GP negligence news

 

Claims against GPs: a new scheme which may speed up the process

The NHS is changing the way in which it responds to negligence claims against GPs. From 1st April 2019, new claims against GPs and other providers of healthcare within GP surgeries will be handled and paid for by NHS Resolution, the same organisation that defends, resolves and pays for claims against hospital doctors and nurses in NHS Trusts. So, how will the new scheme affect doctors and their patients?

What is a GP?

GP stands for ‘General Practitioner’ – the local doctor who provides everyday medical advice and services to people who are registered with their practice or ‘GP surgery’. In the UK there are around 7,000 GP surgeries, with each surgery generally employing a mixture of permanent doctors (some of whom may be partners, others who are salaried) and locums who are employed on a temporary or flexible basis.

GPs now work in a wide range of different settings. They may be employed in a single practice or as part of a multi-site surgery, as part of a federation, or attached to hospitals. It is also possible for a GP to hold more than one NHS contract. Therefore, they can have additional positions outside of their main practice, such as in the armed forces, or in academic institutions.

Claims for medical negligence

It is estimated that in England there are over 300 million patient/GP consultations each year, leading NHS England to describe general practice as “the bedrock of the NHS”. Whilst patients are generally satisfied with the care provided by their GP, given the high numbers of patients that GPs see each year, it is not surprising to learn that the Medical Defence Union estimate that on average, a GP is sued once every 10 years in their professional career, or four times in their working life. Mistakes happen which can sometimes have serious consequences for the patient who is then entitled to claim compensation by bringing a claim.

What is indemnity cover?

Given the high probability of being sued at some point during their career, GPs need insurance in place to protect them. This ‘indemnity cover’ or insurance will cover their legal costs arising from a negligence claim and also any compensation due to the patient. Until recently, GP doctors have purchased this cover from various medical defence organisations, such as the Medical Protection Society (MPS) or the Medical Defence Union (MDU).

What is the Clinical Negligence Scheme for General Practice (CNSGP)?

A new government-backed scheme has now been introduced in England, known as the Clinical Negligence scheme for General Practice (CNSGP). It covers claims "arising from the care, diagnosis and treatment of a patient as part of the NHS in England following incidents which happen on or after 1 April 2019". Enrolment in the scheme is automatic and covers all GPs and staff providing primary medical services, including both salaried and locum GPs, nurses and other health professionals. The scheme is administered by NHS Resolution for the Department of Health and Social Care, in the same way that NHS Resolution handles claims against hospital doctors working in NHS trusts.

CNSGP currently applies only to claims for treatment from 1st April 2019, but the Department of Health and Social Care (DHSC) and the Medical Protection Society (MPS) are already discussing the terms of a possible similar scheme which would allow NHS Resolution to cover claims arising out of treatment which took place before 1st April 2019. 

What level of cover does the CNSGP provide?

Under the new scheme, indemnity is unlimited (i.e. payments out are not capped). There is also no excess to be paid and, if the claim falls within the scheme, GPs will not be at risk of having to meet part of the claim themselves.

What does the CNSGP not cover?

As with the indemnity offered by the defence organisations, the cover will remain discretionary. This means that NHS Resolution will have discretion as to which cases they will pay out for, and which they will defend. So, if a GP wants to settle a claim but NHS Resolution wants to fight it (for example on principle to discourage other similar claims, or to test how the courts will interpret the law in similar circumstances), NHS Resolution may override the GPs wishes and insist that the claim is defended. Alternatively, a GP who wishes to defend their claim, may not be able to do so if NHS Resolution believes the case should be settled.

There are also other limits to the cover. For instance, CNSGP will not cover:

  • Claims arising out of non-NHS work, e.g. private treatment;
  • Complaints where there is no likelihood of a claim arising;
  • General Medical Council (GMC) inquiries;
  • Care Quality Commission (CQC) investigation;
  • Representation at inquests;
  • Disciplinary proceedings against GPs or other members of staff;
  • A range of other legal issues.

GPs will have to keep up membership of a medical defence organisation to assist with these matters.

What are the advantages of the CNSGP scheme for GPs?

The main advantage to GPs is that it should save them time and money. They do not need to pay for this cover as it is automatic under their NHS contract. This will save them the increasingly high costs of annual idemnity cover subscriptions and the administrative work required to keep their claims cover in place. Future costs will now be paid for by NHS England and government. The Minister of State for Care has said that this will allow GPs to “focus on continuing to provide excellent care to patients, knowing they have comprehensive cover in place”.

Many GPs are disappointed that NHS Resolution will decide when a case should be settled or defended, as the new scheme will be discretionary. Some are concerned that they will not be able to protect their reputation if they are forced to admit liability for a mistake or settle (or may only be able to defend the claim at increased personal financial risk).

What are the advantages of the CNSGP scheme for the government?

By introducing this scheme, the government will be able to have more control and oversight of claims and the costs involved. They also hope to attract more doctors to the profession by providing automatic indemnity cover for GPs at greatly reduced cost.

What are the advantages of the CNSGP scheme for the patient?

The advantages to the patient are yet to be seen. However, at Boyes Turner we hope that from now on NHS Resolution will make the process of pursing a claim against a GP much smoother and settlements will be reached more quickly. For claims against GPs arising on or after 1st April 2019, it will no longer be necessary for us to track down the indemnity insurer and negotiations can potentially start sooner.

We are also hopeful that in cases of clear negligence where there are multiple GP defendants (for example, when the patient has seen different doctors within the GP surgery over a period of time, as is often the case), NHS Resolution will prioritise early resolution and settlement for the injured patient, with less time spent arguing over apportionment of blame between GP defendants, resulting in savings in time and costs.

If you have suffered serious injury as a result of negligent GP care and would like to find out more about bringing a claim, contact us by email at claimsadvice@boyesturner.com.

Awareness of the signs and symptoms of sepsis

According to The UK Sepsis Trust, every year 52,000 people in the UK die from Sepsis. Those that survive this aggressive infection/illness, can be left with very severe injuries and complications.

Boyes Turner solicitors are medical negligence specialists with experience dealing with cases relating to the diagnosis and treatment of sepsis. We have helped many clients and bereaved families who have been affected by life-changing or fatal sepsis obtain compensation for their injuries, including amputations.

Sepsis in the news

The signs and symptoms of sepsis have been regularly highlighted in the news and in social media in recent months and years.

A few years ago, the film Starfish (2016) brought the story of Tom Ray to the screen. Tom rapidly developed the infection and deteriorated over a day. The illness caused him to go into a coma. Although Tom recovered from the potentially life-threatening illness, as a result of it, he required quadruple amputations and facial amputations. Tom’s story highlighted the signs and symptoms of sepsis and the importance of acting quickly to treat it.

Earlier this year, Coronation Street’s Jack Webster developed sepsis after cutting his knee playing football. The storyline raised further awareness of the signs of sepsis in children.

Melissa Mead has campaigned to raise awareness of sepsis following the devastating loss of her 12 month old son, William, in December 2014. William developed sepsis following a chest infection. Melissa is an ambassador for The UK Sepsis Trust and was recently awarded an MBE for her campaign work.

The UK Sepsis Trust have recently announced their partnership with Iceland Foods Charitable Foundation. As part of this, in the future we will be seeing information about sepsis, and how to spot it, on the side of milk cartons sold in Iceland stores. Founder and CEO of The UK Sepsis Trust, Dr Ron Daniels BEM regularly highlights the signs and symptoms of sepsis in both adults and children on social media.

As sepsis claims specialists, the Boyes Turner team see first-hand the life-altering effects sepsis can have and what happens when there is a delay in treatment and we support the efforts of all who are raising awareness of the importance of recognising the signs early so that appropriate treatment can be given.

What are the signs and symptoms of sepsis in children?

Identifying the signs and symptoms in children can be difficult, particularly in young children who may not be able to talk and explain how they are feeling. It is important to be aware of the following signs:

  • fast breathing;
  • fitting or convulsions;
  • mottled, bluish or pale appearance;
  • a rash that does not fade when pressed;
  • lethargy/difficult to wake;
  • abnormally cold to touch.

In children under 5, it is also important to be aware if a child is not feeding, is vomiting repeatedly or has not passed urine or had a wet nappy for 12 hours.

What are the signs and symptoms of sepsis in adults?

The UK Sepsis Trust has provided the following guidance on the signs and symptoms of sepsis:

  • Slurred speech or confusion;
  • Extreme shivering or muscle pain;
  • Passing no urine (in a day);
  • Severe breathlessness;
  • It feels like you’re going to die;
  • Skin is mottled or discoloured.

Failure to recognise the signs of sepsis and provide appropriate and timely treatment can be fatal. If you have lost a loved one and have concerns that there may have been a delay in diagnosing and treating sepsis, we can discuss your concerns further and what may be achieved by pursuing a claim.

As solicitors who regularly work alongside families who have lost loved ones, we know that whilst bringing a legal claim cannot change what has happened, it may be a way to obtain information about the treatment the loved one received. And in certain cases, we can help with the inquest process. Where dependent family members have been left without a parent or spouse, compensation can be used to meet ongoing childcare costs, compensate for financial losses and help provide for the future of the family.

Delay in diagnosing spinal tumours - Do I have a claim?

Spinal injuries have a devastating effect on lives. At a distressing time, our specialist spinal injury lawyers can offer straightforward and clear advice and assistance. Our approach is to work with our client and their family as necessary to ensure maximum compensation to help rebuild their lives.

What is a spinal tumour?

There are a range of different tumours which can affect the spinal cord including meningiomas and schwannomas. There are also other tumours which can affect the bones around the spinal cord such as Ewing’s sarcoma.

Surgery to remove a spinal cord or spinal bone tumour is usually the first line of treatment but it may also necessary to have radiotherapy and/or chemotherapy depending on the type of tumour. We obtained a six figure sum in compensation for a 17 year old boy following a delay in diagnosis of a Ewings sarcoma tumour of the spine.

Do I have a claim?

Our spinal injury claim specialists have helped clients who have experienced delays in diagnosis of a spinal tumour, resulting in a delay in treatment of their cancer. Delays in treatment can occur as a result of misinterpreting scans or a failure to investigate the symptoms of spinal cord compression, as well as other reasons.

Early diagnosis and treatment is essential for spinal tumours. The longer a tumour is present and pressing on the nerves in the spine, the more extensive any neurological symptoms will be and it will become less likely that a person will make a good recovery. In some cases, earlier treatment of the cancer by even a few hours or days can make a difference to recovery.

Where someone has experienced a delay in diagnosis of a spinal tumour, it is necessary to establish what injuries have been caused as a result of a delay in diagnosis and treatment of their cancer.

Demonstrating the extent of the damage caused by a delay can be challenging. In cases involving spinal tumours, even with an earlier diagnosis and treatment, often surgery is necessary to relieve any pressure on the nerves in the spine. Different tumours also grow at different rates. If a tumour is slow growing, it could be present for some time before any symptoms become apparent and some nerve damage could have occurred before the point of any potentially negligent treatment.

How we can help

Spinal tumours press on the nerves in the spine and this can result in neurological symptoms. The symptoms can vary depending on where the tumour is on the spine and the period of delay. The symptoms can include altered sensation such as numbness and pins and needles in the arms and hands and legs and feet. Tumours affecting the lower part of the spine can cause bladder and bowel dysfunction.

Following treatment there is a significant period of readjustment and adaptation to ongoing symptoms such as mobility issues. Compensation can help to provide therapies during rehabilitation, private care and specialist aids and equipment which may include assistive technology.

Complications arising from the treatment of spinal tumours can also occur for non-negligent reasons. If you would like to discuss whether you have a potential claim for medical negligence, we can assist you with this and advise whether you may be entitled to compensation which could help with your rehabilitation and recovery.

What is Charcot foot?

Charcot foot is a serious, limb-threatening complication of diabetes in which the bones of the foot or ankle degenerate and become deformed, leading, if incorrectly treated, to disability and amputation.  

The condition arises from a combination of factors associated with diabetes. Diabetics with neuropathy (loss of sensation) have less feeling in their feet and may also have reduced muscle control and tissue damage. This affects their sense of balance and their walking gait and increases their risk of knocks, sprains and cuts, particularly to the soles of their feet. Diabetic neuropathy also reduces their ability to perceive pain following a minor injury to their feet, which means they can remain unaware of an easily treatable injury, such as a blister, until it becomes infected and ulcerated. As they continue to walk and put pressure on the affected foot , this increases the damage to the bones and tissues and their risk of serious disability.

Charcot foot develops over time but is often triggered by a minor injury, such as a sprain or twisted ankle, which remains untreated because it goes unnoticed.

Who is at risk of Charcot foot and resulting disability?

Diabetics are at risk of developing Charcot foot.

Their risk is increased by:

  • poorly controlled diabetes
  • reduced sensation (neuropathy) in the feet
  • impaired vision reducing the ability to carry out daily visual foot checks
  • existing ulceration

How can I reduce my risk of developing Charcot foot?

The key to reducing the risk of Charcot foot and other serious diabetic complications is good management of the diabetes, including good foot care, regular check-ups and prompt medical treatment of any injury (however minor) which could lead to more serious infection.

If an individual with diabetes has reduced sensation in their feet they must carry out daily visual foot checks to ensure that they seek help as soon as possible after a minor injury occurs. If they have impaired eyesight they should ask someone else to check their feet for them.  

They should see their GP immediately if their feet have:

  • Minor cuts
  • Blisters
  • Redness, warmth and swelling
  • Discharge or fluid oozing from the foot into socks or tights
  • Or if they feel generally unwell

Treatment from the GP might include:

  • Antibiotics
  • Advice to rest the foot
  • A review of their diabetic medication and management
  • Referral to a foot-care specialist
  • A personal care plan

What are the symptoms and treatment of Charcot foot?

Charcot foot symptoms can include:

  • Redness or swelling of the foot or ankle
  • The skin feels warmer at the site of the injury
  • A feeling of deep aching
  • Deformation of the foot

If an individual has a suspected or diagnosed Charcot foot, they should be referred immediately to a multidisciplinary foot care team. Treatment will involve reducing the pressure (or weight-bearing) and immobilising the foot in a plaster cast to allow it to heal in the correct position. The condition will be monitored by x rays and at regular appointments with a podiatrist.

Sufferers of Charcot foot and tissue damage through reduced blood supply are at high risk of limb-threatening infection. At the first sign of a new ulceration, wound, swelling or discolouration, the patient should be referred within 24 hours to a multidisciplinary foot care team for urgent treatment of their infection. Any delay can lead to amputation.

Boyes Turner’s clinical negligence team are experienced in acting for amputee clients who are living with serious disability caused by negligent medical treatment of diabetic complications, including Charcot foot.

If you have suffered or are expecting to undergo an amputation and would like to find out whether you have a claim, you can speak in confidence to one of our skilled amputation team at mednegclaims@boyesturner.com.

Meningitis and brain injury - what can you expect?

Boyes Turner are supporting Meningitis Now’s #MayMayhem campaign in which the focus is on putting the fun into workplace fundraising to support the charity’s important work. 

Message behind the #maymayhem

Meanwhile, the message behind the mayhem is that meningitis kills. It also maims, leaving its survivors permanently disabled by limb loss and damage to the brain.

Whilst many of the physical effects of an acquired brain injury give rise to obvious disability, other consequences of the damage to the child’s developing brain can be more subtle, appearing and changing over time, making them harder to understand.

Emotional and behavioural after-effects of brain injury are often misinterpreted, particularly in a growing child or teenager. It is important for the child’s parents, wider family and school to recognise that the child may not be able to control or understand their own emotions and challenging behaviour, and to seek appropriate specialist help to support the child.

What emotional and behavioural changes can I expect following my child’s meningitis brain injury?

Meningitis Now lists some of the common difficulties that children may experience after a brain injury:

  • Tiredness leads to frustration and irritability when the child finds it difficult to return quickly to former activities or struggles to cope at school.
  • Mood swings, such as crying or laughing more quickly, temper tantrums, bedwetting and nightmares are common in the recovery period. Tiredness only makes them worse.
  • Anxiety, depression and loss of confidence come from realising that the illness has changed their life, worry about becoming ill again and coping with the long-term effects of their injury.
  • Apathy, lethargy, despondency and poor motivation can be misinterpreted as laziness, whereas they can arise from damage to the areas of the brain which affect arousal and initiation of activity. Without support, the child can slip beneath the radar at school, thereby failing to achieve their potential, and may become socially isolated.
  • Anger and aggression come from impairment of the brain’s ability to control behaviour and from frustration or struggling to cope emotionally with their injury.
  • Obsessive behaviour and lack of flexibility impede a child’s ability to adapt to different situations, including socially.
  • Disinhibition and sexually inappropriate behaviour in which the older child has no insight into the consequences of their behaviour. This exposes them to added risk of harm, causing friction with parents and teachers, and isolates them from friends who find them embarrassing.

These behaviours can arise from neurological damage to the brain impeding the child’s ability to regulate their own behaviour but also from the child’s psychological reaction to their illness and its impact on their life, their former activities, friendships and independence. Cognitive impairment makes it difficult for the child to communicate their frustration and everything is made worse by fatigue, anxiety and confusion. The child’s pre-injury personality and the dynamics and stresses within the family will also affect the child’s behaviour. Medication, such as anti-convulsants, also affect the child’s tiredness, behaviour and learning capability.

At Boyes Turner we understand that following meningitis or a brain injury the damage may go far beyond the physical. We work with educational, clinical and neuropsychologists, and child psychiatrists to assess the full effect of the injury and to secure the funding necessary to provide rehabilitation, therapy and ongoing support.

Our clinical negligence lawyers also work closely with our Special Educational Needs team to ensure that the child receives appropriate SEN assistance, whether that is in a mainstream or specialist school. By ensuring that we fully understand the child’s needs we are able to secure for them higher levels of compensation.

If you are caring for a child who has suffered a brain injury as a result of negligent medical care please contact by email on mednegclaims@boyesturner.com.

#MayMayhem 2018 - Support Meningitis Now this May

Here at Boyes Turner, #MayMayhem is underway as our brain injury lawyers ‘unleash the mayhem’ in support of leading meningitis charity, Meningitis Now.

Whilst our office antics will raise a smile, along with funds for Meningitis Now’s valuable work in the prevention and alleviation of suffering from meningitis, we’re deadly serious about this devastating disease.

What damage can meningitis cause?

Meningitis can kill within hours. Its survivors can be left with severe disability, including amputation and the serious after-effects of acquired brain injury. These will vary depending on which area of the brain has been affected by the disease.

Where incorrectly treated or late diagnosed meningitis has led to permanent brain damage in a child, it is important that the nature of the injury and the full extent of its impact is understood to ensure that the child is properly compensated for the lifelong pain, suffering and financial loss that they will incur. Different types of injury give rise to different problems in different areas of a child’s life, so we work hard to ensure that the child’s needs, now and continuing into adulthood, are properly assessed and recovered as part of their claim.

What physical symptoms can I expect my child to suffer after an acquired brain injury from meningitis?

Meningitis Now’s fact sheet on the physical effects of acquired brain injury refers to some of the physical problems faced by children after brain injury from meningitis:

  • Impaired movement and coordination

    Where meningitis injures the child’s brain in the neonatal period around or shortly after the time of birth, this can lead to cerebral palsy.

    Brain injury at any age can cause difficulty with movement and coordination, affecting posture, control over gross motor skills such as walking and running, or fine motor skills such as writing or manipulating objects with the hands.

    Muscle tone might be too tight or too loose, affecting the ability to hold the body in certain positions or sit upright, and can cause dizziness, problems with balance and coordinated movements.
  • Seizures (fits) and epilepsy

    Seizures are both a sign of meningitis and an after effect of brain injury.
  • Headaches and fatigue

    Headaches and extreme tiredness are common effects of acquired brain injury, but can also be caused by anti-epileptic medication. They can also affect the child’s behaviour and ability to function at home and at school.
  • Hydrocephalus

    Hydrocephalus is a build-up of cerebro-spinal fluid on the brain when the normal flow of fluid around the brain and spinal cord is restricted. The additional pressure on the brain is sometimes alleviated by  surgical insertion of a shunt to help the fluid drain into another part of the body, such as the abdomen.
  • Incontinence

    Impaired control of bowel and bladder function can follow severe brain injury.

The physical disability arising from a brain injury affects every aspect of the life of the sufferer who may need lifelong assistance with mobility and independence, personal care, education, accessibility and adapted accommodation and will suffer financial losses from their inability (or reduced ability) to work.

Boyes Turner’s specialist brain injury solicitors work with experts in a wide range of disciplines including neurology and paediatrics, occupational therapy and physiotherapy, disabled housing and nursing care to assess our clients’ needs. Our expertise enables us to recover top level damages awards to meet their lifelong needs for therapies, equipment, accommodation, education and care.

If you are caring for a child with serious disability arising from negligent medical care of meningitis please contact us by email at mednegclaims@boyesturner.com.

Meningitis in babies - new warnings from latest research

A new research study into the characteristics of bacterial meningitis in babies below the age of three months has identified potentially dangerous flaws in the way meningitis is currently diagnosed.  

The Meningitis Research Foundation, which funded the St George’s Hospital research team study, Clinical Characteristics and Risk Factors for Poor Outcome in Infants Less Than 90 Days of Age with Bacterial Meningitis in the United Kingdom and Ireland, has warned that doctors relying on the classic sign of fever to trigger further medical investigation may be missing the opportunity to diagnose meningitis in this exceptionally high risk age group.

Whilst babies under the age of three months are 70 times more likely to contract bacterial meningitis than adults, the study found that only 54% of the 263 meningitis babies studied were reported to have a temperature above 38°C. Fever was more commonly reported in older babies, whereas, in the  younger age group, the common but less specific symptoms, such as poor feeding, lethargy and irritability could more commonly be mistaken for mild illness.

Fever is not the only sign of meningitis but is regarded as a key feature. The NICE Guideline: Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management (at paragraph 1.1.1) warns that fever is ‘not always present, particularly in neonates’. Newborn babies (also known as neonates) are the highest risk age group for meningitis.

The study found that other specific features of meningitis, such as bulging fontanelle (the area on top of the head where the baby’s skull bones have not yet fused), seizures, coma and neck stiffness were far less common in infants under three months. Seizures were reported in 28%, bulging fontanelle in 22%, coma in 6%, and neck stiffness in only 3%.

The incidence of bacterial meningitis in babies hasn’t changed since the 1980s. Early diagnosis and rapid treatment remain the key to avoiding the devastating consequences of this deadly disease.

Fever can no longer be relied upon as a reliable main symptom of meningitis in babies under three months old. To assist in recognition and diagnosis, The Meningitis Research Foundation have now updated their symptoms information for parents. The charity has also created a teaching package for clinicians, reflecting the findings of the recent research.

As specialists in clinical negligence claims of the utmost severity, Boyes Turner’s meningitis experts have acted for many children and adults who have suffered permanent brain damage, severe disability and amputation arising from delayed diagnosis and treatment of meningitis.

We support the efforts of charities such as the Meningitis Research Foundation and Meningitis Now and the breakthroughs in awareness and positive change that arise from studies such as this. We now look forward to seeing this awareness reflected in changes to guidelines and clinical practice in the hope that fewer lives will be affected by this devastating disease.

If you are caring for a child with serious disability arising from negligent medical care of meningitis please contact us on 0118 952 7201 or email us on mednegclaims@boyesturner.com.

 

How to end a deputyship

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.

60 seconds with... Sita Soni shares her experience in running cervical cancer clinical negligence cases

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 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.

Vascular Surgery - the latest report from Getting It Right First Time (GIRFT)

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.

 

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