GP negligence news

 

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 us on 0118 952 7219 or email us 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 on 0118 952 7219 or email us on 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 7219 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 or phone 0118 952 7219.

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 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.

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.

 

60 seconds with a medical negligence lawyer - Julie Marsh

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.

Wanted: Leaders for a TB-free world. Together we can end TB

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.

Brighter Future Partner - a year on

Boyes Turner has been proud to support Meningitis Now as a Brighter Future Partner over the last 12 months. The charity is dedicated to fighting meningitis in the UK, supporting the families of those affected and funding vital research into this disease.

Over the past year we have enjoyed finding different ways to raise money to support Meningitis Now’s work, whilst raising awareness of the signs and symptoms of meningitis.

Our first event, in September last year, was the Toddle Waddle  – a sponsored walk for toddlers in Forbury Gardens in Reading.  It was a great success and raised over £700 for the charity and a reminder that these very young members of society are most at risk from the infection. It was great to see so many taking part.

As Christmas approached, the Boyes Turner medical negligence team ran two Christmas wreath making evenings. After the first evening sold out, a second was added and everybody enjoyed making  traditional festive decorations. It was great to see everyone leave with something hand-made that (hopefully) would last the entire festive season.

Then in February of this year, we continued the craft theme, with a ‘Made with Love’ fundraising event for Valentines Day, at which people could make their own Valentines Day card, create Valentine bunting and decorate their own “love mugs”, amongst other crafts.

May Mayhem provided a week of events which included a mobile ice cream trolley touring the office for our staff, a party in the park sports event, a picture quiz and a raffle.  The most sought after prize was the chocolate bouquet!

Solicitor Julie Marsh said:

“We’ve had a fantastic year supporting Meningitis Now. We would like to thank the team of organisers and everybody who has taken part in the fundraising events.”

We appreciate the life changing impact of meningitis has on individuals and their families. Those who survive the condition may experience long term physical effects of sepsis including brain injury and amputation. If you are concerned about the medical care you or a family member has received and would like medical negligence advice please contact our team on 0800 029 4803 or email mednegclaims@boyesturner.com.

Getting it right first time

GIRFT (Getting It Right First Time) has recently published its National Speciality Report into General Surgery, one of a series of 34 clinical speciality audits which will be carried out over the next two years. 

The report forms part of the GIRFT Programme set up by Professor Tim Briggs, National Director of Clinical Quality and Efficiency at NHS Improvement and Consultant Orthopaedic Surgeon at the Royal National Orthopaedic Hospital NHS Trust. The GIRFT Programme arose after Professor Briggs decided to take action to investigate and “fix many of the issues” that his colleagues in orthopaedics experienced, to ensure better care and outcomes for NHS patients. So, in 2012, Professor Briggs carried out his own review of orthopaedic surgery. His small team of specialists undertook a pilot audit, examining NHS data from a variety of sources, visiting over 200 trusts and meeting with over 2000 surgeons and their staff. In peer-to-peer conversation they reviewed their data, discussing and trying to understand the variation in orthopaedic patient outcomes, procurement costs and litigation rates between trusts, sharing best practice and working together to design workable solutions.

His pilot report, named Getting It Right First Time, highlighted the impact of variations in practice. For example, some hospitals had individual surgeons performing very small numbers of complex surgical procedures each year, a practice which renders the procedure less safe in that surgeon’s hands and more costly to the NHS in terms of equipment costs and claims. Some trusts had out of hours MRI scanning provision for emergency conditions, such as cauda equina but others didn’t.

Other expensive variations included infection rates (which ranged from 0.2% to 4.5%, with one hospital’s as high as 15%). Average litigation costs per patient treated also varied amongst units.  Another issue arose from differences in procurement costs, with individual surgeons’ preferences and manufacturers’ sales promotions leading to a growing trend for exponentially more expensive hip replacement joints, to quote one example, whereas evidence suggested that patients had better outcomes, reduced complications and readmission rates with the cheaper procedure.

In short, Professor Briggs’ orthopaedic pilot demonstrated that a frontline clinician-led, shoulder-to-shoulder peer support programme which analysed variations in practice and worked closely with clinicians within the trusts to share best practice and develop locally workable solutions, not only improved patient safety, patient outcomes, but also improved morale and reduced cost.

GIRFT won the approval of the Department of Health and is now overseen by NHS Improvement, with support from the Royal Colleges, NICE and other professional bodies. Led by “Clinical Leads”, who are all respected, frontline clinicians and experts in their particular specialism, GIRFT is now being rolled out over 34 clinical specialties, with reports into vascular surgery, cranial neurosurgery, spinal surgery, cardiothoracic surgery and obstetrics and gynaecology amongst those expected during 2017 and 2018.

Aims of the GIRFT Programme include:

  • Improved patient outcomes
  • Improved patient experience
  • Improved patient safety
  • Reduced complications and readmissions
  • Reduced length of hospital stay
  • Reduced litigation claims and costs
  • Reduced procurement costs (equipment)
  • Re-empowered clinicians and increased morale
  • Increased workforce productivity and reduced locum costs
  • Improvement in NHS trust balance sheets
  • Savings in taxpayers’ money

The GIRFT Programme includes the following stages:

  • A national report on each clinical area
  • A national report on litigation
  • A national report on clinically driven effective hospital management
  • A report and model approach to procurement
  • A GIRFT Implementation Plan for each NHS Trust
  • Hubs to be set up with Clinical and Project Delivery Leads to disseminate best practice and support NHS trusts with implementation and delivery. Additional resources will be provided for trusts requiring intensive support.

Recommended GIRFT changes will work on individual and team levels to apply best clinical practice and reduce unwarranted variation. At trust and national level, GIRFT will involve tactical and strategic changes to service provision (such as, ensuring that complex operations are performed in centres of excellence by experienced surgeons). At national level, GIRFT will work with Royal Colleges, NICE and other national professional associations, NHS England and NHS Improvement and NHS bodies, such as the Care Quality Commission and National Clinical Audit Programme, to provide a streamlined and complementary approach. Work will continue after initial implementation to ensure that the changes and benefits are sustained.

Professor Briggs emphasises that the success of Getting It Right First Time depends upon the embodiment of an ethos of shoulder-to-shoulder, peer-to-peer, clinical review in which clinicians are able to meet, talk through their challenges and review their data in a non-confrontational way.  He says that top-down managerial pressure on clinicians to change their practices doesn’t work and reduces morale. In a GIRFT, shoulder-to-shoulder, peer-to-peer non-confrontational environment, he says solutions become obvious.

Will it work? The indications to date are encouraging. Professor Briggs’ pilot GIRFT programme in orthopaedic surgery cost only £200,000 and has helped save over £50 million in two years, with a reduction in litigation claims and costs from £215 million to £138 million.

At Boyes Turner we welcome any initiative which will bring about genuine improvements in patient care, outcomes and experience. Here, we see another heartening example of top level medical professionals taking fearless action to face up to what’s really going wrong and working together to restore all that’s good about the NHS for patients, clinicians and taxpayers alike.

If you are disabled as a result of medical negligence please call our specialist medical negligence solicitors on 0118 952 7219 or email mednegclaims@boyesturner.com.

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