismissed the need for a dedicated duty.

    The subtle shift in content and tone, while preferable to outright inaccuracy, introduces its own set of challenges. Without clear or codified guidance, students, families, and institutions are left to navigate a murky and uncertain legal landscape.

    That vagueness is deeply problematic. It means widespread confusion about rights and responsibilities, leaving institutions uncertain of their obligation, and exposed to unforeseen legal liabilities – while students are left unsure of the protections they can depend on.

    Worse, the lack of clear, direct, and upfront standards is a reactive rather than proactive system, shifting the burden onto individuals to seek legal recourse only after harm has occurred.

    This approach neither prioritises prevention nor ensures accountability, leaving gaps in a system meant to put students first.

    It is now crucial that the government corrects the public response to our petition without delay. Halfon’s Law remains embedded in the official narrative, and its continued presence in government communications perpetuates confusion, and blocks meaningful progress.

    More importantly, for over five decades, students have been without adequate legal protection, and this gap continues to undermine their safety and wellbeing.

    Nobody should be reassured by a duty that arises in “certain circumstances” where those circumstances would be a matter for “the courts to decide”. Students and universities need instead to know where they stand – with the same sort of clarity on offer for the duty of care that universities as employers owe to their staff.

    The next step is for the government to act – taking concrete steps toward enacting statutory reform that holds higher education institutions accountable for their acts and omissions with regard to student safety and wellbeing, and giving students and their families the confidence that when they enrol into a university, they know the minimum “duty of care” that they can actually expect.

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