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Pressure sores, also known as bed sores and pressure ulcers, are quick to develop but can take a long time to heal. They can be debilitating, extremely painful and, if left untreated, could be fatal. However, with proper nursing care they can also be prevented. Pressure sores as a result of medical negligence are, unfortunately, all too common.
Pressure sores occur as a direct result of unrelieved pressure and distortion of the skin and underlying tissue.
The extra pressure disrupts the flow of blood through to the skin and, without adequate blood flow, the area of skin becomes starved of oxygen and nutrients. The skin can then begin to break down and an ulcer forms.
People with health conditions which limit their mobility are most at risk of developing pressure sores. The elderly can often be at risk of developing sores due to a lack of mobility, and so pressure sores occur in care homes as well as in hospital.
Pressure sores are divided into four different grades, depending on the severity of the sore:
Pressure sores can be easily prevented through good nursing care. Every patient who has or is going to have reduced mobility should undergo an assessment, whether in hospital or a care home.
By risk assessing patients then putting in place appropriate care plans the risk of pressure sores developing is reduced, and could mean that they do not develop at all.
It should be realised that sometimes (despite a high level of nursing care) some patients will still develop pressure sores due to irreversible tissue hypoxia (where the tissue is deprived of adequate oxygen). However, in our experience, most of our clients have developed pressure sores in situations where they could have been prevented.
Once a pressure sore has been identified, a further assessment of the patient should be undertaken, and a revised repositioning plan put into place to avoid the sore worsening.
A pressure sore or bed sore is an area of damaged skin that becomes an open wound.
Pressure sores begin when the weight of your body presses down on the skin beneath you. Your blood cannot circulate properly to that area, and so skin cells break down and die.
The best way to describe how a pressure sore develops is to look at what happens to an orange in a fruit bowl which is not moved for a long period of time. The part of the orange in contact with the fruit bowl (i.e. where the pressure is) becomes mouldy and starts to decay. The same happens with the human body.
People of any age can be affected by bed sores or pressure ulcers . In particular, people with poor mobility who have to spend long periods of time in bed or sat in a chair are at greater risk of a sore developing. People who are unable to change their position are also at higher risk.
Pressure sores often affect patients in hospital but can also affect people who live in care homes.
Pressure sores can also develop as a result of poor nutrition, anaemia, recurrent infection and poor circulation.
There is a tendency to assume that pressure sores are the inevitable result of prolonged bed-rest. This is not necessarily the case.
The first sign that a pressure sore might be forming is a change in the colour of the skin. This can then get progressively worse and can lead to an open wound.
The most common places for pressure sores are over the bones that are close to the skin, like the bottom, heel, elbow, ankle, shoulder, back and back of the ear.
There are a number of risk factors associated with pressure or bed sores, such as:
This is a risk assessment tool, used by nurses/carers to assess which patients are most likely to develop a pressure sore or ulcer.
Simply, the person undertaking the assessment reviews a chart that details all of the factors that might contribute to a pressure sore developing (e.g. build, weight, height, continence, mobility and whether someone has undergone major surgery recently).
Each factor is awarded a numerical value depending on the relevance of the risk factor and, once a final score is calculated, it is supposed to reflect the degree of risk the patient has of developing a pressure ulcer. It was developed in 1987 by Judy Waterlow, and is used throughout hospitals and nursing homes.
In most cases, the answer is yes. The most important factor in preventing sores is to avoid prolonged periods of pressure on any one area of the skin. This can be achieved by encouraging a person to change their position regularly throughout the day.
People who cannot reposition themselves should be moved at regular intervals and at least every two hours for those lying down and every hour for those sitting upright.
Special air filled alternating pressure mattresses and cushions that redistribute pressure help reduce pressure on sensitive areas.
Regular inspection of high risk pressure areas is important to detect early signs and prompt medical care should be provided.
It is also important to keep skin healthy, clean and dry.
NICE is the National Institute of Clinical Excellence.
In 2005, NICE issued guidance on the prevention and treatment of pressure sores, following a collaborative review with the Royal College of Nursing. The guideline gives guidance on the management of pressure sores in both primary and secondary care.
The key priorities identified in the guidance are:
As a pressure sore heals, it will slowly get smaller. Less fluid will drain from it and new healthy skin starts growing at the bottom of the sore. This new skin is light red or pink and looks lumpy and shiny.
It is essential is that the sores do not become infected.
For those who suffer less severe pressure sores, they can be successfully treated by trying to relieve the pressure on them using equipment like a pressure relieving overlay system mattress, cleaning the affected area regularly and applying an appropriate dressing. The wound should be kept clean and moist and the area around it clean and dry.
For more serious pressure sores a procedure called debridement , where dead tissue and other materials are removed from the wound, may be necessary.
In even more severe cases skin grafts, cosmetic surgery or maggot therapy may be necessary. Maggot therapy is a carefully controlled practice whereby a medical professional will try and use maggots to break down and ingest infected or necrotic tissue. As well as getting rid of the infected tissue the maggots also disinfect the wound by killing bacteria and can stimulate wound healing.
Serious pressure sores can be very painful and difficult to heal as the wound has to heal from the inside out. Heels are particularly vulnerable to pressure sores and the sores can cause permanent difficulty with walking as the skin becomes tight and is vulnerable to breaking down.
If there is a failure to recognise and treat the most serious of pressure sores, the necrotic tissue can extend over a larger surface area, and can invade the bone. This in turn can lead to amputation of the affected area.
The healing process can take a significant period of time, and often requires ongoing treatment by district nurses or tissue viability nurses , who specialise in treating ongoing sores.
The healing process is complicated by the cause of the sore, a lack of mobility, and so a carefully planned care regime which involves regular turning and repositioning, is crucial to aid recovery.
If you or a family member or friend has suffered with a bed sore as a result of a medical professional failing to prevent a pressure sore developing, it may be possible to bring a claim.
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Each claimant’s compensation is calculated in accordance with mandatory rules based on their individual circumstances.
The law says that compensation for medical negligence should put the injured person back in the position that they would have been in if the negligence hadn’t happened, in so far as money can.
In a medical negligence claim, the amount of compensation depends on:
Our clients often benefit from different types of compensation, including:
Read more details on how much you can claim and what compensation can pay for.
If you think that you or a family member have received negligent medical treatment which has caused serious injury or disability, we recommend that you speak to one of our friendly, experienced clinical negligence team as soon as possible. You can contact us by telephone or by email. Your enquiry will be handled confidentially and preliminary advice in relation to pursuing a claim will be given free of charge.
Our solicitors will ask you to tell us briefly what has happened, advise you about the limitation deadlines (time limits) which apply to your claim and whether we are able to help you investigate your claim.
Once our initial investigations have taken place, we will notify the defendant (hospital or doctor) of your intention to pursue a claim and invite them to respond, giving them an opportunity to admit liability, before court proceedings are issued.
If liability is admitted, we will enter judgment and apply for an interim payment as soon as possible to meet any urgent needs that you may have as a result of the negligently caused injury.
If liability is disputed, we will discuss with you the further steps that we need to take to progress your claim.
At all times our approachable, experienced clinical negligence lawyers will ensure that you are informed of any developments and understand the process. Your solicitor and our friendly support staff will always be available to discuss any concerns or queries that you might have along the way.
The duration of a medical negligence claim depends on the individual circumstances of the client’s case. The claim is likely to take less time to conclude where:
Circumstances which make the claim more complex and therefore take longer to resolve include:
An initial full or partial denial of liability by NHS Resolution or other medical defence organisation does not necessarily mean that the injured person’s claim will fail. In more than half of our successful cases in 2019, we overcame initial denials of liability by the defendant, resulting in settlements for our clients.(from making a claim page)
We work hard to secure early admissions of liability and substantial interim payments so that we can begin to alleviate financial hardship and provide essential care, respite, specialist equipment, therapies and home adaptations long before the claim has settled. With liability judgments secured and interim funds in place, the individual and their family are able to focus on rebuilding their lives whilst we concentrate on valuing and negotiating settlement of the claim.
As top-rated specialists in cerebral palsy and other serious neurological disability claims, we have access to Legal Aid funding for eligible clients. Where the child’s case is funded by Legal Aid, the family can be sure that on the successful conclusion of the claim, their child will receive their full compensation without any deduction for legal costs. Where Legal Aid is available for a child with serious brain injury, we believe that it is in the child’s best interests for their claim to be covered by Legal Aid.
This form of funding is only available to those who have suffered a brain injury, such as cerebral palsy, at birth or within the first few weeks of life. The child must have suffered their brain injury in England or Wales, and they must not have substantial funds of their own. The parents’ finances are ignored for the child’s application.
Legal Aid funding will only be given to a child where their claim is handled by a solicitor who has been approved as a specialist in cerebral palsy and child brain injury claims by the Legal Aid Agency.
Where Legal Aid is not available, we act for clinical negligence clients on a conditional fee agreement (CFA or ‘no win no fee’) basis. Just as the name says, no win no fee means that unless our client wins their case there are no legal fees for them to pay. If the case fails, we do not get paid for the time we have spent working on their case. Our client’s liability for disbursements (such as expert and court fees) and any entitlement the defendant might have to legal costs is paid by an after-the-event insurance policy.
CFAs make it easier for people to afford a legal claim because they do not have to pay any upfront charges. There are no legal bills along the way. They pay nothing if they lose their claim. If they win, nothing is payable until the end of the case.
If an injured person has legal expense insurance which was in place at the time that they were injured by medical negligence, their legal expense insurance policy might help with funding their claim. If you have legal expense insurance, you should let us know as soon as you are considering making a claim.
A medical examination is usually needed to assess our client’s injury. Where our client has suffered multiple injuries or both physical and psychological injuries, they may need to be examined by specialists in each area. This is important to make sure that our client’s injuries are fully assessed and understood, so that they can be properly compensated.
If a medical examination is needed, we instruct the specialist and make the arrangements. We ensure that they have access to our client’s medical records and are aware of the background to the claim. The hospital or doctor against whom the claim is being made may also ask for our client to be examined by their medical expert.
If a baby, child or teenager under the age of 18 makes a claim for compensation for injuries caused by medical negligence, their claim is made on their behalf by a ‘litigation friend’. This is usually a parent or guardian. As the child’s solicitor, we have a responsibility to make sure that all decisions relating to the claim are made in the best interests of the child. To do this, we work very closely with the child’s family. Some important decisions, such as settlement agreements or the amount of money that is allocated to a child in a claim involving more than one claimant, must be approved by the court.
We are specialists in helping families obtain full compensation for children who have been very severely injured leaving them with permanent disability and lifelong specialist needs. [These claims are complex and must be handled by specialist solicitors.] Our expert children’s claims service includes a dedicated Court of Protection team who help our clients protect, budget and access their compensation via deputyship and trusts, and an SEN team to ensure that their special educational needs are met. Find out more about how we help families, children and teenagers with children’s claims.
In medical negligence claims, compensation for serious injury and disability usually includes a sum for the injury, and sums to compensate for financial losses and the cost of meeting the needs that arise from the disability. Our expert knowledge and experience means that we recover maximum compensation in claims for catastrophic and life-changing injury. We also ensure that our clients receive their compensation in the way that is best suited to meet their needs. In claims involving severe disability, compensation may include early interim payments, lump sums or lifelong, index-linked, annual payments.
Depending on our clients’ injuries, individual circumstances and needs, we can recover compensation to pay for:
Where medical negligence caused someone’s death, compensation may be claimed by the deceased’s dependants and on behalf of the deceased’s estate. Compensation in a fatal injury medical negligence claim can be paid for:
HSSIB is the acronym or shortened name for the Health Services Safety Investigations Body (HSSIB).
In October 2023 the Healthcare Safety Investigation Branch (HSIB) which investigates patient safety incidents, will change its name, its status and the way it works and will become the Health Services Safety Investigations Body or HSSIB.
HSSIB will continue the work of HSIB’s national investigations programme but will not take over HSIB’s maternity investigations. These will be carried out by the new Maternity and Newborn Safety Investigations Special Health Authority or MNSI. This is because the Health and Care Act 2022 gave HSSIB increased powers, beyond those used by HSIB. This will allow HSSIB to conduct patient safety investigations using ‘safe space’ protection, which is not appropriate for maternity investigations into patient safety incidents which have caused serious harm to mothers and newborn babies.
From October 2023, when HSSIB becomes operational, it will be an independent, non-departmental, arm’s length body (ALB) of the Department of Health and Social Care (DHSC). HSIB hopes that the new HSSIB’s new working procedures and independence from the NHS and DHSC will help reassure patients and staff involved in patient safety incidents that their investigations are unbiased and don’t attribute blame, but will help the whole healthcare system learn from the system failures and mistakes that contributed to the patient’s injury. HSIB believes this will help improve patient safety.
HSSIB will work differently from HSIB:
• HSSIB will be run by a board of executive and non-executive directors who will establish and take forward the strategic aims and objectives of the new organisation. HSSIB’s new board of directors will be accountable for the way HSSIB is managed, carries out its investigations, and for its performance.
• HSSIB will have the power to:
o access patients’ medical records without their consent;
o compel people and organisations (such as NHS trusts) to cooperate with patient safety investigations;
o obtain any evidence that it considers relevant for an investigation;
o conduct investigations under ‘safe space’, meaning that evidence that is gathered can be protected from disclosure, even to the affected patient or their family.
• HSSIB will not carry out maternity investigations. These will be taken over by the Maternity and Newborn Safety Investigations Special Health Authority or MNSI.
If you have been contacted by MNSI, HSIB, HSSIB or NHS Resolution after the birth of your child or in relation to the mother’s maternity care, we strongly advise you to contact us on +44(0) 118 952 7201 immediately for free, confidential, specialist advice before you respond. Your child or your family may be entitled to substantial compensation.
Medical negligence cases are legally and medically complex. If you have been seriously injured by medical negligence and want to claim compensation, it is essential that your solicitors specialise in clinical negligence and understand what is required, both legally and medically, to prove your claim.
The law says that a medical practitioner is negligent if they have acted in a way that no responsible body of medical opinion would regard as acceptable. That means that if the care given was of a reasonable standard the court will not regard it as negligent, whatever the result.
Where healthcare is found to be (legally) negligent, then the claimant (the person making the claim) must prove that their injury was caused or significantly worsened by the negligent care. This is important because the patient may already be very ill when they receive negligent medical care. In those circumstances, they must prove that their injury (and its financial consequences) would have been avoided or greatly reduced if correct treatment had been given. This aspect of the medical negligence claim is known as ‘causation’. Causation must be proven, even if negligence is admitted, for the claim to succeed and compensation to be awarded.
Negligence and causation must be proven by supportive opinions from medical experts. We instruct experts in the same field of medicine as the negligent care to tell us whether the care that was given was of a reasonable standard. If negligence is proven, we ask medical specialists in the type of injury suffered, to confirm whether our client’s injury was caused or made worse by the negligent treatment, or would have been reduced or avoided with correct care.
The medical experts make their assessments by examining the evidence:
The experts may also back up their opinion with other reputable sources of professional information, such as:
They will also draw on their own clinical experience when giving their opinion about whether the treatment given was to a reasonable standard and was responsible for causing the injury.
The law states that, in most cases, someone who has been injured as a result of medical negligence has three years from the date of the negligence which caused the injury to issue court proceedings. If they fail to issue court proceedings within that time, their claim will be statute barred, meaning that they lose their right to bring a claim.
There are the following exceptions to the three-year rule:
Regardless of your time limit, we recommend that you contact us as soon as you can after the injury has taken place, even if at that stage you are only considering whether to make a claim. By contacting us early:
Whilst we cannot guarantee that any particular claim will settle out of court, we take great care in investigating and preparing each claim that we take on. Our clients’ claims usually settle successfully without the need for a contested trial.
Occasionally, cases can only be concluded by a formal court hearing, such as where:
Where our client’s claim is complicated by any of the above, we may advise our client that for the case to proceed it must go to a court hearing. Our caring and highly experienced solicitors and barristers ensure that our clients are always kept informed and supported.
Even in non-contested cases, there will be occasions when the case is brought for shorter hearings before the court, such as after a settlement for a child or brain injured adult without mental capacity takes place. In these cases, the lawyers for both sides present the agreed settlement to the court for the judge’s approval.
In a medical negligence claim, compensation will only be paid for injuries and loss that we can prove were caused by the healthcare provider’s negligence. Once we know what mistakes were made, the next step (causation) is to identify the extent of the injury or disability that was caused by those mistakes. This process of proving causation can be complex in claims where there is more than one potential cause for the injury, such as in birth-related brain injury claims. It can also be complicated where the patient would have suffered from the condition that was being treated in any event, but additional injury was caused by negligent treatment or delay.
Proving causation in complex medical negligence cases requires both medical expertise and understanding of the law. We often succeed in claims where NHS Resolution (the NHS’ defence organisation) has denied ‘causation’. You can read more about how we overcome difficulties with causation in complex birth injury cases.
The NHS has a responsibility to provide its patients with a safe and acceptable level of care. If a patient is seriously injured or their condition is made significantly worse as a result of negligent NHS care, the patient may be entitled to claim compensation. Making a claim against the NHS does not affect the patient’s future NHS healthcare. Compensation can help meet the costs of care, therapies, equipment and home adaptations that are needed when an NHS mistake causes injury or disability that permanently affects the patient’s life.
We are experts at helping clients receive the compensation they deserve from the NHS. We understand the concerns that patients and their families sometimes have about claiming against the NHS. You can read our answers to many of the most common questions on our NHS claims page or speak to one of our solicitors about your own claim by contacting us.
No, your NHS treatment should not be affected simply because you are making a claim.
Anyone who has suffered serious injury or disability as a result of negligent NHS or private medical care can make a medical negligence claim for compensation. Special rules apply to children, adults with mental incapacity, and claims arising from a [fatal injury/someone’s death].
Children and teenagers under the age of 18, or anyone with mental incapacity, must make their claim via a ‘litigation friend’. This is usually a parent or guardian in the case of a child, or a partner or other adult family member in the case of an adult with mental incapacity. The solicitor handling the claim takes instructions and works closely with the litigation friend whilst ensuring that decisions are made in the best interests of the child or mentally incapable adult who is making the claim. You can find out more about making a claim for a child.
Some important decisions, such as agreements to settle a child or mentally incapable adult’s claim, must be approved by the court. Arrangements must also be made to safeguard the child or mentally incapable adult’s compensation, whether from an interim payment, lump sum settlement or agreed future payments. Depending on the claimant’s circumstances, this may be done by paying the money into a Court Funds Office account until the child is 18, by appointing a Court of Protection deputy or setting up a personal injury trust. You can find out more about Court of Protection deputyship and personal injury trusts.
If the claim is for bereaved family members and dependants after medical negligence caused someone’s death, the claim must be made by the deceased’s personal representative (executor or administrator of their estate) on behalf of all who are entitled to compensation as a result of the death. You can find out more about making a fatal injury medical negligence claim here.
MNSI is an acronym or shortened name for the Maternity and Newborn Safety Investigations Special Health Authority.
MNSI is the new Special Health Authority which is taking over investigations into patient safety incidents which have occurred during maternity or neonatal (newborn) care. MNSI will continue the work of HSIB’s maternity investigations programme which investigates maternity safety incidents which have caused harm to mothers and babies, including:
The Maternity and Newborn Safety Investigations Special Health Authority or MNSI has been formed to take over HSIB’s maternity investigations programme when HSIB changes status to become the Health Services Safety Investigations Body or HSSIB. The Health and Care Act 2022 did not provide for maternity investigations to be carried out by HSSIB. This is because the new HSSIB will have new powers to investigate most types of patient safety incidents under ‘safe space’, but this process is not appropriate for investigations into intrapartum stillbirth, early neonatal death, babies with severe brain injury diagnosed in the first week of life, or pregnancy-related deaths of mothers (known as maternal deaths).
Instead, in January 2022 the government announced that a new Special Health Authority would be established for up to five years to continue the work of HSIB’s maternity investigations programme. In August 2022 HSIB announced that the new Special Health Authority created to carry out maternity investigations had been named the Maternity and Newborn Safety Investigations Special Health Authority or MNSI.
The government suggested that MNSI’s aim will be to achieve maximum learning from maternity safety incidents by:
HSIB has also suggested that part of MNSI’s role will be to provide NHS trusts with the expertise, skills and resources to carry out their own maternity safety incident investigations in future.
MNSI is expected to take over HSIB’s maternity investigations from October 2023.
If you have been contacted by MNSI, HSIB, HSSIB or NHS Resolution after the birth of your child or in relation to the mother’s maternity care, we strongly advise you call us immediately on +44(0) 118 952 7201 for free, confidential, specialist advice before you respond. Your child or your family may be entitled to substantial compensation.
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What has to be some of the most testing horrible times was dealt with in a dignified, honest, approachable and truly empathetic manner. I could not begin to do Susan justice for her handling of our case.
I approached Boyes Turner after my claim was turned down by one of the Medical Negligence Claim company. My wife was a victim of medical negligence.
Boyes Turner have acted so efficiently on our behalf and was able to win our case. Anytime we contact them, their customer service was very good as they kept us fully informed of every level our case has developed. They are very friendly and approachable and great in their professional advise. I would strongly recommend anyone approach them for their legal and medical negligence services.
Thoroughly professional, knowledgable and approachable with communication and updates as and when needed, in what can be a drawn out process, I was always comfortable asking questions and always received answers which were clear and understandable. Highly recommend
I came to Boyes Turner desperate after searching the web for a firm to use for my sons case. He was only a few months so my mind was all over the place, but from the very first point of contact I felt a sense of relieve and belonging. I was welcomed and looked after by amazing staff who always communicated everything so well and went the extra mile to explain things and ensure I understood what was happening every step of the way (THANK YOU SUSAN BROWN). Susan was amazing I felt like I not only had a solicitor but someone who understood my emotions as a mother and always handled me with so much compassion and that was all I needed to keep me going for the 6 years of the case. Years went by in a breeze because of how professional Boyes Turner was. I am so greatful I went through it all with them and mananged to get my son a good compensation. We look forward our new life where my sons needs are priority after struggling for so long. Thank you Boyes Turner and thank you Susan Brown. My family and I are ever indebted.
From the moment I picked up the phone and spoke to Richard Money-Kyrle I knew I had done the right thing by choosing Boyes Turner to take our claim forward and to represent my son. Both Richard Money-Kyrle and Alpa Rana have worked on our case and they both have been amazing throughout, explaining every step of the way and anything we didn’t understand and keeping me updated constantly. This gave me and my family a lot of reassurance.
Both Richard and Alpa are friendly and gained my trust and have been really easy to talk to which has made the process a whole lot easier and smoother than anticipated.
The outcome of the claim was far more than I could have wished for and that was down to their hard work and expertise
I couldn’t fault them they have been brilliant throughout the whole process I would recommend Boyes Turner to anyone.