Important The content of this document is for general use only and is not legal advice. Parties seeking advice regarding specific proceedings should seek specific legal advice via their defence organisation or employer.
Executive summary
In 2023, the Court of Appeal overturned High Court Reporting Restriction Orders (RROs) that had protected the identities of healthcare staff involved in legal proceedings concerning the care of two critically ill children. Lifting these RROs would have allowed members of the clinical teams to be publicly identified.
Before the Court of Appeal’s decision took effect, two NHS Trusts appealed to the Supreme Court. In April 2025, the Supreme Court dismissed the Trusts’ appeal, meaning the Court of Appeal’s ruling stood and the RROs were withdrawn. The Supreme Court has published a summary of the judgment setting out its reasoning.
Having considered the impact of the ruling, RCPCH recommends that all NHS Trusts (or Boards, in Scotland and Wales, and HSC Trusts in Northern Ireland) who have a paediatric critical care department develop a clear policy on how they will support members of their clinical faculty if they are involved in legal proceedings regarding a child’s care. This should include agreed-upon guidance for engaging clinical staff in such proceedings, guidance for applying to extend reporting restriction orders where needed and consider any specific local challenges and/or considerations. See section 3 for more details.
RCPCH, BMA, Faculty of Intensive Care Medicine (FICM) and Paediatric Critical Care Society (PCCS) have written to medical defence organisations (MDO; Medical Defence Union, Medical Protection Society and the Medical and Dental Defence Union to seek confirmation of support for clinicians affected by this ruling
Summary of the Supreme Court proceedings, interventions and ruling
Summary of proceedings
The Supreme Court Ruling is based on a series of cases heard initially in the High Court. They then progressed to the Court of Appeal before being taken to the Supreme Court for final ruling. The outcome of each proceeding is summarised below, alongside interventions by RCPCH and PCCS.
High Court (Family Division) Judgement, 2021: RROs are a form of injunction issued by a court, which legally prohibits the publication of certain information. In the two primary initial cases ‘Abbasi v Newcastle Hospital NHS Foundation Trust’ and ‘Haastrup v King’s College Hospital NHS Foundation Trust’, both ruled ‘in favour’ of the NHS Trusts, meaning that the RROs could not be lifted and the healthcare staff member’s identities would remain anonymous.
This initial judgement ruled that there was a ‘substantial case for protecting staff anonymity comfortably which outweighed the parents’ basic assertion of their right to freedom of expression.’ As a result, the Court ordered the continuation of the RROs.
Court of Appeal Judgement, 2023: Both cases were then taken to the Court of Appeal together under one hearing, where judgement looked to balance Article 8 (The right to privacy) and Article 10 (Freedom of expression) of the European Convention on Human Rights.
RCPCH and Paediatric Critical Care Society (PCCS) intervened in the two joined cases in the Court of Appeal (and in the Supreme Court, see below). The organisations provided evidence and written submissions outlining the importance of RROs for clinicians and patient care. They outlined the impact that naming clinicians involved in such difficult cases would have on the treating clinicians and on the provision of healthcare for children, particularly in paediatric intensive care units. For more information on the RCPCH and PCCS position, see the Appendix.
Nonetheless, the appeal found that ‘intense focus on the specific rights being claimed delivers the clear conclusion that the article 10 rights of the parents in wishing to ‘tell their story’ outweigh such article 8 rights of clinicians and staff as may still be in play, long after the RROs were made in the respective end-of-life proceedings.’ It was therefore ruled that indefinite RRO’s should not be in place, and the RROs should be lifted, pending any further appeal.
Supreme Court, 2025: The Court of Appeal judgement was appealed by two NHS Trusts and escalated to the Supreme Court, with evidence heard on the 15 & 16 April 2024. RCPCH and PCCS again intervened in the cases.
Judgement was handed down in spring 2025 ruling in line with the Court of Appeal’s judgement in 2023 that RROs should not be in place indefinitely.
The Royal College of Nursing (RCN) issued a response to the Supreme Court Judgement.
Summary of the Supreme Court Ruling
Up to the point of the Supreme Court ruling, RROs had been in place since the start of legal proceedings and would have remained in place indefinitely. This would have meant that the names of healthcare staff involved in the legal cases could not be made public, unless there was a successful application for the RROs to be varied or lifted.
The ruling handed down on 16 April 2025 sets out the legal bases on which the Courts may continue to grant RROs in the future. It states that, going forward, such injunctions should be granted for a limited period and should not remain in place indefinitely.
The judgment anticipates that the initial fixed period of an RRO would usually cover the underlying legal proceedings and a subsequent 'cooling off period'. Individual healthcare staff members would then be able to seek a continuation of the RRO following legal proceedings.
Importantly, the judgment states that the individual healthcare staff members themselves would need to apply to extend the RRO.
If no application is made, then the fixed period of the RRO applies as determined by the courts. Individual healthcare staff members involved in legal proceedings may then be publicly named.
Rights balance
The ruling considers the balance of rights under two articles within the European Convention on Human Rights. These are healthcare staff members’ article 8 rights to a private life and the parents' article 10 rights to freedom of expression in speaking publicly about their experiences.
The judgment notes that, over time, the balance of rights under these two articles may shift. Permanent injunction would therefore not be justifiable.
Following the ruling, the balance of these rights over time will need to be considered by courts when deciding whether to extend the order into a cooling-off period and, if so, how long for.
RCPCH recommendations following Supreme Court Ruling
It will take some time for the impact of the Supreme Court Ruling to become clear as new cases move through the system.
RCPCH has been monitoring this closely together with our colleagues in PCCS, the BMA and paediatric trusts. At present, it is our view that a local approach should be taken to ensuring that each trust where paediatric critical care is carried out has a clearly defined policy for supporting their staff through legal proceedings, including the event where RROs may be lifted.
Our recommendations are therefore as follows:
- NHS Trusts (Boards, in Scotland and Wales, and HSC Trusts in Northern Ireland) should seek to update or develop a clear policy which sets out how colleagues are supported through legal proceedings, including in the event that RROs are lifted. This should be developed together with trust lawyers to encompass risk monitoring, procedures for applying to extend or introduce new RROs where needed, and pastoral support for staff. The policies should address social media, because in some cases clinicians have been identified on social media even when an RRO was in place. The risks associated with identification on social media may become more acute where RRO are lifted and clinicians should be proactively supported to deal with this.
- Paediatricians impacted by this ruling should ensure that they are aware of local arrangements developed by trusts as above. Additionally, paediatricians who are a member of a medical defence organisation may wish to contact them to understand what support is available.
RCPCH will continue to monitor cases in this space and liaise with colleagues. This briefing will be updated if new information comes to light which may be useful to our members.
Appendix: RCPCH and PCCS position on RROs
RCPCH provided evidence jointly with the Paediatric Critical Care Society against the removal of indefinite Reporting Restriction Orders the following reasons:
- We support a culture of openness and continuous learning, rather than a culture which seeks to blame.
- We feel that a culture of blame may deter doctors and other healthcare professionals from sharing errors or near misses where there is an opportunity for learning.
- There are robust existing mechanisms in place that hold doctors and other healthcare professionals accountable for their actions. These include: GMC proceedings, Serious Incident Reviews, DHSC’s Maintaining High Professional Standards in the Modern NHS process and PALS proceedings. It is our view that public naming of doctors and other healthcare professionals will not make doctors and other healthcare professionals more accountable.
- Clinicians are bound by patient confidentiality and so have no ‘right to reply’ when they are named in public discourse. This results in an imbalanced narrative and can cause significant stress.
- Some clinicians have reported threats made both to themselves and their families as a result of their clinical involvement in high profile cases. The lifting of RROs may increase the risk of these types of threats.
The RCPCH position was formulated by the RCPCH Ethics and Law Advisory Committee, and was jointly shared in the Court of Appeal by the PCCS.
The PCCS surveyed their members as a part of the Nuffield Council on Bioethics call for evidence on disagreements in healthcare and found that clinicians cite their concerns about public naming, the media and its wider implications as a key driver in leaving critical care. This has a number of implications:
- A reduced workforce, resulting in overstretched departments and more difficult working environments for staff
- Reduced staffing is likely to result in a reduction in children’s access to high quality, safe and effective patient care
- Reduced succession planning, resulting in a breakdown of future critical care facilities
In addition, 0% of PCCS members surveyed felt that removing RROs would improve patient care.