The Council of Europe Commissioner for Human Rights, Michael O'Flaherty, conducted a visit to Bulgaria from 29 June to 3 July 2026. The visit focused on the human rights of older persons living in long-term care facilities, as part of the Commissioner's broader engagement on this issue across Council of Europe member states. The Commissioner also examined issues concerning the housing rights of Roma communities.

Continuing reforms in long-term care

The Commissioner welcomes the dedication of staff working in long-term care facilities and commends the authorities' efforts to modernise residential institutions and improve compliance with quality standards. He also welcomes the ongoing reform of the long-term care system, supported by policy and legislative developments designed to address population ageing and the growing demand for long-term care services.

However, persistent staff shortages remain a significant challenge. The Commissioner notes concerns about the decline in geriatric expertise following the discontinuation of geriatrics as a specific medical specialisation. He was also informed of the limited availability of specialised dementia care and the lengthy waiting lists for persons requiring such services.

To address these gaps, the Commissioner encourages the authorities to:

• Strengthen specialist geriatric expertise and expand dementia care 
• continue addressing workforce shortages by improving working conditions, enhancing training opportunities and making the care professions more attractive to boost staff retention.

The Commissioner observes that residential care facilities face challenges in appropriately integrating the medical and social models of care, which can at times lead to a less personalised living environment for residents. He encourages the authorities to strengthen coordination between healthcare and social care services to ensure a more integrated, person-centred approach that promotes residents’ well-being in their daily lives.

Addressing gaps in the protection of residents' rights

The Commissioner welcomes the measures adopted in response to serious violations in unlicensed and private care institutions. These include legislative amendments to tighten quality standards and inspections, the creation of reporting channels for residents, and a reinforced criminal law response to abuse.

The need remains for further measures to ensure adequate safety standards, including in terms of fire safety.

Efforts are also needed to strengthen independent monitoring of long-term care facilities, including by facilitating the relevant work of civil society organisations. Effective investigations into allegations of abuse, neglect and other violations of residents' rights remain essential, together with the delivery of criminal accountability for those responsible.

Reforming guardianship legislation

The Commissioner observes that many individuals are still deprived of their legal capacity and placed under plenary guardianship, despite the authorities acknowledging the outdated nature of the legal framework. He encourages the authorities to introduce supported decision-making arrangements that fully respect the autonomy, dignity and rights of the individuals concerned.

Ensuring that housing policies adequately address the situation of Roma communities

The Commissioner welcomes progress in promoting Roma inclusion, particularly regarding poverty reduction, social exclusion, and improved access to education and employment. He commends the successful work of Roma health mediators and welcomes legislative amendments enabling homeless persons and people living in informal dwellings to obtain address registration and identity documents.

He remains concerned by the incidence of forced evictions, such as those affecting residents of the Zaharna Fabrika neighbourhood in Sofia in April 2025, an issue on which he has previously engaged with the Bulgarian authorities.

While the Commissioner welcomes the authorities' efforts to implement judgments of the European Court of Human Rights, including in the case of Yordanova and Others v. Bulgaria, important issues remain unresolved. In particular, the absence of specific legislative provisions addressing proportionality assessment before evictions contributes to inconsistent administrative and judicial practice.

The Commissioner encourages the authorities to:

• ensure that the National Housing Strategy currently under preparation adequately addresses the specific housing situation of Roma communities, including those living in informal settlements.
• introduce explicit proportionality requirements for evictions and demolitions in legislation.
• intensify efforts to combat antigypsyism and consider replicating the successful model of Roma mediators in the housing sector.

During the visit, the Commissioner met with the Minister of Foreign Affairs, Velislava Petrova; the Minister of Justice, Nikolay Naydenov; the Minister of Labour and Social Policy, Nataliya Efremova; the Minister of Health, Katya Ivkova; the Deputy Ministers of Regional Development and Public Works, Pavleta Pelovska and Desislava Georgieva; members of the National Delegation of Bulgaria to the Parliamentary Assembly of the Council of Europe and of the Commission on Human Rights, Religions and Citizens’ Complaints of the National Assembly; the Ombudsman, Velislava Deltcheva; the Committee for protection Against Discrimination; healthcare and social care professionals and civil society organisations. He also met with the Mayor of Varna, Blagomir Kotsev, and visited three long-term care facilities in and around Varna, where he met with residents and staff members and representatives of the local authorities. He thanks all his interlocutors for their openness, and constructive engagement.

European Ombudswoman Teresa Anjinho has found several instances of maladministration in how the EU Agency for Asylum (EUAA) supports Greek authorities in processing asylum applications. 

These included failing to ensure that its caseworkers were sufficiently trained to conduct interviews with vulnerable asylum seekers and not providing asylum seekers with a procedure to report potentially consequential mistakes made by caseworkers during interviews.

The inquiry followed a complaint by two NGOs that provide legal support to asylum seekers on Samos Island.

The Ombudswoman noted that the EUAA must guarantee the protection of fundamental rights in its activities, including when it is only carrying out a support role. For this reason, EUAA asylum support teams should conduct interviews in a way that allows traumatised asylum seekers to give testimony to support their asylum claims.

To improve how it carries out work with Member States related to managing migration at the EU’s external borders, the Ombudsman said the EUAA should ensure that:

- caseworkers participating in asylum support teams receive regular training on vulnerability and victims of human trafficking;

- there are procedures for directing victims of trafficking to the appropriate national authorities;

- there is follow-up by national authorities when vulnerabilities – particularly medical ones – have been identified;

- there is an established system allowing people requesting asylum to report mistakes in an asylum interview and that this is followed by a timely assessment by the EUAA.

Reporting on Member State fundamental rights violations

The Ombudswoman also asked the EUAA to review its internal reporting system for alleged violations of the fundamental rights of asylum seekers by any Member State. In addition, it should ensure that any apparent breaches are notified to the European Commission, including reports of pushbacks.

The Ombudswoman said the review should feed into the ongoing development of the EUAA’s ‘escalation mechanism’ and once this is set up, staff should be informed of their reporting obligations.

To get an overview of the situation in other Member States, the Ombudswoman has asked her counterparts in the European Network of Ombudsmen for their views on how fundamental rights are being upheld during cooperation between the EUAA and national asylum officials.

Background

The ‘European Agenda for Migration’, presented in 2015, introduced the ‘hotspot approach’ whereby EU agencies and Member States work together to manage migration at the EU’s external borders.

In Greece, this resulted in the creation of several facilities in the Eastern Aegean Islands to host people arriving by sea while their applications are processed.

Under operational plans concluded with Greece, EUAA caseworkers are present in these facilities and conduct interviews with asylum seekers. They may also draft opinions on asylum applications. The interview transcripts and opinions are used by the Greek authorities to take individual decisions on asylum applications.

El pasado sábado se publicó en la sección de opinión del diario “La Voz de Galicia” un artículo escrito por el Secretario General de la institución de la Valedora do Pobo, Fernando de Andrés Alonso, sobre los avances normativos y los retos pendientes en la enfermedad de la ELA. Subraya la urgencia de un nuevo modelo de atención para las personas con ELA, por la alta complejidad y el elevado coste económico y emocional de unos cuidados continuos que recaen en gran medida sobre las familias. Aunque la Ley 3/2024 y medidas como el Real Decreto-ley 11/2025 pretenden impulsar mejoras (incluido el grado de dependencia III+), su aplicación avanza con lentitud.  El reto principal es asegurar una atención rápida, suficiente y equitativa que preserve la dignidad de las personas afectadas.

• Good communication is essential to delivering high-quality, compassionate end of life care, says new Ombudsman report.
• Government is urged to prioritise end of life care as part of its 10 Year Plan reforms by prioritising it in the roll out for a Single Patient Record and via training to support professionals to have critical conversations about patients’ prognosis and wishes.
• One case involves a man who was not informed for a month after it was confirmed by tests that his cancer had spread. He found out accidentally and died two months later.

Patients nearing end of life are being failed by poor, unclear communication that compromises care and compounds grief, according to a new report by England’s Health Ombudsman.

The Parliamentary and Health Service Ombudsman (PHSO) is urging the Government to prioritise improvements to end of life care as part of its NHS reforms. 

The report, Conversations that matter most: improving communication in end of life care, highlights widespread failings in the way professionals working in NHS end of life care communicate with patients, families and carers, and between teams and care settings. 

In one case, a Trust failed to clearly and promptly inform a man that his cancer had spread and was terminal. He found out by accident from his GP.

The Ombudsman’s newly published five-year strategy has committed to improving communication in public services as a way of rebuilding trust between the citizen and state. Too often, patients and families are not listened to or communicated with clearly. When the patient voice is not heard, opportunities to resolve issues early are lost, avoidable harm can be repeated, and complaints become harder to resolve and learn from.

Ombudsman Paula Sussex CBE said, 

“For more than a decade, we have highlighted problems with end of life communication. But disturbingly, too many people are still being let down. At their most vulnerable moments, patients and families should be able to rely on care that is clinically effective, compassionate and honest. 

 

“However, our report shows poor communication is causing avoidable distress for those receiving care, their loved ones and the professionals caring for them. Listening to its patients is one of the most powerful tools the NHS has to prevent harm. Patient voice must be at the heart of improvement.

 

“There needs to be better information-sharing, record-keeping, and training that gives staff the confidence and support to have timely, honest conversations about prognosis and people’s wishes. As the Government pushes forward with its plans to develop a Single Patient Record across the NHS, we urge them to prioritise end of life care as an area for roll out. 

 

“Compassionate communication should be a fundamental part of quality care and it needs to be led by the profession themselves. Patients and families deserve care that is clear, coordinated and empathetic, while professionals working deserve systems that support them to deliver it.”

Communication failures remain the most recurring theme in Ombudsman investigations. We have repeatedly raised concerns about communication in end of life care, including in our 2015 report, Dying without dignity, and our 2024 report on DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) decisions.

Casework analysed for this new report shows patients, and their families are often left ill-informed about their prognosis, with poor discussions about treatment, care preferences, where they wish to die and who they want involved in decisions about their care. 

Families are often not told clearly or early enough that their loved one is deteriorating or approaching the end of life, further adding to their grief after their relative has died.

End of life care can be complex and involve multiple teams and settings such as wards, hospices and care homes. Poor communication between these teams affects continuity of care, delays decision-making and leaves patients and families constantly having to chase for updates. 

The Ombudsman spoke to clinicians to understand more about the barriers to good communication. Many described the emotional burden of difficult end of life conversations and the challenges of communicating effectively when faced with time pressures, limited support and access to the right information. 

One case shared in the report involves a man who visited his GP in March 2021 with symptoms of rapid weight loss and abdominal pain and was referred to hospital. A biopsy and scan revealed he had colorectal cancer that had spread to his liver.

The man was not informed the cancer had spread to his liver by hospital clinicians. He found out when his GP, assuming the patient had been informed by the hospital Trust, mentioned it during an appointment in April to discuss pain management. 

The Trust did not directly tell him that his cancer had spread for a month after the tests had confirmed it. He died in June. Because of the lack of clarity about his prognosis and delay in informing him, he was denied additional time to make end of life arrangements. 

The man’s wife said, 

“What stays with me most is how alone and powerless we felt. We weren’t kept informed, we didn’t understand what was happening, and we lost precious time that we can never get back. It was devastating for my husband, and for those of us who loved him, it has left a lasting pain, guilt and loss of trust that never really goes away. That my husband had to suffer will stay with me for the rest of my life.

 

“What we needed was simple, to be told what was going on, for the teams to speak to each other, and for someone to act sooner. It doesn’t cost anything to talk to families and let them know what is happening, but that basic communication was missing. At the end of life, people only get one chance to receive the right care and support, and no family should be left feeling this helpless. The NHS failed us.”

Dr Sarah Holmes, Chief Medical Officer at Marie Curie and consultant in palliative medicine, said:

“Deeply troubling but not surprising, this report shows why too many families are left haunted by a loved one’s death. It highlights fragmented care, overstretched staff, and missed chances to recognise — or tell someone — they are dying. 

 

“That is why Marie Curie is partnering with the NHS to embed teams in emergency departments and GP practices — identifying people earlier, supporting staff, and helping families get care plans and conversations sooner. 

 

“These services must be rolled out nationwide. The UK Government’s Palliative and End of Life Care Modern Service Framework could help fix a broken system — but only with a transformation fund to drive joined-up care. 

 

“Change is long overdue. Families saying goodbye do not get a second chance — and successive governments have had too many.”

The importance of improving communication at end of life care extends beyond the NHS. The Local Government and Social Care Ombudsman will shortly publish a report examining end of life care in the social care sector, highlighting the importance of person-centred care, joined up services and clear, compassionate communication. 

This reinforces the need for improvements across health and social care to ensure people approaching the end of their life, and those close to them, receive coordinated, dignified care.