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Getting It Right First Time (GIRFT) has published its latest report into NHS adult cardiothoracic surgery in England. The GIRFT programme aims to help improve the NHS by identifying variations in practice and procurement, sharing and supporting the implementation of proven best practice with health professionals and hospital managers across the country, thereby improving patient care and saving costs. It does so with funding and support from the Department of Health and is jointly overseen by NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust.

In keeping with previous reports, Cardiothoracic Surgery GIRFT Programme National Specialty Report, makes 20 recommendations which, if implemented could save the NHS up to £52 million a year. The report contains a statement of support from The Society for Cardiothoracic Surgery (SCTS) which also produced a joint response with the Royal College of Surgeons urging the NHS to act upon the recommendations.

The term cardiothoracic surgery relates to surgical treatment of disease in the heart, lungs and major blood vessels in the chest. 7 million people in England have cardiovascular disease which accounts for 27% of all deaths. 28,250 cardiac surgery operations and 69,000 thoracic surgery operations are performed each year. 

Only 31 units in England perform this major, technically demanding surgery in which success depends on highly skilled, multidisciplinary teamwork. Although low-volume compared to many other areas of surgery, cardiothoracic surgery is high cost and often high risk with a measurable mortality rate. Patients needing these sorts of operations have life-threatening diseases and are amongst the most ill that the NHS faces. Since survival rates and clinical outcomes in adult cardiac surgery have been published, they have improved such that the UK’s survival rate for cardiothoracic surgery is currently ranked as one of the best in the world.

The GIRFT cardiothoracic surgery report recommends changes which will improve experience and outcomes for patients which go beyond mortality or survival rates. Delays (which increase risk), cancellations and unnecessarily long stays in hospital will be reduced by a series of measures including:

• Routine day-of-surgery admission
• Ring-fencing of ward and ITU beds for elective cardiothoracic surgery
• Pooling of non-elective cases so that patients are operated on in the next available theatre session with the next available appropriate surgeon
• Ensuring that every patient is seen by a consultant both pre and post-operatively, seven days a week (to avoid delays in waiting for discharge if no consultant can review at the weekend)

Patients’ risk and outcomes (including risk of stroke and deep sternal wound infection) will be improved by measures including:

• Ensuring that conditions needing highly specialised treatment, such as aortovascular surgery and mitral valve surgery, are only operated on by surgeons with specialist skills in that condition.
• Specialist surgeons will operate on higher numbers of cases, as variations in practice,  outcomes and mortality strongly suggest that higher volume is associated with better outcome.
• Minimum activity requirements for surgeons. 
• Major trauma centres to have rotas to cover both thoracic and cardiac trauma surgery rather than relying on cardiac surgeons to provide emergency thoracic surgery cover. (There are only 27 cardiothoracic surgeons in England, with 182 cardiac-dedicated surgeons and 92 purely dedicated to thoracic surgery).
• Centralised and reduced numbers of lung cancer multidisciplinary teams with a thoracic surgeon present on every team.

During their visits the GIRFT team found that because clinicians and providers knew very little about the litigation claims that were being made against them, very few lessons had been learned from claims. The Department of Health has stated its goal to turn the NHS into a learning organisation but unless clinical staff are given information about litigation claims and proper analysis of claims is carried out at local and national levels, opportunities are being missed to improve patient care. GIRFT recommended implementation of their five point plan to reduce litigation costs - including detailed analysis and review of all claims as serious untoward incidents (SUI)  -  to ensure that lessons are learned to save costs and improve patient care.

If you or a family member have suffered serious injury as a result of medical negligence during cardiothoracic surgery call our specialist medical negligence solicitors on 0118 952 7219 or email mednegclaims@boyesturner.com.

A deputyship can be brought to an end automatically or through choice. There are several ways in which a deputyship can end and these are:

1. If a person dies then the deputyship comes to an immediate end and the Death Certificate must be sent to the Office of the Public Guardian. At that point, the Executors of the Will or the Administrators if a person died intestate (without a Will), will take over the administration of the person’s assets.                     
2. The Court of Protection can make an Order terminating the deputyship if the deputy retires or resigns. An application will need to be sent to the Court of Protection with details of the proposed new deputy and confirmation as to the retirement or resignation of the current deputy.
3. A person may recover mental capacity so that they are able to make to their own financial decisions, in which case evidence of recovery such as a doctor’s letter will need to be sent to the Court of Protection together with a COP9.

Please note that apart from in the case of when a person dies, you cannot stop being a deputy until you have received the relevant Court Order discharging you as a deputy. However, the security bond will remain in force for seven years after the death of the person you are deputy for unless there is a Court Order cancelling it. A security bond is an insurance provision which would have been put in place to protect the finances of the person concerned.

We would be happy to assist you in an application to the Court of Protection should you wish to retire and arrange for another person to take over as deputy. We can prepare applications for lay deputies (a family member or friend) or for a professional deputy such as ourselves.

We are also able to prepare the applications to the Court should a person recover capacity and either then manage their finances themselves or wish to place money into a personal injury trust. This may be useful for added protection if a person regains capacity but remains vulnerable and needs additional support and protection.

Ruth Meyer leads our Court of Protection team and has over 20 years specialist experience. Ruth acts as a professional deputy in respect to finances for children and adults who have received an award for compensation for medical negligence or who have an acquired brain injury. However, she is also able to act for people with dementia as well as any other age related illness that affect mental capacity. Please feel free to call any of the team members for a free initial discussion.

If you would like to discuss your current deputyship arrangement or to talk about how to end one up please email our specialist team on cop@boyesturner.com or phone 0118 952 7219.

Following on from Cervical Cancer Awareness Week we asked Sita Soni, an associate solicitor in the clinical negligence team, about her experience of successfully investigating cervical cancer medical negligence cases.

What key information do you need from an individual who has concerns about their cervical cancer medical care?

I always listen to the client’s recollection and their concerns about the care they received first. It’s really important to understand exactly what has happened and how the client feels about it. To understand whether there an investigation should take place, I usually ask the client to let me know:

• What, if any, symptoms they experienced
• Their history of smear testing
• Any relevant attendances at the GP or hospital and advice they were given
• What diagnosis they have been given
• What treatment has been advised/given
• The impact of the diagnosis and/or treatment

Can you investigate a case even if the individual is still having treatment?

Yes. The fact that a medical negligence case is ongoing should make no difference to the medical care the patient receives. It is best to investigate a claim as soon as possible, as the client’s recollection of events will be clearer. 

There are also legal time limits for bringing a claim for medical negligence, so it is better to investigate concerns as soon as possible after the patient suspects that errors have occurred.

How will a cervical cancer medical negligence case will be funded?

Usually the case will be funded by a Conditional Fee Agreement (also called a “no win no fee agreement”) with After The Event insurance. This means that the client doesn’t have to pay any legal costs at the start of the claim and will not be liable for any costs if the case is unsuccessful. In a successful claim the majority of the claimant’s legal fees are paid by the defendant. I take great care in explaining the funding arrangement in detail to my clients to make sure they are entirely comfortable with the agreement. Where a claim, even if successful on its merits, is unlikely to be financially viable for the claimant, I let them know at the outset as we would never advise a client to pursue a disproportionately expensive claim.

How do you investigate whether the hospital/GP has acted negligently?

All cases are different and there is no one-size-fits-all approach to investigating a case. I will, however, always need the claimant’s medical records from their GP surgery and hospital, so in every case I  request these and consider them carefully. I take a detailed statement from my client to record clearly their recollection of what happened. 

Medical negligence claims must be supported by expert evidence. When investigating cervical cancer claims, a gynaecological oncologist is usually instructed to comment on whether the treatment was negligent and if so, to advise on what should have happened instead. The gynaecological oncologist will also comment on the impact, if any, of the negligent treatment, for example, whether intensive treatment like radiotherapy could have been avoided with correct medical care.

Other medical experts may also be required. We select our experts carefully according to the needs of the individual case.

How do you calculate the level of compensation in a cervical cancer case?

The valuation is tailored to the individual client. No two cases are the same because no two clients are the same. I discuss with each client the physical and psychological impact of the negligence, and the extent of their financial loss. We take into account the side effects of any avoidable treatment (i.e. fatigue, pain, bowel and bladder impairment), whether they been able to go back to work or are now on reduced hours and so experiencing a loss of earnings, whether they need extra help at home with cleaning and other chores. The aim is to help my clients rebuild their lives after a cancer diagnosis.

Some of the difficulties are permanent and may require medical treatment or therapy to alleviate, so I look at my clients’ needs for help not only now but also for the rest of their lives. I include the costs of any treatment or therapy required in the claim. I usually instruct experts to help assess the client’s current difficulties and their future outlook. This might involve evidence from a colorectal expert, a pain expert, a care expert and a psychiatrist. 

Why do you think it’s important for cervical cancer negligence cases to be investigated?

Each of my clients have their own reasons for pursuing a medical negligence claim. Some say closure is the most important reason for them. They want to know if things went wrong in their medical care and what could have been avoided. Understanding what has happened allows them to move on. Some clients are seeking help and support to put their lives back on track with private medical treatment and therapy specific to their needs.  Others are concerned about the financial implications for their family if they can no longer work to their full capacity after cancer treatment and want the help that a successful claim can provide by alleviating the financial hardship which often follows cancer negligence. 

My experience in working closely with our clients and volunteering for Jo’s Trust, the UK’s only cervical cancer charity, has equipped me to support my clients during and after the process, to understand their concerns, and fully answer their questions about the next steps.

Sita has recently achieved a £575,000 compensation settlement following a delay in diagnosis of cervical cancer. For more information about this case, have a look at our website here.

The latest report from the GIRFT programme has been published, revealing its findings and recommendations for improving the way vascular surgery is delivered by the NHS in England. Funded by the Department of Health and overseen by NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust, GIRFT is proving successful in helping the NHS to learn and improve its practises by identifying variations in NHS care, sharing best practice with clinicians and hospital managers across the country whilst supporting necessary changes, thereby saving costs.

The latest report sets out 17 recommendations for improvement based on information gathered from NHS data and visits to each of the 70 NHS Trusts which provide vascular surgery services. In addition to raising concerns about quality and discrepancies in the available NHS data, the report highlights fundamental weaknesses in the way that vascular surgery is delivered. Patients are routinely experiencing unacceptable and potentially dangerous waiting times for surgery. These delays increase their risk of experiencing major strokes, life threatening rupture of abdominal aortic aneurysms and amputation, depending on their condition. The report emphasises that by its very nature, even where the need for vascular surgery is not classed as an emergency, it must always be regarded as urgent.

Currently, 43,000 vascular surgery procedures are performed in England each year by 450 consultant vascular surgeons, often working with vascular interventional radiologists, in 70 NHS Trusts. In order to ensure that NHS patients needing vascular surgery can be treated urgently in accordance with NICE guidelines and in a way that minimises their risk, GIRFT recommends that this important and often life-saving surgery must be provided through a reduced number of properly staffed and equipped specialist centres, via an advanced yet proven ‘hub and spoke’ network model that has worked effectively elsewhere within the NHS.

If implemented, the recommended changes could improve surgical outcomes for seriously ill patients whilst also achieving costs savings by reducing length of hospital stays, reducing the number of readmissions and making better use of surgical resources. Other recommendations include opportunities to save money which is currently wasted through variations in the procurement of equipment and other products.

What is vascular surgery?

Vascular surgery saves lives through a variety of important procedures such as reconstructing, unblocking or bypassing arteries that are blocked by atherosclerosis. This hardening or furring of the arteries reduces blood flow to vital organs and, if untreated, can lead to sudden death, strokes and amputation. Another life-saving procedure deals with aortic aneurysms before they rupture, often causing death.

Where surgery is delayed there is always a risk to life or limb. Patients needing vascular surgery are, by definition, very frail and their condition is often compounded by additional complications (or co-morbidities) such as hypertension, diabetes, chronic lung disease or ischaemic heart disease. This puts them at greater risk from surgery, increases their need for intensive post-operative care, raises the likelihood that they will need to be readmitted to hospital and increases their mortality rate when compared to other types of surgery.

The GIRFT report highlights some key procedures in which delays are increasing those risks:

• Abdominal aortic aneurysm (AAA)
  An abdominal aortic aneurysm is a bulge or swelling in the aorta. If it ruptures it causes internal bleeding and sudden loss of blood pressure and is usually fatal without emergency surgery. Most procedures are, therefore, carried out before rupture, with the aim of preventing rupture. Once a patient is identified as being at risk of rupture, surgery should take place urgently. However, GIRFT found that patients whose AAA surgery was classed as ‘elective’ (i.e not yet ruptured) rather than ‘emergency’ (already ruptured) were often having to wait several weeks for surgery.

• Carotid endarterectomy (CEA)
  Carotid endarterectomy removes atherosclerotic build-up in the carotid arteries which carry blood to the brain. This procedure is usually performed on patients who have suffered a minor stroke or transient ischaemic attack (TIA) to prevent the life threatening and disabling major stroke which often follows a minor stroke. NICE guidelines mandate that CEA should be carried out within two weeks of diagnosis of a minor stroke or TIA. However, GIRFT found wide variation between NHS Trusts in the waiting time from diagnosis to CEA surgery, with some patients having to wait for 28 days or more.  

• Lower limb revascularisation
  Lower limb revascularisation treats peripheral vascular disease (caused by blocked arteries) by improving blood flow through the arteries in the legs. Timely revascularisation by angioplasty (using a ‘balloon’ to widen the artery or a stent to keep it open) or bypass can prevent the need to amputate. Around 8,000 lower limb amputations are performed on the NHS each year. Major amputation currently has a 16.5% high emergency re-admission rate and a 7.5% mortality rate. GIRFT found that earlier identification of risk and reduced waiting times for revascularisation could reduce the numbers of amputations.

Dealing with delay

The GIRFT report found that lack of available facilities and lack of integration with other departments were often a cause of delay. However, the key finding of concern was that vascular surgery tends to be carried out only in ‘normal’ working hours, which limits the number of procedures that are carried out each week. Only six NHS hospitals in England currently offer elective (non-emergency) vascular surgery at weekends, even though they all must have on call teams available at weekends to deal with emergencies.

The key recommendation of the report was that vascular surgery should be delivered seven days a week, centralising resources and expertise through specialist hubs. In doing so, patients will be given greater choice from a range of available procedures, surgery will be performed more quickly by more experienced surgeons using better facilities and specialist equipment in an environment where there is appropriate multi-disciplinary support. Recommendations were also made in relation to pre-habilitation and planning for perioperative care thereby reducing avoidable post-operative readmissions.

At Boyes Turner we specialise in helping brain injured and amputee clients rehabilitate and rebuild their lives following severe injury caused by unacceptable treatment delays. We understand the physical and psychological damage that is caused by these injuries and we work hard to obtain compensation which can pay for prosthetic limbs, specialist equipment, adapted vehicles and homes, along with meeting the costs of necessary care and replacing lost earnings.

Whilst the findings of the GIRFT report into vascular surgery highlight the number of patients who are potentially suffering amputations and other serious injury unnecessarily, GIRFT’s previous reports and successful implementation of its recommendations provides hope for improvement.

Boyes Turner welcome the courageous and valuable work that is being carried out by GIRFT’s clinical leads and their teams to identify areas where unnecessary suffering can be avoided and champion best practice to bring about change.  

If you or a family member have suffered serious injury as a result of hospital negligence during vascular surgery call our specialist medical negligence solicitors on 0118 952 7219 or email mednegclaims@boyesturner.com.

Over the following year we will be sharing a series of question and answer articles about our day-to-day lives in the medical negligence team. Following on from World TB Day, we asked Julie Marsh, a senior associate solicitor in the clinical negligence group, about her experience of running medical negligence claims in relation to the delayed diagnosis and management of TB.

What key information do you need from an individual who has concerns about their medical care and whether there has been a delay in diagnosis of tuberculosis?

It is important to have an accurate chronology of events in a case like this. I need to understand why the client thinks there has been a delay in diagnosis and treatment of tuberculosis and how long that delay might have been.

I take a detailed statement from the client and any family members about when they first noticed symptoms indicative of tuberculosis, when they first sought medical help and their condition and reported symptoms at that time. 

It is also important to understand any treatment that has been given over time, and the effect that this has had on the individual.   

Can you investigate a case even if the individual is still having treatment?

Yes.

It is important to investigate a medical negligence claim as quickly as possible. There are time limits associated with bringing claims of this nature which need to be considered. It is also important to start the investigation as soon after the events as possible, so that the client’s recollection of the facts is as fresh as it can be. 

Treatment for tuberculosis can go on for six months or more. Sadly, tuberculosis can have long-lasting effects which need ongoing treatment and management of symptoms, but a client shouldn't wait until the conclusion of their treatment to consider a claim. The sooner we can establish liability, the sooner we can obtain interim payments to help ease any financial hardship from loss of earnings and other costs, often long before the case is finally concluded.

How would a case like this be funded?

Usually a claim is funded by way of a Conditional Fee Agreement (sometimes called a “No Win, No Fee Agreement”) backed by after-the-event insurance. This means that there are no upfront costs to the client to get the investigation underway and that the client will not be liable for any legal costs if the investigation is unsuccessful. In a successful claim, the Defendant pays the majority of the legal costs.  

It is very important to discuss the funding arrangements for bringing a claim with a client at the outset, so that they understand the terms of the agreement and are entirely comfortable with them before a claim is underway. 

Where a claim, even if successful on its merits, will not be financially viable for the claimant, I let them know at the outset as we never encourage a client to pursue a disproportionately expensive claim.    

How do you investigate whether the hospital/GP has acted negligently?

To investigate a claim for medical negligence, it is necessary to assess the standard of care that the patient received from their health practitioner, whether that was their GP, or the doctors at a hospital.   

Once I have a statement from the client, I obtain a copy of their medical records and analyse treatment that was given to the client. It is very important to have the client’s input at this stage as there can be factual inaccuracies in medical records and there might be a factual dispute which is critical to the case.  

A claim for medical negligence must be supported by medical expert evidence. In tuberculosis cases a respiratory physician will usually be required to comment on the extent of the injury that the client has sustained as a result of any delay in diagnosis, and will also be asked to give an opinion on the client’s condition and prognosis. 

The standard of care must be assessed by an expert from the same discipline as the health practitioner whose care gave rise to the claim. So, for example, a GP expert would be needed to assess care from a GP.

How do you calculate the level of compensation in a delay in diagnosis of tuberculosis case?

The valuation of any claim is entirely tailored to the individual client, the impact of their injury and their circumstances. 

The client’s injury and its impact on their life must be considered very carefully. Where there has been a degree of respiratory disability as a result of a delay in diagnosis of tuberculosis, this can have far-reaching effects on the individual, their family and all aspects of their life. I make sure that I understand fully how the claimant’s life has been affected by the additional injury that has been caused by the delay.  

It may be necessary to include a claim for new accommodation. In a case I have recently worked on, the client lived in a very old building where it was difficult to maintain a constant air temperature or to have standard central heating. As a result of the bronchiectasis caused by the tuberculosis and the damage to her lungs from the delay in treatment, any change in room temperature caused extreme coughing fits. My client will need to move to a modern and well insulated and centrally heated house in the future so that these coughing fits can be avoided. In this scenario, we include a claim for the additional costs associated with moving to suitable accommodation from the defendant.   

It is also important to consider the future in cases of this nature. Unfortunately, damage to the lungs can result in reduced immunity to chest and other infections. If a condition called Aspergillosis is contracted then the consequences for the client can be severe, sometimes requiring the removal of a lung, which can be life-threatening and extremely debilitating.  

Why do you think it’s important for tuberculosis negligence cases to be investigated?

Unfortunately, there is currently surprisingly little awareness of tuberculosis and its dangers.  However, the signs and symptoms are relatively easy to identify, and timely treatment for inactive tuberculosis is straightforward with minimal  long term effects. However, the consequences of any delay in treatment can be devastating to the individual and their  family, and the impact on their finances and way of life can be considerable. 

Boyes Turner’s clinical negligence team are currently acting in several cases of serious disability and devastating injury arising from delayed diagnosis and treatment of TB.​ If you or a member of your family having suffered severe injury as a result of delayed treatment for tuberculosis or other infectious disease, contact us on 01118 952 7219 or email claimsadvice@boyesturner.com.

World TB Day takes place on 24 March each year to commemorate Dr Robert Koch’s discovery in 1882 of the TB bacillus, the cause of tuberculosis. At that time, TB accounted for the deaths of one in every seven people. His life-changing discovery ultimately led to a cure for the one world’s most prevalent infectious diseases.

125 years later, TB is still killing 1.5 million people worldwide each year. World Health Organisation figures for 2016 reported that 10.4 million were known to have TB, with 1.8 million deaths from the disease. Despite some improvement in recent years, tuberculosis is still the world’s number one infectious killer, leading to more than 4500 deaths each day, a problem that is now compounded by the emergence of new multidrug-resistant strains of TB.

On World TB Day it’s worth remembering that, despite these alarming statistics, 53 million lives were saved through TB diagnosis and treatment between 2000 and 2016. TB is treatable for most people with a six-month course of antimicrobial drugs, but early diagnosis and correct treatment is key.

The theme of this year’s World TB Day is ‘Wanted: Leaders for a TB-free world’ and is linked to a World Health strategy known as ‘End TB’. The strategy arose from the World Health Assembly in May 2014 which called upon governments worldwide to commit to ending the TB epidemic by 2030. The strategy was adopted by the Collaborative TB Strategy for England 2015-2020 with the aim of reducing England’s year-on-year incidence of TB.

England has one of the highest TB rates in Western Europe. According to Public Health England, in 2016 there were 5,664 notified TB cases in England – that’s more than 10 people per 100,000 of the population. The rate of decline in the numbers of cases since 2012 reduced from 10% to 1% a year. Meanwhile, delays between onset of symptoms and start of treatment rose with 31% of pulmonary TB patients experiencing delays in treatment of more than four months.

Tuberculosis is a bacterial infection which usually affects the lungs but can also infect other areas of the body. It’s spread when the infected person coughs, sneezes or spits and someone else inhales the drops of infected fluid from the air.

When a healthy person is infected by TB bacteria their body’s immune system can often deal with the disease and the TB bacteria remain in the body without causing symptoms or infecting others. This is known as latent TB, a condition thought to affect around a quarter of the entire world’s population.

Once infected there is a 5-15% lifetime risk of becoming ill with TB. That risk increases in those with weakened immune systems, such as smokers, alcohol drinkers, or those with HIV, malnutrition or diabetes. Anyone can contract TB, although the disease is usually found in adults of working age and is most prevalent amongst people living in poverty with malnutrition, poor housing and sanitation, which means that over 95% of TB cases and TB -related deaths occur in developing countries.

Initially the symptoms of active TB, such as cough with sputum and blood, chest pains, fever, night sweats, or weight loss, can be mild, leading to delays in diagnosis and increasing the risk of others being infected.  

However, as World TB Day reminds us, TB is usually treatable, curable and preventable. Awareness, early diagnosis and treatment are key.

Boyes Turner’s clinical negligence team are currently acting in several cases of serious disability and devastating injury arising from delayed diagnosis and treatment of TB.

If you or a member of your family having suffered severe injury as a result of delayed treatment for tuberculosis or other infectious disease, contact us on 01118 952 7219 or email claimsadvice@boyesturner.com.

You are never obliged to stay with the same deputy. The relationship between the deputy and their client must be built on confidence and trust and in the knowledge that they have considered your wishes. You may not always agree on something but then that gives you the opportunity to talk things through and reach a resolution.

Choice is absolutely essential. If you feel you are struggling to work with your deputy then you will feel stressed and costs will increase. You may even feel yourself reluctantly communicating. Surely this cannot be in a person’s ‘best interests’? – Something which goes to the heart of the Mental Capacity Act 2005 

We have a highly experienced team at Boyes Turner and each team member is hand-picked for their empathy, experience and ability to work with people from all different backgrounds. The team is led by Ruth Meyer with over 20 years’ experience. We are specialists in applications to the Court of Protection and acting as a deputy for finances.

At Boyes Turner we don’t just take over but instead work with people to ensure that the spirit of the Mental Capacity Act is adhered to. This includes supporting people in the decision making process so that we take into account their own wishes and feelings as well as their beliefs and values and any other factor that should be taken into account.  We also ensure that we take into account the views of others such as anyone engaged in caring for the person or interested in their welfare and quite often than not this is the parents of the person concerned.

There have been several occasions in which we have helped clients who were either unhappy with their current deputy or felt that their current deputy didn’t have the skills to be able to fully support them and act in their best interest. We have had matters referred to us not only from the general public but also from other solicitors, case managers, financial advisers and other experts.

We would be happy to have a free initial discussion to work out what is best for you and to ensure that any transfer from one deputy to the next is as seamless as possible. 

If you would like to discuss your current deputyship arrangement or to talk about how to set one up please email our specialist team on cop@boyesturner.com or phone 0118 952 7219.

Pembrolizumab – Immunotherapy treatment

Medical professionals are continually investigating new ways to help mesothelioma patients. There are always a number of different trials looking at improving symptoms and curing mesothelioma. All of these trials can be found by looking on the NHS website. One such treatment currently on offer is private immunotherapy treatment.

The treatment is with a drug called Pembrolizumab. Pembrolizumab has not yet been approved by the National Institute for Health Care and Excellence (“NICE”) in the treatment of mesothelioma patients and therefore currently is not available as a free treatment on the NHS. We are unaware of any indication that NICE will be approving Pembrolizumab any time soon.

Pembrolizumab has, however, in limited clinical trials, demonstrated increased survival rates in mesothelioma patients. It is therefore something that many patients with mesothelioma are considering.

How does immunotherapy treatment work?

Put simply, the drug works by making the cancer highly visible to the patient’s own immune system. The patient’s own immune system then kills the cancer.

Immunotherapy treatment and mesothelioma claims

As Pembrolizumab is not currently approved by NICE as a treatment for patients with mesothelioma and is therefore not available on the NHS, the current cost of treatment on a private basis is estimated at £75,000. 

Last year, at Boyes Turner, we were delighted to report our mesothelioma team’s success in securing a settlement for a client which included the cost of this treatment as a separate aspect of his claim. We insisted that as our medical expert believed our client should receive this treatment, he should not have to use the compensation he was awarded for other areas of his loss if he needed the immunotherapy treatment in the future. 

Fortunately, our client did not have to go through court proceedings to achieve his settlement, but we were delighted to hear that in a recent mesothelioma claim, the court has now ordered that treatment for immunotherapy should be funded by the defendant’s insurers.

Instead of waiting for the treating doctors to advise that the mesothelioma sufferer could have immunotherapy treatment, the court in an attempt to reach a quick settlement for the injured claimant, ordered that he could at any time request the costs of his immunotherapy treatment be funded by the insurers.

An order was given for periodical payments, so that mesothelioma claims can be settled without the injured claimant having to wait until their condition deteriorates to the point that their need for immunotherapy treatment is confirmed. The claimant can have the peace of mind of knowing that if or when they need immunotherapy treatment, the insurers have agreed to fund it automatically, whatever the cost.

At Boyes Turner we work hard to ensure that as many of our mesothelioma-affected clients as possible receive lifetime settlements, and we welcome the good news that we do not have to delay the outcome of any mesothelioma claims pending the decision on eligibility for immunotherapy treatment.

Having successfully recovered the cost of immunotherapy treatment for our own eligible mesothelioma-affected clients, we will continue to push the boundaries to improve compensation in mesothelioma claims.

Mesothelioma trials

Our asbestos team are committed to helping change the futures of mesothelioma patients by continuing to research the disease and striving to improve management of symptoms.

Charities such as Mesothelioma UK are strong advocates of ongoing trials and improvements on symptom management for mesothelioma patients and the Boyes Turner asbestos claims team support their efforts with annual sponsorship and fundraising.  

With a number of different trials now available for mesothelioma patients, this decision gives hope that settlement can still be reached in mesothelioma claims without eliminating the opportunity for a client to recoup their costs of any future experimental treatment.

If you or a family member has been diagnosed with mesothelioma or any other asbestos related disease, we may be able to help. Contact us on 0800 884 0718 or email IDClaims@boyesturner.com for a free initial discussion.

The impact of a delay in a diagnosis of cervical cancer can be life changing for all involved – for the individual undergoing treatment, and for their family and friends who support them and provide care and assistance during their recovery. 

At Boyes Turner we are aware of not only the long-term effects a delay in diagnosis of cervical cancer can have, but of the restricting effects of its treatment - from fatigue and the acute pain of primary treatment, to its long standing psychological and physical effects.  

A previous client of Boyes Turner has described her journey through brachytherapy (internal radiotherapy) and chemotherapy and the long-lasting effects of the treatment on her.

In the difficult time following a diagnosis of cancer which has been caused by negligent medical delays, it can be hard to decide whether to make a claim for compensation. Everyone’s circumstances are different and the best way to find out is to talk it through, confidentially and at no cost, with one of our experienced and understanding specialist solicitors.

Generally speaking, there might be several good reasons for pursuing a claim.

• Following a delay in diagnosis, an individual might require specialist treatment, ongoing medication, or specific aids and equipment. The exact nature of the injury, will often determine exactly what treatment requirements will be. Where liability for the delay has been admitted a claim, even in the early interim stages, can help meet these additional costs.
• People who are undergoing cancer treatment often require care and assistance with their day to day living. This can carry on even after they have been cleared of cancer, especially in cervical cancer cases where there can be longstanding after-effects from the treatment. A successful legal claim will allow for a sum of money to compensate the carer for the care and assistance provided to date, and may provide for such future care as is necessary.
• Many people often find themselves having to reduce their working hours, either temporarily during their treatment period, or permanently if there are ongoing symptoms. We can help recover lost earnings to reduce worry about financial hardship.
• In cases where cervical cancer results in a fatality, bereaved families may suffer extreme hardship from the loss of their former loved one’s income. Even if the deceased mother didn't work, her loss will be greatly felt by her dependant family. Whilst nothing can adequately replace the loss of a mother or wife, compensation to help with household services can help keep family life running at this difficult time.

If you or a family member have suffered serious injury as a result of delayed diagnosis of cancer call our specialist medical negligence solicitors on 0800 029 4804 or email mednegclaims@boyesturner.com.

A professional deputy is a practising solicitor with several years of experience in acting for vulnerable clients. They manage the property and affairs of both adults and children who are deemed to be mentally incapable of making their own financial decisions. With children, it is on the basis that they would not be considered to have sufficient mental capacity to manage their finances by the age of 18 and it is likely that they would have received a compensation award as a result of a medical negligence action.

A professional deputy will have a thorough understanding of the Mental Capacity Act 2005 and adhere to the deputyship standards issued by the Office of the Public Guardian (OPG) which can be found here.

They are appointed by the Court of Protection and can be a panel deputy (also known as a ‘Deputy of Last Resort’) or a solicitor of your own choice. Choice is crucial. It is essential that you work with the right person who takes time to listen to you and explain a solution to financial issues.

What does a professional deputy do?

We do not get involved in making financial decisions that a person can make themselves. For instance a person may be able to manage a modest amount of money without our involvement. However, generally we are involved in the routine day to day finances such as paying utilities and invoices for therapy, acting as an employer and paying carers, arranging the payment of tax and making sure you have enough money to meet your needs.

We also get involved in the purchase and sale of property as well as adapting it and working with a team of experts such as architects, surveyors, occupational therapists and VAT experts to ensure the best possible financial outcome.

As a professional deputy we will work alongside a financial adviser to ensure that your money is safely and securely invested but also accessible to meet your needs.

In respect to children and young adults under the age of 25 we are involved in ensuring that your Education and Healthcare Plan fully meets your need and provides you with the therapies that you are entitled to. In this respect we work alongside our education solicitors and the family to achieve the best outcome.

As you can see we take a broad and far reaching approach!

How are professional deputies supervised?

Professional deputies are supervised by the OPG which are the administrative arm of the Court of Protection. The deputy is expected to complete annual accounts as well as an estimate of their annual costs for the OPG to review. They are expected to always act in good faith and in the best interests of their client. The OPG can send a court visitor to discuss with the deputy what policies and procedures they have in place to protect their clients’ interests.

How do they charge?

The OPG have issued a leaflet on professional deputyship fees which can be found at here.

Professional deputyship hourly rates can be found here. These are set by the Government and have not changed since 2010. We operate under Reading rates, which are National Band 1 and considerably less expensive than London rates, making us extremely cost effective.

Each year a professional deputy can either accept “fixed costs” as set out here or ask for the Senior Court Costs Office (SCCO) to assess their costs. The SCCO will look at not only the hourly rate of the fee earner but also the time taken to complete that work to ensure that it is not only fair and reasonable but also proportionate to the value of the assets. We always prefer to have our costs assessed by an independent person.

Top 7 reasons why you should appoint a professional deputy

1. Peace of mind and knowing that someone with considerable experience will be managing the finances in a professional way so that the family can concentrate on care and welfare issues.
2. All legal fees are overseen independently by the SCCO but in particular the deputy will work with the family to keep costs as low as possible.
3. Professional deputies quite often have an extensive network of other contacts such as care managers, therapists, accountants and financial advisers so that the best team can be put in place to assist a client in a holistic way.
4. Professional deputies will be able to make savings in other areas that a lay deputy may not be aware of such as Council Tax reductions.
5. Professional deputies will have a working knowledge of other inter-related financial matters such as State Benefits, tax and VAT exemptions for equipment.
6. Professional deputies will adhere to the deputyship standards as set down by the OPG who also provide independent supervision.
7. A professional deputy will not only have a security bond in place which is a form of insurance protecting the financial assets of the person concerned but they will also have their own professional indemnity insurance.

Why us?

Clients sometimes worry that a Professional Deputy will “take over”. Boyes Turner’s professional deputies are very experienced and will work with a family to ensure that they always act in the client’s best interests. In any event, under Section 4 of the MCA 2005 when acting in best interests a deputy must take into account “if practical and appropriate” the views of ‘anyone engaged in caring for the person or interested in their welfare’. More often than not this will be the immediate family. A professional deputy will know this but it is helpful for families to be aware of this when instructing a solicitor for it gives them the assurance that they too have a voice when decisions are made on behalf of their loved one.

We are regularly appointed by the Court of Protection to act as a professional deputy for individuals who lack capacity. We have particular expertise in managing significant awards of compensation either through medical negligence or through an acquired brain injury but equally our experience means we are adept at managing the finances of people with dementia or other age related issues that affect capacity.

Each case is individual. We take the time to get to know our clients and their family first. We appreciate how stressful our client’s lives are and we will work with you to manage finances and support you in your decision making. Even though we concentrate on finances we never forget the human side to our work. It is not just about finances but also about mutual respect that leads to trust and confidence in what we do.