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Lauren Page Smith, 29, was found at her house in Wolverhampton by her mother in January, lying on the floor with her two-year-old daughter on her chest. The toddler had tried to wake her up.

Lauren's family claim that she had complained of chest pains and vomiting. Her mother Emma Carrington believes paramedics did not take the concerning condition of her daughter seriously.

'We believe that because of her age and the fact that she was calm the paramedics did not think she could be as ill as she was, she did not get the care she needed,' she said.

'There are simply no words to describe how we feel as a family. Through no fault of her own my daughter does not have a future and my granddaughter will grow up never knowing her mother.'

She added: 'Lauren had her whole life in front of her and that has been taken away.'

A post-mortem found that Smith died from a sudden heart attack after a blood clot in her lung. An inquest will take place at the Black Country Coroners' Court on November 1.

Lauren had called 111 for advice and paramedics who arrived at her home performed brief assessments.

Law firm FBC Manby Bowdler, who are representing the Smith family, said they were concerned West Midlands Ambulance Service paramedics misinterpreted Lauren's electrocardiogram (ECG) readings due to a lack of training and told her she was fine instead of taking her to hospital.
The ambulance service's investigation found clinicians felt 'falsely reassured' that Lauren's condition was 'not overly concerning' because of how old she was and that she appeared to be fine.

Her calm demeanour meant that medical staff did not believe the pain score she gave them, the report found.

A West Midlands Ambulance Service spokesman said: 'We would like to apologise to the family of Lauren Smith after what must have been an extremely difficult period.

'The Trust carried out a full investigation into what happened to see what learning could be taken from such a tragic case. We are determined to do everything possible to try and stop something like this ever happening again.

'The review made a number of recommendations which have been implemented, including providing additional learning to our clinicians about recognising acute coronary syndrome (ACS), particularly in women.

'We hope that the inquest will answer all of the questions that the family have about this case.'

Earlier this year, it was revealed that a diabetic woman died after waiting over 16 hours for the West Midlands Ambulance Service, despite her emergency meaning that she required an ambulance in 18 minutes.

Earlier this month, a patient was reportedly declared dead by paramedics but 'woke up' in hospital just hours later. The North East Ambulance Service (NEAS) has issued an apology and started an investigation.

Mother found dead after paramedics gave her the all clear

A young mother was found dead at home hours after paramedics had given her the all clear, her family have revealed.

27 Oct 2023

Tracy Gambrill tragically died on November 19, 2016 - 12 days after undergoing brain surgery at the Royal Hallamshire Hospital in Sheffeld to treat her drug-resistant epilepsy.

An inquest into her death found that her head had likely moved during the surgery, causing a total of three incisions to be made at the wrong trajectory and at “excessive” depths. This ultimately caused a serious brain injury, and death.

Close to seven years after her death, assistant coroner Susan Evans concluded at the end of the five-day inquest, on October 20, that medical negligence was not a contributing factor in Tracy’s death.

Over the week, it was heard in court that Tracy, who was a civil servant, was diagnosed with epilepsy at the age of 10. It was drug-resistant, which made her seizures “difficult to control”. She was also suffering from non-epileptic attacks.

Tracy was referred to neurology at Sheffield Teaching Hospitals NHS Foundation Trust, where it was decided Mr Dev Bhattacharyya, a Sheffield consultant neurosurgeon, would perform a surgery known as SAH. This would see the part of the brain removed that was responsible for causing the seizures.

The court heard that Mr Bhattacharyya was an experienced neurosurgeon who had performed around 80 of these operations at that time. The surgery took place on November 7, 2016. Mr Bhattacharyya was assisted by a relatively junior surgical registrar who had described himself as “book knowledge aware” regarding the surgery.

In his evidence, Mr Bhattacharyya said the position of Tracy’s head - stabilised by clamps - was “extremely important” for the surgery, and it was his responsibility to ensure this.

Neither Mr Bhattacharyya nor the surgical registrar recollected any issues, but it was noted that Tracy was draped, and it was difficult to tell her

position.

Mr Bhattacharyya said there are no ‘anatomical landmarks’ inside the brain. Incisions are based on 'trajectory' which can be helped with the use of ‘BrainLab’ - a piece of equipment that uses scans of the brain to assist in surgery.

It was heard that Mr Bhattacharyya had difficulty finding the temporal lobe inside the brain, but he was “confident” he was cutting laterally rather than medially, which is “where there are all the dangers” if cut into.

A total of three incisions were made to locate the temporal lobe which coroner Evans said were “all at different trajectories and far too long”. There was varying evidence from experts given on the length of the incisions, but it was heard that Mr Bhattacharyya cut at least 2.5 times too deep.

'An awful mistake'
After the first incision, Mr Bhattacharyya had said he was “lost” and had made an “awful mistake” - but he did not stop the surgery. After the third incision, which was done with BrainLab, he said he had felt unwell and he called for assistance from another surgeon, who successfully located the temporal lobe.

Mr Bhattacharyya finished the rest of the surgery, but tragically when medical professionals tried to wake Tracy up from the anaesthesia it was “immediately apparent” she had sustained a serious brain injury.

Coroner Evans said it was likely Tracy’s head had moved prior to the first incision being made, but “it does not however provide a reason why the incision was so deep… There was clearly a serious error in relation to the depth of the incision”.

However, she said the “mistake” did not constitute medical or criminal negligence.

Mr Bhattacharyya has not performed this surgery since.

Giving a narrative conclusion, Coroner Evans said Tracy would have likely died as a result of brain damage caused by the first incision.

An investigation is ongoing by the General Medical Council.

'Several avoidable errors'
Following the inquest, Lee Gambrill, Tracy’s brother, said: "We are very disappointed that, after almost seven years of seeking answers as to why this happened, we are now told it was simply an accident.

"However, it’s an accident that could easily have been avoided and our aim now is to ensure measures are put in place so that this doesn’t happen to anyone else. We therefore welcome the continued investigation by the General Medical Council."

Stephanie Prior, a medical negligence partner from Osbornes Law, who represented the family, said: "It’s clear there were several avoidable errors in this tragic case and it’s therefore appropriate that the General Medical Council should continue their investigation to ensure greater safeguarding in the future.

"Despite the heartbreak, distress and anguish caused by this seven-year battle for answers, the family have continued to act in a dignified manner and have been extremely patient in their wait for this inquest to be held."

Dr Jennifer Hill, Medical Director, Sheffield Teaching Hospitals NHS Foundation Trust: “During Ms Gambrill’s brain surgery in 2016 there was a serious error and tragically she passed away shortly afterwards. We have apologised unreservedly for what happened, but I realise that no apology will ever be enough to alleviate the loss Ms Gambrill’s family and friends feel.

"We have conducted a thorough investigation which led to wider learning and this learning process will continue following the inquest and its findings. We have shared this information with Tracy’s family and hope it provides some reassurance about how seriously we have taken her death.”

Coroner rules no negligence

The inquest into the death of woman after brain surgery in Sheffield has concluded.

25 Oct 2023

Denise Johnson, 55, was sent home from hospital with antibiotics after showing doctors a lump in her right breast. She had been referred to Stafford County Hospital under the two-week urgent cancer referral scheme, but medics did not take a biopsy.

A mammogram and ultrasound were classed as "indeterminate" before the results were downgraded following a review by a surgeon, and Denise was allowed to go home. However, the mum of three continued to be concerned about the lump and even raised her concerns with doctors on four separate occasions.

And more than two years later, a GP referred Denise to a breast clinic where tests showed the lump had more than doubled in size to 3.8cm. She was diagnosed with breast cancer in May 2021 and told the devastating news that the disease had spread to her lymph nodes.

The healthcare assistant, who is from Blyth Bridge, Staffordshire, had surgery to remove cancerous tissue and lymph nodes as well as radiotherapy. As a result of her treatment, Denise developed lymphedema – a chronic condition that causes swelling in the body’s tissue.

She instructed expert medical negligence lawyers to investigate her care and University Hospitals of North Midlands NHS Trust, which runs County Hospital, admitted a breach of duty. The Trust admitted the delay led to Denise’s chances of surviving the cancer being reduced by almost half.
Following treatment Denise now has to have annual mammograms to check that her cancer has not returned. She said: “Although I attended routine mammograms, I also regularly checked my breasts as you can never be too careful. When I was told by the hospital that I had a cyst and didn’t require further treatment, I felt reassured and relieved.

“Deep down I was still worried but had no reason not to believe what I’d been told. However, as time went on, I started to get more worried especially as the appearance of the lump was changing and it started getting bigger.

“By the time of my second referral to the breast clinic I was really concerned but nothing prepared me for the news I had cancer. It was absolutely devastating, not only for me but I also worried for my family.”

After she found a lump, Denise was referred by her GP in January 2019 but following a mammogram and ultrasound, Denise was told she had a cyst.

At a hospital appointment a doctor told Denise she didn’t require surgery and to visit a GP if the cyst became infected. Denise visited a GP in October 2019 after becoming concerned about the lump but was again told it was a cyst and was given antibiotics.

Denise also sought medical advice in February and March 2021 but on both occasions she was sent home with more antibiotics. Following a further appointment in May 2021, a GP referred her to a breast clinic where she was finally diagnosed with breast cancer.

Denise said: “I struggled to come to terms with my diagnosis but also whether more could have been done to diagnose and treat it sooner. One of the hardest things to accept was that my chance of survival had dropped quite dramatically because of the diagnosis delay.

“The treatment was difficult and the side effects still live me now. Before my cancer I used to be a lot more relaxed and outgoing but now I’m a lot more anxious, especially as to whether it will come back. I still live in pain and my lymphedema means I’m not as active as I was nor as confident in myself.”

An NHS report found the “missed opportunity” to diagnose and treat Denise’s breast cancer in 2019 had reduced her chance of survival from 98 per cent to 57 per cent.

The Trust apologised for its care failings and will pay out compensation at a future date. Denise is now using Breast Cancer Awareness Month to raise awareness of the signs of the disease.

She added: “I just hope that by speaking out and sharing my experience I can help others. While there were delays in diagnosing my cancer, it’s vital that women not only continue to attend screening appointments but also carry out regular checks. If they feel something isn’t quite right they should trust their body and instinct and seek a second opinion if needed.”

Catherine Buchanan, a lawyer at Irwin Mitchell, said: “Denise and her family have faced an incredibly tough few years coming to terms with her diagnosis and whether she would survive her cancer.

“Understandably they had a number of concerns about the care Denise received and whether more could have been done to diagnose the disease earlier. Sadly, our investigation validated those concerns with the Trust admitting worrying failings in Denise’s care.”

Doctors dismissed red flag cancer sign

Medics repeatedly dismissed a mother's breast cancer symptoms as a harmless cyst.

5 Oct 2023

The 54-year-old father of two seemingly experienced neglect from medical professionals throughout his battle with cancer. Barrister Ruth Costello from No5 Chambers represented the family during the proceedings.

Paul Johnson passed away on 18th January 2023 under the care of Macmillan Palliative Care within Sheffield’s Northern General Hospital, just months after being diagnosed with advanced lung cancer.

Assistant coroner Carl Fitch concluded that neglect played a role in Mr. Johnson’s passing. He highlighted that seven different medical professionals had the opportunity to initiate further investigations and treatments, including those who were involved in Mr. Johnson’s discharge process.

Mr. Johnson had a complex medical history and sought medical attention for abdominal pain and jaundice in November 2020 from Northern General hospital. A CT scan revealed a lump which could have indicated cancer, but this was not pursued further.

Mr. Johnson’s condition did initially improve; however, he was readmitted to the Royal Hallamshire hospital in Sheffield in November 2022 suffering with left-sided weakness. Imaging then revealed that the initial lump had grown significantly, and a biopsy confirmed non-small cell lung cancer, which had spread through his body.

Mr. Johnson’s sister Kay Hemming, brother-in-law Christopher Hemming, mother Janet Johnson and father Mac Johnson stated: “It has been extremely difficult re-living Paul’s final two years and hearing that there were multiple chances where his lung cancer could have been diagnosed and treated, which could have extended his time with us. To us, it always felt like medical professionals believed Paul wasn’t worth treating and that his health issues were entirely his fault due to how he suffered with alcohol problems. It breaks our heart knowing that in the lead up to his death, Paul felt completely worthless. Life will never be the same for us without Paul; losing him has left a huge void in our family and while nothing can ever bring him back to us at least he is now at peace and no longer suffering.”

Legal experts from Lime Solicitors are investigating the possibility of taking legal action against Sheffield Teaching Hospitals NHS Foundation Trust, which oversees the Northern General hospital. They recognised the multiple missed opportunities when investigating the 2020 CT scan findings and impressed the importance of early detection in lung cancer cases.

Medical failures uncovered in Sheffield inquest

An inquest held on 27th September 2023 at the Medico-Legal Centre in Sheffield has uncovered a series of “missed opportunities” that could have potentially prolonged or saved the life of Paul Johnson.

3 Oct 2023

The married gynaecologist demanded the trainee take her clothes off and look into a mirror as punishment because 'her mistake could mean someone would die' and told her she 'needed to have a scar'.

He also encouraged the junior doctor to let him give her a 'special massage', in which she could 'achieve an orgasm by him only touching her back'.

An employment tribunal heard Chandraharan also sexually harassed a second junior doctor while away for a conference by encouraging them to share a hotel room and repeatedly trying to massage her.

He was sacked from St George's University Hospitals NHS Foundation Trust in south London, where he had worked for 15 years as the doctor in charge of a labour ward and previously clinical director, in February 2020.

Chandraharan tried to sue the Trust, claiming he was unfairly dismissed and racially discriminated against due to him being British Asian.

But an employment tribunal has now thrown out his case and criticised the NHS doctor for perpetrating 'serious' sexual harassment.

The employment tribunal heard Chandraharan denied all allegations and claimed other senior doctors 'coerced' the women to make up allegations because they were 'racists' and 'envious of his success'.

Chandraharan even threatened to sue WX for 'defamation action to seek £2 million in damages'.

Employment Judge Tony Hyams-Parish dismissed the doctor's claims of unfair dismissal and race discrimination.

Judge Hyams-Parish said his actions amounted to 'serious sexual harassment' and that he was 'difficult to believe' in evidence and 'misleading'.

The hearing in Croydon, south London, was told Chandraharan invited the first trainee - named only as 'WX' - to a conference in 2015, and while driving them there made creepy comments.

A tribunal report said: 'He asked her about her personal life. He referred to himself and WX as 'Commander and Commandee' and said that he was offering her 'special training'.

'He told WX that she was the 17th special trainee and that he still kept in touch with previous trainees. He told WX not to say anything to anyone as no one would understand.

'During the car journey, Chandraharan asked WX a question from a chapter in a book he had given her.

'For getting the question wrong, he suggested that she should take one item of clothing off. WX declined and thought it was a joke.'

At the hotel, Chandraharan asked WX to come to his room to 'practise a presentation' but said it was too noisy.

The report continued: 'Once in his room, he asked WX to take off her clothes for the mistake that she had made.

'Chandraharan did not touch her. It felt to WX that it was all about mental control.

'He told WX that it was only if she was scarred that she would avoid future mistakes and improve her skills. Her mistake could mean that someone would die.

'Chandraharan told WX that she 'needed to have a scar'.

'WX took off her clothes until she was naked. He did not do anything. He told WX to 'look at her image in the mirror, in front of her Consultant, so that she would never repeat the mistake again'.'

After dinner, he told her 'he was good at massage'. He said ' it was a special massage, where she could achieve an orgasm by him only touching her back'.

He also gave her a coin, saying that she could give it back whens she was 'ready to accept the pleasant experience' and said 'he gave all his trainees a 50 pence coin to remember him when he died'.

WX said she was left scared that she was 'alone in a small town' and felt like an 'antelope trying to run away from a lion'.

'Humiliated and embarrassed', she later reported the incident to the Trust but was 'fearful of repercussions as she felt he was very powerful and could damage her career'.

She was so 'terrified' she didn't want to pursue a formal complaint and in August 2017 Chandraharan was given an informal warning.

However, in 2019, it emerged another female doctor at the Trust, named as 'YZ', had also been sexually harassed at another conference.

YZ came forward and reported that he made 'sexualised comments' at her, repeatedly encouraged them to share a hotel room, and made creepy advances.

While working in his hotel room, he began massaging her neck but she moved away.

'He touched her again, a bit lower down her back', the report said. 'This happened two or three times and every time YZ asked him to stop, he would start again.

'YZ said the next time he quickly put his hand on her back under her top and quickly moved it then towards her bottom.

'YZ responded by slapping his hand away and said 'Edwin, what are you doing? I don't know what you've been thinking, but I don't want to have sex with you Edwin'.

'He said 'I promise no sex, at least for me'. He then apologised, saying that it was the first time in 15 years he had got his diagnosis wrong.'

Later that trip, Chandraharan told her 'in five years time you will look back and remember that in Poole you lost an opportunity and someone else will take your place'.

Both victims, along with other women at the Trust, formed a WhatsApp group and brought formal allegations against the doctor and he was sacked for gross misconduct in February 2020.

Male NHS consultant ordered a female junior doctor to strip naked

A senior NHS consultant was sacked after he ordered a junior doctor to strip naked in front of him in a hotel room as punishment for getting a question wrong, an employment tribunal has heard.

3 Oct 2023

'Angel of Death' serial killer nurse Beverley Allitt will go before a panel of experts today in her first steps towards release, according to reports.

She will appear before a mental health tribunal where she will be assessed for a potential transfer to a mainstream prison for the first time since her sentence began.

The former nurse, now 54, killed Liam Taylor, seven weeks, Timothy Hardwick, 11, Becky Phillips, two months, and Claire Peck, 15 months, over the course of 59 days at Grantham Hospital in Lincolnshire in 1991.

She was handed a minimum 30-year sentence in 1993 for murdering the four children and attempting to kill nine others.

However, she spent just a week in prison before she was diagnosed with a psychiatric disorder.

Allitt could now be moved from Rampton Secure Hospital in Nottinghamshire to a mainstream prison, The Mirror reports.

Allitt's reign of terror: A timeline of the murders
February 23, 1991: Allit claimed her first victim, seven-week old Liam Taylor

March 5, 1991: She killed 11-year-old Timothy Hardwick after he was admitted to the ward having suffered an epileptic seizure

April 1991: She gave two-month-old Becky Phillips an insulin overdose after she was admitted to the ward for gastroenteritis

April 1991: One-year-old Claire Peck died after she was left alone with Allitt following an asthma attack
1993: Allitt received 13 life sentences

This means that Allitt could apply for parole six months after a potential move to the new prison.

But her victims and her families have said they feel 'terrified' at the thought of the killer going free once again.

Alan Usher's daughter Kayley was just 15 months when Allitt attempted to kill her by injecting an air bubble under her arm.

Kayley survived but has been left with long-term health issues such as with fine motor skills, hearing and mobility.

Mr Usher told The Mirror: 'Allitt should never have been in a hospital, she should have been sent to prison.

'Can you imagine if she were freed? It would destroy Kayley. She's be terrified, looking in cupboards and around the house because she didn't feel safe.'

Alan and his wife Sharon adopted Kayley when she was a toddler and the family still live in Grantham.

Allitt took the lives of four children and tried to kill nine others by tampering with their injections.

Originally her crimes were suspected to be down to natural causes, but blood samples retained from nine of the children who had collapsed or died revealed that they had been injected with lethal doses of insulin, potassium or lignocaine.

After a lengthy trial, Allitt was found guilty of four murders and nine counts of causing grievous bodily harm with intent, and was given 13 life sentences.

It was claimed in mitigation that she was suffering from Munchausen Syndrome By Proxy.

This is a syndrome where a parent or caregiver causes an injury, usually to a child, to then gain attention as the carer.

The paediatric nurse claimed her first victim, seven-week old Liam Taylor, on February 23, 1991, by injecting him with a large dose of insulin.

She killed 11-year-old Timothy Hardwick on March 5 that year after he was admitted to the ward having suffered an epileptic seizure.

In April that year she gave two-month-old Becky Phillips an insulin overdose after she was admitted to the ward for gastroenteritis.

One-year-old Claire Peck died after she was left alone with Allitt following an asthma attack, also in April 1991.

Nurse Beverley Allitt in first steps towards release from prison

Allitt was handed a minimum 30-year sentence in 1993 for the child murders

2 Oct 2023

Slow recovery or the new normal? What’s next for the personal injury market

Andy Cullwick, head of marketing at First4Lawyers, discusses IRN’s latest report on the UK personal injury market:

25 Sept 2023

A comment piece in The Times claimed that the NHS in England pays £8.2 billion in annual clinical negligence compensation for maternity care.

Columnist Janice Turner on Friday 8 September said: “It is mind-blowing that the NHS in England now pays £8.2 billion in annual clinical negligence compensation for maternity care, more than double the total £3.2 billion maternity and neonatal budget.”

But the most recent annual accounts for NHS Resolution, which deals with compensation claims on behalf of the NHS in England, show that the clinical negligence payments in 2022/23 were £2.6 billion.

This is up from just over £2.4 billion the previous financial year.

NHS Resolution also says that 41% of the £2.6 billion of clinical negligence payments in 2022/23 related to maternity, which would equate to around £1.1 billion.

This is much lower than the £3 billion a year a recent NHS England board paper said is spent on maternity and neonatal services.

Full Fact has contacted The Times to ask about this figure but has so far not received a response. However, the article has now been amended to say: “It is mind-blowing that the NHS in England now reckons the annual bill for clinical negligence in maternity care is £8.2 billion.”

It is the responsibility of the newspaper to ensure the Editors' Code of Practice is upheld by external contributors, as well as editorial staff. In line with this, the press must take care not to publish inaccurate or misleading information and a significant inaccuracy must be corrected promptly.

Where does the £8.2 billion figure come from?

While we do not know exactly how Ms Turner calculated the £8.2 billion “annual bill” figure, a report in The Times from April mentioned the same number.

The article said: “The total cost of harm from clinical negligence was £13.6 billion in the 2021-22 reporting year, according to an annual report from NHS Resolution, the arm of the Department of Health and Social Care that handles litigation.

“Sixty per cent of the cost of harm was for maternity claims, amounting to £8.2 billion for the year.”

So this could be where Ms Turner’s figure comes from.

But the cost of harm is not the same as the amount paid in clinical negligence compensation. An NHS Resolution definition of the cost of harm says that “the cost of harm is the present value of the estimated cost of claims that we expect to receive, or have already received, from incidents that occurred” and that due to “delays in clinical claims being notified to NHS Resolution, the majority relates to claims that have not yet been received and is therefore based on an actuarial assessment of claims’ volumes and values”.

NHS Resolution’s annual report for 2021/22 does state that “60% of the total clinical negligence cost of harm (£13.6 billion)” relates to maternity services, which would be £8.2 billion. While these were the most recent figures available when the April Times article was published, figures for the latest year were released in July.

The latest accounts from NHS Resolution say the cost of harm in 2022/23 was £6.6 billion, with 63% of this relating to maternity (£4.2 billion).

NHS Resolution’s accounts say that the £7 billion drop year-to-year was mainly due to a change in Treasury discount rates, which “has had the effect of significantly reducing the value of claims”.

The accounts also say: “These rates are used to convert future payments into a present value.”

So the annual cost of harm is not the same as the amount actually paid out in compensation. It is the value of the claims that have been reported, along with an actuarial estimate of claims NHS Resolution expects to receive in the future arising from incidents in that financial year.

Read the full article here: https://fullfact.org/health/maternity-nhs-compensation-clinical-negligence/

NHS in England is not paying billions in maternity negligence says FullFact

NHS England claimed it was now paying £8.2 billion in annual clinical negligence compensation for maternity care. FullFact comment that it is not true, stating NHS Resolution's annual accounts show a total of £2.6 billion was pent on clinical negligence payments in 2022/23.

18 Sept 2023

The intention is that the lower damages clinical negligence claim FRC (LDFRC) scheme will come into force through secondary legislation and after approval by the Civil Procedure Rule Committee. A further consultation will be launched on how disbursements will work under the proposed scheme.

Making the announcement, the Department of Health & Social Care said the annual expenditure on clinical negligence claims continues to rise and that legal costs represent a ‘sizeable proportion’ of this.

‘Our policy intent in proposing implementation of this scheme is to facilitate faster resolution of claims at a cost that is proportionate to the value of the claim,’ the department said. ‘We are also committed to ensuring that access to justice for claimants is protected and any risks to access to justice mitigated.’

The new streamlined protocol aims to facilitate early resolution and save costs. Claimants will be expected to have obtained early expert evidence on their condition and prognosis, and to include this in the bundle of evidence with the initial letter of claim.

Exclusions to fixed costs will include neonatal deaths and stillbirths (although not fatal claims in general), cases requiring more than two medical experts, claims involving a protected party or children and cases involving litigants in person.

New rules will enable the court to impose sanctions where the protocol is not followed.

If the claim is overvalued at the outset and subsequently settles for less than £25,000, it will be subject to fixed costs, whether or not the pre-action protocol has been followed.

The government announcement adds: ‘While we understand the concerns about predicting the ultimate settlement value of a claim, we believe that the expectations for claimants and defendants are clear. In particular claimants will need, early on, to obtain relevant information and evidence, assess the risks around valuation of a particular claim, and value the claim accordingly.’

Following the end of the fixed costs protocol, if the claim is not settled, the claimant may proceed to litigation and if the claim is not settled before the allocation stage, the court will allocate the claim to a case management track.

The government said its overarching policy intent ‘is to allow a proportion of claims to be resolved even more quickly, even if this is only a minority of claims within the LDFRC scheme’.

The costs for stage one standard track claims are limited to £5,500 plus 20% of damages agreed. This includes all steps up to and including the ‘stocktake’ of the case which can last up to 38 weeks. A further £500 can be claimed for stage two, an eight-week period including neutral evaluation.

The decision to press on with fixed costs comes despite overwhelming opposition from the claimant firms and representative groups that responded to a consultation last year. Concerns were expressed that clinical negligence claims of any value were too complex and therefore unsuitable in principle for fixed costs.

The new regime will work in tandem with the fixed recoverable costs scheme for most civil claims up to £100,000 – coming into force next month – which includes alimited number of clinical negligence claims where liability is admitted.

Fixed costs on most lower-value clin neg claims from April 2024

Fixed costs will be imposed on clinical negligence claims worth up to £25,000 from next April, the government announced today.

15 Sept 2023

A central issue of contention is the “nominal” recoverable fees proposed for costs-only proceedings, which the ACL believes do not accurately reflect the actual work required. This criticism aligns with the ACL’s broader view that the Ministry’s approach is “piecemeal and unreasonable,” raising serious concerns about access to justice and the adequacy of the proposed fees.

One key recommendation from the ACL is to delay the implementation of the new rules until at least April 2024, emphasizing the need for more comprehensive reforms.

The ACL has consistently opposed additional FRCs, fearing they will hinder access to justice. They also call for a comprehensive review of costs provisions in the Solicitors Act 1974, echoing the Master of the Rolls’ view last year.

Concerns about timing

The ACL has taken issue with the six-month gap between the implementation of the new FRC regime and the proposed changes, which they argue will create confusion and inconsistency in the application of rules.

Inadequate fees

The ACL criticized the “one size fits all” approach of a condensed assessment procedure for FRC-related disputes, particularly those focused on interpreting the rules. They argue that the proposed costs (£500) are inadequate for cases that demand a high level of expertise. Rather, the organisation advocates for a flexible cost cap based on the value of the claim.

Regarding fixed costs for issuing part 8 costs-only proceedings, the ACL members believe the proposed levels (£300 for a claimant and £150 for a defendant) are insufficient for the necessary work involved. They anticipate that these low caps will not deter the initiation of proceedings, as they are often used to resolve disagreements over costs.

Critical negligence claims: too complex?

The ACL argues that clinical negligence claims should be excluded from the extended FRC regime due to their complexity. They highlight the significant investigations and costs related to expert evidence, which the proposed FRCs may not adequately cover. The ACL suggests postponing the inclusion of clinical negligence claims until the Department of Health & Social Care’s separate FRC scheme for cases up to £25,000 is published and the extended FRC regime has settled for other claim types.

ACL chair Jack Ridgway says: “Irrespective of our opposition to the FRC extension on principle, it is clear that the government’s piecemeal approach to reform is only going to cause more problems than it purports to solve. It fails to give the legal market sufficient time to plan, prepare and adapt to what will be a significant upheaval.

“The Ministry of Justice needs to fix the Solicitors Act before tipping a new load of cases into the system. Otherwise, it will fail in its stated aims of improving access to justice and providing clarity and certainty to all parties in respect of the costs of civil litigation.”

ACL critiques MOJ fixed costs reforms

The Association of Costs Lawyers (ACL) has set out its opposition to the Ministry of Justice’s proposed reforms to the fixed recoverable costs (FRC) regime. These reforms, set for implementation next April, have drawn criticism from the ACL on various fronts.

15 Sept 2023

It has, however, responded to complaints from claimant lawyers about the proposed level of costs and increased what was on offer.

The Department for Health and Social Care (DHSC) said the new process “should facilitate quicker resolution so harmed people get compensation more quickly, make legal costs more proportionate and predictable, and make an important contribution to controlling rising clinical negligence costs for the NHS”.

It estimated that the reforms would save NHS hospitals £1bn and other healthcare providers in the public and private sector £1.3bn.

The changes apply only to pre-issue cases worth between £1,501 and £25,000; where claims go on to litigate, they will then be caught by the separate fixed costs regime being introduced next month.

If a claim is overvalued but subsequently settles within this range, the fixed costs will apply regardless. “It will therefore not be advantageous for claimants to unreasonably overvalue a claim at the outset,” the DHSC said.

The consultation, published in January 2022, was based on the blueprint drafted by a Civil Justice Council (CJC) working party in 2019. Members could not agree on the figures for the fixed costs and the DHSC chosen the figures put forward by the defendant representatives, rather than the claimant representatives.

There were 98 responses, with claimant lawyers generally against the reforms and defendants in favour.

The consultation outcome document said claimant solicitors provided no data to back up their assertions that many would find it unprofitable to work on these claims and that this could restrict claimants’ access to justice.

It said: “We do know that FRC schemes for civil claims based on damages bands already operate well in other areas of civil law, including in personal injury claims.

“While we acknowledge that clinical negligence claims can be more complex than other areas of civil law, the aim of Sir Rupert Jackson’s recommendation, the CJC working group and subsequent development of the proposals was to take into account this known complexity and ensure that the process and costs framework were appropriate to this specific claim group.”

Nonetheless, the DHSC said it took note “of the strength of feeling” and agreed to increase the costs levels to halfway between the two groups on the CJC working party.

This means the total fee for standard track work will be £7,000 plus 30% of damages, rather than £6,000 plus 20% of damages.

For light-track claims – where liability and causation is admitted – the fee for all stages will be £3,250 plus 20.5% of damages, compared to the original £2,000 plus 10% of damages.

The additional bolt-on fee for protected parties has increased from £650 to £1,800.

The DHSC said: “We believe this significant increase to costs at all stages will mitigate risks to access to justice across all claims in the scheme and better takes into account the claimant perspective in the CJC working group, representing a fair position on claimant costs.”

There will be a 12.5% London uplift, where the claimant is based in London and uses a lawyer in the capital.

“The proposals could make small legal firms less able to compete with larger firms that have greater economies of scale and can provide services ‘en-masse’ more cheaply,” the DHSC acknowledged. “Firms with small, specialised departments are therefore likely to be disproportionately impacted…

“We also acknowledge concerns that the proposals may result in changes to the way the clinical negligence legal market organises itself and manages claims.

“However, the proposals are intended to prompt cultural and behavioural shifts in how lower damages clinical negligence claims are handled, and we remain convinced there is a good economic case for making the proposed changes.”

The standard track will begin pre-issue with a letter of claim detailing all the evidence, accompanied by an offer to settle.

The defendant will have to send a letter of response outlining their case and responding to the offer within six months, to which the claimant will have a right to reply. There will be sequential exchange of experts’ reports and witness statements.

If unsettled, there will then be a mandatory ‘stocktake’ enabling the parties to examine the strength of each other’s position and work towards settlement, with mandatory but non-binding neutral evaluation – carried out by a lawyer from an approved list – if the case has still not settled.

The parties will not have to accept the outcome of this, but there will be costs consequences for a party that presses ahead to trial and failed to better the evaluation.

The light track will involve a similar but quicker process where liability is admitted within eight weeks.

The scheme will not apply where: more than three experts are needed (the consultation had proposed two); the claim is made against multiple defendants where the allegations of negligence against each defendant are materially different; the claim arises from a still birth or neonatal death, including claims made by secondary victims; and where limitation is raised by the defendant as an issue.

The process will be aided by template claim letters and model elements for expert reports, with costs consequences for not complying with the process, such as not providing sufficiently detailed evidence at the outset of the process.

The proposals will now go to the Civil Procedure Rule Committee. The scheme will apply to claims where the date of notification falls on or after the date the new rules come into force next April.

The DHSC will also conduct a further consultation focusing on the specific issue of how to deal with disbursements in the new scheme.

There will be a post-implementation review within three years.

Fixed costs for lower value clinical negligence claims

Fixed recoverable costs for clinical negligence claims that settle pre-issue for up to £25,000 will come into force next April, the government announced today.

15 Sept 2023

In Mainline Pipelines Ltd v Phillips & Anor, His Honour Judge Paul Matthews, sitting in the High Court, stressed he did not criticise the defendants for representing themselves - but said they should expect no special treatment.

The principle that civil procedure rules apply equally to litigants in person was established in Barton v Wright Hassall, where the Supreme Court ruled that being without a lawyer did not justify allowing a lower standard of compliance.

Matthews expanded on this point, saying that in the modern day litigants in person had no excuse for not knowing the rules.

‘It is their responsibility, in choosing to take part personally in formal legal proceedings, rather than by way of professional legal representation, to make themselves aware of the relevant procedural rules, and to follow them,’ said the judge. 'Many litigants in person (though not the defendants in this case) seem to think that it is the judge’s job to look after their interests, or at any rate that the judge will do this, and even advise them what to do. But the judge cannot do any of this this. The judge is both independent of the parties and impartial between them. The parties must arrange for their own legal advice.’

The judge said many published textbooks and handbooks on civil procedure are usually available in libraries, as well as information on the Ministry of Justice website and other sites full of case law precedents and offering free legal advice.

In the underlying case, a dispute over the repair of a multi-fuel pipeline which runs under part of the defendants’ farm, the claimant’s solicitors had written to their opponents urging them to take legal advice. At one stage the claimant even offered to contribute £400 plus VAT to the cost of advice.

In the modern legal services market, said Matthews, it was ‘perfectly possible’ to obtain short, limited advice on a point of construction from solicitors, or from a barrister operating via direct access, at 'modest cost' without engaging lawyers to defend the whole proceedings. ‘It is unfortunate that the defendants did not take up this offer. It might have saved the need for this expensive litigation.’

Failures by the defendants to follow the rules were found to have made matters more complicated, slower and expensive.

The judge found no real prospect of successfully defending the claim at trial and granted summary judgment to the claimant.

Dont expect favours from the court, judge tells LiPs

Litigants in person have been told they had every opportunity to get legal advice and should not rely on the court to accommodate their decision to go it alone.

25 Aug 2023

The Association of Personal Injury Lawyers sent the government a formal letter before action last month and confirmed today it had formally issued a JR claim over several aspects of the plans to extend fixed costs.

The Gazette has contacted the Ministry of Justice to ask whether the legal action makes any difference to the intended 1 October start date for the new costs regime.

A consultation published earlier this summer suggested there may be elements that the MoJ wants to look at again. This closes on 8 September, and both parties have agreed that the JR is stayed until three weeks after that point, with APIL having the opportunity to amend its grounds for issuing proceedings.

The JR is based on several challenges to the MoJ plans to extend fixed costs to most civil claims worth up to £100,000.

The rules suggest that clinical negligence cases included in that bracket should be moved to the new intermediate track if ‘both breach of duty and causation have been admitted.’ But APIL points out it is not specified at what stage of the case those admissions must be made, and if they are not made until late in the proceedings, a solicitor will have had to undertake significant work on the case only to then find that fixed costs apply which do not cover the costs of the tasks undertaken.

This, it is suggested, creates a risk that solicitors may not take on clinical negligence cases of this value.

APIL is also challenging provisions relating to vulnerable people which leave solicitors having to cover part of the additional costs incurred. The Court of Appeal ruled last month in Santiago v MIB that preventing a vulnerable party from fully participating in proceedings was not in accordance with the overriding objective.

APIL said it fears that the government has underestimated the impact of the new rules on vulnerable people and that the provisions will interfere with their access to the courts.

Further challenges are based on fixed costs for representation at inquests and an apparent reversal of Court of Appeal case law which allows parties to contract out of fixed costs when there is a dispute in settlement agreements.

APIL added that it would continue to attempt to engage with the MoJ and try to help address the concerns and consequences of what will happen when the new rules come into force.

Injury lawyers fight fixed costs reforms through the Courts

Personal injury lawyers have made good on their threat to challenge the fixed costs reforms in court by issuing judicial review proceedings.

24 Aug 2023

The Court of Appeal decision in Croke v Wiseman, from 1981, on so-called ‘lost years’ compensation, has been contended by claimant lawyers ever since and regularly cited by judges who say their hands are tied by it.

Lost years refers to the potential income of a child after the date of their calculated life expectancy. Currently, severely injured children can claim for loss of earnings only up to the point at which they are expected to live, but lawyers argue they should also be compensated for the work and pension they would have accumulated after that date.

The claimant in CCC v Sheffield Teaching Hospitals NHS Foundation Trust has now been granted permission to challenge Croke in the Supreme Court and potentially overturn the current restriction on children’s right to claim for future losses.

Lawyers in CCC had claimed for £823,506 for lost years in addition to £224,000 for loss of earnings. Mr Justice Ritchie declined to assess the damages for lost years, saying this was ‘not a matter for off the cuff judgments’.

This element of the decision will leapfrog to the Supreme Court with claimant lawyers hoping that judges will finally overturn the restriction on infant claims.

John McQuater, immediate past president of the Association of Personal Injury Lawyers, said it was right and appropriate to look again at this issue. ‘The ruling in Croke is inconsistent with judicial authority, with many judges citing that were they not bound, they would have allowed for injured children to claim loss of earnings for the portions of their lives which have been cut short by negligence,' he said.

‘The judgment has been widely criticised over the years as being out-of-step with the principle of full compensation and being in conflict with the notion of treating everyone equally. A child’s lost years are distinguished and devalued, while an adult would be compensated.’

The judgment in CCC was noteworthy for several other features, not least that it was the first quantum-only cerebral palsy case to go to trial in more than six years.

The claimant, now eight, suffered severe chronic partial hypoxic ischaemia before and during her birth, and now requires two care workers to provide 24-hour care.

The judge awarded a full gratuitous care claim with zero deduction. In other cases there have been deductions where family members are carers, but Ritchie outlined the strain the claimant’s mother had been under and made a full award.

The trial also featured a ‘day in the life’ video, shot over a 24-hour period, to demonstrate the child’s care needs and providing evidence of the benefits of hydrotherapy.

The judge awarded a lump sum of £6,866,615 and an index-linked periodical payment of £394,940 per year.

He was also highly critical of the costs analyses of defendant experts who gave evidence. Ritchie said one purported care and occupational therapy doctor instructed by the defence gave evidence that was ‘flimsy and unimpressive’ and he was not an expert in constructing, designing and managing care packages for children with cerebral palsy.

Another defence expert had stopped NHS practice with cerebral palsy children 18 years ago and gave evidence on hydrotherapy that was ‘out of date’ and not ‘well informed or balanced’.

James Drydale, solicitor for the claimant, from Sheffield firm Taylor Emmet, said: 'It is pleasing that all the intense focus we have put into this will not only change a little girl’s life but will also assist other families and their lawyers pursue cases like this. This is an important case that brings clarity on many issues commonly seen in these complex cases but that don’t often come before the court.'

Lost years compensation principle set for Supreme Court

Controversial case law going back more than 40 years and bitterly opposed by personal injury lawyers will be tested in the Supreme Court.

16 Aug 2023

It comes after years of failures to meet targets, and mounting pressure on the NHS to improve cancer services.

One charity said it was “deeply worried” about the move, while others say it could lead to improvements in diagnosis.

The NHS is supposed to meet a certain threshold for each target. But many of these targets have not been met for some time. For example, at least 85 per cent of patients should start a first treatment for cancer within two months (62 days) of an urgent GP referral when cancer has been suspected.

Only 59.2 per cent of patients in England who had their first cancer treatment in June after an urgent GP referral had waited less than the target of two months.

The target of 85 per cent has not been met since 2015.

Some 91.3 per cent of people started treatment within 31 days of doctors deciding a treatment plan in June 2023, against the target of 96 per cent. It was the sixth worst performance on record.

Another target to be scrapped, is that patients see a specialist within two weeks if their GP suspects they have cancer.

A new “Faster Diagnosis Standard” proposes that patients who have been urgently referred should have cancer ruled out or receive a diagnosis within 28 days.

The NHS said that the plan would help diagnose more cancers earlier and save more lives, because the current two-week wait target sets no expectation of when patients should hear if they do, or do not, have cancer.

Cancer Research UK said that the proposed new targets should lead to improvements in diagnosis.

But Naser Turabi, Cancer Research UK's director of evidence and implementation, said of the figures last week: "Despite the best efforts of NHS staff, it's incredibly worrying that cancer waiting times in England are once again amongst the worst on record."

Oncologist Pat Price, the head of the Radiotherapy UK charity, told the BBC she was “deeply worried” because “the clear and simple truth is that we are not investing enough in cancer treatment capacity”.

Professor Pat Price, visiting oncology professor at Imperial College London and co-founder of the Catch Up With Cancer Campaign, criticised the Government’s plans to scrap cancer targets for patients to see a specialist within two weeks.

Speaking on BBC Radio 4’s Today programme, she described it as “fiddling around with targets” in the middle of a crisis.

Under the new proposals, the Faster Diagnosis Standard will have an “initial performance threshold of 75 per cent”, meaning that three-quarters of patients should have a diagnosis within a month.

When the consultation was launched, Cancer Research said that it would like to see a 95 per cent target in the future.

Steve Barclay, the Health Secretary, would not be drawn into claims that two-thirds of cancer targets will be changed.

Asked about the newspaper reports by BBC Breakfast, he said: “There is a consultation at the moment, the story relates to a leak, and ministers don’t comment on leaks.”

He had earlier said: “This is something led by clinicians working in cancer.

“It is not something being imposed by the Government, it is in response to requests by those working in the cancer field and any changes, if they are announced in the coming days, will be in consultation with the leading cancer charities.”

NHS set to scrap most cancer waiting time targets ‘to speed up diagnosis’

Cancer treatment targets will be scrapped in the NHS to try and 'speed up diagnosis'.

14 Aug 2023

Some 48 hours later, shortly before Christmas last year, the "kind and helpful" child passed away.

Her heart stopped beating after she suffered acute myocardial necrosis (death of the organ's cells). Pathologists have been unable to establish why.

A paediatric consultant responsible for safeguarding children told Maya's family it was likely triggered by sepsis.

Now, her mother Magdalena Wisniewska, 26, is calling for someone to take responsibility for her daughter's death.

She said she has barely left the house, which she shares with six-year-old son Nathan and partner Raj Blande, since losing Maya on December 21, 2022.

Magdalena, from Margate, Kent, said: "We were just a happy family with plans and ambitions for our children's future, but we are not the same family anymore.

"We completely lost the will to live.

"Our lives are ruined and will never be the same again, but we are here because we have to take care of another child."

The family were looking forward to Christmas at home when, on December 18, Maya began to feel tired, weak and cold to the touch with no appetite.

The next day, Magdalena booked an appointment with a GP, but as they prepared to leave home, Maya collapsed.

She was taken to QEQM Hospital where she was diagnosed with tonsillitis.

Doctors told her she could go home with antibiotics, but she collapsed again before being discharged.

Magdalena said: "I asked the doctor about Maya's tummy pain, white tongue, pale colour and her body being freezing cold to touch, but he said this was normal with tonsillitis.

"Maya was also vomiting in the hospital bed, so they gave her an anti-sickness injection and we came back home."

The Holy Trinity & St John's Primary pupil had a sleepless night, during which she continued to complain of stomach pain, thirst and dizziness.

In the morning, her panicked mother called 999 because Maya was too weak to stand unaided and she was taken back to QEQM by ambulance.

Following a negative Covid test, she was diagnosed with influenza and put on a drip, still pale and cold.

By 3pm, she was admitted to a children's ward, having been unable to urinate for two days.

Clinical staff reportedly reassured the family that Maya's symptoms were not cause for significant concern.

Magdalena said she tried repeatedly to flag that her daughter was behaving strangely, even reporting she could see monkeys that weren't there.

That night, Maya again couldn't sleep and her mother tried to comfort her as she begged for water that was being rationed on a doctor's nil-by-mouth order.

On December 21, after another sleepless night, Magdalena raised concerns with staff again, reportedly warning them of her daughter's shaky breathing, discoloured skin and disorientation.

The mum claimed clinicians told her that Maya just needed a good rest.

Staff were said to have taken her daughter's heart monitor off because they were concerned the beeping was disrupting her sleep.

That afternoon, as staff attempted to take a blood sample while Maya was helped by her stepdad, her heart stopped beating.

Her mum said: "After a few seconds Maya went silent and my partner found out she had stopped breathing.

"At this point no one else even reacted as if something had happened, but [my partner] asked for help.

"Then all the other staff gathered in our room. They started resuscitation to save her and her heart came back for a few seconds, but then it stopped beating again. This time Maya passed away.

"On the day before she passed she was very pale in colour and she said to me, 'Mummy, I think I'm going to die', and I said, 'Don't say that Maya'.

"We asked them for help because she was saying strange things like she could see a monkey moving on the wall.

"We tried to tell the doctor and the nurse but nobody listened to us."

'I'LL NEVER GET OVER IT'
Her partner Raj said he will never forget the moment Maya took her last breath in his hands.

"I just can't get over it - I don't think I ever will," he said.

"There were tons of people treating her but none of them could find out what it was until it was too late.

"Nothing can bring us our daughter back and I know our lives will never be the same.

"As her stepdad, I just feel guilty as I wish I could have done anything differently, as when I look back the red flags were there."

To help keep her memory alive, the family have kept the Christmas tree Maya decorated before she died in their living room.

They also regularly visit a bench erected in her honour under her favourite tree in Dane Park.

Magdalena and Raj met the East Kent Hospitals Trust's chief executive, Tracey Fletcher, on December 28 and were told an investigation would be carried out into Maya's death.

In March, an independent consultant paediatrician said it was likely caused by flu which developed into sepsis, producing lethal toxins affecting her heart.

An inquest opened last month but was adjourned until September 25 for a review to be completed.

Jane Dickson, the chief nursing officer at East Kent Hospitals, said: "I am so sorry to Maya's family for their loss.

Six year old died after being sent home from hospital with tonsilitis

Little Maya Siek's mum insisted her daughter was gravely unwell after she collapsed twice, but doctors sent her home with antibiotics.

14 Aug 2023

He said he was forced to put on the brakes when driving his car in November 2017 to avoid hitting an animal in the road, but this meant that the van behind him crashed into the back of his vehicle.

Dr Salhab sought compensation for the damage as well as for injuries to three other passengers he claimed were in the car at the time.

But it was argued by solicitors for the van driver’s insurance company that Dr Salhab had deliberately caused the collision, and that only one passenger was in the car with him at the time – making his claims “fundamentally dishonest”.

The trainee surgeon subsequently attempted to put an end to his claim, but a hearing at Leeds County Court was later held after a request from the insurance company’s solicitors.

While the judge found that the collision had not been deliberately brought about by Dr Salhab, he conceded that it came as a result of the trainee surgeon’s “erratic and possibly deliberately aggressive driving” – and that Dr Salhab had been guilty of fundamental dishonesty for claiming that there were four passengers in the car at the time of the accident.

At a High Court case in February this year, Dr Salhab admitted that his conduct in relation to the County Court claim had been in contempt of court. He was sentenced to four months imprisonment which was suspended for 12 months and was given a fine of £2,500.

In June, Dr Salhab appeared before a Medical Practitioners Tribunal Service hearing, during which he explained that he had not properly checked the claims paperwork when he signed it, but admitted that “he was aware that the claim was dishonest”.

In his defence, Dr Salhab explained he had reflected on his actions and had developed a “management plan” to help him transfer the decision-making skills he picked up in his professional life to his personal life.

He blamed issues in his personal life for his mind being “preoccupied”, which was allegedly why “he was not carrying out sufficient checks or being careful about what he signed”. Dr Salhab said he had realised the claim was wrong which was why he wanted to discontinue the County Court claim. The report from the hearing said he “apologised unreservedly for his actions”.

But the report concluded: “The tribunal found that Dr Salhab’s actions were extremely serious and unquestionably amount to serious misconduct, as he himself conceded.”

It added that his “dishonesty lasted for a significant period of time” and that there was “an attempt to conceal the full extent of his dishonesty” which meant that it was “to some extent, covered up”.

It said: “The tribunal concluded that Dr Salhab’s conduct was fundamentally incompatible with continued registration and therefore determined that erasure was the only appropriate and proportionate sanction that would properly mark Dr Salhab’s misconduct.”

It was subsequently directed that Dr Salhab’s name should be removed from the medical register.

Trainee surgeon at Leeds Teaching Hospitals struck off after lying in car crash insurance claim

Dr Mohammad Abou Salhab was working in the Trauma and Orthopaedics department at the Leeds Teaching Hospitals NHS Trust when, in 2019, he submitted an insurance claim about a crash that happened two years earlier.

1 Aug 2023

The Association of Personal Injury Lawyers (APIL) sent the government a formal letter before action earlier this month ahead of a potential judicial review.

The MoJ issued a consultation on Friday – two weeks after receiving APIL’s letter – asking for views on aspects of the fixed costs reforms which come into effect on 1 October. Practitioners remain concerned that the rules as they are drafted include clinical negligence cases valued up to £100,000 which were never intended to be part of the extension.

In a email to members on Tuesday, APIL chief executive Mike Benner said the organisation had highlighted fundamental concerns, including the need for proper formal consultation on the inclusion of clinical negligence. The statutory instrument to bring in the changes was laid in parliament on 24 May and it states that clinical negligence claims will be moved to the new intermediate track – and therefore subject to fixed costs – ‘if breach and causation have been admitted’.

But Benner pointed out that the rule as drafted does not specify when those admissions must be made. ‘If they are not made until late in the proceedings, a solicitor will have had to undertake a significant amount of work on the case, only to find that it is then allocated to the intermediate track and fixed costs are applied which don’t cover the costs of the work undertaken,’ he said. ‘This creates a very real risk that solicitors will not take on clinical negligence cases of this value at all.’

The letter before action also raised concerns that the new rules do not allow fixed costs to be recovered from inquests or applications to restore a company to the companies register for the purposes of claiming compensation. APIL has called for fixed costs to be made available in these cases and has already provided alternative drafting.

The government said its consultation followed issues being raised by stakeholders in response to the rule publication.

The MoJ wants views on whether an early admission of liability should be required to push clinical negligence into fixed costs. It also asks about inquest costs, whether costs on assessment should be fixed and whether to update the fixed trial advocacy fees for inflation.

MOJ considers rethink after legal threat over fixed costs

The Ministry of Justice has been threatened with legal proceedings over plans to include clinical negligence claims in the fixed costs extension, it has emerged.

26 Jul 2023

Jason Evans from Coventry is among signatories to hand over a letter on Monday amid complaints the government is dragging its heels over the issue.

Government's ministers are set to appear before the Infected Blood Inquiry this week.

"People are dying without seeing any acknowledgement," said Mr Evans.

The inquiry was established in 2017 to examine how thousands of patients in the UK were infected with HIV and hepatitis C through contaminated blood products in the 1970s and 1980s.

About 2,400 people died in what has been labelled the worst treatment disaster in the history of the NHS.

Commons Leader and former paymaster general Penny Mordaunt is to give evidence on Monday with Prime Minister Rishi Sunak appearing on Wednesday. Chancellor and former health secretary Jeremy Hunt is due to appear on Friday.

Surviving victims and families of the bereaved received interim compensation payments of about £100,000 from the government in October.

But the chairman of the infected blood public inquiry, Sir Brian Langstaff, said the scheme should be widened so more people, including orphaned children and parents who lost children - could be compensated.

Mr Evans was four years old when his father Jonathan, a carpenter, died in 1993 after he contracted both HIV and hepatitis C during treatment.

"We need action to happen now because people are dying, not just people infected but the bereaved families as well," he said.

"We know that 380 children were infected with HIV, many of those died in childhood, and their parents are now in their 80s.

"We know of people who have died only recently," he said.

"This delay denies victims and their families any sense of tangible progress," the letter from relatives to the government said.

"Many continue to die without full redress, this can not be right.

"The interim payment for deaths not yet recognised is critical."

A government spokesman said it "accepts the moral case for compensation and work is ongoing across the UK Government and in consultation with the devolved administrations to consider as quickly as possible the recommendations put forward in the inquiry's second interim report."

Bereaved relatives in government compensation plea

The son of a man who died after he was given infected blood is among those handing in a letter to the government calling for wider compensation.

24 Jul 2023

Failings in maternity care accounted for a major part of the bill at 41 per cent – roughly £1.1billion – up from 38 per cent.

One family, whose baby 'suffered a massive brain injury' during birth, is seeking a seven-figure payout to cover the 24/7 care their child now needs.

Of the 10,062 new claims made last year, 13 per cent were specifically birth-related. The other most common areas were emergency medicine, orthopaedic surgery and general surgery, according to the report from NHS Resolution.

The NHS paid £490.9million to claimant's lawyers last year, with a further £158.8million on their own legal costs. In some cases, the NHS paid almost as much in legal costs as in damages.

Charities and lawyers warned the figures show maternity wards 'still aren't safe'. Dr Kim Thomas, chief executive of the Birth Trauma Association, which supports parents who have experienced traumatic births, said: 'The same mistakes are being made over and over again. There's a culture of cover-up [and] blame and not learning from mistakes. It's unbelievably distressing for families.'

Suzanne White, head of clinical negligence at Leigh Day, which represents thousands of families said: 'Things are steadily getting worse.

'There are midwives saying they are worried about going into work because there aren't enough of them.'

It was revealed last year that more than 200 babies and nine mothers died due to poor care at the Shrewsbury and Telford NHS Trust. And now 1,700 cases of harm are being investigated at Nottingham University NHS Trust.

A spokesperson for NHS Resolution said: 'Our Early Notification Scheme enables an earlier investigation of compensation entitlement than has been possible in the past and for learning to be shared rapidly with the NHS.

'Our Maternity Incentive Scheme draws on expertise to promote the best standards of care so... we can prevent these incidents happening again.'

NHS spends £2.7 BILLION settling medical negligence claims in one year

The NHS spent a staggering £2.7billion settling medical negligence claims for poor care last year – nearly 10 per cent more than the previous 12 months, figures reveal.

24 Jul 2023

Eight out of 10 NHS claims now settle pre-issue

The proportion of claims settled by NHS Resolution pre-issue hit a record 80% in the last year, but the cost of claims still rose, according to its annual report.

20 Jul 2023

Emily Chesterton, from Salford, died after being seen twice by a physician associate, a role which the NHS said supports doctors in diagnosis.

The 30-year-old, who lived in London, was told her calf pain was a sprain, when she actually had a blood clot.

Her mother Marion said more regulation was needed around physician associates.

The actress, who was originally from Worsley, went to The Vale Practice in Crouch End in October 2022.

She believed she was speaking to a GP about her symptoms, but instead saw a physician associate, who gave a diagnosis of a sprained ankle.

What I saw working undercover at a GP surgery
GP chain swapping doctors for less qualified staff
She returned in November and highlighted her additional symptoms of shortness of breath and a swollen and hot leg.

At that appointment, the physician associate prescribed anxiety medication.

Ms Chesterton collapsed later that day and died in hospital on 8 November, three weeks after she first sought medical advice.

At her inquest in March, the coroner concluded that after presenting with her symptoms, she "should have been immediately referred to a hospital emergency unit".

They said it was likely that she would have then been "treated for pulmonary embolism and would have survived".

Her mother Marion told BBC North West Tonight her daughter "didn't know she hadn't seen a doctor".

"Physician associate sounds grander than a GP," she said.

"If I had known earlier that she had not seen a doctor, I would have marched back to the surgery or gone straight to hospital.

"I didn't, because she trusted she had seen a doctor - I feel so guilty now."

She said she only found out her daughter saw a physician associate a week before the inquest, which had left her "devastated".

A serious incident review by the London practice found Ms Chesterton was never told she was not speaking with a GP.

Her mother said there needed to be more regulation around physician associates and added that the role to be renamed to avoid confusion.

"We went from coming down to see her for her 30th birthday to her dying in my arms," she said.

"We need there to be no more Emilys."

About 3,000 physician associates work in the NHS, who support GPs in diagnosing and managing patients under the supervision of a doctor.

The NHS's website said those applying for the role need to either be a graduate with a "bioscience-related" degree or a "registered healthcare professional", such as a nurse or midwife, and training takes about two years, involves "many aspects of an undergraduate or postgraduate medical degree" and focuses "principally on general adult medicine in hospital and general practice".

Barbara Keeley, the Labour MP for Worsley and Eccles South, recently raised Ms Chesterton's case in the Commons.

She said it raised "serious questions about the wider use of physician associates in the NHS, and particularly about allowing the provision of unsupervised one-to-one consultations in general practice".

Stressing the need for a national register, she said the person who saw Ms Chesterton had been dismissed from the practice, but was still working as a locum.

A Department of Health and Social Care spokeswoman said the NHS Long Term Workforce Plan made it "clear that physician associates can provide vital support in providing medical care" and can free up doctors "to focus on tasks only they are qualified to do".

Bereaved mum calls for physician associate role clarity in misdiagnosis case

The mother of a woman who died after a misdiagnosis by an NHS worker she mistakenly believed was a GP has called for better patient protection.

12 Jul 2023

Paul Wainwright, head of the counter fraud and intelligence team at Browne Jacobson in Birmingham, had 'numerous communications' with Sven Raymond Bogmer, who has been found in contempt of court for claiming he lost the use of his right hand after surgery.

Bogmer brought a claim against Nottingham University Hospitals NHS Trust in October 2017 for negligent medical treatment. His claim form said he had suffered 'significant injury to his right arm' which 'prevents [Mr Bogmer] from undertaking simple day-to-day activities such as opening a bottle or crisp packet'.

Video surveillance was carried out in January 2020, the High Court heard. Footage showed Bogmer walking his dog, pressure-washing his car, carrying shopping and operating a petrol pump, all while using his right hand normally and without signs of discomfort. In a statement, Bogmer said the activities depicted in the surveillance had not required significant effort or heavy use of the right arm, adding: 'I have good and bad days'.

The claim had been resolved in January 2021 after the trust made a drop hands offer, which was accepted by Bogmer.

In September 2022, the trust applied to bring committal proceedings against Bogmer. Despite the 20-month delay, permission was granted for the proceedings to go ahead.

Mr Justice Constable, convicting Bogmer, said the defendant 'had no honest belief' in the truth of the claims he made about his injuries and 'made them with the deliberate intention of deceiving the experts and in due course the court'.

'To the extent any of the representations of loss of function and deterioration were accurate (which I do not accept), Mr Bogmer in any event falsely, and dishonestly, represented that the symptoms he said he experienced and the associated impacts were caused by the…surgery, when (to the extent they existed at all) they predated the surgery and were unrelated to it.'

During the course of his judgment, published on Monday, Constable praised Wainwright for the way he had communicated with Bogmer. Wainwright had spoken to Bogmer’s wife in June about the defendant’s decision not to attend his trial for contempt.

Bogmer - who represented himself - has cancer and said in an email: 'My GP and Oncologist advised me not to worry over this case and focus on my own well-being, after being given a very short life expectancy.'

Constable said Wainwright had 'quite properly and with a great deal of sensitivity' been staying in communication with Bogmer and his wife in the lead up to the committal hearing. The High Court judge thanked Wainwright and said his dealings with the Bogmers 'exemplify the great professionalism, courtesy and sensitivity in dealing with difficult matters of this nature with a litigant in person, of which the legal profession should be proud'.

Judge hails solicitors courtesy and sensitivity in dealing with dishonest clin neg claimant

A High Court judge has praised a solicitor for conduct 'of which the legal profession should be proud' over his dealings with a dishonest clinical negligence claimant.

12 Jul 2023

The families of a teenager and a 62-year-old man were not told paramedics' responses were being investigated by North East Ambulance Service (NEAS).

The deaths, in 2018 and 2019, were raised by a whistleblower last year.

NEAS chief executive Helen Ray said she was sorry "for any distress caused to the families" by past mistakes.

Among the findings of the independent review carried out by Dame Marianne Griffiths, were inaccuracies in information provided to the coroner, employees who were "fearful of speaking up" and "poor behaviour by senior staff".

The study, commissioned by the former health secretary Sajid Javid in August, examined four of the five cases that were highlighted by the whistleblower, initially in The Sunday Times.

It found two bereaved families were left in the dark about investigations into the response of paramedics called to help their loved ones.

The family of 17-year-old Quinn Milburn-Beadle, from Shildon, County Durham, only found out what happened when a family liaison officer visited a few days before her inquest in April 2019.

The review said a rapid response paramedic - who has since been struck off - "did not adhere to national and local guidelines" in stopping CPR and declaring her dead.

It found that "however small the probability of recovering was" the teenager "deserved that chance and so did her family". A narrative verdict was recorded by the coroner almost two years after her death.

In the case of 62-year-old Peter Coates from Dormanstown near Redcar, he had called 999 in March 2019 when a power cut meant his home oxygen supply stopped working. The review discovered crews arrived 36 minutes after his call.

It found one team had stopped to refuel the ambulance en route and another was unable to make the three-minute journey because a power cut had prevented the gates at the ambulance station from opening.

Mr Coates' family, who eventually learned what happened via the whistleblower, believe if the crews had reached him sooner "he might still be alive".

Another call highlighted in the report was in November 2019 when a 62-year-old man had fallen on to a wooden laundry basket.

Despite his niece telling 999 operators she feared he had suffered a punctured lung and was struggling to breathe, it took more than an hour for an ambulance to arrive. In that time the man was in cardiac arrest and died.

The review found there was a "trend" for NEAS to provide coroners with "confusing or conflated" information rather than the original material and there was "no independent communications with families" which would have "lessened the trauma".

'Anxious, frustrated and stressed'
It also found opportunities for learning were missed, with established processes not being followed by NEAS.

It noted "leadership dysfunction" and "antagonism" between leadership teams. Staff were "fearful of speaking up" and those who did raise concerns were left "anxious, frustrated and stressed", it said.

Included among the recommendations were:

That concerns of reports being altered inappropriately should be addressed
Consideration of whether accountability procedures were properly followed through
If not, then further action should be contemplated
Call handlers should be trained to ask for help where the clinical safety of patients is at risk
A senior, independent doctor should be included in the review of deaths and their referral to a coroner
The review also stated that NEAS - the second smallest ambulance trust in the country - required additional funding.

Dame Marianne Griffiths paid tribute to the families for sharing their testimonies.

"It is clear that they are not only devastated by the loss of their loved ones but also by the ambulance service's response to the legitimate questions about their care," she said.

"The families' primary motivation remains to spare others this pain."

She added the NEAS "co-operated fully" with the investigation and the current executive team was "committed to making the recommended changes".

NEAS chief executive Helen Ray said she had written to the families involved to apologise and invited them to meet in person, adding that the 15 recommendations were being "actioned at pace".

"There were flaws in our processes and these have now either been addressed or are being resolved. We are grateful the report recognises that we have a new leadership team committed to addressing the issues," Ms Ray said.

She added governance, systems and processes relating to investigations and coronial reports had been "strengthened" and resources had been increased allowing issues of concern to be "easier to be flagged".

Earlier this month, health watchdog the Care Quality Commission (CQC) identified improvements to NEAS services were needed during a fresh inspection of emergency and urgent care services.

However, the CQC said NEAS had made "some improvement" and moved its rating from "inadequate" to "requires improvement".

North East Ambulance Service apologises to families

An ambulance service has apologised to families following a review into claims it covered up errors by paramedics and withheld evidence from coroners.

11 Jul 2023

Costs Judge Leonard, sitting in JXC v NIS, said the firm’s budget overspend was unreasonably incurred and unreasonable in amount. Irwin Mitchell had tried to secure the court’s permission to recover more than £200,000 after falling short of recovering the entirety of its costs from the defendant. The personal injury claim against the Ministry of Defence was settled in 2021 for a lump sum of £5.1m and annual payments of £310,518.

In a ruling from April published this week, the judge found the claimant’s litigation friend was not kept properly informed during the course of the claim.

Standard information was provided years after the event and never applied to the facts of the case. The litigation friend, referred to in the judgment as JXC, was told in 2020 that the court had ‘now’ set a budget, whereas in fact a budget had been set almost five and a half years earlier and was shortly to be revised for the second time.

Leonard said no attempt seemed to have been made at any point to obtain JXC’s authority or keep her [the litigation friend] advised of anything to do with the budget set. She was given no opportunity to authorise the three budgets Irwin Mitchell submitted to the court for approval, or to authorise (or decline to authorise) any element of spending outside the limits set by those budgets.

The judge added: ‘Costs incurred in excess of budget are likely to come straight out of the client’s pocket, with no prospect of recovery. It follows of necessity that it is incumbent upon a solicitor to monitor accruing budgeted costs (as IM said they would) and before budgeted figures are exceeded, to advise the client of the implications of doing so and of such options as applying for budget revision or avoiding the overspend. None of that happened here.’

The court heard that the total overspend, including VAT, was around £234,000. Base costs claimed by Irwin Mitchell from the claimant significantly exceeded the budgeted figures.

Irwin Mitchell sought to recover around £213,000 from the claimant based on the total difference between base costs recovered from the defendant and the firm’s bill of costs.

The conditional fee agreement with the claimant had explained that he could expect to recover the majority of, but not all, costs and disbursements from the defendant. The same information was given orally to JXC as well as a careful explanation of basic charges, success fees, disbursements and ATE. The judge noted that the solicitor handling the case advised the litigation friend about costs incurred during the course of the claim but did not distinguish between sums that might be irrecoverable.

The firm argued in court that the shortfall was ‘defined and demonstrable’ with the level of informed consent required to make it reasonable. It said that solicitors were not under a burden to set out every possible outcome of any potential cost recovery or disallowance, and that to require an explanation of the intricacies of budgeting would not assist a client or meet any proper test of informed consent.

The firm further argued that the budget overspend was neither unusual in nature or amount, and a shortfall of 20% of the overall costs claimed was at the ‘lower end’ of client contributions.

Irwin Mitchell has confirmed it will not appeal the decision. A spokesperson said: 'Recoupment of costs from damages is clearly still a developing area of law, and none more so than where protected parties are involved. There are still differing decisions on these issues and each case will have to be considered against its individual facts. Unfortunately there is still no appellant authority to help the profession.'

Law firm told it cannot recover costs shortfall from claimant

A judge has ruled that national firm Irwin Mitchell cannot recover its costs shortfall in a multi-million-pound case from the claimant’s damages.

5 Jul 2023

Hosted on Learning Hub, the module, which is free to access, is designed to support clinicians working in maternity services.

The module uses three illustrative case stories to immerse learners into the antenatal, intrapartum and postnatal care provided to mothers and the neonatal care provided to their babies.

Completion of this module takes approximately two-and-a-half hours and can be used as evidence of CPD hours undertaken for revalidation.

By navigating the module’s content, learners will deepen their understanding of NHS Resolution’s role within the healthcare system, develop their understanding of the law of negligence as applied to clinical claims, and explore how clinical decisions and actions can lead to avoidable harm.

Developed in collaboration with clinicians and academics from Staffordshire University and London South Bank University, the e-learning module is tailor-made for multidisciplinary teams within maternity services who are seeking innovative ways to achieve the National Maternity safety ambition.

Dr Denise Chaffer, director of safety and learning at NHS Resolution, commented: “Our unique collaboration with our academic partner has enabled us to develop this very innovative learning resource to support our aim in sharing direct learning from our EN [early notification]cases to support prevention of harm in maternity care which so significantly impacts on parents and families’ experience.

“We have jointly developed a valuable tool to support maternity staff and their colleagues in enhancing their understanding and drive improvements in safety in maternity services.

“This module offers a unique opportunity to gain direct insights from NHS Resolution, focusing on learning from harm and sharing a platform for direct learning from Early Notification cases.

“It introduces an innovative approach that takes clinicians on a comprehensive journey through a maternity case, from the incident itself to the legal process, fostering personal reflection and facilitating flexible and complimentary learning alongside face-to-face education and training.”

Sangita Bodalia, head of early notification (legal), added: “This innovative and immersive module introduces maternity colleagues to the EN scheme and focuses on the legal test for clinical negligence. It highlights the key elements that medico-legal experts will be assessing when a maternity investigation takes place.

“This may not always be front and centre when undertaking clinical practice, and this module provides a vital reminder to inform improved and best practice going forward, ensuring we are always learning from harm.”

Annette Anderson, head of early notification (clinical), said: “This is an excellent maternity module, and is something I would have liked to have been able to access when I was a student midwife, and during different stages of my midwifery career. To all clinical colleagues this is a real opportunity to enhance your clinical practice, and learn something new in relation to the Early Notification Scheme and legal process. Please do make time to access this training if you can.”

NHS Resolution launches e-learning module to support clinicians working within maternity services

NHS Resolution has launched its first, innovative e-learning module focused on the significant avoidable harm that can occur during the antenatal and postnatal care of mothers and their babies and is seen in the cases notified to its Early Notification Scheme.

16 Jun 2023

Olivier Branford, 49, showered the women with compliments before bedding them at his private clinic.

The married father-of-three also sent them sexually explicit messages, which included naked photos of himself, and shared details of his sexual fantasies.

He had sex with one woman at the Cadogan Clinic, in Chelsea, West London, after telling her she was "beautiful" and that he "loved her body".
Cambridge-educated Branford bedded another woman – behind her husband's back – after saying her new breasts were "perfect" and he wanted to "oil them up" and put them on his Instagram page.

He had sex in "multiple positions" with a third patient at the clinic while she was still recovering from breast surgery, despite it not being clinically advisable.

Admitted Charges
Branford admitted 14 of the 18 charges against him when he appeared at a Medical Practitioners Tribunal Service (MPTS) misconduct hearing in November last year.

Two of the remaining four charges were later found proved.

The tribunal reconvened last week, when Branford's fitness to practise was found to be impaired, and decided on Monday to erase him from the medical register. It previously heard how Branford encouraged an "emotional attachment" with all three women so he could have sexual relationships with them between 2019 and 2020.

One woman – known as Patient A – went to his clinic and told him she "hated the way she looked" and that her large breasts were causing her back and shoulder pain and self-esteem issues. He responded by sending her a WhatsApp message saying he could "fix her and make her love her body".

They exchanged further messages via Instagram and WhatsApp, with Branford complimenting the woman about her figure and the way she looked. Over time, the messages became more flirtatious, with Branford telling the woman that he "loved her body" and that "he wanted her to become his muse" so he could paint her.

Sexual Fantasies
In other messages, he described sexual fantasies which included them "French kissing" and touching and stroking each other, and he admitted pleasuring himself when he thought of her. Branford sent the woman a photo of his penis and begged her to be his "secret lover", and they later had sex twice at his clinic after he used oil to massage her breasts and in between her legs.

He sent a second patient – Patient B – sexually explicit messages, telling her: "I am French, so sensuality is good. You are very desirable and sexy."

The pair shared and acted out sexual fantasies, which included phone sex, and he sent her a naked selfie, which included his penis, and she responded: "Oh my gosh! Beautiful. Enormous."

After they had sex at his clinic, her feelings towards him then changed because it was no longer "special between them".

Branford had sex with a third patient – Patient C – after she underwent a breast enlargement.

He flirted with her during an initial consultation and gave her his phone number, and then 'liked' sexy photos of her on her Instagram page – one showing her in the back of a taxi wearing lingerie and thigh-high boots – and described her as "elegant".

After her surgery, the woman told him she had the "best t****** in London" and he admitted to peeking at her tummy while she was under the anaesthetic, "but he'd wanted to look lower".

Believed Woman Was a 'Praying Mantis'
They later had sex in multiple positions at his clinic, despite him knowing it wasn't "clinically advisable" for a patient to do so for at least two weeks following breast surgery. But Branford claimed that unlike the two other patients, he never encouraged an improper emotional attachment with Patient C, and she was just as eager to have sex with him and was "up for it straight away".

He also agreed with a social media post which described her as a "praying mantis who f**** men and eats them alive".

The Cadogan Clinic were contacted for comment.

Plastic Surgeon Dr Olivier Branford Struck Off for Having Sex with Vulnerable Patients

A top plastic surgeon has been struck off for having sex with three vulnerable patients who came to him for breast procedures.

13 Jun 2023

$A mum claims a hospital caused her son life-changing brain damage after he fell from a hoist while being treated for spinal injuries. Andrew Kent, 45, was admitted to Northwick Park Hospital after being badly hurt in a motorbike crash in February last year. The 45-year-old, from Barnet, north London, suffered fractures to his cervical spine, his skull, forearms and ribs, and permanently lost the function of his arms and legs. His injuries then worsened after he fell from a hoist used to transfer him between his bed and wheelchair during treatment on 10 May 2022. He was immediately sent for CT scans of his head, which showed he’d suffered a brain haemorrhage. He was left with damage to his frontal lobe, leaving him unable to walk, talk, shower or feed himself, and requiring round-the-clock care. His mum Vicki Gooding, 64, said: “Andrew had just nipped out to my mum’s on a motorbike - it was 7 o’clock in the evening. He was on his way home and a car just pulled out on him.” The 64-year-old has now become his full-time carer and says her son is a “completely different person” after falling from the hoist. She said: “I have to be with my son - I’m just not prepared to send him off to a home. He has two head injuries and he’s a completely different person. “He hasn’t been able to have a shower or bath for two years, and if he can’t be hoisted onto the toilet, he just can’t go. For obvious reasons, he’s still absolutely terrified of the hoist.” Ms Gooding said Andrew was “getting on just fine” before the fall in hospital, and had been showing signs of slight improvement after working well with physiotherapists. But she says “there was nothing left of him” after he fell and his condition became “so much worse”. He was later transferred to St Mary’s Hospital in Paddington before eventually being sent home almost a year later on 5 May 2023. He now receives constant care from a team of physiotherapists, his mum, girlfriend and other family members. But while she’s desperate to keep living with her son, Ms Gooding admits her home is inaccessible and her son has been left with “no dignity”. She explained: “He spends his days lying in a hospital bed in my living room. There’s no dignity about it at all - carers come in every day and change him, and I’m barely able to give him any privacy. “I kicked off at Barnet Council and told them we desperately need a wheelchair ramp. Andrew has a powerchair but it’s no good if he can’t actually leave the house. He needs regular exercise because it helps with the physio - but I’m just at a loss. He can’t shower or bath - he hasn’t done so for two years. “We need somewhere bigger - we keep slipping down the list of priorities and I just don’t see how you could get someone more disabled than Andrew. I want to keep us all together. He needs the support of his family.” Northwick Park said it carried out an internal probe following the fall and concluded that the sling and hoist used were both adequate and operational. But the hospital added that the weight of the sling hooks may have contributed to Andrew’s fall. Ms Gooding later received a letter from the hospital saying it was "extremely sorry" for the incident - an apology she says she does not accept. She said: “I don’t accept their apology and we were disgusted by the letter. There hasn’t been any help.” A spokesperson for Northwick Park said: “We are very sorry for the injury sustained by Mr Kent and have apologised to him and his family. As part of our serious incident investigation, we have already undertaken an extensive review of our training and equipment checks and have made changes to prevent such an incident from occurring again. As part of this process, we have shared our investigation report and learning from it with Mr Kent and his family.” As for Andrew and Ms Gooding’s accommodation, a Barnet Homes spokesperson said: “Barnet Homes allocates all properties according to Barnet Council’s Housing Allocations Scheme, which uses a banding system. Ms Gooding is currently in our highest priority band and we are actively seeking an alternative property for the family, which will meet their needs. “In this case, we will be offering the family a two-bedroom wheelchair-adapted property when one becomes available, acknowledging that there is an acute shortage of social housing in London, and this may take some time. We will also ensure that this property is as close as possible to Ms Gooding’s support network. “Work began this month to install a suitable access ramp to Ms Gooding’s current home. Initial works to install the ramp had taken place earlier this year, but a change in the family’s equipment needs caused a delay, which has now been resolved.”$

Mum slams hospital as son left with life-changing brain damage

Andrew Kent is unable to walk, talk, shower or feed himself after a fall in hospital

13 Jun 2023

Whistleblowers at Brighton’s main hospital raised concerns about roughly 40 deaths after alleged “botched operations”, it has been reported.

Police have confirmed they are investigating the allegations which are said to have taken place over a five-year period.

A spokesman for Sussex Police said: “Sussex Police has received allegations of medical negligence at the Royal Sussex County hospital, Brighton, and is currently assessing these allegations.

“The concerns raised relate to neurosurgery and general surgery in a period between 2015 and 2020. “Enquiries are at an early stage and this does not necessarily mean this will lead to criminal prosecution.

“We are working closely with partner agencies and the hospital trust is cooperating fully with our review.”

The Guardian reports that a tribunal hearing against University Hospitals Sussex NHS Foundation Trust brought by one of the dismissed whistleblowers was halted due to the police investigation this week.

The Guardian reported that Daniel Dyal, the judge in the tribunal, stated: “The police investigation overlaps significantly with the patient safety and mortality issues about which there is a lot of evidence in this case.”

He said it was the West Sussex coroner who first reported allegations about the deaths to the police in April.

The Guardian reported that he said the police investigation could lead to “charges of serious offences including, perhaps, gross negligence manslaughter”. Witnesses from the trust, including two senior clinicians, risked “prejudicing their position in future criminal proceedings” if they gave evidence at the tribunal, he said.

Brightons Royal Sussex hospitals medical negligence deaths probe

Police are investigating possible medical negligence at the Royal Sussex County Hospital after reports of dozens of deaths.

9 Jun 2023

Grail's flagship cancer detection blood test Galleri is designed to detect more than 50 types of cancer before symptoms appear.

The company, owned by Illumina Inc, said the letters were mistakenly sent by PWNHealth due to a software issue and that it "was in no way related to or caused by an incorrect Galleri test result".

Grail said it had reached out to the patients immediately after the issue, adding that no patient health information has been disclosed or breached due to this.

The software issue being faced by PWNHealth has now been resolved, it said.

Illumina is currently appealing regulatory orders in the U.S. and EU, which are asking the gene sequencing company to divest Grail after it jumped regulators to close its acquisition of the cancer test maker.

Grail Says About 400 Patients Incorrectly Informed They May Have Cancer

Cancer test maker Grail Inc said on Friday that its telemedicine vendor erroneously sent letters to about 400 patients suggesting they may have developed cancer.

5 Jun 2023

Olivia Maunder, 15, was later diagnosed with Ewing Sarcoma – a rare form of the disease affecting the bones and surrounding tissue – and now has just months to live.

Staff at Frimley Park Hospital, in Camberley, Surrey, initially missed the tumour in Olivia's pelvis when she had an MRI scan in March 2021.

Instead, doctors diagnosed her with complex regional pain syndrome (CRPS), a little-known condition often thought to be caused by the body reacting abnormally to an injury.

Over the following three months the teenager endured 'indescribable agony' and was taken to A&E on multiple occasions.

But Olivia, from Bordon, Hampshire, said she was offered little help from staff and at one point was told to 'calm down'.

She added: 'I was even told that I was mirroring my mum's pain as she had had back problems. I wasn't being treated at all, I just existed in pain.'

Olivia's mother, Carol Rolfe, 52, said: 'We told the doctors so many times how much pain she was in.

'She was screaming in pain, but we were asked, 'Have you tried a mindfulness app?' and were told it was stress. They wanted her to be quiet and not disturb others.'

Olivia initially felt 'relieved' after receiving the CRPS diagnosis – but then became frustrated when she was given no pain medication.

'I knew that I was in pain and that this wasn't in my head,' she said.

The teenager and her family began to question the CRPS diagnosis further when her pain continued to increase over time.

And a second MRI was arranged only after her mother spoke to an expert on the condition.

Only at this point was the tumour discovered but by then it was so extensive that surgery was no longer an option.

A serious incident report carried out after the missed diagnosis at the hospital later revealed significant failings in her care.

Olivia first began to feel 'niggles' in her back in 2020 but she didn't see a GP until January 2021, after the pains worsened over the Christmas period.

After months of painful chemotherapy and radiotherapy, Olivia was able to go back to school in April 2022.

However, her condition has since deteriorated and she was recently told she has months to live.

'When the doctors said they had found a tumour in my pelvis it felt like an out of body experience. I was in shock,' she said.

'Afterwards I was extremely angry. They told me I had a tumour three months after they said I was making it all up and had been suffering terribly.'

The family have now instructed solicitors Devonshires Claims to take legal action against Frimley Park Hospital Trust.

Jeanette Van-Cauter, a specialist medical negligence lawyer from the law firm, said: 'Olivia is one of the bravest young people I have met, and her story is one of the most tragic... this is unacceptable and I believe that those responsible should be held to account.'

Frimley Health NHS Foundation Trust medical director Dr Timothy Ho said: 'We are very sorry for the considerable distress caused by the delay in diagnosing Olivia's cancer and have met with Olivia and her family to share the results of our thorough investigation.

'We are committed to learning from the investigation and improving services and will support Olivia and her family as best we can at this difficult time.'

Doctors missed teenager's terminal cancer - and told her to try mindfulness

Doctors failed to spot terminal cancer in a teenager, suggesting instead that she try a mindfulness app to deal with her 'indescribable agony', her family claim.

5 Jun 2023

The move followed a February inspection of Montague Court in Edgbaston, after the CQC received "information of concern regarding training compliance, staff supervision, and lack of opportunity for staff and people using the service to give feedback about the hospital".

As a result of the inspection, the CQC said it had taken enforcement action and "served the provider with a warning notice" requiring it to make immediate improvements. The service, which is provided and run by Options for Care Limited, is now in special measures, which means it will be kept under close review by the CQC and re-inspected to check on the progress of improvements.

Complex Care Needs
Montague Court is an 18-bed mental health long-term complex care locked rehabilitation hospital for men aged 25 to70 with complex needs. It is registered to provide care and treatment to people detained under the Mental Health Act. The facility was last rated as 'oustanding' in September 2018 following a routine CQC inspection.

During the most recent inspection, there were 16 people in residence in the hospital.

Specific points of contention in the CQC's inspection included:

Multiple ligature points for which risk mitigation actions had not been followed by staff
Insufficient alarms to keep staff, visitors, and people safe

Staff did not routinely check medical equipment, with blood glucose monitoring machines not routinely checked or calibrated

Staff did not follow General Data Protection Regulations to keep people’s information confidential
Governance systems were not sufficient to identify potential risks

Significant risks that were identified by the CQC had not been recognised, assessed, monitored, and mitigated by the hospital, which was not aware of the level of risk posed by multiple issues

Staff did not receive regular supervision and annual appraisals

'People Weren’t Safe'
Amanda Lyndon, CQC interim deputy director of operations in the Midlands, said: "During our inspection of Montague Court, we found the standards of care had significantly deteriorated since our previous visit; people weren’t safe and were at risk of avoidable harm.

"The hospital didn’t provide an environment that was clean, well maintained or fit for purpose. We found staff couldn’t observe people in all parts of the hospital; we saw multiple blind spots, which weren’t mitigated by any mirrors or individual risk assessments. Also, the standards of cleanliness were well below what people should be able to expect. It was visibly dirty with food on both the furniture and floor, which is totally unacceptable, and nobody should have to live in these conditions.

"Staff didn’t always develop care plans that were holistic and recovery-orientated or record the person's involvement in developing their plan. Also, they didn’t regularly review and update care plans, which could result in people not receiving appropriate care to meet their individual needs."

On the good side, the inspection found that staff had used a full range of rooms and equipment to support treatment and care. There was a dedicated activity centre with a therapy kitchen, as well as an IT suite and games room, quiet areas, and a room where people could meet with visitors in private, including a dedicated family room. Residents had access to their own mobile phones.

Decline in Standards 'Not Good Enough'
Ms Lyndon noted: "However, throughout the inspection we did see staff treating people with respect, and they offered people a choice of food and drinks. People told us they were offered a variety of good quality food.

"The overall decline in these standards isn’t good enough and we’ve told the provider what they must do to improve, as nobody should ever have to live in a service which is unsafe.

Ms Lyndon said that the CQC will continue to monitor Montague Court closely to ensure "the necessary improvements are made urgently to keep people safe and free from harm".

"If we are not assured people are receiving safe care, we will not hesitate to take further enforcement action, even if this results in closure of the service," she said.

Birmingham Mental Health Hospital Placed in Special Measures

A Birmingham hospital for patients with mental health conditions has been downgraded from 'outstanding' to 'inadequate' and placed in special measures by the Care Quality Commission (CQC).

1 Jun 2023

Family doctors are being taken to court by their patients as a result of spiralling hospital waiting lists — even though GPs are not responsible for the crisis.

It comes as official figures show 14% of the population — around one in seven — had been waiting longer than a year for an outpatient or inpatient appointment at the end of March.

The growing risk to patient safety, as the health service struggles to cope with demand, and the potential for primary care doctors to be held accountable have been blamed as reasons for the rising number of GPs who are handing back their contracts.

Sixteen GP surgeries in Northern Ireland have handed back contracts in recent months, bringing the key NHS service closer to collapse.

The British Medical Association (BMA) has warned a further 30 practices are “in crisis”.

The BMA has been calling for changes to the indemnity system here in a bid to reduce the number of surgeries facing closure.

Dr Alan Stout, chair of the BMA’s GP committee in Northern Ireland, explained: “All of those patients who are on a hospital waiting list have to be cared for until they get their appointment. While they’re waiting to be seen, it’s the GP that’s carrying the risk.

“It’s the same for a patient who goes to an emergency department and they aren’t admitted, and for those who are discharged from hospital and they’re becoming frailer and frailer — but they’re being discharged earlier and earlier.

“They’re our responsibility and the risk is getting greater and greater and GPs are paying for it.

“GPs are being sued by their patients. They’re saying the GPs didn’t push hard enough for the hospital appointment. It’s really stressful for the GP. They have to spend a lot of time on all the paperwork, and it’s expensive too.”

Family doctors have already warned that they’re struggling to meet the cost of running a practice, in light of the cost-of-living crisis affecting all businesses.

In one case last year, a GP surgery saw its annual energy bill rise from £30,000 to £130,000.

Some GP surgeries have had to scale back opening hours in a bid to remain financially viable.

The indemnity system for GPs in NI is different from that in place in England and Wales.

GPs in NI are not covered by a state-backed scheme and pay thousands of pounds a year to be covered for clinical negligence.

The annual indemnity amount increases when a GP has had to make a claim having been sued by a patient.

However, in England and Wales, the system was changed in 2019 so that state-backed schemes automatically cover all GPs if they are providing NHS services, and family doctors pay a nominal fee for cover.

A Department of Health spokesperson said, in the state-backed scheme, “the cost of claims’ administration and of successful clinical negligence claims are met from within the health budget”.

They continued: “We are continuing to take forward work to look at the model of GP indemnity provision in Northern Ireland.

“A number of possible options, including the current model and a number of state-backed model options, have been identified.

“We recognise that there is expectation amongst GP representative organisations in Northern Ireland and political representatives that the review of the indemnity model will be progressed at pace.

“We have been clear, however, that the pace of this work is subject to completion of the business case process and that, as such, there are a series of steps that will need to be completed.

“This process is necessarily very detailed, given the potential costs and risks associated with GP indemnity options.

“It is likely that any final decision on the implementation of a new model for GP indemnity in Northern Ireland will require ministerial agreement.”

NI patients suing GPs over hospital waiting time targets

Northern Ireland GPs are being hit with bills of thousands of pounds as they are sued by patients coming to harm on hospital waiting lists.

29 May 2023

Freedom of information requests from the Scottish Conservatives show 475 successful claims were settled by the NHS over the four-year period, totalling £163.1 million.

The true cost, however, is likely to be higher, with NHS Greater Glasgow and Clyde – the country’s biggest health board – not providing data to the party, while NHS Borders and NHS Grampian did not give figures for last year due to claims not yet being processed.

Between 2018 and 2021, the figures show, annual payouts rose from £24.5 million to just shy of £55 million.

NHS Lothian spent almost £43 million on compensation, the highest of any health board during that time.

While some boards presented a breakdown of classifications which led to claims – such as medical negligence – NHS Lanarkshire was the only one to provide further details.

According to the board, reasons for payouts included a woman’s ovary being removed without consent, a man’s testicle being removed without consent, a patient having their eye glued shut, and a “failure to properly examine baby resulting in imperforate anus going unnoticed and resulting in death”.

Responding to the figures, Scottish Tory health spokesman Dr Sandesh Gulhane said: “My heart goes out to the patients and families who have suffered as a result of failings in Scotland’s NHS.

“But the buck for this stops with a succession of SNP health secretaries – including Humza Yousaf. These figures are a damning indictment of the SNP’s dire workforce planning, which has left our health service woefully under-resourced.

“Dedicated staff are dangerously overstretched and, tragically but inevitably, this is leading to more mistakes and a growing number of compensation claims.

“At a time when budgets are so tight, the NHS can ill-afford to be spending vast sums on compensation. It goes without saying that this money could be far better spent on frontline patient care.”

Paul Cannon, the secretary of the NHS Lanarkshire board, said: “NHS Lanarkshire makes payments where the standard of care has fallen below that which would be expected, which is not necessarily an error.

“Offers to settle claims are often made before cases are tested in court, where it appears that we may be at fault, or where we accept limited liability.

“Offers are also made on an economic basis if the cost of defending the claim is grossly outweighed by the cost of settling the claim.”

A Scottish Government spokesperson said: “We sympathise with any patient whose treatment has failed to reach the standards we all expect from our health system.

“Scotland has one of the most transparent healthcare systems in the world and is also a leader in patient safety. Our NHS learns constantly from care experiences that go well and those where standards falls short.

“Particularly in rare cases of clinical negligence, health boards and care professionals must learn from these situations and make improvements. These cases can take a number of years to settle so there will be fluctuations in compensation payments from year to year.”

NHS spent £163m on compensation to Scots patients since 2018

The NHS paid out more than £160 million in compensation to patients between 2018 and 2022, figures show, with one case involving a baby who died after an improper examination.

27 May 2023

Dr Ian Cunliffe and Dr Mark Goldman were accused of ignoring warnings about Paterson and not taking action to stop his malpractice, which left victims scarred, disfigured and with long-term psychological effects.

Mr Paterson, who worked at NHS and private Spire hospitals in the West Midlands, was jailed for 20 years in 2017 after he was convicted of 17 counts of wounding with intent and three counts of unlawful wounding against 10 patients. An inquiry later concluded that more than 1000 patients were subjected to damaging and unnecessary operations over 14 years before he was finally stopped.

Mr Paterson was found to have exaggerated patients' cancer symptoms and performed needless mastectomies when less-invasive treatment was more appropriate. He also carried unregulated 'cleavage-sparing' mastectomies (CSMs) which increased the risk of cancer returning in patients.

A GMC spokesperson said: "We note the decision, by a medical tribunal, to grant Mr Goldman and Mr Cunliffe's application for costs.

"We will review the decision in full."

None of the Charges Proved
The GMC investigation against Dr Cunliffe and Dr Goldman, former medical director and chief executive, respectively, at the Heart of England NHS Foundation Trust, was opened in 2013 following the publication of review by Sir Ian Kennedy, on behalf of the Trust’s board, into Paterson’s surgical practice.

The two men appeared before a Medical Practitioners Tribunal Service (MPTS) misconduct hearing accused of various charges which included failing to protect patients from "the risk of harm" posed by Mr Paterson, not acting sooner to stop him, and not reporting him to the Trust or the GMC.

But their cases concluded in October, last year, with none of the charges found proved.

An application for their legal costs was made earlier this month with their counsel Mark Sutton KC, arguing that both Dr Cunliffe and Dr Goldman, along with their families, had suffered "immense stress and anxiety of the grossly protracted process hanging over them".

The final chapters of the doctors' careers, which had been devoted to loyal service to the NHS, had been "entirely eclipsed and blighted by the proceedings", he said.

Mr Sutton deemed the GMC’s prosecution "profoundly unsatisfactory", saying they had failed to conduct "an open-minded and through investigation" and had adopted evidence from other inquiries to support a range of allegations that had never been specifically investigated.

GMC's Conduct Found 'Unfair' and 'Unreasonable'
A MPTS tribunal has now ruled to grant the application for costs – which are likely to run in the six figures – after finding the GMC's conduct "unreasonable" by failing to adhere to its own rules in pursuing allegations against Dr Cunliffe and Dr Goldman.

It said it was "unfair" of the GMC to make a case against them when allegations were not supported by evidence and witnesses were not prepared to give evidence. The tribunal also found that the GMC failed to share a schedule of evidence, presented its case in a "faltering manner" and caused unnecessary delays during the course of the hearing – making the case "more bewildering" than necessary.

Dr Cunliffe and Dr Goldman shouldn't have undergone such an experience, it concluded, and it "did not, therefore, consider that this was a case where it should be concerned with the chilling effect which an order for costs may have on the GMC, a regulatory body".

The amount of costs to be awarded will be determined after all parties make submissions.

GMC Investigation 'One of the Most Stressful Things a Doctor Can Face'
Dr Caroline Fryar, director of medical services for the Medical Defence Union (MDU), said: "Being investigated by the GMC is one of the most stressful things a doctor can face. It is vital that any allegations put to doctors are properly evidenced. The tribunal rightly noted that in the cost award determination.

"There is a high bar for a tribunal to surmount in order for it to find that a regulator should pay the legal costs in case it has brought but failed to prove," she noted, while adding that the tribunal found that the GMC had failed to conduct a reasonable investigation/call relevant witnesses, failed to disclose documents, failed to serve evidence, and caused unnecessary delays to the proceedings. "Consequently, it felt that the threshold had been crossed, and that the regulator should pay the defence costs," she said.

"The regulatory regime that doctors are subjected to must be proportionate, timely, and above all – fair. In this instance, the tribunal found this was not the case," Dr Fryar added. "The MDU believes it was right to stand on principal in this case, to reaffirm these values and their importance. We are sure the GMC will learn lessons from this case, and we will continue to work constructively with them in that spirit."

History of the Paterson Case
Paterson was jailed for 15 years in 2017 following a trial at Nottingham Crown Court with his sentence later increased to 20 years by the Court of Appeal, which deemed the original jail term "unduly lenient".

In 2020, an independent inquiry investigated how he was able to carry out unnecessary surgeries undetected for so many years. It found 1000 women were subjected to needless surgery between 1997 and 2011 and he was allowed to carry on performing harmful procedures due to "a culture of avoidance and denial" in a "dysfunctional" healthcare system where there was "wilful blindness" to his behaviour.

The report from the inquiry, chaired by the Rt Rev Graham James, a former bishop of Norwich, called on ministers, NHS bosses, and the private healthcare industry to introduce measures to reduce the risk of another health professional inflicting such life-changing harm on patients.

It also led to a further 5500 of Paterson’s patients being recalled and in 2021 Spire Healthcare set aside £22 million to cover the costs of new compensation claims.

A £37 million compensation package for more than 750 patients was approved by a High Court judge in 2017. This included £27.2 million paid out by Spire Healthcare and £10 million paid by Paterson's insurers and former employers at the Heart of the England NHS Trust.

GMC Ordered to Pay Costs to Cleared NHS Chiefs

The GMC have been ordered to pay costs to two former NHS chiefs who were cleared by a medical tribunal of failing to protect patients from rogue breast cancer surgeon Ian Paterson.

24 May 2023

$Jesse Western, 17, suffered a fractured skull and a brain haemorrhage when he stepped out in front of a lorry days after being detained under the Mental Health Act. The teenager survived the incident but was left with serious injuries from which he is still recovering. But his family say the life-altering incident could have been avoided if his autism spectrum disorder had been correctly managed by the Norfolk and Suffolk NHS Foundation Trust (NSFT). And Stuart Richardson, chief executive of NSFT, has apologised in writing to Jesse and his mother, Stella Owens, for the shortcomings in his care. Michael Portman-Hann, of the family's legal representatives FBC Mandy Bowdler, who is pursuing a clinical negligence claim on their behalf, said Lauren Coates, a consultant psychiatrist, had originally dismissed his condition as being as a result of Ms Owens' parenting. He said: "The doctor in the children and young people's mental health team decided at Jesse's first appointment in 2015 that although he had autistic traits, the behaviours Jesse was showing were because of his mother's parenting. "As a result, she refused to give Jesse the diagnosis of autism spectrum disorder (ASD) which would have meant a treatment plan was put in place for him. "To compound the damage, the consultant also refused to accept the diagnosis of a later private assessment that found Jesse did indeed have ASD." He added that five years later, in June 2020, when Jesse was admitted to the Queen Elizabeth Hospital, King's Lynn, under the Mental Health Act, Dr Coates "refused" to do a full assessment on him. He was discharged and three days later attempted to take his own life. Mr Portman-Hann added: "This was a catalogue of decisions made on the basis of personal prejudice against Jesse's mother and not on the clinical needs of Jesse himself." Ms Owens said: "When Jesse had his first appointment in 2015, the consultant fixed on me and my parenting, saying Jesse's behaviour was his way of getting his needs met. "She couldn't - or wouldn't - get past that. "Had she made an ASD diagnosis at that point, we would have had a treatment plan and some tools to prevent Jesse's anxiety reaching crisis point. "None of this should have happened and Jesse should never have got to the point where he felt he had no other way out. "As a result of the trust's failures, Jesse has lost out on so many opportunities which could have been awarded to him had he received an earlier diagnosis. "This has had a substantial effect on his education and Jesse feels he has missed out on being able to enjoy his formative years." In a letter to the family, Mr Richardson wrote: "I offer my sincere apologies for the trust's failures to appropriately manage Jesse's autism spectrum disorder and undertake a comprehensive psychiatric assessment following his admission to the hospital. "I was desperately saddened to hear that had a psychiatric assessment occurred prior to his discharge home, this is likely to have avoided Jesse's attempt to take his own life. "I am truly sorry that the trust failed you both and for the impact this has had on you and your wider family. "The trust always strives to provide the highest quality of care to its patients and I can assure you that the failings identified in care on this occasion have been shared with all practitioners and agencies involved with the intention of learning and ensuring no-one else should suffer this experience."$

NHS admits failings in care of Norfolk teen with autism

The boss of the region's troubled NHS mental health trust has admitted there were failings in the care of a teenager with autism who suffered life-changing injuries in a suicide attempt.

23 May 2023

Rapid consolidation in the UK's personal injury lawyer market could be set to deliver new challenges for the insurance sector.

As the insurance industry looks to fight its corner with the Ministry of Justice (MoJ) on its proposals to implement changes to the way injury awards are calculated, personal injury (PI) law firms are undergoing a round of consolidation.

The figures are stark. In 1999 Accident Lawyers 4U undertook a survey and found there were 2,000 claimant PI firms in the UK.

By 2021, data from the the OIC portal released by the MoJ revealed there were only 284 firms registered. These data also revealed that 83% of the claims submitted to the portal were submitted by just 12 of the largest firms.

This consolidation has led some to argue the market will soon be dominated by a handful of “mega” personal injury firms, which will have the capabilities, in terms of research and capacity, to rival those available to the major defence law firms.

With private equity companies looking to invest in the personal injury sector, there are also fears that the drive to deliver a return may well fuel efforts to create US-style class actions lawsuits with the aim of obtaining large group settlements.

Nicola Critchley, president of the Forum of Insurance Lawyers (Foil) and partner at law firm DWF, said: “We continue to see consolidation in the personal injury market and we have seen a significant drop in the number of high street firms offering personal injury services.

”The number of personal injury claims has reduced due to a combination of factors, including the pandemic and the whiplash reforms.

“Even the larger firms operating in this space has seen challenges and significant reduction in profits in recent years and it seems that economics of scale may be a key factor to longevity in this market, which is the subject of further reform with the fixed costs extension for cases up £100k being introduced in October 2022.”

A noticeable reduction
Liam McGuire, partner at Horwich Farrelly added: “In the past you could find several personal injury law firms in every town. It is no longer the case.”

He warned that the bigger the claims firms get, the more the more they would require claims volumes to maintain their income growth.

“If you are going to stay in the sector, particularly the high volume and small value claims, then you need to be serious,” he added.

“To be serious, [newly consolidated firms] need to make money and that has to be at the cost of the insurance industry and its clients.

”It is not a doomsday scenario but the industry needs to be aware of the move toward more consolidation and the challenges it may pose.”

Laurence Besemer, chief executive of the Foil added that the new larger firms would need to implement corporate rules that require a consistency of approach for the consolidation in the market to have any real effect.

“From low value slips and trips through to catastrophic injuries, fair settlements have always been achieved more efficiently when there has been good dialogue and understanding between the parties,” he explained.

“Whether this is more easily achieved as a result of the recent rapid consolidation of the claimant law firm market from a large number of small firms into a small number of large firms is not clear yet.”

Class action potential
The UK is already seeing a rise in the potential for more class action claims, with television advertising seeking claimants in order to build a large tort case.

McGuire says: “Ten years ago a lot of US law firms were taking an interest in the UK, but for several reasons it did not take off.

“Given the market is now more settled I wonder whether we may see a move to a more US style approach and a renewed interest from the US firms.”

Technology is also likely to have a role to play in the sector’s consolidation and the approach from claimant lawyers to the non-complex claims.

The use of artificial intelligence (AI) may allow claimant lawyer to simply use the AI system to operate the high volume, low value cases through the OIC portal.

AI would would reduce the costs of the case and also free up lawyers to focus on the more complex and higher value cases.

“As technology and AI becomes more accessible it could be used for the volume work,” said McGuire.

“The AI could be not only programmed to move the non-complex cases through the portal but be tasked to identify those cases which could be potentially more valuable. The use of AI would deliver not only cost efficiencies but also consistency of approach.

“The bigger firms will use AI to run cases through the portal from start to finish.

“It could use past data to identify the cases where a whiplash claim has progressed to a chronic claim pain and highlight new cases which mirror that data as claims that require greater consideration.

“In the past you would need a paralegal to go thought the background and make a decision to whether the claim should be put on a certain track.”

Potential upsides?
The move to larger but fewer personal injury firms may have some upsides, despite the threat to the insurance industry.

Besemer explained: “On the one hand, the same claimant law firm is now likely to be settling claims with the same insurer or defendant lawyer more often and this regular engagement should, in theory, create better relationships and lead to more effective communication.

”On the other hand, with multiple offices and many handling solicitors, it’s unlikely that the same individual solicitor will be regularly dealing with the same insurer or defendant lawyer.

”Unless the very large claimant law firms adopt corporate policies – statements of handling practice that are enforced across all offices – claims handling behaviours are unlikely to be any more consistent, and thereby productive, than they were when the claimant community was a disparate number of small firms.”

McGuire said if the bigger law firms looked to implement a strategy across its entire company then it may well aid insurers and their lawyers.

He said: “If the claimant lawyers adopt a specific approach to cases, it will enable the defendant lawyers to understand the approach they will take and with it adapt their defence to counter the claimant strategy.

Consolidation of PI law firms poses new classes of risk for insurers

Increased demands for profit at consolidated claimant law firms will come at the cost of the insurance industry and its clients says partner

17 May 2023

Draft rules for the extending of fixed recoverable costs – set to take effect this October – appear to include clin neg claims entering the intermediate track, where breach of duty and causation are admitted. The extension applies to claims worth up to £100,000.

The MoJ has always maintained that clin neg would not be included. Indeed, the Department of Health is still considering its response to a consultation on proposals for FRC applied to claims worth up to £25,000.

Speaking at the Society of Clinical Injury Lawyers conference in Birmingham yesterday, outgoing chair Paul Rumley said the draft rules are ‘either a mistake or a calculated "thin end of the wedge"’. SCIL has asked the MoJ for clarity and for clinical negligence cases to be excluded.

New chair Sharon Allison said lawyers are ‘surprised and alarmed’, especially as the draft rules appear to usurp the talks on FRC for lower-value cases. ‘The proposals would affect the most vulnerable in society, including the elderly, and some cases of still births where negligence has occurred,’ said Allison. She added that SCIL will seek a judicial review if necessary.

Sean Linley, senior costs draftsman at Newcastle firm Carter Burnett, said the draft rules would likely lead to protracted disputes between health trusts and claimant lawyers about the allocating claims. He said: ‘You could have a scenario whereby a claimant argues a case is fast track to get standard costs and a defendant argues it is intermediate track to get FRC. This is why clin neg implementation should be delayed.’

Ian Cohen, a clin neg solicitor who runs his own consultancy, said it was unlikely many cases meeting the criteria for fixed costs would be issued and allocated.

‘I can see no justification for a claimant or a claimant lawyer, to issue in such cases, unless you have explored all alternative [resolution] methods,’ he added. ‘So why try and introduce [clin neg] in to FRC now? I can only assume it may be a way of restating the government’s commitment to bringing in FRC in lower-value cases and not a real attempt to bring [clin neg] into the scope of the intermediate track.’

The MoJ has confirmed that the rules, which will be laid in late May 2023, will state that clinical negligence claims must be allocated to the multi-track, and so excluded from FRC, except where the claim is one which would normally be allocated to the intermediate track and breach of duty and causation have been admitted.

A spokesperson added: 'Our proposals regarding costs in the intermediate track are in line with Lord Justice Jackson’s recommendations.'

JR threat amid clin neg fixed costs confusion

Lawyers have demanded to meet the Ministry of Justice after it emerged that some clinical negligence claims may be captured by new fixed costs rules.

5 May 2023

Northern Ireland medical negligence costs double in a year

The amount of government money spent on medical negligence cases and legal fees in Northern Ireland doubled within a year.

24 Apr 2023

The total cost of harm from clinical negligence was £13.6 billion in the 2021-22 reporting year, according to an annual report from NHS Resolution, the arm of the Department of Health and Social Care that handles litigation. Sixty per cent of the cost of harm was for maternity claims, amounting to £8.2 billion for the year. NHS England spends £3 billion annually on maternity and neonatal services, a board paper published in March confirmed.

The cost of harm, which is defined as the current value of the estimated cost of claims expected or received from incidents in the financial year, includes an estimate of the lump sum owed for claims, future periodic payments and legal costs.

“We spend more on the cost of harm, when we could be spending more on prevention,” said James Titcombe, a bereaved father and campaigner at the Baby Lifeline charity.

Analysis by the Times Health Commission, following independent research by the charity Baby Lifeline, found that there were more than 10,000 clinical negligence claims brought against the NHS in 2021-22, with a total value of over £6 billion. Of those claims, 12 per cent were for obstetrics, accounting for 62 per cent of the total value, or £3.74 billion.

These figures did not surprise Titcombe, who became a central figure in the Morecambe Bay investigation after he lost his newborn son Joshua in 2008 due to significant failures in the maternity unit of the Furness General Hospital in Cumbria.

Instead of a culture of learning, Joshua’s death led to a trust-wide cover-up, the extent of which was revealed in the 2015 report of the independent inquiry. It concluded that 11 babies and a mother had died avoidably at the Cumbria trust between 2004 and 2013.

“There was basically a cover-up, medical records went missing, and there were huge discrepancies between what my wife and I knew happened and what the staff had reported as happening,” Titcombe said. “That process damaged me greatly and meant the trust didn’t learn.”

Now on the Times Health Commission, Titcombe has worked closely with Jeremy Hunt and the charity Patient Safety Watch to drive systemic change.

Last year NHS England was faced with record maternity litigation costs. Titcombe says that continual testing against national patient-safety frameworks is key to preventing a culture of denial that is still prevalent in trusts.

Referring to an independent investigation of the maternity and neonatal services in East Kent, which was published last October, Titcombe was struck by the similarity of the findings to the Morecambe Bay inquiry.

Failures at the Queen Elizabeth The Queen Mother Hospital in Margate and the William Harvey Hospital in Ashford between 2009 and 2020 included suboptimal care that led to significant harm, failure to listen to families and actions that made the experience of families distressingly poor. According to the report, the problems could have been tackled at eight separate opportunities. Had care been given to the nationally recognised standards, the outcome could have been different in 45 of the 65 baby deaths.

The UK has a compensatory system in obstetric cases in which the claimant must prove negligence. However, countries such as Japan and Sweden have introduced a no-fault compensation model where proof of negligence is not required.

Litigation claims against the NHS often take years to settle, leaving the NHS with significant financial liabilities as claims add up over time.

“For the families affected, the last thing on their mind is litigation,” Titcombe said. “They want the organisation to learn and they want to heal. They don’t want to be dragged through legal processes that re-traumatise them for years and years.”

In 2021-22, the health service’s financial liabilities for obstetrics claims reached £41.5 billion — £36.8 billion of which was for claims of negligence causing cerebral palsy or brain damage.

Sara Ledger, head of research at Baby Lifeline, said: “For the rest of their lives, these babies will need medical care and specialist equipment — years of payments to families for the necessary ongoing care of severely disabled children and adults.”

She said there were gaps in prevention strategies and “massive” workforce shortages that, if tackled, would save lives. “In our own research into the training that maternity healthcare professionals receive year-on-year, we found that maternity staff were often not being trained in key topics shown to be the main causes of harm and death in maternity in 2020-21,” she said.

“One of the main barriers to providing this training was lack of resource and funding.”

The NHS said: “Over the last decade, the NHS has made improvements to maternity services in England — with many fewer stillbirths and neonatal deaths — but we know further extensive action is needed to improve the experiences of women and their families across the country.

“The NHS is investing £165 million annually to grow our workforce, strengthen leadership and improve culture in order to do this. We will continue to work with NHS trusts, the government and our partners to make necessary changes and implement the recommendations from recent maternity reviews.”

NHS Resolution said it “aims to resolve claims quickly and fairly and where possible to keep cases out of costly and distressing court proceedings”.

It added: “Year-on-year the number of cases going to court has reduced and currently a record 77 per cent of cases are resolved without going anywhere near a court, with only a tiny proportion going to trial.

“Doing all that we can to improve the safety of maternity care is a priority for NHS Resolution. As a National Health Service body which is not a regulator but has a relationship with every provider of maternity services in England, we are uniquely placed to bring together patients and healthcare providers to help improve safety, sharing what works well, as well as the insights we have on what can improve.”

Maternity payouts cost NHS twice the price of care itself

The cost of compensating mothers and their families for harm caused by NHS maternity services is more than double what the health service spends on such care each year, analysis shows.

15 Apr 2023

There has been a 6% reduction in litigated cases in the last two financial years, equating to 572 cases and costs savings to the taxpayer.

The average difference in costs paid to claimant solicitors on litigated versus non-litigated closed cases was around £57,000 per claim.

But NHS Resolution cautioned that it had still to investigate the impact of Covid on the number of claims before it could be certain about the extent to which the fall in litigated claims was due to the protocol.

The Covid-19 clinical negligence protocol – unveiled in August 2020 and last updated in June 2021 – is a collaboration between NHS Resolution, patient charity Action against Medical Accidents (AvMA) and the Society of Clinical Injury Lawyers (SCIL).

Unlike other time-limited claims protocols that were agreed during lockdown, the agreement is in place until one of the parties gives notice to end it.

Simon Hammond, director of claims management at NHS Resolution, said: “The clinical negligence protocol has proven how collaboration can be of benefit to all parties. We look forward to working with SCIL and AvMA on the possibility of developing how the protocol could apply in a post-Covid environment.”

Lisa O’Dwyer, director of medico-legal services at AvMA, said: “The impressive likely cost savings are testament to what can be achieved when key, specialist clinical negligence stakeholders come together and collaborate.

“More generally, it is very positive to note that both claimant and defendant practitioners have derived considerable benefit from the clinical negligence protocol.”

SCIL chairman Paul Rumley added: “These figures are very encouraging, and we are pleased to be part of this effective, practical and now costs-saving work. It goes to show how specialist claimant lawyers and indemnifiers can work in collaboration to find practical solutions to the challenges faced.”

The protocol provides:

Moratoriums on limitation until three months after the protocol ends;
Making email to serve and receive documents the default position;
Encouraging innovation, such as medical experts examining clients online;
Encouraging more co-operation to progress claims, particularly interim payments of damages and costs to avoid unnecessary court hearings;
Settlement meetings and mediations to take place remotely wherever possible; and
Considering whether costs budgeting needs to take place initially or an adjournment sought in order to save court and other resources.

Covid clinical negligence protocol cut number of litigated claims

A protocol agreed in the wake of Covid-19 to better manage clinical negligence claims during the pandemic is remaining in place after it appeared to reduce the number of contested cases.

28 Mar 2023

A father has been left with a “death sentence” because delays caused by the record NHS backlog meant his tumour grew too big to operate on.

Professional musician Don Jackson was diagnosed with liver cancer last June but was reassured his tumour was small and that he could expect a liver transplant in two to three months.

The father-of-five says he faced repeated delays for seven months for scans during which he was belatedly informed he could use a live donor from his own family.

Repeatedly delayed scans and checks eventually showed his relative was a good match and would donate half his liver, but after a scan last month he was given the devastating news his cancer was now 5mm too big for NHS rules to allow the op.

Don, in his 50s, was told the news in a phone call from the hospital and informed he had just months to live.

He said: “The NHS is on its back. They could have saved me half a year ago if it was running correctly. They said my cancer was very, very small.

“I was told it would be ‘two to three months’. If you look at the NHS website it says it should be 65 days. I waited seven months and now they say they’re going to leave me to die.

“I asked the hospital ‘what’s the delay with all the scans?’ They said they’ve a massive waiting list and they haven’t got the staff and only so many specialists can do them. They’ve just got no resources.”

Don is one of the best-known songwriters and record producers in his home city of York, having starred in bands including The Crowmen as well as digitally remastering albums for other bands.

When diagnosed with the cancer last June his NHS doctors told him to have his bag packed, because the surgery could happen at a moment’s notice.

Then he had one tumour that was 3cm big and “completely manageable”.

"Every time I saw doctors they just said I can't believe you haven't had it yet,” he said. "One doctor said 'I bet all the money I've got in the world you'll have that transplant within a week'.

“Over Christmas I heard nothing about the scans and they admitted they had forgotten me.”

By the time the NHS was ready to carry out his operation Don had two tumours in the liver, which combined came to just over 5cm.

NHS rules state that if the total size of the tumours combined is more than 5cm they will not operate.

Don, whose youngest child is just two years old, said: “When they called me in January I was just devastated.

“They’ve left me for dead and given me a few months to live. I had to wait for my kids to come home from school and tell them. We thought it was game over.”

Other countries operate on tumours up to 7cm including Turkey and Don is now trying to raise £80,000 in a matter of weeks to have the transplant there before it is too late.

A local appeal has raised half the funds so he is currently in Istanbul undergoing the first tests on a ‘pay as you go’ basis, while his family and friends at home desperately attempt to raise the remaining sum.

Dr John Adams, from Leeds Teaching Hospitals NHS Trust, said: "The safety of our patients is our top priority. Our specialist clinical teams individually assess the suitability of each patient waiting for a liver transplant."

He continued that the eligibility criteria for liver transplants in the UK "is based on nationally agreed guidelines, administered through the Liver Advisory Group, and aligned with international practice".

A spokesperson for the NHS Blood and Transplant said: "Hospital transplant units have the responsibility for making decisions whether an individual should be listed for transplant based on the policy for each organ.

"If a patient does not meet the criteria, the transplant unit can appeal to the National Appeals Panel for that organ, which includes clinicians from other transplant centres."

Dad left with tumour as it grew too big to operate on after NHS delays

Musician Don Jackson faced 'repeated delays' for scans for seven months before being told the horrendous news in a phone call from the hospital that he had just months to live

27 Feb 2023

Emma Currell, 32, was rushed to Watford General Hospital when she suffered a seizure in hospital transport taking her home from dialysis treatment in 2020.

The inquest at Hatfield Coroners' Court heard that Emma, who lived with nephrotic syndrome - a kidney disorder that means too much protein is passed into protein in the urine - suffered a second seizure as she waited to be seen in Accident and Emergency.

She needed a CT scan and an anaesthetic team was called to sedate her as her tongue swelled and she bled from the mouth.

A tube that should have been placed in her trachea, the windpipe, to allow her to breathe was mistakenly placed in her oesophagus, the food pipe.

Emma, who lived in Hatfield and was mother to a six year old, went into cardiac arrest and died that night on September 5, 2020.

After the inquest Emma Currell's sister Lauren said: 'Today was the hardest thing to bear for my family since Emma died. We're glad at least to have some clearer answers as to what happened.

'We will never get over Emma's death. The hospital has said that they have now put in place improved procedures and training to ensure this type of devastation never happens to anyone else. We trust they will fulfil their promise.'

Emma Kendall, representing the family in an ongoing civil claim, said that 'The Royal College of Anaesthetists ran the No Trace=Wrong Place campaign in 2019 precisely so that this type of catastrophe never occurs.

'All it takes is a few minutes training so that staff can operate safely. This tragedy should simply not have happened.'

Dr Sabu Syed, a trainee anaesthetist, told the hearing: 'Initially the tongue was incredibly swollen and a lot of blood was coming from the mouth. I used suction to remove blood and I was able to push the tongue to the side and got a partial view.'

She said she believed she inserted the tube into the trachea, but now knows it was the oesophagus.

Dr Syed said she asked her senior colleague Dr Prasun Mukherjee to check the position of the tube. 'Dr Mukhejee was busy doing other tasks.

I had a look myself. Unfortunately her tongue was more swollen.'

Technician Nicholas Healey said he tested the machinery when there was no carbon dioxide reading. He said: 'There was nothing to indicate a leak in the machine.

'I was not confident the tube was in the right place. I escalated that to the team.

'A couple of doctors listened to her chest and they were confident there was a reaction.'

He said that both he and Dr Syed had raised concerns about the tube being in the wrong place.

Dr Mukherjee told the hearing: 'I had confidence in my colleague that the tube was appropriately placed.'

Graham Danbury, the deputy coroner for Hertfordshire, asked him: 'Did you, with greater experience, consider that you should have done the administration?'

He replied: 'It is difficult.' He said younger colleagues needed to gain more experience.

Dr Mukherjee said he still detected breathing after the tube was inserted and had assumed the machine readings had malfunctioned and there was a problem with the monitor.

He said he was also concerned about the risks of removing the tube and the danger of surgery.

Asked if it had crossed his mind to summon a more senior colleague, he said: 'I probably did not have enough time to ask for external help.'

He said: 'Retrospectively and with hindsight we know the tube was in the wrong place.'

He agreed he had made the wrong decision, saying that at the time they were dealing with the Covid pandemic.

Dr Thomas Sanbach, who carried out a serious investigation report after Emma's death, said a guideline checklist had been drawn up for trachea procedures outside the operating theatre at Watford Hospital.

There is also to be simulation training for staff and the presentation of a video to staff from the Royal College of Anaesthetists entitled No Trace = Wrong Place, a safety campaign aimed at those who manage patients' airways.

In his conclusion the coroner said: 'Because she was fitting she needed to be sedated to be fit to go into CT machine. Her tongue was swollen making viewing into her mouth difficult. Dr Syed had the responsibility of inserting the tube.

'It was inserted and we now know it was inserted into the oesophagus rather than the trachea.'

He said possible 10 minutes elapsed before it was noted her blood pressure was low and the disappearance of carbon dioxide readings had not been acted on for a considerable period of time. She suffered cardiac arrest and it was not possible to resuscitate her.

'It is accepted by the hospital that the tube was initially in the wrong place and Dr Mukherjee said action should have been taken sooner,' he said.

Mother died after trainee doctor inserted breathing tube into oesophagus instead of windpipe

A young mother died after a trainee doctor wrongly inserted a breathing tube into her food pipe instead of her windpipe, an inquest heard today.

27 Feb 2023

Helen Leigh, 25, of Rotherham, South Yorkshire, was diagnosed with Non-Epileptic Attack Disorder (NEAD) before her death in May 2018.

Her mother Deborah Leigh is seeking to raise awareness of the condition.

Sheffield Teaching Hospitals NHS Foundation Trust said Helen's treatment was carefully considered by seizure specialists.

In September last year Mrs Leigh settled a clinical negligence claim with the trust, which did not admit liability.

Helen was diagnosed with epilepsy and prescribed medication in November 2014 after a seizure.

But in September 2015, Royal Hallamshire Hospital neurologists changed her diagnosis to NEAD, which causes attacks similar to epilepsy but with no physical cause.

Helen was taken off her medication and assured her seizures could not be fatal, her mother said.

Mrs Leigh, a GP practice manager, said: "The frequency and severity of her seizures were increasing over time, and this was reported to the neurologist who repeated that Helen did not have epilepsy."

In May 2018, Helen suffered a fatal seizure at home.

After her death, a neurologist told her family "in retrospect, Helen probably had both epileptic and NEAD seizures," Mrs Leigh said.

She added: "I was so angry - and still am. I think Helen's death was avoidable."

'Devastated'
Mrs Leigh said: "Not once before Helen died were we told that you can have both epilepsy and NEAD.

"Had we known this, we would have been able to have different conversations with those treating her."

Dr Jennifer Hill, the NHS trust's medical director, said several investigations were carried out into Helen's condition and changes to her treatment were only made after discussions with her and after "careful consideration by specialists in seizure disorders".

Rotherham woman died of seizure after being told she did not have epilepsy

A woman died of an epileptic seizure after being told she did not have the condition, her mother said.

26 Feb 2023

Dr Camilo Valero was accused of putting the patients at "unwarranted risk of harm" when he carried out two gallbladder removals, just 6 days apart, at Norfolk and Norwich University Hospital in January 2020. Both patients suffered severed bile ducts and complications after undergoing a laparoscopic cholecystectomy and needed reconstructive surgery.

A Medical Practitioners Tribunal Service (MPTS) tribunal in Manchester heard how Dr Valero had committed similar errors during both operations and had "misinterpreted the anatomy", not obtained the critical view of safety, and failed to seek help from colleagues.

The MPTS panel concluded he put the patients at "unwarranted risk of harm", and they sustained "avoidable" injuries when he acted "beyond his level of competence".

The Panel added: "The mistakes in these cases ultimately caused irreversible and life-changing complications for the patients."

Dr Valero admitted various charges relating to his operative failings and the MPTS panel ruled his actions amounted to serious misconduct. But it noted his insight, remorse, and remediation which meant he was "highly unlikely" to repeat the same errors.

It found Dr Valero's fitness to practise was not impaired, meaning no sanction could be imposed, and issued him with a warning instead.

Details of the Cases
The tribunal heard how one 32-year-old female patient, known as Patient A, suffered a "high volume" bile leak after Dr Valero mistakenly severed her bile duct during her gallbladder procedure. The operation left her feeling sick, in constant pain, and drifting in and out of consciousness.

She was later transferred to Addenbrooke’s Hospital, in Cambridge, for almost 11 hours of corrective surgery but has continued to suffer health complications.

Patient A, who attended the tribunal, was told by Charles Foster, counsel for the doctor, that he wished to apologise and had "got in wrong" with her surgery.

"He recognises that you had a terrible time and is very sorry for that," Mr Foster said.

A Patient C, a 63-year-old man, suffered injuries after "similar failings" when Dr Valero performed gallbladder surgery on him, the tribunal heard.

The man, who served with the armed forces, also needed further surgery at Addenbrooke’s Hospital but will need more reconstructive surgery and a possible liver transplant in the future.

The patient, the tribunal heard, believed that Dr Valero’s operation "completely changed his life" because he is no longer able to do things he used to.

Mistakes were 'Catastrophic': GMC
Bob Sastry, counsel for the GMC, said Dr Valero was guilty of "serous misjudgements" and the effects on each patient were "catastrophic, with significant and irreversible long-term complications".

He said the operative failures "fell significantly below" the standard to be expected of a reasonably competent general surgeon and Dr Valero would still pose a risk if he was allowed to work unrestricted.

But Charles Foster, counsel for Dr Valero, described the two procedures as "particularly difficult", putting the tribunal's findings "at the bottom" of the bracket in relation to serious misconduct.
Bile duct injuries were a "recognised complication" that occurs in 0.3% of cases, he said, and Dr Valero recognised what went wrong, namely that he "did not have the critical view of safety".

Dr Valero knew how to avoid making the same mistake in the future, added Mr Foster, and, if in doubt, would consult colleagues.

The tribunal heard that a The Royal College of Surgeons review of Mr Valero's practice had found two cases of bile duct injury in 200 such operations performed over a 2-year period. He has since carried out 30 similar operations, under supervision, of which five were emergencies.

Several charges relating to a third patient, Patient D – who has cerebral palsy, epilepsy, and learning difficulties. Accusations that ehe patient was allegedly wrongly discharged by Dr Valero in March 2021 were found not proved.

Dr Valero has not been allowed to perform gallbladder surgery unsupervised after restrictions were placed on his practice at an interim orders tribunal in July 2021, but that order has now been revoked.

Trust Admitted Liability for Patients A and C
In legal cases brought by Patient A and C, Norfolk & Norwich University Hospitals (NNUH) NHS Foundation Trust has admitted liability for the errors and standard of care provided to them.

Lawyer Marianne Stapleton, of Irwin Mitchell who is representing the two patients, said they had "struggled significantly" over the past 3 years and continued to have concerns over what happened to them and how it would impact their lives going forward.

She said: "While today's outcome doesn't go far enough in terms of what they hoped for, we note the panel’s decision and welcome the training and supervision provided to Mr Valero to help prevent patients being put at risk in the future.
"Nothing will ever change what [Patient A & C] have been through, but we'll continue to support them at this difficult time. It's also vital that lessons are learned, and the highest standards of care are maintained at all times to ensure patient safety."

NNUH Medical Director, Erika Denton, said: "We accept the decision of the Medical Practitioners Tribunal and offer our apologies to the two patients who experienced serious injury and complications during laparoscopic cholecystectomy surgery in 2020.

"We fully investigated the incidents at the time and commissioned the Royal College of Surgeons to review what happened, which resulted in a number of changes to strengthen our surgery processes.

"Mr Valero has expressed his profound sorrow and apologies for the errors that occurred during these two laparoscopic cholecystectomies."

Tribunal Warns Surgeon After Botched Surgeries

A surgeon who botched gallbladder operations on two patients causing them "irreversible and life-changing" injuries received only a warning from a medical tribunal.

8 Feb 2023

Jordan Del’Nero, from Westfield, Sheffield, had to undergo surgery to remove the tumour when it was discovered. Part of her jaw had to be removed and reconstructed, with five teeth extracted and a skin graft taken from her left leg. She endured severe leg pain for months after the skin graft and was forced to take time off from her job as a catering assistant.

Jordan, now aged 25, was just 15 when in August 2013 she was referred to Charles Clifford Dental Hospital, which is run by Sheffield Teaching Hospitals Trust, due to concerns about a lump in the left side of her mouth. In the previous 12 months she had sought medical advice and been prescribed antibiotics to treat the lump.

She said neither she nor her parents had been contacted about a follow-up appointment, leading them to believe she did not need to be seen by doctors. More than five years later, in January 2019, Jordan started suffering bad toothache and was prescribed antibiotics and told to visit hospital by a GP. Following scans and a biopsy, she was diagnosed the following month with salivary gland cancer.

Jordan determined to raise awareness of oral cancer in young people
Jordan is now calling for lessons to be learned, after lawyers at Irwin Mitchell secured her an undisclosed settlement from Sheffield Teaching Hospitals to help fund the ongoing care and treatment she requires.

“Even four years on I’m still coming to terms with my diagnosis and my appearance. I have scars on my neck and leg from surgery and would like to have dental implants to replace my lost teeth,” she said. “I try and remain as positive as possible but sometimes I do worry about what the future may hold. I just hope that by speaking out I can help others who may be going through something similar and to help raise awareness of oral cancer, especially in young people.”

Irwin Mitchell said the trust had initially denied a breach of duty but subsequently admitted that Jordan had been added to the system as a ‘new routine’ appointment rather than an ‘urgent’ case as she should have been. The law firm said there was ‘no evidence’ she had been contacted either by phone or by mail for an appointment to be arranged, with the trust unable to explain why she wasn’t seen.

Sheffield Teaching Hospitals ‘sincerely apologises’ and says changes have been made
Dr Jennifer Hill, medical director at Sheffield Teaching Hospitals Trust, said: “Jordan should have attended for an urgent appointment in 2013 and it is unclear whether an appointment was sent to her and why this did not happen. I would like to sincerely apologise to Jordan for the impact this has had on her physical and mental well-being and appreciate that this will have been very distressing. I can assure her that we have taken what happened seriously and made changes to prevent it happening again.

“All new patient referrals for our dental service are now managed by a central Patient Booking Hub and we have introduced a new system that enables better tracking of referrals. Patient correspondence is sent via an electronic system which tracks correspondence from the time it is produced to when it reaches Royal Mail.”

Sheffield woman diagnosed with cancer after 5 years attending hospital

A young Sheffield woman who was diagnosed with cancer more than five years after attending hospital with a lump in her mouth has secured a payout.

6 Feb 2023

But ministers are resolute that the extension of fixed recoverable costs for other civil cases will go ahead as planned from October.

An MoJ spokesperson said: ‘We want to reform civil justice costs because giving all parties certainty upfront will ensure no one is locked out of justice for fear of how high their legal fees might be if they lose. However, it is important that our reforms are aligned with wider reforms in the housing sector which is why we’ve taken the decision to delay introduction in these instances by two years.’

The two-year extension takes any possible implementation date beyond the next general election, so the policy could be reconsidered in any case by an incoming government.

The present government had come under pressure from various sources to rethink its plans to limit costs for running housing cases. The calls grew louder last summer when the MoJ opted to delay extending the regime to legally aided housing possession cases by two years.

Critics argued that if lawyers were not properly paid for bringing successful cases against landlords then tenants and borrowers would not have access to justice.

The MoJ is understood to believe that ensuring costs are known upfront and controlled is the best way to help parties pursue litigation without the fear of spiralling costs. It argues that parties will be able to more effectively plan litigation and consider whether it is appropriate.

The delay will allow for the impact of other reforms to the housing sector to ‘become clearer’ over the next two years. In particular, the Social Housing Regulation Bill is intended to rebalance the power between renters and landlords and to strengthen regulators’ powers to take tough action against rogue landlords.

Housing secretary Michael Gove has also written to the legal profession asking it to refer social housing tenants to the housing ombudsman for advice about resolving disputes with landlords.

The MoJ said last November that it would not meet its April 2023 target for extending fixed costs to most civil claims valued up to £100,000.

The delay to housing fixed costs was accompanied by an assurance that the government is ‘pressing ahead’ with wider costs reforms, ahead of them being implemented this October.

Fixed recoverable costs for housing kicked into long grass

The government has confirmed it will delay the implementation of fixed costs in housing cases for two years. The Ministry of Justice said that it remains committed to the principle of fixed costs but wanted to wait to see the effect of other changes in the sector.

6 Feb 2023

Passing sentence on Friday, District Judge Grace Leong said there had been "systematic failures" in care.

The Care Quality Commission (CQC) announced last July that it was prosecuting the trust over admitted mistakes which led to Sarah Andrews, and her baby, Wynter Andrews, not receiving safe care and treatment by its maternity services.

Wynter died shortly after her birth in September 2019.

An inquest the following year found that Wynter died from hypoxic ischaemic encephalopathy, which could have been avoided if staff had delivered her earlier. Assistant coroner Laurinda Bower found the baby's death "was contributed to by neglect" at the hands of NUH NHS Trust.

Court Case
During the case at Nottingham Magistrates' Court, the trust admitted it did not ensure safe maternity care and treatment for Sarah and Wynter, due to a lack of adequate processes and systems to ensure staff managed all risks to patients' health and wellbeing. This exposed both mother and daughter to a significant risk of avoidable harm, which constituted breaches of regulations 12 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 

Passing sentence today, the judge said: "The catalogue of failings and errors exposed Mrs Andrews and her baby to a significant risk of harm which was avoidable, and such errors ultimately resulted in the death of Wynter and post-traumatic stress for Mrs Andrews and Mr Andrews.

"My assessment is that the level of culpability is high, where offences on Wynter and Mrs Andrews are concerned.

"There were systems in place, but there were so many procedures and practices where guidance was not followed or adhered to or implemented."

It is understood that the full fine after a trial could have been £1.2 million, but this was reduced to £800,000 because of the trust's early guilty plea.

The trust will also pay prosecution costs of £13,668.65 and a victim surcharge of £181.

We Are Truly Sorry
Following Wednesday's hearing at Nottingham Magistrates' Court, the trust's chief executive Anthony May apologised and said: "We are truly sorry for the pain and grief that we caused Mr and Mrs Andrews due to failings in the maternity care we provided. We let them down at what should have been a joyous time in their lives. Today, we pleaded guilty and will accept, in full, the findings of the court.

"While words will never be enough, I can assure our communities that staff across NUH are committed to providing good quality care every day and we are working hard to make the necessary improvements that are needed for our local communities, including engaging fully and openly with Donna Ockenden and her team on their ongoing independent review into our maternity services."

Mr May added that since Wynter's death, the trust has implemented a number of changes to its maternity services, including:

Improved access to clinical guidelines with the introduction of the Pocket Pal app for maternity staff and aligned Trust guidelines with national recommendations where available

Implemented BadgerNet, a maternity digital clinical system to support seamless care across all parts of the pregnancy pathway

Investment in staff training for obstetric emergencies, foetal heartbeat monitoring and human factors
Investment in equipment, including foetal heartbeat monitoring machines and devices to measure jaundice in babies

Introduced foetal monitoring leads for midwifery and obstetrics, tasked with supporting the team to follow best practice

Strengthened the senior clinical team, appointing more consultant obstetricians and providing better cover across our two hospitals

Ongoing recruitment of midwives, including from overseas and the appointment of two heads of midwifery
Focus on retaining midwives, offering the option to work flexibly to suit their needs

Introduced a flow coordinator role to support the maternity service 24 hours a day, seven days a week
Separating our emergency and routine assessments at both hospitals, leading to over 90% of our women and families being seen in triage within 15 minutes

Launched a 24/7 Maternity Advice Line, so anyone using our service can speak to a dedicated midwife about any concerns before or after birth

Ongoing improvement of our staff feedback service and encouraging colleagues to raise any concerns through our Freedom to Speak Up Guardians and through other channels

Improving record-keeping, including the assessment of risks and handovers between midwives and medical staff

Developed a comprehensive Maternity Improvement Programme, overseen by the Maternity Oversight Committee, led by one of our Non-Executive Directors

Developed a maternity dashboard to identify themes and trends in activity, clinical incidents and staffing to ensure better oversight of the service

Already Under Fire
As previously reported, NUH NHS Trust is already under investigation over serious failures in its maternity services, where dozens of babies died or were brain damaged due to care failures in recent years.

Nottingham Trust Fined for Failings in Care for Mother and Baby

Nottingham University Hospitals (NUH) NHS Trust has been fined £800,000 after pleading guilty to two charges related to the death of an infant and the poor care of its mother at the trust's Queens Medical Centre in Nottingham.  

27 Jan 2023

Parents of a little boy whose legs had to be amputated following a rare infection are suing a health board for £10million. Romeo Hadley, then three-years-old, was enjoying a day out shopping with his family when he started to feel seriously unwell.

The illness led to both of Romeo's legs being amputated above the knee. Katie and Jon are Romeo's parents who allege the University Hospital of Wales did not correctly diagnose their son's condition for more than 36 hours, a failure which led the infection to claim both legs.

The parents say if Romeo had been dealt with sooner, he may have lost some toes and the infection would not have been extensive and taken his legs. Speaking to WalesOnline, Katie and Jon, both 51, said their son is "the most inspirational, amazing boy that you will ever meet" but they face huge costs to give him as full a life as possible.

"[The hospital's] failure cost Romeo his legs and he will forever have to live with the consequences of that," they said. "People understandably think that seeking millions of pounds in compensation is wrong.

"However, until you have experienced it you do not understand the costs involved in recovery and rehabilitation." The parents, who have filed a High Court claim against Cardiff and Vale University Health Board, said they received a hurtful backlash from recent tabloid coverage of the case.

"When the public think of people suing the NHS, they can be under the impression that the amount awarded is paid by the specific NHS trust out of their budget. This is incorrect," they said, pointing out that health boards pay for membership of a clinical negligence scheme which covers compensation.

Romeo felt a sudden pain in his legs on January 17, 2015, while the family were shopping in an Ikea Superstore. He screamed in agony as a rash spread across his thighs.

His parents rushed him to the University Hospital of Wales where he was given morphine. Romeo was recorded as vomiting and had "abnormal" blood test results, according to the writ claiming clinical negligence.

The claim alleges that Romeo was initially treated for Henoch-Schonlein purpura (HSP) which causes small haemorrhages, a widespread rash, and usually gets better in a few weeks without treatment. He was actually suffering from purpura fulminans (PF), a condition which causes skin to die rapidly and affects around one in every 500,000 to one million births.

Romeo's legs were allegedly still moving freely when he was admitted. His parents claim the rash then spread over a larger area of his legs and bottom.

Staff were unable to find a pulse below his thighs and surgical cuts were made to release tension in his legs, the writ states. It adds that two days later Romeo's legs were cold to the touch and a surgeon found that tissue in his legs was dying.

On January 20, his legs were amputated through the knees in a ten-hour operation. After three days he had another surgery where his legs were amputated near the top of his thighs.

He spent nearly six months in hospital, going through 36 follow-up operations and other invasive procedures, according to the claim. The parents said: "We have brought the claim because essentially we feel that the hospital failed to correctly diagnose Romeo’s condition for more than 36 hours despite clear signs of purpura fulminans.

"If you look at the difference between the blotching of the skin in a case of HSP and compare that with PF, you can clearly see the difference. Romeo will require prosthetics which currently cost in the region of £70,000 to £100,000 and will need to be changed on average every three years.

"There are also different prosthetics such as a water limb if you want to swim. Why should Romeo not experience the joy of something so simple such as swimming in the sea that most take for granted?

"If Romeo cannot have a prosthetic because his stumps are too small, he will have to spend his life in a wheelchair. We already know the cost of that and the adaptations we have already had to make to our home so he can move independently around his own home.

"Doors need to be widened, bed heights changed etc. If we go on holiday Romeo will need a wider seat, more expensive travel insurance, a room adapted for wheelchairs whilst away.

"That all costs more money." They added: "As Romeo gets older, he will want to live independently and will need a bungalow which are often more expensive.

"He will need an adapted home that is also secure and as risk-free as possible. He will have to have specialist equipment to get himself in and out of a bath or shower, in and out of his bed, to answer the door safely, close his curtains, all things most of us do without thinking, but which will cost him more money to just do safely."

The parents said they had hoped the hospital would "admit their mistakes early" and save the family the expense of getting various medical reports. Their solicitor said: "This did not happen and instead [the health board] accused the family of altering the photographs they had taken of the developing dark skin... This accusation was unfounded and very hurtful to the family."

Katie and Jon, who have a daughter called Seren, adopted Romeo in December 2013 after having difficulties conceiving a second child. After Romeo's amputations Katie gave up her job as a mental health nurse and Jon reduced his hours as a dental technician so they could care for him.

"He goes to a mainstream school and he's got amazing friends who just accept him and don't see him as any different," said Katie. Jon added that "football mad" Romeo has a season ticket for Cardiff City and is a huge fan of Man City striker Erling Haaland.

Romeo's friends make sure to include him when they play football and he enjoys being a goalkeeper, but recently he became frustrated that he could not do the same after-school sports activities as other children. He had always refused to try wheelchair sports but recently he gave them a chance because he felt he was missing out.

Katie said they have been "the making of him" and he now plays wheelchair versions of basketball, tennis and rugby. Jon added that Romeo has been used to whispered comments for most of his life but wheelchair sports have boosted his confidence.

"Kids stare, adults stare, everybody stares," he said. "Romeo can hear as they go past and say, 'He's got no legs.'

"When he started doing the tennis and basketball, and seeing all the other kids in chairs, he's really come out of himself." The family's solicitors Phoenix Legal, who have been preparing the claim for years, said the health board has requested an extension for providing a formal response.

The firm has agreed to an extension until February 8. A spokesperson for Cardiff and Vale University Health Board said: "We appreciate that this is a very sad and difficult situation for Romeo, his family and our staff members.

"However, due to the ongoing litigation, we are unable to comment any further at this time."

Parents of little boy whose double amputation made him a wheelchair user sue health board for 10m

Ongoing costs for Romeo include prosthetics which currently cost in the region of £70,000 to £100,000 which also need changing frequently and home adaptations to accommodate a wheelchair user

26 Jan 2023

Adam Cheshire was born at Shrewsbury Hospital nearly 35 hours after mum Charlotte’s waters broke. In the hours after his birth Adam struggled to feed, was crying and started grunting, all signs of early-onset Group B Strep (GBS) infection, a type of bacterial infection which can lead to life-threatening conditions such as meningitis if not treated quickly.

Around 14 hours after his birth, Adam was transferred to a neo-natal intensive care unit. The following day he was diagnosed with GBS and meningitis and spent nearly a month in intensive care.

On Monday the High Court approved a liability agreement agreed by Shrewsbury and Telford Hospitals NHS Trust.

Now aged 11, Adam has brain damage. He has hearing and visually impairments and has been diagnosed with autism, severe learning difficulties and behavioural problems. He is likely to be reliant on others to care for him for the rest of his life and will be unable to work.

Charlotte, 45, of Newport, Shropshire, instructed expert medical negligence lawyers at Irwin Mitchell to investigate the family’s care under Shrewsbury and Telford Hospitals NHS Trust. Last year an independent review found more than 200 babies could have survived if they had received better care. Mothers also died or suffered injuries because of failures in care and children were left with life-changing conditions.

Irwin Mitchell is representing a number of families affected by care issues at the trust as well as hundreds of other patients who have suffered maternity care issues under other NHS Trusts across the country.

Following legal submissions, Shrewsbury and Telford Hospitals NHS Trust has agreed to accept 80 per cent responsibility for Adam’s brain injury and agreed an interim payment.

The next stage of his case involves obtaining evidence to establish the amount of compensation Adam requires to help fund the specialist life-long care and therapy he needs.

The liability agreement and an interim payment of compensation approved by the High Court will be managed by Irwin Mitchell’s specialist Court of Protection team.

Following the liability approval, Adam’s mother, Charlotte, a Church of England priest, has joined her legal team in calling for lessons to be learned to improve maternity safety nationally.

Charlotte said: “My pregnancy with Adam was in many ways textbook but it felt that changed when my waters broke. From that point I just had a mother’s instinct something wasn’t right but I was reassured by the midwives so many times that everything was okay.

“At no point in my pregnancy or in the hours after Adam was born was I told about Group B Strep. I later found out following a review of my records, that early in my pregnancy it was decided that I wouldn’t have a test for GBS because I didn’t have the risk factors associated with it. It was very hard to learn that this had been considered but not discussed with me considering the eventual outcome.

“While Adam is adorable and I’m so thankful to have him in my life, it’s difficult not to think how things could have turned out much differently for him if he’d received the care he should have. Adam will never live an independent life and will need lifelong care. While I’m devoted to him, I’m now raising a severely disabled son, which is extremely challenging and has changed the path of both our lives forever.

“Nothing will ever make up for what he’s gone through but today means we can try and start looking to the future as a family as we have the answers we deserve and the security of knowing Adam’s needs will be taken care of.

“My heart goes out to all the other families who have been affected by maternity issues, not only at Shrewsbury and Telford but elsewhere. There continues to be too many stories of how families are left to pick up the pieces following care failings so it’s vital that families continue to speak out. What’s happened can never be forgotten and improvements in care need to continue to be made, not just at Shrewsbury and Telford but elsewhere."

Sara Burns, the expert medical negligence lawyer at Irwin Mitchell, representing Charlotte, said: “While the maternity failings which were allowed to manifest at Shrewsbury and Telford over many years are well documented, their shocking nature never diminishes.

“Behind each case is a human tragedy of how families have been left devastated by medical errors. Many of these were avoidable and have led to the deaths of babies or incredibly serious birth injuries, which have caused severe disabilities and people and needing a lifetime of specialist care.

“We believe that Adam’s care was typical of many issues families have raised. Serial observations were missed, signs that should have been acted upon weren’t and serious illnesses were diagnosed too late.

“Sadly, what happened at Shrewsbury and Telford doesn’t seem to be an isolated incident. We continue to receive many first-hand accounts from families across the UK affected by issues in maternity care.

“As we continue to campaign for improved maternity safety, it’s vital that, where appropriate, all Trusts learn lessons from the issues identified in this case to uphold the highest standards of care.

“Although GBS can make babies very unwell, most will recover with prompt treatment. A simple test can be conducted to highlight whether an expectant mum is a carrier of group B Strep and her care plan can be adjusted to ensure intravenous antibiotics are provided throughout labour to prevent the infection being transmitted.

“Everything possible must be done to prevent this infection in babies.”

A spokesperson for The Shrewsbury and Telford Hospital NHS Trust said: “We are very sorry for the failings in the care provided to this family, unfortunately we are unable to comment on ongoing legal cases.”

Mum wins legal case against Shropshire hospital trust after her son suffered brain injuries at birth

A mum has vowed to continue campaigning for change after specialist medical negligence lawyers secured her severely disabled son a liability settlement following one of the UK’s worst maternity scandals.

24 Jan 2023

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ACL critiques MOJ fixed costs reforms

Fixed costs for lower value clinical negligence claims

Dont expect favours from the court, judge tells LiPs

Injury lawyers fight fixed costs reforms through the Courts

Lost years compensation principle set for Supreme Court

NHS set to scrap most cancer waiting time targets ‘to speed up diagnosis’

Six year old died after being sent home from hospital with tonsilitis

Trainee surgeon at Leeds Teaching Hospitals struck off after lying in car crash insurance claim

MOJ considers rethink after legal threat over fixed costs

Bereaved relatives in government compensation plea

NHS spends £2.7 BILLION settling medical negligence claims in one year

Eight out of 10 NHS claims now settle pre-issue

Bereaved mum calls for physician associate role clarity in misdiagnosis case

Judge hails solicitors courtesy and sensitivity in dealing with dishonest clin neg claimant

North East Ambulance Service apologises to families

Law firm told it cannot recover costs shortfall from claimant

NHS Resolution launches e-learning module to support clinicians working within maternity services

Plastic Surgeon Dr Olivier Branford Struck Off for Having Sex with Vulnerable Patients

Mum slams hospital as son left with life-changing brain damage

Brightons Royal Sussex hospitals medical negligence deaths probe

Grail Says About 400 Patients Incorrectly Informed They May Have Cancer

Doctors missed teenager's terminal cancer - and told her to try mindfulness

Birmingham Mental Health Hospital Placed in Special Measures

NI patients suing GPs over hospital waiting time targets

NHS spent £163m on compensation to Scots patients since 2018

GMC Ordered to Pay Costs to Cleared NHS Chiefs

NHS admits failings in care of Norfolk teen with autism

Consolidation of PI law firms poses new classes of risk for insurers

JR threat amid clin neg fixed costs confusion

Northern Ireland medical negligence costs double in a year

Maternity payouts cost NHS twice the price of care itself

Covid clinical negligence protocol cut number of litigated claims

Dad left with tumour as it grew too big to operate on after NHS delays

Mother died after trainee doctor inserted breathing tube into oesophagus instead of windpipe

Rotherham woman died of seizure after being told she did not have epilepsy

Tribunal Warns Surgeon After Botched Surgeries

Sheffield woman diagnosed with cancer after 5 years attending hospital

Fixed recoverable costs for housing kicked into long grass

Nottingham Trust Fined for Failings in Care for Mother and Baby

Parents of little boy whose double amputation made him a wheelchair user sue health board for 10m

Mum wins legal case against Shropshire hospital trust after her son suffered brain injuries at birth

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