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Patient Safety Fears after GP Surgery Limits Patient Access

In a message to patients on 22 June 2022, Donnington Medical Practice in Telford has indicated that they are now only prioritising ‘urgent’ assistance for patients due to staffing issues.

This message lacks any meaningful detail and raises significant concerns as to the meaning of ‘urgency’ in this context. In particular, there is no guidance as to:

  • What constitutes ‘urgent’ medical assistance?
  • Where should patients go in the first instance?
  • How do patients know what is "urgent" and what is not?
  • How does this fit in with ‘urgent’ assistance that requires urgent hospital treatment?
  • Are patients better off seeking assistance at A&E or elsewhere?
  • How patients are to obtain prescriptions, test results and medications?

Laura Weir, an associate solicitor with Shrewsbury based law firm, Lanyon Bowdler, said: "This message may have unintended and potentially devastating consequences for patients and their families. The worrying lack of detail will likely discourage patients from seeking help who unknowingly require urgent medical assistance. Additionally, this shift in priority will likely exacerbate the current backlog of appointments, creating even further delays for patients who are already in dire need of medical treatment."

Donnington Medical Practice has not provided any further guidance or criteria in relation to this notice, and so the matter of ‘urgency’ remains unclear.

Nottingham Maternity Review – Donna Ockenden Takeover

The Nottingham Maternity Unit was rated as inadequate by the Care Quality Commission (CQC) in 2020 and a review, similar to that completed by Donna Ockenden into the Shrewsbury and Telford Hospital Trust (SaTH), began. The review relates directly to the Nottingham University Hospital (NUH) Trust after repeated examples of poor care were uncovered along with failures to investigate.

The CQC issued a warning notice in March 2022 highlighting specific concerns over triage services and increased stillbirths. Nineteen serious incidents were reported by maternity staff between March 2021 and February 2022, as well as five current Healthcare Safety Investigation Branch investigations. The CQC warning was issued having identified that staff were not always carrying out observations to make sure patients’ conditions were not deteriorating, and that triage wait times were too long.

Families involved in the review previously sought the input of Donna Ockenden in the Nottingham review due to a lack of confidence in the clinical team involved, the extremely slow pace of the review and the increasing numbers of families coming forward. The original remit was too narrow and considered not independent enough.

An interim report was published in April 2022, which highlighted that maternity services nationally were ‘under immense scrutiny’, in light of reports such as that conducted by Ockenden into SaTH. Evidence of ‘bullying behaviour’ had been uncovered with some staff displaying ‘unacceptable behaviours such as being rude and abrasive’. Sharon Wallis, director of the midwifery unit at NUH said “our teams are working hard to make the necessary improvements, but recognise we have more to do and are absolutely determined to speed up the pace of change and deliver quality services”.

NHS England have now confirmed that Donna Ockenden will chair a new team with new terms of reference into the review of the maternity services at NUH. Sir David Sloman, Chief Operating Officer for NHS England has said he has “taken on board various views” those concerned with the original review team have shared. Ockenden will develop terms, which reflect both the need to drive urgent improvements to local maternity care and the need to deliver actionable recommendations, which can be implemented as quickly as possible. No timescale has yet been confirmed however.

This announcement is no doubt welcomed by those families involved and will hopefully result in a robust review. This change in leadership comes as a result of the families campaigning for Donna Ockenden’s involvement, and some even publishing personal details of their cases online in a desperate bid to be heard by those in charge.

Donna Ockenden taking over as chair of the review offers hope that the failings at NUH, specifically the maternity unit, will be uncovered and hopefully encourage ongoing and future care to be improved. She has commented that her first priority is to listen to those families affected and notes that the CQC safety warning, and the stories shared already, indicates ‘something that is very, very wrong at the trust’.

Lanyon Bowdler are supporting hundreds of families under Donna Ockenden’s review into the maternity care at SaTH. If you or your family have been affected by poor maternity care either under SaTH or Nottingham, please speak to a member of our specialist team.

West Midlands Ambulance Service Faces ‘Titanic’ Collapse

We are all taught from a very young age that if it’s a genuine emergency, where someone is seriously injured or ill, and their life is at risk, we should call 999 and the ambulance service will be there to help. However, West Midlands Ambulance Service (WMAS) is now at terrible risk of collapse.

WMAS Director, Mark Docherty, has warned that by 17 August 2022, the service will fail. They are currently facing a ‘catastrophic situation’ of long hospital handovers and delayed response times which is undoubtedly putting lives at risk. Mr Docherty has warned that patients are dying needlessly everyday due to the strain on the service.

In an interview with the Health Service Journal, Mr Docherty raised his concerns over the potential ‘Titanic moment’ collapse of WMAS and called for NHS England and the Care Quality Commission (CQC) to step in and control the concerning situation.

A major concern is the that some patients have waited in the back of an ambulance for 24 hours before being admitted to hospital, and that serious incidents have quadrupled in the past year - largely as a result of these severe handover delays. This is a national problem and NHS data has shown that in March 2022, ambulance trusts nationwide had slow response times to even the most urgent of incidents.

Mr Docherty says the NHS England officials have downplayed the problem of delayed discharge, and he has questioned why the CQC have issued improvement notices about hospital corridor care, but not the ambulance handover delays when patients are dying every day due to avoidable delays. The CQC have commented that the impact of the escalating pressure on the NHS is severe and the long delays for patients are unacceptable.

Over 100 serious incidents have been recorded at the West Midlands Ambulance Service relating to patient deaths, resulting from the service being unable to respond as the ambulances were held outside hospitals. There have been a number of reports of Shropshire patients waiting extreme periods of time for hospital beds, and repeated anger over death’s occurring as a result of the ambulance delays.

Mr Doherty predicts that WMAS will collapse by 17 August 2022, stating this is when a third of the resources will be lost to delays - meaning that ambulances simply will not be able to respond to emergency calls. The risk level was rated at its highest level ever in October 2021, and the situation has failed to improve since. In April 2022, there were 17,795 hours lost due to handover delays of over 30 minutes. By June, this had risen to over 2,100 hours which is the highest number ever experienced by WMAS, with the worst delay involving a crew waiting more than 25 hours at the Royal Shrewsbury Hospital.

NHS England has said £150 million has been allocated to tackling this issue, but is this just a tiny sticking plaster on a massive gaping wound? Is it too late for the service to be saved? Will other ambulance services nationwide face the same fate?

With Mr Docherty stating that this is the biggest problem facing the NHS right now, the question remains: how much worse can it get and what happens if this collapse does in fact happen?

Families of Nottingham Maternity Review call for Donna Ockenden to Takeover Investigation

The Donna Ockenden Review reported in March 2022 found repeated failures at the Shrewsbury and Telford Hospital Trust (SaTH) spanning over a 20 year period whereby both babies and mothers died or were left seriously disabled. The widespread media attention of this review has incited families cared for by the Nottingham University Hospital (NUH) NHS Trust, including Queens Medical and City Hospital, to ask for Donna Ockenden’s input into an ongoing review into the Nottingham Maternity Unit.

A review similar to that completed by Donna Ockenden is in progress in Nottingham relating to the failings at the NUH Trust after dozens of babies died or suffered life-altering injuries. However, families have complained about the lack of progress being made with the investigation, saying that the review is “moving with the viscosity of treacle".

The Nottingham Maternity Unit was rated as inadequate by the Care Quality Commission (CQC) in 2020 when an inspection concluded that there were serious concerns and that staff did not always understand how to keep women and babies safe. The inspectors warned of unsafe staffing levels and patient safety incidents potentially being wrongfully downgraded i.e. incidents were not being investigated properly and people were therefore put at risk of harm as lessons were not being learnt.

A re-inspection in March 2022 resulted in the CQC issuing a warning notice to the NUH Trust highlighting specific concerns over triage services and increases in still births. Investigations have found that at least 46 babies have suffered brain damage and 19 were stillborn between 2010 and 2020.

These findings are all too familiar to those families involved in the Ockenden SaTH Review which examined 1,486 cases between 2000 and 2019 and found at least 201 baby deaths with significant or major concerns over the care received.

The NUH maternity review is currently chaired by NHS Manager, Cathy Purt. However, families involved have questioned her experience in maternity services, as well as of running an inquiry of this magnitude. It has been reported that 84 families were originally involved in this review and this has since increased to 461 following publication of the Ockenden Review.

The NUH maternity review has been ongoing for the past 6 months and is due to be completed by 30 November 2022. However, only 3 clinical leads are involved compared to the 76 clinicians employed in the Ockenden Review. The families are concerned that the review team are unprepared and lack experienced leadership to handle such a large and vitally important review.

Families involved in the NUH Trust review have contacted the Health Secretary Sajid Javid directly raising their concerns and have requested for Donna Ockenden to take over the investigation. Donna Ockenden has since responded to the families directly and noted that she is deeply honoured by their request but any involvement on her part would be subject to approval from the Health Secretary.

As nationally recognised clinical negligence solicitors, we at Lanyon Bowdler are representing a number of families relating directly to the Ockenden Review, and it is hoped that their patient journeys will lead to positive changes and improvements at SaTH. A public enquiry into the NUH Trust, similar to that of the SaTH Ockenden report, is important to ensure that those families affected are provided with support and compassion to come forward and share their experiences, and thereafter highlight and improve upon any identified failings in maternity care.

World Health Day

7 April marks World Health Day which is celebrated all over the world to commemorate the anniversary of the founding of the World Health Organization (WHO) in Geneva in 1948.

The WHO's constitution states that its objective "is the attainment by all people of the highest possible level of health".

Each World Health Day, a theme is chosen that highlights an area of priority concern for WHO and this year the theme is “Our Planet, Our Health”. WHO says: “In the midst of a pandemic, a polluted planet, increasing diseases like cancer, asthma, heart disease, on World Health Day 2022, WHO will focus global attention on urgent actions needed to keep humans and the planet healthy and foster a movement to create societies focused on well-being”.

WHO estimates that more than 13 million deaths around the world each year are due to avoidable environmental causes. This includes the climate crisis which is the single biggest health threat facing humanity. The climate crisis is also a health crisis.

WHO along with the National Institute for Health and Care Excellence (NICE) create evidence based clinical guidelines, which provide the benchmark for best practice in healthcare. WHO surgical safety checklist is in current use worldwide in the effort to improve patient safety.

But what happens when the guidelines are not followed? If for example, a patient approaches their GP with symptoms that are suspicious of an illness or disease and the recommended guidelines for referral are not made, then there could be a delay in the diagnosis and treatment of that disease which is likely to give a poorer outcome for the patient.

If you think that you or someone you know has had a delay in their diagnosis or treatment then get in touch with a member of our team.

Donna Ockenden: ‘The Independent Review of Maternity Services at The Shrewsbury and Telford Hospital NHS Trust’

Wednesday 30 March 2022 marks the publication of Donna Ockenden’s final independent review into maternity services at The Shrewsbury and Telford Hospital NHS Trust. The long-awaited report follows on from the first report, ‘Emerging Findings and Recommendations from the Independent Review of Maternity Services at The Shrewsbury and Telford Hospital NHS Trust’ which was published in December 2020.

The first report observed important emerging themes that concerns were not appropriately escalated, leading to a direct impact on the safety and quality of care provided to women and their babies. The aim of the first report was to focus on immediate improvements for the Trust and the wider maternity system across England.

The final report which was published today has reviewed the maternity care received by 1,486 different families, involving 1,592 clinical incidents. Cases span from as early as 1973, with the latest in 2020. As such, it is the largest ever number of clinical reviews conducted as part of an inquiry relating to a single service in the history of the NHS.

The report highlights woefully poor practice over a period of decades, to include a reluctance to carry out caesarean sections, a failure to train staff properly to read CTG (heart monitoring) traces; inadequate team working, a refusal to follow national guidelines, an inability to learn from mistakes and a culture of cover-up. It has been identified that there are 60 areas where improvements could be made at The Shrewsbury and Telford Hospital NHS Trust.

Harrowingly, the report identifies 201 cases of still birth and neonatal deaths that could have been avoided if better care had been provided and 9 avoidable maternal deaths. Other babies were starved of oxygen and left with life-changing disabilities. It was found that false reassurances were given to families about the maternity services despite repeated concerns being raised.

Within the report, Donna Ockenden addresses the Secretary of State for Health and Social Care and states that the review is about an NHS maternity service that failed – “it failed to investigate, failed to learn and failed to improve and therefore often failed to safeguard mothers and their babies at one of the most important times in their lives”.

Whilst the report says the review team are encouraged by staff feedback that following the publication of the first report in December 2020 there does seem to have been a recent improvement in maternity services at the Trust, even now early in 2022 there remains concern that NHS maternity services are still failing to adequately address and learn lessons from serious maternity events.

Commenting on today’s publication, the Birth Trauma Association’s CEO, Dr Kim Thomas, said:

“The Ockenden’s findings are so shocking that they must provide an impetus for change. The lives of babies and mothers have been lost as a result of neglectful care over a period of decades. The fact that it has taken this long to investigate is in itself highly worrying. It is now time for an overhaul of maternity care that priorities the safety and wellbeing of mothers and babies”.

We have profound sympathy for all of the families who have suffered indescribable loss and harm as a result of maternity failings at The Shrewsbury and Telford Hospital NHS Trust and we hope that this report will herald the improvements in maternity care that they have been asking for.

NHS England Abandons Targets for ‘Normal Births’

Maternity units throughout England have been instructed to stop using targets aimed at limiting the number of caesarean sections in the bid to pursue normal births, over fears that mothers and babies have been put at risk by using total caesarean rates as a measure of performance management.

In a letter, Jaqueline Dunkley-Bent NHS England’s Chief Midwife, and Dr Matthew Jolly, the National Clinical Director for Maternity, raised concerns that ’the potential for [maternity] services to pursue targets may be clinically inappropriate and unsafe in individual cases’.

For several years, medical bodies have been calling for the targets to be scrapped, and following the announcement these bodies have now welcomed the changes. Last July, a Commons Heath and Social Care Committee Report said it was ‘deeply concerning‘ that maternity services have been penalised for having high rates of caesarean section in the past. The Royal College of Obstetricians and Gynaecologists (RCOG) have welcomed the change, with Dr Jo Mountfield Vice President saying ‘the targets carry certain benefits and risks which should be discussed with women as they choose how they wish to give birth. Women and people giving birth should feel supported and their choices should be respected’.

The Royal College of Midwives (RCM) formally abandoned its normal birth campaign in 2017. Responding to the change of policy, the RCM’s chief executive, Gill Walton, said that decisions about clinical care should be made in the best interests of the woman and the baby ‘and not because of an arbitrary target’.

A caesarean section is when a baby is delivered through a surgical cut into the abdomen and womb. They are carried out for a number of reasons and it can be a planned or emergency procedure.

A “normal delivery” is one that refers to childbirth through the vagina.

The National Institute for Health and Care Excellence (NICE) have provided new guidance which suggest that maternity staff should treat cases on an individual basis, rather than following the aim to promote as many natural births as possible.

Currently around one in four babies are born by caesarean section in the UK but there is some variability between hospitals and trusts nationally. Our local Shrewsbury and Telford Hospital NHS Trust (SaTH) had among the highest normal delivery rates in England between 2010 and 2018.

There has been some concern that the pursuit of normal deliveries may have contributed to some instances of poor maternity care, including at SaTH where the deaths of a number of mothers and babies are being investigated by Donna Ockenden, the Chair of the Independent Maternity Review at SaTH. Publication of the second part of the Independent Maternity Review is currently scheduled to take place no later than 24 March 2022.

Listen to our podcast about the concerns at SaTH, via this link.

Here at Lanyon Bowdler our solicitors have been involved in a number of cases that concern labour and delivery method decisions in maternity care.

If you have concerns about the maternity advice and care you have received, please get in touch with our team who will be able to assist you sensitively.

Retired Consultant speaks out about the Shrewsbury and Telford Hospitals NHS Trust maternity scandal

Ahead of the Panorama special this evening, a BBC News article published today provides an informative and emotive overview of the origin of this inquiry and the findings released thus far.

Born out of grief of their own tragic losses at the hands of the trust, Kayleigh Griffiths and Rhiannon Davies collated 23 cases comprising of still births, neonatal deaths, maternal deaths and child brain injury and approached Jeremy Hunt, the then Health Secretary. An inquiry was then launched in May 2017 with Donna Ockenden, a leading Midwife, appointed as lead.

One of the themes the inquiry has already identified following the publication of Ms Ockenden’s preliminary report in December 2020 is the failure to properly investigate after something went wrong. The trust either failed to investigate entirely or carried out their own investigation, outside of national guidance. As a consequence, fewer incidents were reported to NHS regulators, which inevitably impacted the opportunity to learn lessons and led to the same mistakes being made repeatedly.

As families were campaigning for an external review of the trust, Mr Bernie Bentick, Consultant Obstetrician and Gynaecologist was advocating for change inside the organisation. He is the first former staff member to speak openly about what was happening inside the trust.

He has revealed that he wrote to the senior management team several times voicing his concerns. During his interview with Panorama, Mr Bentick said:

"I believed that some of the ways they responded to problems were to try to preserve the reputation of the organisation rather than to do anything practical. They were prepared to make small, what they regarded as proportionate, changes to try to improve the situation. But I don't think they really understood the gravity of the cultural problems within the trust."

Mr Bentick advised that a gap developed between the management of the trust and the clinicians caused by the lack of good quality, trained managers who had as much professional accountability as the clinicians. He said:

"If the resources had been made available to employ adequate numbers, then the situation may have been profoundly different. I feel intense sorry and sadness for the families and I would hope that the NHS responds in a way that ensures that quality of care is at the forefront of what we provide in the NHS."

The full interview will feature as part of the Panorama special this evening, alongside an interview with our Head of Clinical Negligence and partner, Beth Heath. As we represent a large number of families involved in Ms Ockenden’s inquiry and beyond it is important to focus on implementing change and supporting the trust in doing this to avoid further unnecessary tragedy.

Podcast

You can also listen to Beth and Katherine Jones talk about the three regular themes, presented to them by families involved in the inquiry, via our podcast here.

If you have concerns regarding your maternity care, our experts are always here to listen. Please contact us by phone on 01743 280280 or email info@lblaw.co.uk.

Investigation Reveals 999 ‘Postcode Lottery’ of Pregnancy Care

An investigation has revealed that pregnant patients, calling 999 for help whilst waiting for an ambulance, are given different instructions by call handlers depending on their location.

A report, undertaken by the Healthcare Safety Investigation Branch (“HSIB”), was published on 17 February 2022 following an investigation to help improve patient safety, concerning advice given to pregnant patients waiting for an ambulance due to a maternal emergency.

The HSIB reviewed an incident whereby a pregnant patient telephoned 999 and was given advice by a non-clinical call handler. The mother subsequently suffered a placental abruption and lost a large amount of blood, and both she and the baby required a significant amount of care.

The HSIB investigation into that case identified aspects of the pre-arrival instructions, given by call handler, were not in line with maternity guidance. This created a risk of harm to both pregnant patients and their babies.

Sadly, the HSIB identified 15 further cases where similar concerns were identified, which prompted this national investigation.

The HSIB also discovered that there are two different triage systems being used by 999 operators in England, meaning two patients in different locations, with the same clinical emergency, would be provided with differing advice. The HSIB considered this created a ‘postcode lottery’ of care for pregnant women, which could have disastrous consequences for expectant mothers and their babies.

A number of safety recommendations were made by the HSIB, including guidance which should be developed for maternity emergencies in the non-visual, non-clinician-attended environment. A further recommendation noted that a regulatory mechanism should be identified to provide formal oversight of 999 maternity pre-arrival instructions for NHS provided care in England. It was also recommended that patient safety incident investigation standards should be developed to further support cross-boundary investigation.

If you have concerns about the maternity advice and care you have received, or any other type of treatment, please get in touch with our team who will be able to assist you sensitively.

National Heart Month – Calling Attention to the Warning Signs of Heart-related Conditions

While 14 February is earmarked for celebrating affairs of the heart, February is also National Heart Month, which aims to call attention to the warning signs of heart-related conditions which, according to the British Heart Foundation, one in two of us will experience in our lifetime. National Heart Month is an opportunity to arm ourselves with a greater awareness of circulatory disorders such as heart attacks, cardiac arrest, vascular dementia and heart disease, so that we can better prepare ourselves should we encounter these conditions in our lives.

Heart attacks
Heart attacks occur when the blood supply to the heart muscle is somehow cut off and is often caused by a blocked coronary artery. Heart attacks can starve the heart muscle of oxygen, which may leave it permanently damaged. Symptoms of heart attacks can include chest pain, the sensation of pain travelling to other parts of the body from the chest outwards (including your left arm, but note either or both arms, upper back and jaw can also be affected), shortness of breath, sweating and nausea.

Cardiac arrest
Cardiac arrest is when the heart suddenly stops pumping blood around the body. While blood is not moving around the body, the brain becomes starved of oxygen and may suffer damage as a result. This will often cause a person to collapse or become unconscious, very quickly become grey and stop breathing. Both heart attacks and cardiac arrest are medical emergencies and you should call 999 if you believe you or someone else is experiencing either.

Vascular dementia
Vascular dementia occurs when the blood vessels within the brain leak or become blocked, resulting in the loss of brain cells which cannot be reached. This condition causes problems with mental abilities such as concentration, communication and memory, it may also cause personality and mood changes as well as physical symptoms such as tremors or balancing difficulties. These symptoms can start suddenly or gradually, although they tend to worsen over time. There is currently no way to reverse the loss of brain cells prior to the diagnosis of vascular dementia.

Cardiovascular Disease (CVD)
This is an umbrella term encompassing an array of heart and circulatory disorders including strokes, coronary heart disease, which reduces or stops the flow of oxygenated blood to the heart and can lead to heart attacks, and vascular dementia. CVD is one of the primary causes of death and disability in the UK and some of the risk factors for developing CVD are high blood pressure, high cholesterol, and a family history of CVD.

Lanyon Bowdler acknowledges the difficulties and worry heart-related conditions can place on someone, and this is only worsened where there is a suggestion of substandard medical care, including warning signs being missed. If you believe yourself or a loved one has been affected by insufficient care regarding a circulatory disorder, our Clinical Negligence team are on hand to discuss this with you further.

For more information about the above conditions, please visit the links below:

Heart attacks:

https://www.bhf.org.uk/informationsupport/conditions/heart-attack/symptoms;

https://www.nhs.uk/conditions/heart-attack/;

Cardiac arrest:

https://heartresearch.org.uk/cardiac-arrest/;

https://www.bhf.org.uk/informationsupport/conditions/cardiac-arrest;

Vascular dementia:

https://www.alzheimers.org.uk/about-dementia/types-dementia/vascular-dementia;

https://www.hopkinsmedicine.org/health/conditions-and-diseases/dementia/vascular-dementia#:~:text=Vascular%20dementia%20is%20the%20second,blocked%20by%20a%20blood%

20clot;

https://www.nhs.uk/conditions/vascular-dementia/;

Cardiovascular disease:

https://www.nhs.uk/conditions/cardiovascular-disease/;

https://www.bhf.org.uk/informationsupport/conditions/cardiovascular-heart-disease.

“Disappointed and concerned” – The deficiencies in Vascular Services provided by Welsh Health Board

The Royal College of Surgeons of England have found that patients who received vascular service within Betsi Cadwaldr University Health Board (“the Health Board”) have suffered a substandard of care due to failings. Vascular services seek to provide diagnostics and treatments for the vascular system, ie the vessels that carry blood and lymph through the body. After significant changes to the way the Health Board provide the vascular services over recent years, The Royal College of Surgeons of England have released a “damning” report concerning the provision of care to their patients.

Background

In brief, the Health Board announced in January 2013 that all services for major and complex in-patient arterial surgery and emergency vascular surgery would be centralised onto a single site at Ysbyty Glad Clywd Hospital. As part of this transition, interim arrangements established two provision sites; one at Ysbyty Gwynedd Hospital and Wrexham Maelor Hospital. However, centralisation of provision vascular services was delayed due to renovations at Ysbyty Glad Clywd Hospital and an external invited service review in 2015 concluded that patients’ safety was being compromised with the provision of the two site model.

The review suggested that the Health Board should not delay the decision to centralise the provision of major and complex arterial surgery and emergency vascular surgery as part of delivering the vascular surgery service by an integrated network hub and spoke models at Ysbyty Gwynedd Hospital and Wrexham Maelor Hospital. This would be otherwise known as the integrated vascular network and its purpose was to improve early decision-making capability and access to diagnostics, allowing for early treatment.

In April 2019, complex vascular services were moved from Ysbyty Gwynedd Hospital and Wrexham Maelor Hospital to Ysbyty Glad Clywd Hospital, therefore implementing the integrated vascular network and centralisation as the review had encouraged. After patients and staff raised fears about the new service at Ysbyty Glad Clywd Hospital, the Health Board was requested in September 2020 to review its vascular services.

The Report

On 20 January 2022, The Royal College of Surgeons of England issued “Report on 44 clinical records relating to vascular surgery on behalf of Betsi Cadwaladr University Health Board” (https://bcuhb.nhs.wales/news/updates-and-developments/updates/vascular-services/vascular-services/clinical-vascular-report-january-2022-pdf/).

The review considered the clinical records and background of 44 patients.

In summary, the report identified concerns relating to the clinical records, whereby the majority of the records were illegible, disorganised and incomplete. The report also identified, in one shocking instance, a patient was offered an amputation that was considered to be inappropriate by the review team, due to the patient’s age and previous medical history/conditions. The review team suggested alternative treatment such as conservative or palliation care should have been considered by the Health Board before proceeding with the unnecessary and futile amputation. In another instance, a patient had been discharged following an amputation without a care plan and the patient’s wife had to ‘carry him to the toilet’ as a consequence of this.

Overall, the majority of the 44 clinical records did not document communications with the patients regarding their care and informed consent, including the risks and benefits to the treatment.

In its recommendations, the report suggested the Health Board reviewed the care of the patients that the review team were unable to determine the outcome of, in order to ensure it has met its ethical and legal obligations. It was also recommended that the Health Board should review the MDT and clinical pathway arrangements to those undergoing vascular surgery, to ensure that there is appropriate MDT input into the decision-making for every patient and this decision-making be documented. The consent-taking practices should also be reviewed within such services to ensure that patients are given appropriate information of risks, benefits and alternatives of treatment, and it is legibly documented.

The Executive Medical Director at Betsi Cadwaladr University Health Board, Dr Nick Lyons, responded to the report on 3 February 2022 stating “since I joined the Health Board, it has become very clear to me a significant amount of improvement work is needed to enable us to deliver the very best outcomes for our vascular patients across our North Wales network”. He also stated that he was “very concerned to note the review’s findings in relation to the quality and consistency of care provided – we must do better”.

Health Minister’s Response to RCS Report

Following the report being issued, Eluned Morgan, Minister for Health and Social Services for Wales, released her written statement on 3 February 2022 where she noted she was “disappointed and concerned” by the report. She stated, “the cases reviewed here involve real people and their families and there will be many others who may be worrying about the quality of the care they have received or are about to receive and whether this service is safe”.

The Minister proceeded to state that “For the sake of people in North Wales who need this service, and the staff working to provide this care, we must now do all we can to ensure the Health Board implements to properly, to make the pathway seamless and to improve outcomes”.

We at Lanyon Bowdler understand and appreciate our clients’ concerns when receiving healthcare services and treatment, in particular when there may be poor care provided to them. If you consider that you have been affected by substandard care, our team are happy to discuss your treatment with you and guide you through the process.

Will Artificial Intelligence Reduce Clinical Negligence?

Artificial Intelligence (“AI”) has long been tipped to transform our world, and will change the nature of employment roles as machines complement the human workforce. With partial automation of tasks, many job responsibilities will be reconfigured so that a human touch is no longer needed.

Recently, a fully-autonomous robot has successfully performed keyhole surgery on pigs – without the guiding hand of a human surgeon. Apparently, the robot surgeon produced “significantly better” results than its human counterparts. The surgery has been described as a “breakthrough” and is another step towards the day when fully autonomous surgery can be performed on human patients. (https://www.theguardian.com/technology/2022/jan/26/robot-successfully-performs-keyhole-surgery-on-pigs-without-human-help)

But does AI have the capability to reduce incidences of clinical negligence for the NHS, and will that mean less people being unnecessarily injured/dying in a hospital setting?

A quick overview of the law in relation to clinical negligence: to be able to successfully pursue a claim for clinical negligence, a person must clear two legal hurdles: firstly, the treatment complained of amounted to a “breach of duty” – that it was so poor that no reasonable body of medical opinion would have considered it to be reasonable or normal; and secondly that the breach of duty caused the person to suffer injury (“causation”).

Going back to the pig surgery, the Smart Tissue Autonomous Robot (STAR) carried out laparoscopic surgery to connect two ends of an intestine in four pigs. This process of connecting two ends of an intestine (“anastomosis”) is a highly technical and challenging procedure in gastrointestinal surgery, requiring a surgeon to apply sutures with a high degree of accuracy and consistency. Whilst anastomotic leaks can occur naturally or non-negligently, one misplaced stitch, or poor technique, can result in a leak that could lead to the patient suffering fatal complications. Thus, breaches of duty arising from anastomotic leaks are, sadly, quite commonplace.

In contrast, according to a paper published in Science Robotics, the STAR robot excelled in carrying out the robotic anastomosis, with the resultant suturing being better than anything a human surgeon could do.

On this basis, it is easy to see that there is the potential to revolutionise surgery, and for robots to reduce the incidences of harm caused by human errors and avoidable complications, such as those caused by a missed stich or an untoward hand tremor. This, naturally, is a good thing, and correspondingly would reduce claims being made against the NHS.

However, a word of caution: we have been here before.

AI has been touted as the saviour to the medical profession before. Back in February 2016, Google’s AI subsidiary, DeepMind, announced it was working with NHS Trusts to analyse patient data. The company intended to combine AI, machine learning with bulk medical data to develop models that could predict or diagnose acute kidney injury. However, issues around patient confidentiality meant that in 2017, DeepMind Health (later a division of Google Health) was found to have not complied with UK data protection laws, according to the UK Information Commissioner’s Office (https://www.cnbc.com/2017/07/03/google-deepmind-nhs-deal-health-data-illegal-ico-says.html).

Similarly, in February 2020, Google Health, the branch of Google focused on health-related research, clinical tools, and partnerships for health care services claimed that its’ AI models could “beat” humans when interpreting mammograms and detecting breast cancer. However, as studies have found, you can show the same early-stage lesions to a group of doctors and get completely different interpretations about whether the lesion is cancerous or not. Even if the doctors do agree as to what a lesion shows — and their diagnoses are actually correct — there’s no way of knowing whether that cancer will prove to be fatal. This leads to over-diagnosis, triggering a chain of painful medical interventions that can be costly and life-changing. In the case of breast cancer, it may lead to radiotherapy, chemotherapy, the removal of breast tissue (a lumpectomy), or the removal of one or both breasts entirely (a mastectomy). These aren’t decisions to be rushed, and ultimately may lead to treatments that, clinically, are not medically necessary and lead to an increase in claims for medical negligence being made. (As an aside, in August 2021, Google’s parent company, Alphabet, said it was shutting down its Google Health Division, so clearly all is not well in the land of AI (https://www.forbes.com/sites/johanmoreno/2021/08/21/google-dismantling-health-division/?sh=71316d9de401))

Clearly, there is tremendous potential for AI to help change the provision of care for patients for the better. But it is not a silver bullet or panacea to eradicate human error in the clinical decision making process or during the performance of surgery. It is not designed to remove humans from the equation. Instead, AI should be regarded as a tool which clinicians have at their disposal – just like a scalpel or stethoscope – to help them carry out their clinical duties effectively and, most of all, safely.

Therefore, it may be a little while yet before we see fully autonomous robot doctors roaming the halls of hospitals and GP surgeries across the country…

Cervical Cancer Awareness Month and Changes to Smear Tests: What does it mean?

January marks Cervical Cancer Awareness month of the purpose of which is to spread awareness of cervical health and educating individuals of risks or symptoms they should be aware of. According to Cancer Research, there were approximately 3,200 new cases of cervical cancer each year with 99.8% of estimated to have been preventable.

This year’s Cervical Cancer Awareness month has coincided with the recent announcement by the Welsh Government that women and people with a cervix will now receive their cervical screening every five years rather than every three years in Wales. The extension to the cervical screening interval was introduced on 1 January 2022. As a result, it has never been more important to discuss cervical cancer and the purpose of smear tests.

What is Cervical Cancer?

Cervical cancer is a cancer which is found anywhere in the opening between the vagina and the womb, otherwise known as the cervix. Nearly all cervical cancers are caused by an infection from certain types of ‘Human Papillomavirus’ (HPV) with one preventable measure of developing cervical cancer being to attend regular smear tests to screen for this virus and for abnormal cells.

There are more than 100 different types of HPV and only certain types will cause cervical cancer. One purpose of the smear test is to determine whether a high risk HPV is present within the cervix of an individual.

What is a ‘Smear Test’?

A smear test, otherwise known as cervical screening, is a procedure used to prevent cervical cancer. Women and people with a cervix aged between 25 to 64 are invited to attend for a screening and a sample of cells is taken from their cervix. The cells are then checked for high risk HPV, which can cause changes to the cells of the cervix and consequently develop into cancer.

In England, women and people with a cervix aged 25 to 49 are invited to attend their cervical screening every three years, whilst those aged 50 to 64 will be invited every five years.

In Wales from 1 January 2022, women and people with a cervix aged between 25 to 49 will be invited to attend their smear test in five years’ time following a smear test where HPV was not found. The process for those aged 50 to 64 remains unchanged.

The reason for this change is Public Health Wales indicated that recent evidence has shown that it was safe to extend this timeframe in individuals where HPV was not identified during their screening.

Petition

Following the announcement, a petition was launched to revert screenings every three years opposed to five years due to fears of further deaths from cervical cancer. This petition currently has over 900,000 signatures at time of writing.

Public Health Wales responded to the backlash following the announcement by acknowledging that they had not done enough to explain the reasons for the change to cervical screening. They stated that they are working to make the reasons for the change clearer, and to provide further information.

Cancer Research UK also confirmed that the change in cervical screenings was based on evidence and not related with cost-saving purposes.

What are the signs and symptoms of Cervical Cancer?

The signs and symptoms of cervical cancer include:

  • Vaginal bleeding that is unusual for you
  • Changes to your vaginal discharge
  • Pain during sexual intercourse
  • Pain in your lower abdomen, between your hip bones, or in your lower stomach

For further information, please visit the NHS website below.

Symptoms of cervical cancer - NHS (www.nhs.uk)

Treatment for Cervical Cancer

Treatment for cervical cancer will vary and depend upon where in the cervix the cancer is, its size or stage and whether it has spread to anywhere else.

Usually, treatment will include surgery such as a hysterectomy or a combination of chemotherapy and radiotherapy.

According to Cancer Research, more than 60% of individuals will survive their cancer for five or more years after diagnosis, with earlier diagnosis being key to survival rates.

At Lanyon Bowdler, we understand and appreciate the difficulty our clients have in coming to terms with a cancer diagnosis, particularly when there may be concerns in relation to the standard of care that they have received. If you consider that your care has been affected by a delay in diagnosis, our team is happy to discuss your treatment with you and guide you through the process.

Podcast

In the summer of 2020 Beth Heath and Katherine Jones recorded an episode of The Legal Lounge where they spoke about the delay in diagnosis on cancer using two fictitious but typical case studies, one relates to cervical cancer, you can listen here: https://apple.co/38Opw4Y

References:

Cervical cancer statistics | Cancer Research UK

Cancer: Cervical screening in Wales to be every five years - BBC News

Pre Action Protocol for the Resolution of Clinical Disputes

Last month the Civil Justice Council (CJC) produced an interim report on the review of “Pre-Action Protocols” and launched a consultation on the subject of PAP reform. The consultation closes on 24 December 2021.

What are Pre-Action Protocols?

Pre-Action Protocols (“PAPs”) were introduced in 1999 with the aim of encouraging effective management of potential claims before the commencement of court proceedings. Early settlement was encouraged, the idea being to resolve claims at an early stage without court proceedings being necessary, and at minimum cost.

The Clinical Negligence Protocol

The above review includes the Clinical Negligence Pre-Action Protocol, known as the “Pre Action Protocol for the Resolution of Clinical Disputes”. This protocol applies to all claims against hospitals, GPs, dentists and other healthcare providers. It sets out the procedure that parties are expected to follow before the issue of Court proceedings. In summary, it sets out a timetable for the exchange of relevant information, relevant to the dispute and how the parties should confirm their respective positions on that dispute.

One of the key parts of the protocol is for claimants to send a “Letter or Claim” to the defendant healthcare provider. This is a formal letter setting out initial details of the claimant’s case, including the alleged negligence and harm caused as a result. In accordance with the protocol, defendants are supposed to provide a full “Letter of Response” within four months of receipt of the Letter of Claim confirming whether liability is admitted or if denied, with reasons for that denial.

One of the issues in practice is that often defendants are not able to respond to a Letter of Claim within the four months deadline. This is often due to a number of factors, including delays in obtaining the independent medical evidence which is needed to advise on the care provided and alleged harm caused as a result.

Possibly the biggest advantage of the protocol is that there is the potential for a defendant to make admissions of fault at the Letter of Response stage, with claims then often being settled without the need and expense of Court proceedings.

However, there are issues with the protocol, which need to be addressed, some of which are identified in the CJC’s report. Some of these include the following:-

  • Delays with the Letter of Response - I have often experienced considerable delay with defendants providing a Letter of Response (even pre-pandemic). On occasion, when the defendant does provide a response, it often does not adequately respond to the allegations of fault, and further time is then spent trying to clarifying their position and the reasons for a denial of liability. This can be incredibly frustrating for claimants - the delay eats into the time period allowed before the deadline for starting Court proceedings, and delays provision of potential treatment and support that could help the injured claimant;
  • Failures to respond to a Letter of Notification - the protocol specifies that parties may send a “Letter of Notification” at an early stage to invite liability. This is less formal than a “Letter of Claim” and can be sent when there is strong evidence of negligence at an early stage. For example, there may have been an internal investigation carried out by the hospital trust that has identified failings in the care provided. The Letter of Notification is designed to invite early admissions and therefore, save time and costs. However, it is now more common to see defendants refusing to investigate and respond after receiving a Letter of Notification, preferring instead to wait for a for a Letter of Claim;
  • Disclosure of medical records - there are often delays in obtaining all records. Sometimes key records are missing following initial disclosure and a lot of time can be spent chasing providers for this information;
  • Sanction for non-compliance - the CJC report indicates a belief that the Courts are inconsistent when enforcing pre-action protocols and sanctions for non-compliance. The most likely sanction here would be a costs penalty. The inconsistent approach appears to be the most common complaint made during the CJC’s preliminary consultation.

Reform

The CJC’s interim report outlines a number of possible options to consider for all pre-action protocols. One of these includes a “good faith” obligation on the parties to resolve or narrow the dispute. Another is a requirement to produce a list of agreed issues and issues in dispute, as part of a formal “stocktake” before the commencement of court proceedings.

It will be interesting to see the outcome of the consultation. Major reform seems unlikely but hopefully any changes will adequately address the above issues and refocus minds as to the aims and objectives of the pre-action protocols, including early resolution of claims.

Useful link to report and consultation survey

https://www.judiciary.uk/announcements/civil-justice-council-launches-consultation-on-pre-action-protocols/

March with Midwives: Maternity Crisis

On Sunday 21 November 2021, midwives across the UK staged vigils in order to call on the Government to address the ‘crisis’ in maternity services.

Organisers of the demonstrations, March with Midwives, said: ‘It is clear that maternity services in the UK are in crisis. Giving birth in the UK, a high-income country, is becoming critically unsafe. This is unacceptable… This is a genuine national emergency which impacts every level of society.’ March with Midwives claim that 2021 has seen maternity services become unsafe for staff and users; as of July this year, 41% of all maternity services are rated inadequate or requires improvement for safety.

It is reported that many of the midwives attending the vigils conveyed the same message: they are understaffed and overworked. One campaigner who has worked in the profession for almost 20 years said that she often goes into work feeling worried about the number of women she will have to look after. Others considered that the shortage of midwifery staff means it is currently ‘critically unsafe’ to have a child in the UK.

Jon Skewes Executive Director for External Relations of the Royal College of Midwives (RCM), showed support for the vigils and pointed to a recent RCM survey which had found that 57% of midwives in the UK are considering leaving the profession. The concerning statistics showed that for every 30 newly qualified midwives, 29 of them will quit.

Worryingly, these are not new findings. In 2018, a total of 1997 midwives (16% of the RCM membership) took part in the UK Whelm Study. The results showed that an alarming number of the UK’s midwifery workforce was experiencing significant levels of emotional distress and work-related burnout. It is thought that the global pandemic has rapidly exacerbated these issues and it is feared that maternity services are now at breaking point.

Amongst those who also took to the streets were parents who consider that their pregnancy or labour was negatively affected by problems in the profession. Some parents reported bullying and coercion to ensure compliance, and it was considered that trauma, amongst both parents and midwives, is rife.

The Government has responded by saying that a £95 million recruitment drive is underway which aims to hire an additional 1,200 midwives. A Department for Health and Social Care spokesperson said: ‘We are committed to patient safety, eradicating avoidable harms and making the NHS the safest place in the world to give birth’.

Lanyon Bowdler’s award winning clinical negligence team has extensive experience of dealing with maternity and birth injury cases. If you have concerns about the maternity care you have received, our team are happy to discuss the matter with you and guide you through the process sensitively.

“Perfect Storm” of Delays in A&E and Ambulance Services Risk Lives

Patients’ lives are being put at risk due to a “perfect storm” of long waiting times in accident and emergency departments causing significant delays in ambulance handovers, with the situation showing no signs of improving.

There is concern that it is only a matter of time before patients suffer serious harm, or death, following reports that a 72-year-old man from Whitchurch, Shropshire was left waiting more than 10 hours for an ambulance (article here).

Long waiting times in emergency departments are becoming normal, with some patients spending days in A&E wards before they can be admitted into hospital. This then means that ambulances have to wait outside the doors of A&E departments for beds to become free before they can hand over sick patients for assessment and treatment. The sight of queues of ambulances outside of hospitals is now a worryingly common sight, and shows a system that is beginning to creak under immense pressure.

The situation is not isolated to one area of the country. NHS figures from September show that 5,025 patients waited for more than 12 hours to be admitted to hospital in England. That is only 1% of the 506,916 admitted via A&E, but it is more than 10 times as many as the 458 waiting more than 12 hours in September 2019 and nearly twice as many as the January peak of 2,847. Some hospital trusts are declaring major incidents as they have simply run out of space to treat patients.

In October this year, a patient in Cambridge died in the back of an ambulance whilst waiting outside an overwhelmed hospital A&E department (article here). In that case, the patient suffered a cardiac arrest while paramedics were waiting to hand her over to A&E staff and were forced to wait outside with other ambulances because the A&E unit was “extremely busy”.

Sadly, people do die in an ambulance on the way to hospital or at a scene of an incident. But no one should die in the back of an ambulance parked outside an emergency department waiting to be admitted for investigation and treatment. The situation is becoming desperate, and as the NHS faces another critical winter period whilst already under immense pressure from COVID and staffing issues, it is simply a matter of time before patients start to suffer real harm as a result.

For more information, please contact our clinical negligence team.

Delays in Cancer Referrals

Cancer is defined by the NHS as “a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs.” It is because of this uncontrollable growth and reproduction of cells that early detection and commencement of treatment for cancer have long been considered the most effective method of improving outcomes for patients. Screening services have therefore been developed to try to detect cancers at their earliest stages, eg, breast and prostate cancer, but unfortunately this is not available for all cancers. For many patients, the path to being diagnosed begins when they attend their GP with worrying symptoms, such as unplanned weight loss, tiredness or unexplained bleeding.

GPs follow clinical guidelines to determine whether to refer the patient for specialist secondary opinion. The National Institute for Health and Care Excellence (NICE) states that for urgent referrals, the wait to see secondary healthcare should be within two weeks of the GP seeing the patient, or 48 hours if very urgent. It is obvious why such guidance is in place - the earlier a cancer is diagnosed, the better the chances of successfully treating it.

In an ideal world, every patient who presented to their GP with potential cancer symptoms would immediately be referred within the recommended two week timeline, if not before. They would receive a rapid diagnosis and quickly begin receiving appropriate treatment.

Sadly, we do not live in an ideal world, but nevertheless it is worrying to read that patients attending their GPs with concerns about such symptoms are not being referred for urgent investigations quickly enough.

The Independent recently reported on research funded by Cancer Research UK, which found that six out of 10 patients in England were not being referred within the two-week recommended period. The impact of delays in diagnosis on prognosis was alarming - a four-week delay alone increased the risk of death by 10%. It was appreciated by the authors that GPs are in a difficult position, conscious of being too cautious and over-referring patients, which could cause oncological services to become overwhelmed. However, this caution should not prevent a necessary and mandatory referral.

GPs are also challenged by patients with vague or very complex symptoms not typical of cancer, or those with pre-existing illnesses, as well as delays caused as GPs await diagnostic test results.

Delays in diagnosis of cancer cannot all be blamed upon GPs or any other healthcare provider. However, the NHS in England is reported to have failed to meet its target of diagnosing and treating 85% of cancer patients within two months, and has not met this target since 2015. Underfunding and difficulties recruiting and retaining trained staff across the NHS are compounding the issue.

This will undoubtedly worsen significantly as a consequence of the COVID-19 pandemic, during which patients have been reluctant or unable to attend their GP surgeries, with telephone and remote appointments becoming the norm. Although remote appointments may be more convenient for GPs to see patients, there is still the need to take a full and proper history to assess if a referral is required and ensure proper safety netting advice is given.

The results of the research need careful consideration to ensure that systems are in place going forwards to support both patients and GPs, and to ensure that those that need specialist services are referred as swiftly as possible.

Tune in to our podcast episode here in which we discuss delays in diagnosis of cancer.

For advice or more information, please contact our clinical negligence team.

Lung Cancer - Types, Signs, Stages, Prognosis, Treatment

Lung cancer affects around 47,800 people in the UK every year. It is one of the most common and serious types of cancer. It tends to affect older people, with around 45% of those diagnosed in the UK aged 75 and older.

There are two main types: non-small cell and small cell.

Non-small Cell Lung Cancer

This is the most common and makes up more than 87% of cases. The three types of non-small cell lung cancers are adenocarcinoma, squamous cell carcinoma, or large-cell carcinoma.

Small Cell Lung Cancer

Sometimes known as “oat cell cancer” due to its appearance under a microscope, this type of lung cancer is less common than non-small cell and it usually spreads faster to other parts of the body. It is usually caused by smoking.

Since this cancer grows quickly, it tends to respond well to chemotherapy and radiation therapy. Unfortunately, there is a greater risk of recurrence than with non-small cell lung cancer, usually within one to two years. However, the recurrence of small cell lung cancer after five years of disease-free survival is very rare.

Signs and Symptoms

In the early stages of lung cancer, there are usually no signs or symptoms, but as the cancer progresses many people eventually develop symptoms including:

  • a persistent cough
  • coughing up blood
  • persistent breathlessness
  • unexplained tiredness and weight loss
  • an ache or pain when breathing or coughing

Many of the above symptoms can also be caused by other medical conditions but finding lung cancer early can mean that it is easier to treat so it is important to visit your GP if you are experiencing these symptoms.

Stages and Grades

The stage of a cancer tells you how big it is and whether it has spread. The grade of a cancer is based on how the cells look under a microscope. This can indicate how quickly or slowly the cancer might grow and whether it is likely to spread.

Cancer is usually staged using the TNM (Tumour, Node, Metastasis) system to create a number staging system, with stages 1 to 4. Stage 4 is advanced lung cancer where the cancer has spread. For small cell lung cancer, there is also a simplified staging system called limited and extensive stage. For more information on how lung cancer, or indeed any cancer, is staged you can visit Cancer Research UK.

Cancer cells are graded 1 to 4 with 1 tending to be slow growing and less likely to spread than grades 3 and 4 where the cells look very abnormal and tend to grow quickly and are more likely to spread. These are also called poorly differentiated or high grade.

Prognosis

As lung cancer does not usually cause noticeable symptoms until it has spread through the lungs or into other parts of the body, the outlook is not as good as many other types of cancer. However, survival depends on many factors including the spread of the cancer at diagnosis.

There are no UK-wide statistics available for survival of different stages of lung cancer or individual treatments. The figures below are for survival by stage in England for people diagnosed between 2013 and 2017.

Stage 1 - More than 55 out of 100 people (more than 55%) will survive their cancer for five years or more after diagnosis.

Stage 2 - Around 35 out of 100 people (around 35%) will survive their cancer for five years or more after diagnosis.

Stage 3 - Almost 15 out of 100 people (almost 15%) will survive their cancer for five years or more after diagnosis.

Stage 4 - Almost 5 out of 100 people (almost 5%) will survive their cancer for five years or more after they are diagnosed.

Treatment

How lung cancer is treated will also depend on a number of factors including the type of lung cancer, where it is, its size, whether it has spread and a person’s general health.

Researchers around the world are always searching for improved treatments for lung cancer. One of those of particular note is a tablet called sotorasib, which will soon be offered on the NHS to eligible lung cancer patients in England following approval by the UK Medicines and Healthcare products Regulatory Agency (MHRA). It will be used to treat adults with non-small cell lung cancer with KRAS G12C mutation.

This mutation is present in a quarter of all tumours and is referred to as the “Death Star” because of its spherical appearance and impenetrable nature. The sotorasib tablet attaches with the KRAS G12C mutation and inactivates it, thereby hindering cell division and cancer growth. It is expected that nearly 600 NHS patients in England will benefit from the treatment annually.

Here at Lanyon Bowdler we understand the difficulty our clients have in coming to terms with a cancer diagnosis, particularly when there are questions about the standard of care they have received. If you consider that your care has been affected by a delay in diagnosis, it is important to consider all the options available to you. Our team is happy to discuss the matter with you and guide you through the process sensitively.

What’s next for NHS Maternity Services?

On 11 August 2021, the Independent held a virtual event to discuss what improvements need to be made to NHS maternity services. ‘NHS maternity scandal: Inside a crisis’ was attended by two of our clinical negligence solicitors, given the large amount of maternity claims Lanyon Bowdler is pursuing against The Shrewsbury and Telford Hospital NHS Trust spanning across a number of years.

The speakers included midwife and chair of the independent investigation into the maternity services at The Shrewsbury and Telford Hospital NHS Trust, Donna Ockenden, the president of the Royal College of Obstetricians and Gynaecologists, Dr Eddie Morris, patient safety campaigner and bereaved father, James Titcombe, and the Independent’s, Shaun Lintern.

Donna Ockenden provided an update of her review, noting the review closed to new applications in July 2020 with a total of 1,862 families involved. Donna explained that her interim Emerging Findings Report was released in December 2020. This interim report did not contain any recommendations, but rather contained ‘must do’ immediate actions written by real doctors and midwives who are still working within the NHS. Donna likened the interim report to a call to action. Important areas, which were highlighted in the Emerging Findings Report, included the lack of listening to families, the lack of risk assessment, issues with obtaining informed consent, lack of training for staff and a lack of collaboration between staff.

James Titcombe was a member of the panel. He is a patient safety specialist following the death of his 9 day old son, Joshua, at Furness General Hospital. Joshua’s death sparked the Morecambe Bay maternity investigation. James explained that the most shocking factor for him involving the events with his son was how their family was treated after Joshua’s death. He explained there was an unkindness towards families. James felt the overzealous pursuit for vaginal birth had gone too far and the campaign for having a natural birth was unhelpful. James also recalled the lack of communication between the staff with the doctors and nurses not talking to each other. James explained that people thought the Morecambe Bay incident was an isolated issue rather than there being issues affecting maternity units across the country. He believes that systemic change is needed in every maternity unit.

Dr Eddie Morris considers that the resources put into maternity units have not kept up with rapid pace of change of expectant mothers in the UK. Dr Morris explained that there are increased risks for pregnant women with raised BMIs. Those women with raised BMIs risk developing gestational diabetes, having larger babies and there is an increased risk of needing intervention during labour. Dr Morris noted that during COVID maternity staff were being redeployed, which was inappropriate given that pregnant women were continuing to give birth to babies.

Donna Ockenden considers one of the major issues is that maternity units are not treated in the same way as accident and emergency units. Donna believes that maternity units should be treated as women’s accident and emergency units as the NHS staff do not know who is going to enter the front door on a day-to-day basis and must be responsive.

The NHS maternity services were granted £96 million in funding this year. Donna believes that with this funding maternity services have made some progress and more staff have been recruited. However, issues remain with the retention and wellbeing of staff. The retention of staff has to be an ongoing focus for the NHS.

Although the UK is considered one of the safest places to give birth, if you have been affected by any of the issues raised in this blog or indeed any wider issues relating to maternity care, please get in touch with our team, who are experienced in dealing with claims of this sensitive nature and will guide you at every stage.

COVID-19 and the Impact on Cancer Diagnoses

It is no secret that the last 18 months have been difficult for us all with the COVID-19 pandemic hitting our global community and specifically the UK enduring numerous lockdowns from March 2020.

The COVID-19 outbreak has greatly affected the UK’s economy, education, and travel industry but specifically it has put immense pressure onto our healthcare services. The NHS has and continues to go above and beyond to care for patients during these difficult times and remains dedicated and focused, which we should continue to recognise. However, with the rise of COVID-19 patients in hospitals the NHS has been chronically understaffed and overworked, which has unfortunately caused a huge impact on cancer diagnosis, referrals, and treatment.

As of June 2020, MacMillan Cancer Support estimates that nearly 50,000 cancer diagnoses have been missed during the COVID-19 outbreak with 650,000 cancer patients suffering disruption or delays in their treatment, a number which is still rising today with an ever-increasing backlog of cancer treatments. MacMillan Cancer Support is referring to those suffering as the forgotten ‘C’ and is calling on the government to acknowledge the scale of the cancer backlog and commit the additional resources required to tackle it.

Early diagnosis is critical to increasing the chances of survival and treatment is more likely to be successful before the cancer has had chance to spread. Below are some examples of how an early diagnosis can really make a difference.

Early Diagnosis of Bowel Cancer

In England, more than nine in 10 bowel cancer patients survive the disease for five years or more, if diagnosed at the earliest stage.

Early Diagnosis of Breast Cancer

Almost all women diagnosed with breast cancer at the earliest stage survive their disease for at least five years.

Early Diagnosis of Ovarian Cancer

More than nine in 10 women diagnosed with ovarian cancer at its earliest stage survive their disease for at least five years. This falls to just over one in 10 women when ovarian cancer is diagnosed at the most advanced stage.

Early Diagnosis of Lung Cancer

Almost nine in 10 lung cancer patients will survive their disease for at least a year if diagnosed at the earliest stage. This falls to around one in five people when lung cancer is diagnosed at the most advanced stage.

Cancer Research UK conducted a survey of cancer patients early in the pandemic (1 – 28 May 2020) to understand their perspectives on the initial impact COVID-19 was having on their testing, treatment and care. Some key findings include:

  • Around one in three (34%) cancer patients reported that their testing had been impacted since the start of the pandemic.

  • Almost one in three (29%) cancer patients reported that their treatment had been impacted since the start of the pandemic.

  • Cancer patients who experienced delays and cancellations reported waiting on average 13.4 weeks for tests and 13.5 weeks for treatment.

In January 2019 the NHS Long Term Plan (LTP) was published and set out stretching ambitions and commitment to improve cancer outcomes and services in England over the next ten years. Their key ambitions state that by 2028, 55,000 more people each year will survive their cancer for five years or more and 75% of people with cancer will be diagnosed at an early stage (stage one or two). There is hope for our future, but this does not take away the significant delays in treatment and diagnoses that patients faced in 2020/2021.

Lanyon Bowdler Solicitors support clients daily in pursing clinical negligence claims relating to delayed diagnosis and/or treatment, some of which are sadly fatal claims. If you would like to investigate the care you or a loved one received, please feel free to contact a member of our clinical negligence team. In our latest podcast episode, Beth Heath and Katherine Jones from our clinical negligence team talk about the delay in diagnosis of cancer, using fictitious, but typical cases to illustrate the challenges people are facing.

For additional information from MacMillan Cancer Support regarding their findings of missed cancer diagnoses, please click here.

To receive more information about early diagnosis, visit Be Clear on Cancer - a campaign that aims to improve early diagnosis of cancer by raising public awareness of signs and/or symptoms of cancer, and to encourage people to see their GP without delay.

Could it be Sepsis?

A warning has been issued to NHS trusts across the country to ensure that their sepsis screening tools are up to date. The Royal College of Emergency Medicine has recently highlighted the danger of using out of date triage tools following several reported incidents in emergency departments.

Sepsis is the body’s abnormal and extreme response to an infection which sets off a reaction that can result in tissue damage, multi-organ failure and death. For reasons that we don’t fully understand, the body goes into overdrive as a response to an infection which can start anywhere in the body. The infection could be from a chest infection, UTI or from an infected cut or wound.

Sepsis affects more than 250,000 people in the UK every year and is more common than heart attacks. It kills more people than bowel, breast, and prostate cancer and road traffic accidents combined, totalling 52,000 per year including 1000 children.*

Despite these staggering facts, awareness of the signs of sepsis are low and symptoms are often mistaken for other illnesses meaning that there are up to 14,000 preventable deaths in the UK every year.

Symptoms of sepsis include:

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 mottled or discoloured

Symptoms in babies and small children varies slightly but includes breathing very fast, having a ‘fit’ or convulsion, looking mottled, bluish, pale or having a rash that does not fade when you press it. Being very sleepy, cold to touch, not feeding or vomiting repeatedly and not passing urine for 12 hours are all signs of sepsis in babies. If you spot any of these signs then call 999 and just ask, “could it be sepsis?”

Unfortunately sepsis is a very serious and life-threatening condition and can develop very quickly. As soon as a patient has been diagnosed as possibly having sepsis, there is a “Golden Hour” when medical staff will, amongst other things, start antibiotics, give IV fluids and measure urine output.

NHS staff are currently working incredibly hard in very difficult conditions but the sooner that treatment can start, the better the patient outcome. Sadly one in four people who develop sepsis suffer permanent, life-changing after-effects, including amputations.

For more information on sepsis or further support, contact The UK Sepsis Trust.

(Source: The UK Sepsis Trust).

Group B Streptococcus

July is Group B Strep Awareness Month, an annual campaign to highlight the importance of group B strep awareness, education and research.

Many people may not have heard of group B streptococcus (GBS). It is a type of bacteria that is very common in both men and women and usually lives in the bottom (rectum) or vagina. It affects two to four women in 10. GBS is normally harmless and most people will not realise they have it.

GBS is common in pregnant women and rarely causes any problems. However, it is the most common cause of severe infection in newborns and can lead to sepsis, pneumonia or meningitis.

Infection in newborns may be divided into two types:

Early Onset Disease (EOD)

This occurs in the first week of life and is usually acquired through bacteria from the mother.

Late Onset Disease (LOD)

This occurs between the seventh and ninetieth day of life. In these cases the baby is presumed to have been infected after birth, and infection may have been acquired while in hospital. The exact mode of transmission in late onset disease is unclear although outbreaks in hospitals are known to occur.

According to the Royal College of Gynaecologists on average, in the UK, every month 43 babies develop early-onset GBS infection. Of those, 38 babies make a full recovery, three babies survive with long-term physical or mental disabilities and two babies die from their early-onset GBS infection.

Data from Public Health England reveals that rates of group B strep infections in babies have risen by 77% in the past 24 years.

In the UK GBS is not routinely tested for, but may be found during tests carried out for another reason, such as a urine test or vaginal swab. If GBS is found in the urine, vagina or rectum during pregnancy, or a previous baby has been affected by a GBS infection, you may need extra care and treatment such as antibiotics.

The charity Group B Strep Support is trying to raise awareness and has called for action to educate parents, doctors and midwives about the bacteria and potential problems for newborns.

If you are worried about group B strep, speak to your midwife or GP for advice. Talk to them about the risks to your baby and ask their advice about whether to get tested.

Most babies with a group B strep infection make a full recovery if treated.

For more information, please contact our clinical negligence team.

COVID-19 & The Coroner’s Court

As the UK approaches another grim milestone of registering nearly 130,000 deaths due to COVID-19*, significant pressures have been placed upon those working for Her Majesty’s Coroner Service nationally, as different regions have had to cope with a considerable increase in death referrals being made.

*128,222 deaths as at 04/07/21, where death occurs within 28 days of a positive test (statistics here).

Under s.1(2) of the Coroners and Justice Act 2009 (“CJA”), a coroner is under a duty to investigate a death where there is reason to suspect that:

  • the deceased died a violent or unnatural death,
  • the cause of death is unknown, or
  • the deceased died while in custody or otherwise in state detention.

Anyone can refer a death to a coroner, but The Notification of Deaths Regulations 2019 set out the duty of medical practitioners to refer certain deaths to the coroner. The Notification of Deaths Regulations 2019 were also relaxed during the pandemic by The Coronavirus Act 2020 to allow a medical practitioner, who attended the deceased within 28 days before death (a new longer timescale, and could be by video call), or attended after death, to register the death in the normal way, by the medical practitioner completing a Medical Certificate of Cause of Death (“MCCD”).

Ordinarily, as COVID-19 is a naturally occurring disease, any death arising from COVID-19 would constitute a “natural death”. Where a person dies a natural death, a coroner has no duty to investigate under s.1(2) CJA because there is no reason to suspect that the death is “unnatural”. This is confirmed in the Chief Coroner's Guidance No. 34 paragraphs 17-23.

However, a coroner’s duty to investigate may be engaged where a natural death becomes “unnatural” due to some form of human error or mistake. The question of what amounts to a death by “natural causes” was considered in the case of R (Touche) v Inner London Coroner [2001] QB. In that case, on 6 February 1999 Laura Touche gave birth to twins, delivered by caesarean section. On 15 February 1999, tragically, she died. She was only 31. She died from a cerebral haemorrhage, the result of severe hypertension, possibly secondary to eclampsia. The medical evidence suggested that had her blood pressure been monitored in the immediate post-operative phase, her death would probably have been avoided.

In Touche, it was held by the Court of Appeal that a death by “natural causes” should be considered an “unnatural death” where it was wholly unexpected and would not have occurred but for some culpable human failing. Lord Justice Brown stated that: “It is the combination of their unexpectedness and the culpable human failing [emphasis added] that allowed them to happen which to my mind makes such deaths unnatural. Deaths by natural causes, though undoubtedly they are, should plainly never have happened and in that sense are unnatural…”

In the context of COVID-19, this will be a fact-specific issue. It is well known that patients could contract the disease whilst in hospital as they are effectively “hubs” where the disease can spread from COVID-19 positive patients. Simply because a patient contracts COVID-19 whilst in hospital does not necessarily mean that the death was “unnatural” – it must be shown that the natural death was turned unnatural by a culpable human failing.

It would be fair to say that during the first wave, hospitals struggled to deal with the influx of COVID-19 positive patients and how to safely treat and isolate them away from the general hospital population, in addition to the difficulties of sourcing lack of personal protective equipment (“PPE”) for staff. Over time, proper PPE was sourced and provided; “Red zones” were set up for high risk patients (such as those who tested positive for COVID-19) who were isolated and treated by staff wearing full personal protective equipment; whilst “green zones” were established to treat patients considered at a medium to low risk.

Take one hypothetical example: Patient A is admitted into hospital with symptoms of stroke and is cared for on a low risk “green” ward. This ward had no COVID-19 positive patients when Patient A was admitted, and Patient A himself was COVID-19 negative upon admission. However, within a week, doctors and patients in the adjacent beds began to test positive and soon after Patient A also tested positive. He subsequently developed respiratory symptoms, and died 10 days later from hospital acquired COVID-19 pneumonitis. An internal investigation carried out by the hospital afterwards confirmed that staff members were not adhering to social distancing and that they were not changing PPE between patients, which caused an outbreak of COVID-19 on the low risk green ward.

In the above scenario, it is clear that the “culpable human failure” was the failure to adhere to social distancing and not changing PPE between patients, thus increasing the risk of staff-to-patient infection.

However, a coroner would then have to consider if that failure was causative – i.e. it was the failure to comply with social distancing and not changing PPE between patients that caused Patient A to become infected from COVID-19, and that he did not contract it naturally from some other means.

The question of causation was discussed in the case of R (Chidlow) v Senior Coroner for Blackpool and Flyde [2019] EWHC 581 (Admin) 12 March 2019 where it was determined that the culpable human failing must have contributed more than “minimally, negligibly or trivially” to the death, on the balance of probabilities.

In Patient A’s case, if it can be proven that the failure to comply with social distancing and not changing PPE between patients more than minimally, negligibly or trivially contributed to Patient A contracting COVID-19 and dying, this would render the death unnatural. In these circumstances, the coroner may then return a narrative conclusion which highlights the failings and causative link, and which would then be recorded for posterity on a Record of Inquest.

In summary, COVID-19 has posed significant challenges to Her Majesty’s Coroner Service – not only due to the sheer volume of deaths being referred, but also complex factual, medical and legal issues which a coroner is required to consider. As the death toll continues to rise (albeit at a slower rate than in 2020), it is likely that these pressures will continue for some time to come.

For more information, please contact our medical negligence team.

National Bereaved Parents Day – 03 July 2021

This blog is written by Chloe Forrester in our clinical negligence department.

Losing a child is an unimaginable loss and something no parent should have to go through. Sadly, in the UK 14 babies are stillborn or die within four weeks of birth (1) and in 2018 there were 2,488 infant deaths (aged under one year) (2)

Saturday 03 July 2021 is National Bereaved Parents Day, hosted by charity A Child of Mine based in Stafford, UK. The focus of this day is to raise awareness of any and all parents, who have sadly lost a child of any age under any circumstance. Throughout the year A Child of Mine hosts various fundraising events to raise money to continue to offer families within the UK the support they need. They run pop-up café events which welcome anyone affected by the death of a child, miscarriage support groups and playgroups for bereaved parents and their children born before or after loss.

It is important to find support during this incredibly difficult time. There are numerous charities, helplines and support groups to help any parent with grief and other children within your family, who may need some support following the loss of a sibling.

Occasionally, the grief of a parent or guardian can be exacerbated by concerns that their pregnancy, birth or subsequent medical care was not managed appropriately. If you would like to investigate the care you or your child received, please feel free to contact a member of our clinical negligence team.

Other support available:

SANDS, still birth and neonatal death charity;

Young Minds, a charity to help support young people with grief and loss;

When a child dies. A guide for parents and carers (NHS England); and

(1) https://www.sands.org.uk/about-sands/media-centre/news/2019/11/significant-fall-number-babies-dying

(2) https://bit.ly/2SGf0bE

More Avoidable Suffering for Parents and Their Babies as Another Maternity Scandal Comes to Light

At Lanyon Bowdler we work on behalf of a significant number of families affected by the maternity failings at The Shrewsbury and Telford Hospital NHS Trust. Therefore the recent news coverage regarding Nottingham University Hospitals NHS Trust tells a highly concerning, yet familiar, story.

An investigation into the maternity services at Nottingham University Hospitals NHS Trust (“the trust”) has revealed that dozens of babies have died, or were left with severe brain injury, following errors made during their mother’s pregnancy and labour. The findings mirror the recent maternity scandals at The Shrewsbury and Telford Hospital NHS Trust and East Kent Hospitals University NHS Foundation Trust.

Investigations

An investigation has concluded the services provided by the trust over the past decade fell below the reasonable standard of care expected and that the deaths and the injuries to a large number of babies were avoidable.

It is alleged that that the trust failed to investigate concerns, altered reports to divert the blame from the maternity unit and/or lessen the severity of incidents, and key medical notes were missing or never made.

It is reported that there have been 201 clinical negligence claims against the trust’s maternity services since 2010, with half of those being made in the last four years. Those claims included 15 neonatal deaths, 19 stillbirths, 46 cases of brain damage and 18 cases of cerebral palsy. Most of those claims arose from one or more of the following: a delay in diagnosis and treatment; a failure to escalate; a failure to recognise complications and inadequate monitoring.

CQC Findings

In October 2020 The Care Quality Commission (CQC) carried out an inspection whereby they identified numerous failings where staff had failed to interpret, classify and escalate concerning foetal heart rates.

The CQC identified between July and September 2020 that there was 488 reported incidents at the trust’s maternity unit. The CQC found a number of incidents were inappropriately graded. In one instance, as recently as 2020, the death of a mother was categorised as a low harm incident and babies or women who were admitted to intensive care were labelled the same.

In May 2021 the CQC inspectors determined that despite improvements there were still areas to address.

Lessons to Be Learnt

The CQC has reported that there are concerns about the safety of maternity units across the country with 41 per cent being rated as inadequate or requiring improvement on safety.

At Lanyon Bowdler we are astutely aware of the importance of lessons being learnt and this is something we believe is imperative for these maternity units across the country.

We have extensive experience of dealing with maternity cases. If you have concerns about the maternity care you have received, our team is happy to discuss the matter with you and guide you through the process sensitively.

Congenital Diaphragmatic Hernia

Congenital Diaphragmatic Hernia (CDH) is a potentially fatal birth injury. It can be an extremely serious condition and a newborn affected by CDH will require immediate treatment following delivery. Therefore early and accurate diagnosis is enormously important.

June 2021 is CDH Awareness Month and I suspect that not many people will have heard of CDH as it is a rare condition. Following a baby receiving a diagnosis of CDH some parents will face a heartbreaking decision, as they will have to decide whether to continue with their pregnancy. The survival rate for CDH is around 50%. Sadly some babies are severely ill after their birth and do not survive, and those that do survive often have other complex needs.

What is Congenital Diaphragmatic Hernia (CDH)?

CDH affects the organs in the abdomen and chest. It occurs when the diaphragm fails to close during the baby’s development creating a hole. This consequently allows the small intestine and liver to move partially into the chest. As a result this pushes the heart and lungs to one side impacting their growth and development.

Images available at: https://cdhuk.org.uk/about-cdh/what-is-cdh/ [Accessed 21 June 2021]. Thanks to CDH UK.

When Can It Be Diagnosed?

CDH can be diagnosed at the 12 week routine scan, but it is more commonly diagnosed at the 20 week routine scan. In some cases, the baby may not be diagnosed until the final weeks of pregnancy or after the baby is born. In rare cases, CDH can also be diagnosed later in life during routine medical appointments or procedures.

If the sonographer notices something unusual on the scan or suspects the organs are not where they should be, the mother is likely be invited for further scans and antenatal appointments. If diagnosed early, babies can receive treatment before birth which may increase their chances of surviving.

Notable symptoms of CDH which can be identified after the birth of a baby include difficulty breathing, fast breathing, fast heart rate, blue tinge of the skin, difficultly feeding, the chest may be lopsided or the abdomen may be caved in.

Treatment

Commonly the baby will undergo a surgical procedure after their birth to move the organs back into the abdomen and to repair the hole in the diaphragm. However, the severity of the condition will be assessed following diagnosis and there is a chance a minimally invasive operation could be performed during the pregnancy to help the development of the baby’s lungs.

Ongoing Problems

Babies with CDH may have ongoing problems with their lungs, hearts, digestive systems and cognitive development. They may have feeding difficulties, suffer from reflux and there is a risk of re-herniation. They can also suffer from hearing loss and have speech and developmental issues as a result of ventilation and long periods of hospitalisation.

Although most cases of CDH are diagnosed during pregnancy, a third are missed despite increased ultrasound scans and improved guidelines to aid the detection.

CDH UK provides helpful information and support if you, or somebody you know, has been impacted by CDH.

If you, or your child, has been affected by the above, please do not hesitate to contact our clinical negligence team.

Call for Equality of Arms at Inquests for Bereaved Families

A long-awaited report by MPs into the coroner service of England and Wales has recommended that families should be entitled to public funding for legal representation, regardless of how much money they have.

The report follows a review by MPs on the House of Commons Justice Committee into the activities of the coroner service, details of which can be found here.

Presently, public funding for bereaved people to have legal representation at inquests is only available in exceptional cases and depends on how much money a family has. This has often led to concerns in large and complex inquests - such as the inquests into the 1989 Hillsborough disaster where many people were killed in a crowd crush - where public bodies facing criticism are usually represented by legal teams at public expense, but the bereaved families have to fight to receive public funding to be legally represented.

The committee said it was unfair that bereaved people should not have similar representation. Bereaved people, the report said, should not be put through the difficult process of meeting complex legal requirements – and be means-tested for legal aid – when the public authorities they sometimes have to face up to in court are legally represented and funded by the tax-payer. Allowing families an automatic right to have publically funded legal representation at inquests at the most complex inquests will ensure that they can fully participate.

The report also made other recommendations, such as:

  • the creation of a national coronial service for England and Wales;

  • to invest in pathology services to ensure there coroners can access the pathology services they need;

  • for an inspectorate for that service to ensure consistent standards; and

  • for a charter of rights for bereaved people.

These recommendations are a welcome acknowledgment of the problems that bereaved families have faced for many years. For too long, there has been criticism that public bodies can “lawyer-up” to defend themselves at inquests, whilst families often have to fund lawyers privately at great expense, or go it alone at a time when they are at their most vulnerable. The Ministry of Justice should therefore act now to ensure that the committee’s recommendations are put into effect with minimal delay.

For more information or advice, please contact our clinical negligence team.

Women and Babies Put at Risk at Worcestershire Royal Hospital

A senior doctor at Worcestershire Royal Hospital has been censored after raising concerns that changes being implemented within the maternity unit, in line with NHS England’s new model of antenatal care, have left wards dangerously understaffed.

Continuity of Carer

NHS England has introduced a new model of antenatal care known as “Continuity of Carer”. The model encourages women to be seen by the same midwife throughout their pregnancy and labour, with the aim that all women will be offered a continuity midwife across hospitals in England by March 2023.

However, concerns at Worcestershire Royal Hospital arose when midwives were pulled from core staffing in order to create dedicated continuity teams, leaving the maternity unit dangerously understaffed. Whistle-blowers revealed that the unit was short of five or six midwives per shift and as a result, women with high risk pregnancies were experiencing long delays in giving birth after being induced, some for up to five days.

Meanwhile, women with a continuity midwife, who were often considered low risk, were receiving accelerated care and able to skip the queue because their midwife was available straight away. For example, women in urgent need of a caesarean section were made to wait, whilst other low risk women who had been placed on the Continuity of Carer pilot proceeded to a planned or elective caesarean section first.

Jane Sandall, Professor of Women’s Health at King’s College London, previously warned that the Continuity of Carer model needed to be implemented carefully. She said, “All women should be prioritised according to need for escalation and ongoing treatment according to national and trust guidance, and whether they are in a continuity of carer model or not should make no difference to how this is managed by a trust. I don’t understand why this was allowed to happen”.

Ongoing Concerns

This follows after the Care Quality Commission (CQC) carried out an inspection at Worcestershire Royal Hospital in December 2020 in response to four separate alerts from concerned members of staff in relation to the safety of the maternity department.

A subsequent report published in February highlighted, amongst other things, dangerously low staffing levels and a reluctance by staff to raise concerns. The CQC ordered Worcestershire Acute Hospitals NHS Trust to make improvements and downgraded the maternity service from ‘Good’ to ‘Requires Improvement’.

Internal audits also showed that the maternity unit was short-staffed on the delivery suite for almost half of all shifts between July and December 2020. It is therefore worrying to hear that the same issues remain and that women and babies continue to be put at risk.

‘I Cannot in All Conscience Continue to Remain Silent’

The problems at Worcestershire Royal Hospital hit crisis point in April this year when the maternity department’s clinical director, Dr Catherine Hillman, resigned from her role after posting a message to staff on an internal Facebook page which was later taken down by senior bosses.

Within the post, she spoke out about the “gridlocked system”, saying that, “Women being cared for by core midwifery staff have been experiencing unacceptably long delays for induction of labour, resulting in bed blocking on the antenatal ward with enormous anxiety and frustration for all. Conversely, women being cared for under the continuity system have had a more streamlined experience, with timely care when required”.

Dr Hillman raised concerns that this has created a two-tiered system, where women were no longer being prioritised on clinical grounds.

However, the Facebook message was removed within hours and a further statement, supporting Continuity of Carer, was put in its place. On 10 April 2021, Dr Hillman resigned from her role, saying that the maternity unit was, “at best precariously safe” and ,“I cannot in all conscience continue to remain silent and simply watch and wait as events unfold.”

‘It’s Such a Stressful, Horrible Environment’

Since Dr Hillman’s resignation, other staff at the trust have also raised concerns. One midwife explained that, “The women have been induced medically and they’re waiting to go to the delivery suite to have their waters broken. These women are told they’re high risk and that their babies could potentially die and then they wait for days on the antenatal ward for a midwife to become available so that they can be cared for on the delivery suite. Every time, as a midwife, you go to put a lady on a monitor to check the baby's heartbeat, you are literally hoping it's there and it's all ok. It's such a stressful, horrible environment.”

It has also been revealed that four women have died at the Worcestershire Acute Hospitals NHS Trust between July 2019 and December 2020, with midwives stating that they work in fear of what might happen during their next shift.

In one incident, a women in her early 20s collapsed and died in the maternity unit after being on the ward for several days.

Future Implementation for Continuity of Carer

Despite clear issues, the roll out of Continuity of Carer is set to continue with NHS England issuing a statement last month saying, “Some potential barriers need tackling at the outset, including putting adequate staffing in place.” They consider that the model has been proven to significantly improve women’s overall experience of care and is safer for babies. However, others remain wary, particularly in regards to trying to speed up implementation across England, which may place additional burdens on midwives and maternity support workers.

Lanyon Bowdler’s award winning clinical negligence team includes members of the Law Society’s Clinical Negligence Panel and AvMA panel members. The team has extensive experience of dealing with birth injury cases. If you have concerns about the maternity care you have received, our team are happy to discuss the matter with you and guide you through the process sensitively. Please contact us.

Inadequate Care for Children’s Mental Health at Telford Hospital

The Shrewsbury and Telford Hospital NHS Trust has been forbidden from admitting any new patients under the age of 18 who present solely with acute mental health needs after accusations that they have failed to keep young people safe.

This follows after the Care Quality Commission (CQC) carried out an unannounced inspection of the children and young people’s service at the Princess Royal Hospital in Telford on 24 February 2021 after receiving concerns about the quality and safety of treatment provided.

Safety Concerns

The inspection found that many children had not received an adequate risk assessment on admission and that staff "generally relied" on rapid tranquilisation, with one child receiving this 27 times during their admission. The inspection also found that staff had not received appropriate restraint training, and that some staff had not had any restraint training at all. Other concerns raised showed that staff did not fully understand how to protect children and young people from abuse and that they did not consistently follow local and national guidance for safeguarding referrals.

A Section 31 notice, which aims to prevent further harm, was issued two days later placing the trust under urgent conditions. The trust was ordered to review the records of all acute mental health inpatients under the age of 18, and not to admit any more unless they had associated physical needs. The CQC also ordered the trust to implement safeguarding systems and to train all staff working with under-18s with mental health needs to ensure they were “appropriately competent” to do so.

A Section 29a notice was also issued on 12 March which accused the trust of failing to take account of children, young people and their families’ individual needs and preferences, particularly in regards to food choices for those with eating disorders.

As a result of the inspection, the trust’s rating for children and young people’s services was downgraded from ‘Requires Improvement’ to ‘Inadequate’.

Improvements

Nursing Director, Hayley Flavell has since confirmed that the trust addressed some concerns immediately and drew up plans to correct others, including devising a system to track young patients’ location and to ensure that all staff have received appropriate training.

Ms Flavell said that, “There is now an opportunity to look widely at how we care for adults who attend our emergency department with mental health issues. We’re going to see more mental health coming into the organisation, so we need to make sure what we do isn’t just focussed on children and young people.”

Chief Executive at the trust, Louise Barnett agreed that the inspection had been an opportunity to improve, but said, “It absolutely shouldn’t take an inspection with a series of conditions and warning notices,” to provoke it.

The CQC continues to monitor the trust closely to ensure that patient safety improves and has confirmed that they will return to check that sufficient action has been taken.

The implications of the COVID-19 pandemic has created a surge in mental health problems amongst children and young people. It is therefore vital, now more than ever, that young patients are able to access the help and support they need. Lanyon Bowdler’s award-winning clinical negligence team includes members of the Law Society’s Clinical Negligence Panel and AvMA panel members. The team has extensive experience of dealing with mental health claims and if you have concerns about the care you have received, our team is happy to discuss the matter with you and guide you through the process sensitively.

The NHS

During the COVID-19 pandemic, our NHS has fondly become a national treasure. We have supported and clapped our wonderful key workers and been grateful for their incredible and tireless work. The thought of suing this overstretched and underfunded service that is available to all could, to some, seem like a dreadful thing to do. But what if you have been affected by a failure of the NHS that has left you or a family member with devastating and life-changing consequences?

What Is Clinical Negligence?

All medical professionals, whether in the NHS or private sector, owe a duty of care to their patients. If the care delivered falls below a reasonable standard and this causes harm, injury, or death, then the medical professional is negligent in the eyes of the law.

Can I Get Compensation?

NHS Resolution is the legal arm of the NHS and recognises that things can “go wrong” and when that happens, those involved should be properly informed and compensation should be fairly paid.

While financial compensation cannot undo damage caused to a patient or bring back a loved one who has died because of clinical negligence, it can help to ease future financial burdens. For the child who now has additional care needs, compensation can help to give them the care and the quality of life that they and the family deserve. Our expert clinical negligence team has recently secured compensation of over £26 million for one client.

How Can I Make Sure This Does Not Happen to Someone Else?

We find that one overriding theme is that people who have suffered from clinical negligence want to make sure that the same thing does not happen to someone else. The only way that mistakes can be learned from, is if they are fully investigated so that improvements to practice can be made. NHS Resolution is also keen that the NHS learns from mistakes to prevent reoccurrence.

Here at Lanyon Bowdler, we are passionate about helping to bring about change to improve healthcare services to make them safer for all. If you think that you or a member of your family may have been affected by clinical negligence, then get in touch with our specialist clinical negligence team.

Delays in Diagnosis of Bowel Cancer

This blog is written by Katie Little in our clinical negligence department.

It is a subject that many find embarrassing and would rather not talk about, however bowel cancer is the fourth most common cancer and the second biggest killer in the UK and it can affect anybody. April 2021 is Bowel Cancer Awareness Month and it is important that you are aware of the signs and symptoms and when you need to take action. If the disease is diagnosed in the early stages, prognosis is normally good but as time passes, the prospects of recovery diminish significantly.

Symptoms of Bowel Cancer

The main symptoms of bowel cancer to look out for are:

  • Blood in your poo
  • A change in your bowel habit (i.e. going to the toilet more or less often than usual)
  • Lower tummy pain, bloating or discomfort

#NoButts Campaign lead by Deborah James, 39 year old with incurable bowel cancer

If you experience any of the above it is important to visit your GP as soon as possible. They should take details of your symptoms, general health and family history. They may also carry out an examination. If the GP is concerned, you will be referred to a specialist.

However, here at Lanyon Bowdler, we are aware that sometimes things don’t go to plan and this can have a devastating outcome if it results in a delayed diagnosis. If you attended an appointment with your GP presenting with any of the symptoms above and they failed to refer you to a specialist for further investigations (or were delayed in doing so), they did not carry out the correct testing or screening, or if they misdiagnosed you with irritable bowel syndrome (IBS) or colitis (for example) then you may have a claim for the harm suffered as a result.

Remember, early detection is key. Be aware of the symptoms and note that the NHS also offers a bowel screening system to all of those aged between 60 and 74. Every two years you will be sent a home test kit which simply involves collecting a small sample of poo to send for testing. If you are eligible for a home test kit, take up this offer.

The below links provide helpful information and support if you or somebody you know has been impacted by bowel cancer:

For more information and advice, please contact a member of our clinical negligence team.

Misreporting of Cervical Smears & Delayed Diagnosis of Cervical Cancer

All women in the UK from the ages of 25 to 65 are invited for routine cervical smear tests. For women aged 25 to 49, this invitation arrives every 3 years; for women aged 50 to 65 it arrives every 5. In 2019 - 2020, 4.63 million women were invited for a cervical smear but only 3.20 million accepted the invitation.

What is a Smear Test?

A smear test is a generally painless procedure used to check the heath of the cervix. The test involves collecting cervical cells using a swab (soft brush) which are then tested for the presence of the Human Papilloma Virus (HPV). If this is negative, no further action is required. If this is positive, a cytology screen is carried out to check for the presence of abnormal cells. If these are identified, an invitation for a colposcopy is sent for further testing to be carried out and if necessary, treatment of the abnormal cells. If identified at an early stage, this usually involves a LLETZ or similar procedure to remove the affected cells completely.

Reporting Errors

It is therefore important that as many women as possible attend for their cervical smear. It is also important to be aware that whilst the vast majority of cervical smear results are correctly reported, smear tests are studied and reported by humans and humans can make mistakes.

Sometimes negative smears are reported as positive and positive smears are reported as negative. Where a negative smear is erroneously reported as positive, this can result in women undergoing further invasive investigations that were not necessary. Where a positive smear is reported as negative, the consequences can be devastating. This is because if abnormal cells are left untreated, they can continue to develop and can turn into cervical cancer. Once a patient has cervical cancer, they are likely to need radical treatment such as a hysterectomy, chemotherapy and/or radiotherapy with life altering results. In some cases, the cancer proves fatal.

Should I Be Worried?

The vast majority of cervical smears are correctly reported as negative and fortunately, mistakes are few and far between. However, any woman presenting with any of the following symptoms following a negative cervical smear is encouraged to contact their GP for advice:-.

  • Unusual bleeding between periods, after intercourse or after menopause;
  • Unusual or unpleasant discharge;
  • Pain during intercourse;
  • Lower back pain/pelvic pain.

At Lanyon Bowdler, we have extensive experience in representing women whose cervical smears have been misreported or whose diagnosis of cervical cancer has been delayed. If you have been affected in the same way, please do not hesitate to contact us.

False Claims Made by Local Maternity Units Mean Millions to Be Repaid in NHS Funds

A number of trusts located throughout the UK have been forced to repay money granted to them following incorrect data being provided in self-assessments of their own maternity units.

Lanyon Bowdler acts on behalf of a significant number of families affected by failings in maternity services at the Shrewsbury and Telford Hospital NHS Trust. We have seen concerning events that took place in the 1980s repeat themselves in the 2020s, showing that lessons do not seem to have been learnt. The Shrewsbury and Telford Hospital NHS Trust was one of the trusts highlighted as being forced to repay money, with the amount to be repaid by the trust totalling £953,000.

An article by The Independent states that a further six hospital trusts across the UK were also forced to repay money given, with the largest sum paid back by University Hospitals Birmingham. Following an internal review this trust repaid a total of £3 million.

NHS trusts are supposed to meet 10 safety actions to include ensuring systems are in place to review deaths, monitor women and plan staffing levels. The trusts should also report incidents to the Healthcare Safety Investigation Branch, which investigates maternity incidents within the NHS.

News of a number of trusts falsifying figures will not assist in restoring public faith in the NHS maternity services, particularly after an independent inquiry, leaked in 2019, found that more than 40 babies died due to poor care at the Shrewsbury and Telford Hospital NHS Trust and that an ongoing independent review by Donna Ockenden is now looking into 1,862 cases of possible concern.

Families affected question where the grants of the original sums of money ended up being spent, particularly with reports indicating that some trusts exhibited unsafe cultures and parents had expressed concerns over staffing levels. Criminal prosecution is being contemplated against two trusts given that deaths had occurred in their respective maternity units.

It is worth noting that out of the 115 NHS trusts that had self-declared themselves to meet the necessary safety actions, only 14 trusts failed on at least one measure. The response of NHS Resolution noted that they recognised poor governance which required further action. The chief executive of each trust is expected to sign off all declarations of individual maternity units meeting standards, so questions will be asked whether the misreporting has originated from the highest level.

This news coming to light will clearly cause worry for pregnant women in the local communities affected. Independent inquiries seem to be needed more than ever, particularly where babies and their mothers are suffering avoidable injury whilst attending these hospitals. 60% of all clinical negligence claims against the NHS between 2018 and 2019 involved maternity services.

Lanyon Bowdler has vast experience in maternal and birth injury claims and has a dedicated team dealing with enquiries and potential claims arising from the Shrewsbury and Telford Hospital NHS Trust maternity scandal. If you, or someone you know, has experienced possible negligent prenatal or postnatal care, or something has gone wrong during the labour period, please contact our team who will be able to assist with your enquiry.

A Look at Prosthetics

Prosthetic limbs have an important role to play in enabling amputees to retain independence and live rewarding lives. However, although they have been around since ancient times, their designs have, until relatively recently, been limited to those which are passive and purely cosmetic, or those which have some articulation to assist with everyday activities, such as walking or carrying, but whose functions are somewhat limited.

It has only been with recent advancements in technology and the availability of modern materials, such as carbon fibre, that greater levels of comfort and sophistication have become possible and now prosthetics are increasingly complex and tailored to meet the individual needs of the wearer, who may have different prostheses for different purposes e.g. the flexible running blades used by athletes. The development of 3D printing has further aided the speed of progress, enabling complex, lightweight limbs to be manufactured relatively cheaply. Limbs for children are now available in a variety of colours and designs, even super-hero themed, should you wish!

Although prosthetic limbs utilising socket and harness and cable systems to provide the wearer with control over the prosthetic attachment are still commonplace, development in surgical approaches to prosthetics is also adding to the choices available to amputees. Osseointegration is one of these. It provides a titanium connection point surgically fitted into the bone of a residual limb so that prosthetic attachments can be connected. This is reported to give patients a more natural feel to the movements they make when using their prosthesis.

Understandably, effectively mimicking the movements of natural limbs has long been the focus of prosthetic development, with some success. For example, battery powered ‘bionic’ prosthetic hands have been developed, which use myoelectric sensors fitted to the muscles in the residual limb to sense impulses produced through muscle contraction to control the prosthetic. The improvement in control and dexterity afforded by this type of prosthesis is impressive, with the user safely able to handle even fragile objects using the hands.

A recent Sky News story reported on new research in America, which is expanding on this idea of utilising residual muscles to control prosthetic limbs. Surgically re-activating muscle pairs that control joints, such as ankles and elbows (which are typically severed during amputation procedures), enabled patients in the study to obtain increased precision in the control of their prosthesis, in part because it afforded them a sense of where their missing limb should be, and therefore where their prosthetic limb was.

What Next?

Well, although still under development, researchers have already successfully produced prosthetics, which can be controlled by the user’s thoughts and which provide the wearer with a sense of feedback - of touch. Although it may be some time before these become mainstream, there is cause for optimism regarding the speed of development of such complex prosthetics and the range of prosthetic options available to amputees.

Sadly, it is not uncommon in the field of clinical negligence law to encounter individuals who have suffered amputations as a consequence of the negligent treatment they have received. Typically, but not exclusively, this occurs in diabetic patients, cancer patients and those who have developed sepsis. Adjusting to life with an amputation impacts upon physical and mental wellbeing, can affect relationships and ability to work and increases everyday living costs. An amputee may need home modifications to enable them to live independently, a specially-adapted vehicle and other mobility aids to assist them, and will very likely continue to need the input of medical specialists and therapists throughout their life.

At Lanyon Bowdler, we are familiar with the problems individuals face as a result of such injuries and are able to assist, not just with making a clinical negligence claim for compensation, but in helping to identify and locate support services and products which will make life a little bit easier in future. Please contact our clinical negligence team for more information.

Consultant Gynaecologist under Review for Allegedly Causing Harm to Hundreds of Female Patients

A former specialist in obstetrics and gynaecology, Dr Daniel Hay, is currently under investigation for treatment he provided at the Royal Derby Hospital and Ripley Hospital between April 2017 and June 2018, which resulted in many of his patients experiencing ‘unnecessary harm’.

Concerns Raised

Owing to concerns raised by his former colleagues in late 2018 an initial review into the treatment of 58 women was commenced. This was later widened and 382 women have now been identified as having potentially been affected.

The review encompasses major surgical treatment such as hysterectomies as well as minor surgical treatment and outpatient treatment carried out by Dr Hay within the relevant period.

Intermediary Findings of the Review

The University Hospitals of Derby and Burton NHS Foundation Trust, who are conducting the review in conjunction with NHS England, has found instances of women not counselled appropriately as to alternative non-surgical options to hysterectomies and also instances where treatment ‘fell significantly below’ standards resulting in:

  • Burns;

  • Temporary paralysis;

  • Infected wounds;

  • Uncontrolled and abnormal bleeding problems;

  • Significant abdominal pain, and

  • Severe mental health issues.

Dr Hay has since retired from the trust. The full anonymised report is due to be published at a later date, which is yet to be announced.

Other Options

Sadly where patients have uterine or ovarian cancer major gynaecological surgery such as a hysterectomy is often unavoidable, but with diagnoses, such as uterine fibroids and endometriosis, there may be other ways of treating or dealing with these problems. The treating doctor should discuss the different options available and their side effects with the patient in order to allow them to make an informed decision.

Pain and Recovery Times

If surgery is a necessity or the patient has elected to proceed down this route then it is important to note that, whilst some level of pain and discomfort is considered normal following major abdominal or pelvic surgery, this should be capable of being controlled by painkillers.

Recovery times can be six to eight weeks after an abdominal hysterectomy but are often shorter following a vaginal or laparoscopy hysterectomy. Many of Dr Hay’s patients experienced continuous pain and, in some cases, worsening symptoms beyond this time frame.

Clinical Negligence Claims

Not all complications from surgery provide grounds for a legal claim, but it is important to be aware that these may have arisen due to potential failings on the part of the doctor.

Lanyon Bowdler’s award winning clinical negligence team includes members of the Law Society’s Clinical Negligence Panel and AvMA panel members. The team has extensive experience of dealing with gynaecological cases. If you have concerns about gynaecological care you have received, our team is happy to discuss the matter with you and guide you through the process sensitively. Please contact us.

Whistleblowers Raise Concerns about Maternity Services at Worcestershire Royal Hospital

A number of concerns raised by whistleblowers at Worcestershire Royal Hospital are causing concern about the safety of the maternity department, particularly midwifery staffing levels, risk and incident reporting and governance.

The Care Quality Commission became concerned about the hospital's maternity services after the inspection team were contacted by four whistleblowers between July and September, who reported that the service was always short-staffed and they were often moved within the department. This prompted an inspection of the hospital’s maternity services in December 2020.

Findings

Inspectors found that staffing levels were lower than planned and that these staffing shortages should have been reported on an incident reporting system, but weren’t because staff didn’t have time and assumed senior staff would do it. Midwives also said that these staffing shortages had a knock-on effect of them being frequently moved within the department.

Midwives reported to inspectors that morale was low and that they felt their concerns and views were not being considered by management. The CQC inspectors also found that not all staff were up-to-date with training and not all safety incidents were reported.

Inspectors did identify areas of good practice including collaboration between different disciplines to give mothers and babies good care and effective implementation of infection prevention and control measures.

Worcestershire Acute Hospitals NHS Trust's maternity services has now been moved down from a "good" rating to “requires improvement”, the same as the trust’s overall rating.

Improvements

The trust in charge of Worcestershire Royal Hospital was ordered by the CQC to make a number of improvements, which include engaging with staff for feedback, monitoring staffing levels and reporting and learning from all incidents and near misses.

Chief nursing officer at the trust, Vicky Morris, said, “The safety of mums to be and their babies is, and always has been, the absolute priority for everyone working in our maternity service. Managing maternity services through the Covid-19 pandemic has been extremely challenging for all our staff and we thank them for their commitment during what has been a very difficult period.”

She went on to note that the trust had already been making changes over the staffing issues before the inspection.

"We have run a very successful recruitment campaign for midwives and once the next round of recruitment is completed next week we should have filled all our vacancies and recruited an additional 10 midwives," she said.

COVID-19 has understandably had a profound impact on the NHS, stretching its staff in ways never seen before, but it is important that we do not accept falling standards in the care of pregnant mothers and delivery of babies and we at Lanyon Bowdler echo the words of CQC’s Chief Inspector of Hospitals, Professor Ted Baker, that “it is crucial that women get the safe and personalised birth experience they are entitled to and that midwifery staff feel supported and valued in order to achieve this. The service must ensure that any risks are identified, and safety incidents are correctly shared and reported to reduce their impact.”

Lanyon Bowdler’s award winning clinical negligence team includes members of the Law Society’s Clinical Negligence Panel and AvMA panel members. The team has extensive experience of dealing with birth injury cases. If you have concerns about the maternity care you have received, our team are happy to discuss the matter with you and guide you through the process sensitively. Please contact us.

World Cancer Awareness Day 4 February 2021

Today is World Cancer Awareness Day. A day aimed to unite people across the world in raising awareness of cancer and its impact in the hope of preventing future deaths.

Never has this message been more important than in the wake of the COVID-19 pandemic. Cancer patients have been one of the groups of people most badly affected by the pandemic, and this may not just be current patients. In particular, concerns have been raised in relation to a lack of research funding. This could mean that not just current patients but future patients are affected. This could easily include any one of us.

This year, the World Cancer Day theme is “I Am and I Will”. I have signed up to one of the 21 day challenges on the initiative’s website. These include challenges to raise awareness, improve your own health and to support someone else with cancer. In the spirit of raising awareness, here are six things I have learnt about cancer over the past 10 years.

  • Side effects of treatment are not just hair loss and feeling sick. Don’t get me wrong, they are big ones, but side effects can include almost anything and can be incredibly debilitating.
  • Once you have had treatment, if it’s successful, that’s it. Perhaps it is for some, but for many it really is not. Even if successful, patients can suffer long-term side effects or complications as a result. And of course there is the follow up and potentially years of “scanxiety”. It really is a marathon and not a sprint, and support is needed for the long haul, not just immediately post diagnosis.
  • Never underestimate the kindness of strangers. People’s reactions can surprise you and support can come from the most unlikely of places. Any gesture, even small ones, can mean the world to someone going through treatment.
  • Neutrophils are your best friends. What is a neutrophil? A type of white blood cell that protects us from infection. Some cancer treatment effectively wipes these cells out and can lead to neutropenia (an abnormally low level of neutrophils) and potentially, neutropenic sepsis. Cancer patients can be extremely vulnerable to infection, something which the COVID-19 pandemic has undoubtedly increased awareness of.
  • Cancer treatment can be expensive. I don’t mean the actual treatment here – I mean the knock-on effects. The potential loss of earnings, the bits and pieces you need to get to make treatment more bearable, and don’t forget the many, many hospital appointments and associated travel costs.
  • Cancer affects the whole family. Of course the main focus should be the patient, but don’t forget their support network, who sometimes need support too.

No doubt many of us know someone who has been or is affected by cancer. Through my work and personal life, I have had the privilege of knowing and working with many people who have had a cancer diagnosis. These people are some of the most inspirational characters you will ever meet. They need our support, now more than ever.

Perineal Tears During Childbirth

It is common knowledge that a mother who delivers a child by caesarean will need six weeks to recover physically. If a caesarean is required then the implications are discussed at length during the antenatal period, and preparations can be made by the mother to ensure she can rest and recover once the baby arrives. What is less talked about by midwives, doctors and mothers themselves are tears, despite research finding that nine in 10 women will tear to some extent during a vaginal delivery.1

Grading a Tear

Tears are graded from first degree to fourth degree. Small, skin-deep tears are known as first degree tears and usually heal naturally. Tears that are deeper and affect the muscle of the perineum are known as second degree tears. These usually require stitches by a midwife. A third degree is a tear that extends into the muscle that controls the anus (the anal sphincter). If the tear extends further into the lining of the anus or rectum it is known as a fourth-degree tear. Third and fourth degree tears require surgical repair by a doctor as soon as possible after your baby is born, under spinal anaesthetic or an epidural in theatre. You are likely to need a catheter for a short period afterwards and the follow-up care includes pain relief, a course of antibiotics to reduce the risk of infection, laxatives for comfort and physiotherapy follow-up. Most women make a full recovery within four to six weeks, although rarely complications can arise and medical advice should be sought as soon as possible. Key complications to look out for include:

  • Signs of infection such as if your stitches become more painful or smell offensive;

  • You cannot control your bowels or when you pass wind; or

  • Continued pain and discomfort when having sexual intercourse.

It is also important to focus on your mental health. Experiencing complications when giving birth can be very distressing and disturbing, and for some women there is a risk of post-traumatic stress disorder. Following a perineal tear, if you are developing anxiety, have low mood or feel that you need additional support, you should talk to your healthcare professional.

The diagram below from The Royal College of Obstetricians and Gynaecologists helpfully summarises the anatomy and how tears are graded.

Difference Between an Episiotomy and a Tear

A tear happens spontaneously with delivery, however, an episiotomy is a cut made by a healthcare professional through the vaginal wall and perineum. This may be done if your baby needs to be born more quickly or to make more space for your baby to be born. If you have an episiotomy you will need stitches. These are normally done under local anaesthetic.

On the most part, it is thought that an episiotomy will help prevent a severe tear as it can be controlled, however, it is possible for an episiotomy to extend and become a deeper tear.

When to Consider Making a Perineal Tear Claim

Whilst suffering a tear is incredibly common, there are situations where the acts and/or omissions of midwives and doctors can lead to a mother either suffering a worse tear or having a more complicated recovery. Women tend to be reluctant to discuss their symptoms and see this as part of having a baby. Whilst not all tears will give rise to a legal claim, it is important to talk about your delivery and recovery and be aware of potential failings. The most common types of claims we see include:

  • Poor birth planning and/or management of labour;

  • Failing to repair a tear in a timely manner after delivery;

  • Failing to appropriately identify the severity of a tear leading to a sub-standard repair; and

  • Failing to act on signs of infection post-repair.

If you would like to discuss your labour or perineal tear with one of our experts, please call us on 0800 652 3371.

Further Information:

If you would like further information, the following organisations specialise in supporting women who have suffered perineal tears:

RCOG Perineal Tears Hub: www.rcog.org.uk/tears

Mothers with Anal Sphincter Injuries in Childbirth (MASIC): https://masic.org.uk

Birth Trauma Association: www.birthtraumaassociation.org.uk

Bladder and Bowel Community: www.bladderandbowel.org

1 https://www.ouh.nhs.uk/patient-guide/leaflets/files/12101Ptear.pdf

Whistleblowers Raise Concern about Patient Safety at Essex Maternity Unit

A number of incidents at a maternity unit in Essex are causing concern over serious failings in care. The Care Quality Commission (CQC) visited Basildon Hospital following whistleblowers alerting the CQC of their fears about patient safety. The tip-offs followed a number of serious incidents where six babies were at risk of brain injury after being starved of oxygen at birth.

An article published by BBC noted that the CQC found unsafe staffing levels at the maternity unit at Basildon Hospital during August 2020. This finding follows the maternity unit being rated as inadequate in June 2019. The rating followed the shocking death of a woman in February 2019 where a mother lost six litres of blood after giving birth via emergency caesarean section at Basildon Hospital. The Independent newspaper noted that the coroner concluded that there had been a breakdown in communication, a lack of leadership as well as a lack of co-ordination and team work. The NHS Trust has since apologised for not enacting improvements quickly enough and stated their services were safe to use.

Following the leaked report of the Shrewsbury and Telford NHS Trust maternity scandal detailing the number of deaths of both mothers and babies, it appears that lessons have not been learnt by maternity units in the wider NHS. The findings from the most recent CQC inspection of Basildon Hospital noted a number of concerns including the fact that only four shifts had safe staffing levels in August 2020, expectant mothers at high risk of complications had given birth in the low risk part of the unit and required safety meetings at shift handovers did not occur. The levels of skill and experience of the staff was also found to be concerning.

The NHS Trust responded to the findings by stating they had a robust improvement plan in place and that significant action had been taken since the CQC visit. Only time will tell whether lessons have indeed been learnt from another devastating death within an NHS maternity unit.

The NHS is understandably stretched due to Covid-19 but these findings pre-dated Covid and it is important that as a nation we do not accept falling standards in the care of pregnant mothers and delivery of babies.

The clinical negligence team at Lanyon Bowdler has extensive knowledge and experience in dealing with birth injury cases and handles an extensive caseload of maternity-related cases. If you, or someone you know, has been affected by a birth injury, our friendly team will be happy to discuss the matter with you in confidence. Please contact us.

The Rugby Brain Injury Claims

It was recently reported that a large group of ex-rugby players, some of whom are only relatively recently retired, are bringing claims against rugby governing bodies following the shocking news that they have been diagnosed with a form of early onset dementia and probable chronic traumatic encephalopathy. Those bringing the action claim that their diagnoses have arisen from negligent mismanagement related to repeated head injuries and concussions sustained throughout their careers. A number of current and former players have since publically shared their own concerning experiences, including World Cup winner Kat Merchant, who recently told the BBC that at the age of 35 she suffers ongoing symptoms of concussion and has a lower cognitive capacity than previously.

What Should Be Considered?

These cases will doubtlessly be complex and multi-factorial, but, in order to be successful, the claimants will essentially have to prove that they were owed a duty of care by the defendants before proving that the defendants breached the relevant standard of care that applied throughout their playing careers. They will then have to show that their diagnoses were more than likely caused by such a breach or breaches by the defendants. Another key factor to be considered will be the degree of risk to which a player will have consented to by taking part in a high impact sport such as rugby, whilst any court decision would likely seek to avoid adversely impacting and hindering a desirable activity. Rugby is a sport enjoyed by millions across the world and brings many benefits such as physical fitness, discipline and social interaction and any court judgment will likely, as a matter of public policy, be cautious not to detract from these benefits.

It is unusual to see such high-profile and widespread litigation arising in a sporting context, although the above claims are not without some sort of precedent. In 2011, a class action lawsuit was brought against the NFL by a group of former American football players, leading to the creation of a fund specifically for players with such claims which, to date, has paid out over eight million dollars. The litigation also prompted a raft of changes to improve safety surrounding concussions. It is unclear how the claims brought in the rugby context will progress, but the claimants have already set out a list of “15 commandments” to improve safety surrounding head injuries in the game. Such requests include a limit to contact training and improved education on the issue of concussion.

Which Other Sports Have Been Impacted?

Whilst the progress of the litigation is something that lies in the hands of the relevant parties and potentially the court, it is worth noting the impact that these claims have already had by way of the significant publicity the story has generated and the number of players that have subsequently shared their story. It has also shone a light on other sports. Despite its significantly higher profile, football often appears to be playing catch up in its implementation and application of safety surrounding head injuries, something highlighted by Alan Shearer in his 2017 documentary ‘Dementia, Football and Me’. This was starkly evident when Arsenal defender David Luiz recently played on for 40 minutes after suffering a head injury before eventually being substituted. The impact was so severe it caused a fractured skull to his opponent, Wolves striker Raul Jimenez, requiring emergency surgery.

Whilst the circumstances of the claimants that have ignited the litigation in rugby are tragic, the increased publicity has prompted further debate and put significant pressure on sporting governing bodies to ensure that the sports they govern are as safe as they reasonably can be. This increased awareness of the risks of concussion can also benefit wider society, with the NFL litigation leading to considerable progress in the medical sector’s understanding of chronic traumatic encephalopathy. Such benefits can apply beyond the high-profile sporting sphere and, whilst the priority of most personal injury claimants is to obtain a settlement that seeks to improve their quality of life following their injury, we often see claimants who want to ensure that lessons are learned and that other people don’t suffer in the way they did. Such benefits are often just as important to our clients as the settlement itself and are benefits that can be salvaged from desperately sad situations, such as those the rugby claimants have found themselves in.

Failings in Maternity Care Confirmed by Donna Ockenden Report

This year we have united in pride and admiration for our NHS but today’s report reminds us that we must also accept that in the past not everyone has experienced the standard of care from the NHS that they deserve.

Today’s report from Donna Ockenden highlights shocking examples of failings in maternity care provided at the Shrewsbury and Telford Hospital NHS Trust between 2000 and 2019. The report identifies disappointing and deeply worrying themes, which have jeopardised patient safety and caused harm to babies and mothers for years.

Women at their most vulnerable were not listened to and were denied empathy, appropriate care and the opportunity to deliver their babies safely. A full list of the failings can be found within the report linked here, but the most harrowing findings include:

  • The failure to appropriately risk assess pregnancies. There was little or no discussion with the mothers about options for delivery and the risks involved. Where a mother was to give birth was decided for her, without full disclosure of the risks and options available.

  • There were a significant number of cases where midwives and obstetricians did not demonstrate an appropriate level of competence in particular in relation to knowing when to escalate, the interpretation of foetal wellbeing traces and the use of oxytocin.

  • There is disturbing evidence of a number of repeated attempts at vaginal delivery with forceps, sometimes with excessive force causing significant injury and death.

  • The Trust perceived their low caesarean rates as “good care” when, in reality, this created a dangerous culture where women had little freedom to express any choice on mode of delivery. In some individual cases the report recognises that earlier recourse to a caesarean delivery would have avoided death and injury.

What happens next?

As we at Lanyon Bowdler fight for justice for those families who have been affected, we must also look to the future. This is our local trust. Our staff, friends and family all give birth here and so this is an incredibly personal cause to our team.

Alongside specific recommendations for Shrewsbury and Telford Hospital NHS Trust, the report has identified the following seven essential actions, which must be implemented immediately, across nationwide maternity services:

  • Enhance and strengthen safety by increasing partnerships between trusts and local networks.

  • Ensure women and families are heard.

  • Staff who work together must train together.

  • There must be robust pathways in place for managing women with complex pregnancies.

  • Staff must ensure that women undergo a risk assessment at each contact throughout the pregnancy pathway.

  • All maternity services must appoint a dedicated lead midwife and lead obstetrician both with demonstrated expertise to focus on and champion best practice in foetal monitoring.

  • All trusts must ensure women have ready access to accurate information to enable their informed choice of intended place of birth and mode of birth, including maternal choice for caesarean delivery.

The second part of Ms Ockenden’s report will follow in 2021, however it is expected that the Trust acts upon her recommendations immediately. Improvements must be made to ensure the maternity services at our local trust are safe.

We have profound sympathy for our clients and the families that have suffered indescribable loss. If you would like to discuss a potential claim, please contact us on 0800 294 5915 or via our website for a free consultation.

The Anti-malarial With a Dark Side

Anti-malarial medication is a widely accepted and distributed form of preventing malaria, and is often prescribed to travellers and adventurers here in the UK for those visiting high malaria-risk zones.

Malaria itself, a potentially fatal disease, transmitted through mosquitos and parasites, or malaria vectors, can cause multi-organ failure and death if untreated. The World Health Organisation (WHO) estimates that 93% of all malaria cases originate within the continent of Africa, with other high-risk zones including East Asia and the Pacific Islands accounting for the rest. In 2018, there were around 228,000,000 cases worldwide and around 450,000 deaths caused by malaria.

What Are the Most Commonly Prescribed Anti-malarial Drugs?

Here in the UK, the most commonly prescribed anti-malarial drugs are known as Doxycycline, Mefloquine, Chloroquine and Proguanil. Doxycycline is an antibiotic drug, commonly used to cure chest infections and sexually transmitted infections (STI) but is also used for malaria prevention. It is seen as the safest anti-malarial for use and is widely prescribed to people travelling into malaria zones. Whilst there are some side effects, the majority of these are short term and serious side effects only occur in around 1 in 1,000 people.

Mefloquine, commonly known as Larium, is the second most commonly prescribed anti-malarial drug to those traveling to high-risk areas. Larium itself has been used globally by countries including the UK, the USA, Canada, Denmark and France, and for many years was seen as the inexpensive preventative measure to prescribe to those travelling overseas, including military personnel.

What Are the Side Effects of Larium?

Larium works by interfering with the growth of parasites within the red blood cells in our body. On the face of it, Larium is a highly effective drug used to prevent malaria. However in recent years more and more people have reported severe psychiatric side effects, lasting many years after the drug had been taken. During the period of April 2007 and March 2015, 17,368 UK armed forces personnel had been prescribed Larium whilst deployed on operations overseas, with no prior risk assessment being taken. Side effects of Larium can be severe and mentally debilitating, and can include the following:

  • Depression or anxiety
  • Suicidal thoughts
  • Self-endangering behaviour
  • Psychosis
  • Paranoia
  • Panic attacks
  • Unusual behaviour
  • Feeling of confusion
  • Hallucinations
  • Aggression or agitation
  • Restlessness
  • Unusual mood swings
  • Disturbance of attention

Sleeping issues are the most common side effect, affecting 1 in 10 users, with many reporting insomnia and hallucinations during sleep. Prior to all prescriptions of Larium, a GP should conduct a thorough check of all medical records to ensure there are no pre-existing medical conditions, including a mental health check-up, to ensure suitability of the drug. Since the drug’s manufacture in 1989, there have been thousands of prescriptions without these checks being done, leading to neurological disorders developing in many, particularly in those associated with the armed forces.

The risks of using Larium are well documented, and numerous studies have been undertaken to evaluate the side-effects, yet the UK armed forces continued the use of this drug and still does to this day. Many soldiers, sailors and airmen have suffered with anger issues, anxiety and post-traumatic stress disorders (PTSD) following their return from operational theatres, all of which may have been exasperated by the prescription of Larium. Neurological and psychological disorders can have a lasting impact on someone and may cause constant struggles in family and work life, which can lead a person to suicide if not properly managed.

If possible, Larium should be avoided if an alternative is available and if you have been prescribed it in the past and are experiencing symptoms listed above, you should speak with your GP for a check-up.

Music Therapy – How Does It Benefit Patients?

This week I watched an inspiring presentation about the potential benefits of music therapy for people, who have been affected by brain injury or neurological disease.

The presentation was by an organisation called Chroma. Chroma provides music therapy services for patients with neurological and spinal cord injuries across the UK. I was particularly interested to learn about “neurologic music therapy” and how music can be used to help injured patients with their rehabilitation. This therapy can be used for people who have cognitive, sensory, and motor function deficits related to neurologic disease.

I studied neuroscience alongside law at university and have always been particularly interested by anything “brain related”. It was a (very) long time ago and inevitably science has come on leaps and bounds since then, but I remember learning about the concept of “neuroplasticity” and the idea that the human brain is able to change and adapt throughout its lifetime. Music therapy, as I understand it, can be used to encourage and promote this plasticity in the brain.

Brain or neurological injury can damage or disrupt neural networks in the brain, causing significant impairment. Plasticity involves the creation of new neural pathways and rehabilitation can be designed to promote this activity, which plays a part in helping people overcome impairments due to brain injury.

So How Does Music Therapy Help?

Listening to music involves several areas of the brain, as does learning to play an instrument. These activities may help to strengthen connections between neural networks in the brain and improve the brain’s ability to adapt to changes in the environment.

For example, if a patient is working on improving their gait, they can be encouraged to move to a particular rhythm. This has been shown to improve walking speed and distance in patients with Parkinson’s disease. Benefits have also been seen in stroke patients. I am sure that most people will be able to relate to the impulse to move in sync to a beat, even those non-dancers!

In addition, the enjoyment of listening to music, or playing an instrument, may also have an effect. This can release dopamine (a “feel good” neurotransmitter), which can have a positive effect on neural connections in the brain. It also plays an important part in learning and the brain’s motivation/reward systems. All key in forming and strengthening neural connections.

Brain and neurological injuries can have such a devastating impact on someone’s life and it is incredible to think that music could make such a functional difference here. It has certainly renewed my appreciation for music in general, although perhaps not for all genres!

Transparency/Accountability in the Private Sector

In the news this week there have been warnings of cancellations of operations on the NHS as a result of COVID-19. It would appear that this is to help the NHS cope with potential rising numbers of coronavirus cases this winter.

Many routine surgeries were cancelled or postponed earlier in the year because of the pandemic. The impact of the pandemic has also been keenly felt by oncology services, with worrying reports of cancer patients experiencing delays in treatment. It is predicted by the Lancet Oncology Journal that these delays will inevitably result in unnecessary deaths from cancer, which is a tragic outcome. NHS hospitals across the country are now facing a backlog and it could be possible that ongoing delays see more patients considering whether they are able to go private. With the ongoing strain on the NHS as a result of the COVID crisis, there is the potential for more services to be outsourced to the private sector.

Recently, stories surrounding orthopaedic surgeon Derek McMinn have made headlines, reporting that patient bones had allegedly been stored without full consent or licence over the last few decades. It is understood that many of his patients were seen at the private BMI hospital in Edgbaston. These accounts also bring to mind the fairly recent scandal involving breast surgeon Ian Paterson, who subjected many patients to unnecessary surgeries and exposed some of the gaps in protection for private sector patients.

How Easy Is It for Patients with Legitimate Claims to Receive Compensation?

Generally, doctors who work at private hospitals are not “employees” of that hospital in the way they usually would be if they worked for an NHS trust. Doctors working at private hospitals must therefore have their own individual indemnity insurance. This can sometimes make it more difficult for patients with legitimate claims to receive adequate compensation, which was one of the issues faced by Ian Paterson’s patients. Cases are, of course, fact-specific but the private hospital itself is not always accountable if things go wrong. This is in contrast with care within the NHS when it is the relevant NHS trust, which is accountable.

What Are ‘Never Events’?

Last month the Private Healthcare Information Network (PHIN) published data on serious patient safety incidents in private acute care from 2019. This appears to be the first time a comprehensive dataset of “Never Events” involving private patients has been published in the UK. Never Events are defined by the NHS as patient safety incidents that are “wholly preventable”. The data published by PHIN refers to 21 Never Events being reported in a private setting and include instances such as wrong site surgery and wrong implants/prostheses being used.

The publication of the above information is interesting as this type of information is something that is already monitored in the NHS on a regular basis. The NHS has routinely published this information as part of an open and transparent approach to patient safety and so that lessons can be learned where things go wrong (whether this culture is, in fact, always adopted is a subject for a different day).

It is important to note that the PHIN data indicates that data was submitted from only 287 out of 595 private provided sites. This would indicate there is still some way to go in terms of improving transparency within the private sector. However, hopefully this is still a step in the right direction and patients will now have access to more information to enable them to make better informed decisions about treatment.

With increased transparency, it is hoped that this will also lead to better protection for patients in the private sector and greater consistency across the board with regard to accountability in healthcare generally.

Appendicitis – The Importance of Prompt Treatment

The average appendix measures 9cm in length and most of us have one. There has been much debate between scientists as to the purpose of the appendix from enabling us to digest a diet of leaves and tree bark once upon a time to protecting beneficial bacteria living in our gut. One thing they can agree on, however, is that we don’t necessarily need one.

So why am I dedicating a blog to what can essentially be viewed as a useless organ?

The answer is that having this tiny tube (it measures 6mm in diameter) can potentially be life threatening if it becomes inflamed; a condition known as appendicitis. Appendicitis is a common condition that develops when a blockage or infection develops in the appendix and, generally, will only become worse without treatment.

What Do the Symptoms of Appendicitis Include?

Symptoms of appendicitis include pain, nausea, vomiting (which is generally green), diarrhoea and fever. Classically, the pain comes and goes in the middle of the stomach before moving to the lower right hand side where the pain remains severe and constant.

If appendicitis is missed, the ‘bad’ bacteria continue to multiply causing the appendix to become more and more inflamed as it fills with pus. By on average 48 – 72 hours after the onset of symptoms, the appendix bursts under the pressure of the inflammation and the pus begins to spread throughout the abdominal cavity; a condition known as peritonitis which becomes fatal if the infection enters the blood stream. It is therefore vital that appendicitis is diagnosed and treated as soon as possible.

What Is the Treatment for Appendicitis?

Treatment for appendicitis almost always involves the removal of the appendix via keyhole surgery or a small incision in the right lower abdomen. However, when the appendix bursts and the infection becomes widespread, it can be necessary to operate through an incision along the middle of the abdomen. This is because in addition to removing the appendix, the surgeon will need to wash out the area thoroughly to remove the collections of pus that may have formed (abscesses) and to go some way to treating the infection. Patients who require this treatment will usually require a longer hospital stay, IV antibiotics and drains (either during the original surgery or subsequently). These patients will inevitably be left with an extensive scar and can be left with long term complications including altered bowel habits and in women and girls a compromise to their future fertility.

Not everyone presents with the classic symptoms of appendicitis and it is not uncommon for symptoms attributed to gastroenteritis (inflammation of the intestines) or a urinary tract infection by medical professionals. However, appendicitis should always be safely ruled out before conclusively reaching a diagnosis as to another cause of patient’s symptoms because of the serious complications that can occur if appendicitis is missed. This is usually done through a combination of blood tests, a CT and/or ultrasound scan.

Unfortunately, we act for a number of clients for whom this did not happen. As a result, their appendix burst and/or their infections continued to develop and they have suffered avoidable injuries as a result.

If you or someone you know has been affected by a delay in diagnosis and/or treatment of appendicitis which has resulted in them suffering a worse outcome than they might have otherwise had, please contact our specialist team for advice.

Bereavement Damages Update

When a person dies as a result of negligence either following an accident or clinical negligence, a limited group of people are entitled to compensation under the Fatal Accidents Act 1976.

The bereavement award is currently limited to £12,980. Whilst no amount of compensation can make up for the loss of a loved one, it is a very low level award. The bereavement award of £12,980 was set in 2013 and has not been increased since. There have been calls for the government to review the award and to consider a substantial increase. However, the Ministry of Justice has rejected calls for a full consultation on bereavement damages stating that the award will be increased to reflect inflation since the previous increase in April 2013.

Defending its decision not to carry out a full review, the Ministry of Justice has stated that bereavement damages “are and were only ever intended to be a token payment to a limited group of people”.

The exact increase in the amount of bereavement damages that will be awarded under the Fatal Accidents Act in England and Wales is yet to be confirmed.

If you have any queries about a fatal injury claim please contact our specialist personal injury department.

Coronavirus - what is it and where does it come from?

Coronavirus is making all the headlines at the moment but what is it and where does it come from?

On 31 December 2019 the World Health Organisation (WHO) China office heard about the first reports of a previously unknown virus causing a number of pneumonia cases in Wuhan, a city of over 11 million people in Eastern China. The disease appears to have originated from a seafood market where wild animals were traded illegally. Corona viruses are known to jump from animals to humans so it’s thought that the first people infected contracted it from animals. However, some people without links to the market have also been infected so the exact source is still not conclusive.

The WHO advise that the incubation period between infection and symptoms lasts up to 14 days but other sources quote up to 24 days. Many symptoms of corona viruses are often mild much like a cold, runny nose, cough and fever. These symptoms can become more serious leading to respiratory disease such as pneumonia and bronchitis. This can be particularly dangerous in older patients or people with existing health conditions.

On 11 February 2020 the WHO announced that the official name of the disease was now Covid-19.

The majority of cases have been in China but cases have now been confirmed in many other countries including the UK. As of 17 February 2020 70,620 cases had been confirmed in China with 1,770 deaths from the disease. Approximately 715 people outside China including nine in the UK have been tested positive for the disease. So far six people have died from the virus outside of China.

If symptoms are minor no treatment is needed. If they become more severe, treatment relies on keeping the body going with breathing support until the immune system can fight off the virus. However, work to develop a vaccine is underway and the hope is that it will be available by the end of the year.

Very recent news reports that more cases have been confirmed in South Korea. The WHO has declared it a global emergency but believe it can be contained. It is also hoped that the coming warmer weather may slow down the spread of the virus. Let us all hope this is the case.

East Kent Hospitals Baby Death Investigation

At Lanyon Bowdler we have been working on behalf of a significant number of families affected by failures at the Shrewsbury and Telford Hospital NHS Trust, which has hit headlines again recently after news broke about the leaked independent inquiry report. It is therefore all the more concerning to read the recent news coverage concerning East Kent Hospitals NHS Trust which sadly tells an all too familiar story.

Investigation into East Kent Hospitals NHS Trust

Last week, a BBC investigation discovered that since 2016, at least seven preventable baby deaths may have occurred at East Kent Hospitals NHS Trust. One of those is Harry Richford who was born at the Queen Elizabeth The Queen Mother Hospital in Margate in November 2017. Harry sadly passed away just a week after he was born following complications with his delivery and neonatal care.

On Friday 24 January 2020, coroner Christopher Sutton-Mattocks ruled that Harry’s death was “contributed to by neglect” and “wholly avoidable”. The BBC reported that the coroner identified a number of failings in Harry’s care including, but not limited to, failure to expedite delivery once the cardiotocography (CTG), which monitors a baby’s heartrate, had become pathological and a lack of consultant involvement during both the delivery and resuscitation attempts.

Upon conclusion of the inquest, Harry’s father, Tom Richford said, "Accidents happen every day but failing to learn from them appears to have become part of the culture of this trust. It was known there was a risk. The risk was present as far back as 2014." It is that failure to learn from mistakes which is most familiar to those of us working with clients who have been failed by maternity services. We have heard from many clients who were told by the hospital treating them that lessons have been learnt from their case, and yet more cases with similar facts continue to come to light.

A 2015 report by the Royal College of Obstetrics and Gynaecologists (RCOG) reviewing obstetric services at East Kent Hospitals NHS Trust uncovered a number of concerning findings that contributed to Harry’s death, including a reluctance/refusal by some consultants to attend out of hours when requested and a failure to attend CTG training. Despite these concerns however, the full report was not provided to the Care Quality Commission (CQC) until January 2019.

Criticisms from Dr Bill Kirkup CBE

This was heavily criticised by Dr Bill Kirkup CBE, the Chairman of the Morecambe Bay investigation into maternity and neonatal services at Furness General Hospital. He told The Independent: “When there is sufficient concern about a service to prompt an external review, the report must be available immediately to those responsible for assuring the quality of the service. That was the reason for the recommendation of the Morecambe Bay investigation, and it is disappointing that the Care Quality Commission apparently had no sight of this report until now.”

Towards the end of 2019 my colleague, Beth Heath took part in BBC Radio 4’s Women’s Hour alongside Dr Kirkup, discussing the news coverage regarding Shrewsbury and Telford Hospital NHS Trust. He made it clear that he hoped that lessons would be learnt from the Morecambe Bay investigation report, which was circulated to other hospital trusts in 2015. Sadly there continues to be a worrying pattern of repeated failings in maternity care despite the rhetoric from hospital trusts of “lessons being learnt”.

Following the conclusion of Harry Richford’s inquest, East Kent Hospitals NHS Trust is now under criminal investigation by the CQC.

Lanyon Bowdler’s award winning clinical negligence team includes members of the Law Society’s Clinical Negligence Panel and AvMA panel members. The team has extensive experience of dealing with birth injury cases, in particular cases involving neonatal deaths and we are handling many cases arising out of the Shrewsbury and Telford Hospital NHS Trust baby death scandal. If you have concerns about the maternity care you have received, our team are happy to discuss the matter with you and guide you through the process sensitively.

More Clinical Negligence Cases Against Shrewsbury & Telford Hospitals

Further to my statement earlier this week, we have been acting on behalf of families impacted by the Shropshire maternity scandal and have received a raft of new enquiries from worried families.

I work in our clinical negligence department, where we currently have about 35 active maternity cases and have dealt with up to 50 cases against the Shrewsbury and Telford Hospital NHS Trust over the past 15 years. The number of claims arising motivated us to employ an in-house midwife to assist with investigations.

We have received more than 70 new enquiries since the news broke about the leaked report into mother and baby deaths in Shropshire.

New enquiries are coming in quickly from other families, who have suffered heartbreaking bereavements or life-changing injuries whilst being cared for by Shrewsbury and Telford hospitals in recent years.

We have spoken with so many families who have been affected by failings at these hospitals, many of whom have been told by the hospital that lessons have been learned from their loss and tragedy, and yet the evidence of still more cases creates increasing distress and a tragic loss of trust in the community.

In April 2017 the Trust sent letters to expectant mothers reassuring them that the service was safe and they had learnt but we have received enquiries that post date this.

We already feared that the failings had been worse than originally reported, and with every new family who comes forward, the number of clinical negligence cases against the Shrewsbury and Telford Hospital NHS Trust is likely to grow.

One of the many cases dealt with by Lanyon Bowdler is Sharon Morris, of Bridgnorth, who gave birth to twins at Royal Shrewsbury Hospital in 2005. The first twin was delivered successfully, but the second twin, Olivia, was not delivered until 1 hour and 12 minutes later, during which time she was deprived of oxygen, causing brain damage.

Olivia should have been urgently delivered given the absence of a reassuring heart beat. The Shrewsbury and Telford Hospital NHS Trust admitted they were negligent in failing to deliver Olivia earlier, and had she been delivered in a timely manner they admitted she would not have sustained brain damage and would have developed normally.

Olivia now needs 24-hour care, cannot eat or speak, struggles to walk and has learning and behavioural issues.

The family successfully pursued a clinical negligence case against the hospital trust, with compensation meaning they could move to a specially adapted house to enable Olivia to have her own purpose-built bathroom and other vital facilities.

Sharon said the details of the leaked report into the failings in maternity care were all too familiar.

“It’s heartbreaking, but the contents of this report came as no surprise to be honest,” she said.

“We went through our clinical negligence case because we wanted to secure Olivia’s future, and we needed compensation to be able to give Olivia the best life we could.

“No amount of money or apologies can change the mistakes that were made in that hospital, but Olivia’s long-term care has to be paid for and, as her parents, we will not live forever.

“We can only hope that changes will now finally be made to urgently improve things at our local hospitals because we must ensure that these mistakes stop happening.”

More Clinical Negligence Cases Against The Shrewsbury & Telford Hospital NHS Trust

Further to my statement earlier this week, we have been acting on behalf of families impacted by the Shropshire maternity scandal and have received a raft of new enquiries from worried families.

I work in our clinical negligence department, where we currently have about 35 active maternity cases and have dealt with up to 50 cases against the Shrewsbury and Telford Hospital NHS Trust over the past 15 years. The number of claims arising motivated us to employ an in-house midwife to assist with investigations.

We have received more than 70 new enquiries since the news broke about the leaked report into mother and baby deaths in Shropshire.

New enquiries are coming in quickly from other families, who have suffered heartbreaking bereavements or life-changing injuries whilst being cared for by Shrewsbury and Telford hospitals in recent years.

We have spoken with so many families who have been affected by failings at these
hospitals, many of whom have been told by the hospital that lessons have been learned from their loss and tragedy, and yet the evidence of still more cases creates increasing distress and a tragic loss of trust in the community.

In April 2017 the Trust sent letters to expectant mothers reassuring them that the service was safe and they had learnt but we have received enquiries that post date this.

We already feared that the failings had been worse than originally reported, and with every new family who comes forward, the number of clinical negligence cases against the Shrewsbury and Telford Hospital NHS Trust is likely to grow.

One of the many cases dealt with by Lanyon Bowdler is Sharon Morris, of Bridgnorth, who gave birth to twins at Royal Shrewsbury Hospital in 2005. The first twin was delivered successfully, but the second twin, Olivia, was not delivered until 1 hour and 12 minutes later, during which time she was deprived of oxygen, causing brain damage.

Olivia should have been urgently delivered given the absence of a reassuring heart beat. The Shrewsbury and Telford Hospital NHS Trust admitted they were negligent in failing to deliver Olivia earlier, and had she been delivered in a timely manner they admitted she would not have sustained brain damage and would have developed normally.

Olivia now needs 24-hour care, cannot eat or speak, struggles to walk and has learning and behavioural issues.

The family successfully pursued a clinical negligence case against the hospital trust, with compensation meaning they could move to a specially adapted house to enable Olivia to have her own purpose-built bathroom and other vital facilities.

Sharon said the details of the leaked report into the failings in maternity care were all too familiar.

“It’s heartbreaking, but the contents of this report came as no surprise to be honest,” she said.

“We went through our clinical negligence case because we wanted to secure Olivia’s future, and we needed compensation to be able to give Olivia the best life we could.

“No amount of money or apologies can change the mistakes that were made in that hospital, but Olivia’s long-term care has to be paid for and, as her parents, we will not live forever.

“We can only hope that changes will now finally be made to urgently improve things at our local hospitals because we must ensure that these mistakes stop happening.”


It was a privilege today to talk alongside Dr Bill Kirkup CBE on BBC Radio 4’s Women’s Hour. Dr Kirkup was the Chairman of the Morecambe Bay Investigation into maternity and neonatal services and shares our concerns in relation to the care families have received at the Shrewsbury and Telford Hospital NHS Trust and considered there were unmistakeable parallels with the scandal at Morecambe Bay. Dr Kirkup explained that the Morecambe Bay Investigation Report detailing numerous failings and deficiencies was circulated to other hospital Trusts in 2015, of which Shrewsbury and Telford Hospital NHS Trust was one. It was hoped that lessons would be learnt from Morecambe Bay in the wider NHS.

More clinical negligence cases against Shrewsbury and Telford hospitals

Further to my statement earlier this week, we have been acting on behalf of families impacted by the Shropshire maternity scandal and have received a raft of new enquiries from worried families.

I work in our clinical negligence department, where we currently have about 35 active maternity cases and have dealt with up to 50 cases against the Shrewsbury and Telford Hospital NHS Trust over the past 15 years. The number of claims arising motivated us to employ an in-house midwife to assist with investigations.

We have received more than 70 new enquiries since the news broke about the leaked report into mother and baby deaths in Shropshire.

New enquiries are coming in quickly from other families, who have suffered heartbreaking bereavements or life-changing injuries whilst being cared for by Shrewsbury and Telford hospitals in recent years.

We have spoken with so many families who have been affected by failings at these hospitals, many of whom have been told by the hospital that lessons have been learned from their loss and tragedy, and yet the evidence of still more cases creates increasing distress and a tragic loss of trust in the community.

In April 2017 the Trust sent letters to expectant mothers reassuring them that the service was safe and they had learnt but we have received enquiries that post-date this.

We already feared that the failings had been worse than originally reported, and with every new family who comes forward, the number of clinical negligence cases against the Shrewsbury and Telford Hospital NHS Trust is likely to grow.

One of the many cases dealt with by Lanyon Bowdler is Sharon Morris, of Bridgnorth, who gave birth to twins at Royal Shrewsbury Hospital in 2005. The first twin was delivered successfully, but the second twin, Olivia, was not delivered until 1 hour and 12 minutes later, during which time she was deprived of oxygen, causing brain damage.

Olivia should have been urgently delivered given the absence of a reassuring heart beat. The Shrewsbury and Telford Hospital NHS Trust admitted they were negligent in failing to deliver Olivia earlier, and had she been delivered in a timely manner they admitted she would not have sustained brain damage and would have developed normally.

Olivia now needs 24-hour care, cannot eat or speak, struggles to walk and has learning and behavioural issues.

The family successfully pursued a clinical negligence case against the hospital trust, with compensation meaning they could move to a specially adapted house to enable Olivia to have her own purpose-built bathroom and other vital facilities.

Sharon said the details of the leaked report into the failings in maternity care were all too familiar.

“It’s heartbreaking, but the contents of this report came as no surprise to be honest,” she said.

“We went through our clinical negligence case because we wanted to secure Olivia’s future, and we needed compensation to be able to give Olivia the best life we could.

“No amount of money or apologies can change the mistakes that were made in that hospital, but Olivia’s long-term care has to be paid for and, as her parents, we will not live forever.

“We can only hope that changes will now finally be made to urgently improve things at our local hospitals because we must ensure that these mistakes stop happening.”

Leaked Report on the Shrewsbury and Telford Hospital NHS Trust Maternity Scandal

I am a clinical negligence solicitor in our Shrewsbury branch, acting on behalf of families affected by failures at the Shrewsbury and Telford Hospital NHS Trust. The report is sadly not surprising, but makes for horrific reading.

We have been working on behalf of a significant number of families, who have suffered bereavement and life-changing brain injuries as a result of failings at these hospitals, and we are therefore acutely aware of how this scandal has affected them, and continues to do so.

The contents of the leaked report sadly do not come as a surprise, given that we have seen repeated failings over a substantial number of years, with little apparent learning from previous mistakes.

We have seen action plans within investigation reports that year after year have been very similar, with no real change or improvement.

It has been clear that major failings took place which led to the deaths and severe brain injuries of babies, which could have been avoided, and it now looks like the failings go back even further than anyone feared.

This report will inevitably cause more worry for our local community, and in particular expectant mothers, and we will continue working on behalf of local families whose lives have been shattered due to clinical errors at the Shrewsbury and Telford Hospital NHS Trust.

One of our clients, Sharon Morris, said: “I am not shocked at these findings. Every day for the last 14 years we are constantly reminded of the failure by SATH to help me give birth to healthy twins.

“I was prepared for a caesarean after baby number one, but during that time they failed to notice my baby number two was in distress because they were monitoring the wrong heartbeat. My daughter was starved of oxygen during this time and is now severely disabled needing 24-hour care, can't eat, can't speak, struggles to walk and has learning and behavioural issues.

“This was not something we signed up for and I would not wish it upon anyone. No amount of money can change things and all we can now hope for is that changes are made to ensure other families don't suffer like we do. How can we trust the NHS?”

Medication Shortages

A survey of pharmacists found there has been a shortage in every major group of medicines in recent months.

A UK wide survey of 402 community pharmacies found a number of common medications to include HRT, contraceptives and anti-epileptic drugs among others are in short supply.

The UK Government announced a ban on some drug exports in order to protect access to those drugs for NHS patients. The restriction will stop wholesalers selling some medicines outside of the country for a higher price. The drugs on the export list include a number of HRT drugs, adrenaline pens for severe allergies, hepatitis B vaccines and a number of contraceptive drugs. Approximately 360,000 prescriptions of HRT are dispensed every month.

Among the shortage is antidepressant drug ‘Fluoxetine’ and pharmacists have been authorised to dispense alternative drugs without going back to the GP for this specific product.

The shortage of medications can also cause confusion with patients receiving different brands each month or a completely different drug as substitute.

A shortage in medication is also meaning that the cost of the medication is increasing which is adding to the financial strain of Clinical Commissioning Groups as GP practices struggle to keep within prescribing budgets.

The British Medical Association have said there are a number of reasons why medication shortages happen but it can have a serious effect on how quickly patients receive appropriate treatment. The shortage is also increasing the pressure on GP practices. Dr Farah Jameel of the BMA has said that "Practices often won't know that a drug is in short supply until patients return from the pharmacy and these extra GP appointments can dramatically add to their already burgeoning workload - as well as distressing patients."

The Department of Health and Social Care has instructed that patients should continue to order their repeat prescriptions but not ask for more medicines than they need.

If your health has been adversely affected due to a shortage in medication then feel free to contact our specalist clinical negligence team to see if we are able to assist you.

Relationships after Brain Injury

Relationships are a very important and intimate part of life. They give us a sense of security and wellbeing, and contribute towards our sense of self-identity. It is often our closest relationships that provide the vital emotional and practical support needed when hardships are faced, such as when a brain injury occurs.

For some people, the emotional, behavioural, physical and cognitive changes after brain injury can have an impact on existing and future relationships. There are a number of ways in which this can happen and a number of different outcomes. Some relationships may strengthen, whereas others may become strained over time or even completely break down.

Continuing support from friends can help the survivor feel more positive

Brain injury can cause changes in the way a person thinks, feels and behaves and can also affect their physical ability. This can sometimes affect the relationships they have with their friends. Many people will not know what a brain injury is and how it can impact someone, and therefore may not be able to understand how and why their friend has changed.

Friends might also assume that once the survivor is out of hospital, they will be ‘back to normal’. However, for many survivors the emotional, cognitive and behavioural effects only become noticeable once they have returned home. The survivor might need time to adjust to their new circumstances, and friends might need to adjust accordingly as well. Learning about the effects of brain injury and identifying ways of offering support can help friends during this period of adjustment.

Continuing support and care from friends can also help the survivor to feel more positive about themselves and their circumstances, which can have a positive impact on their overall recovery and general wellbeing. In turn, this can have a positive impact on the friendship and it can become possible to move forward creating new memories together.

Ways to support your friend

1. Learn about brain injury

  • Read about brain injury and speak to your friend about what they are personally experiencing.
  • Remember that brain injury symptoms can fluctuate on a day-to-day basis, so while your friend may appear to be well and functioning on one day, they might struggle the next.
  • Learn about different coping strategies to help your friend with managing the effects of their injury.

2. Encourage your friend to seek support

  • Encourage your friend to contact their nearest Headway group or branch for support in their local area.
  • If you suspect your friend is feeling depressed, gently encourage them to talk about how they are feeling and to seek support, either from yourself, other friends or professional services.
  • If your friend is experiencing ongoing problems from their injury which are affecting their quality of life, encourage them to seek support from their GP or local adult social care team.

3. Look out for your friend

  • Ask after your friend and offer to help out where needed. At the same time, respect their independence and do not assume that they cannot do things by themselves, as many survivors learn ways of adapting to their injury over time.
  • If you are concerned that your friend lacks insight, and you notice anything which causes you to be concerned for their safety, consider speaking to their partner or other family members.
  • If appropriate, attend rehabilitation sessions with your friend and ask the rehabilitation team if there are any activities that you can help your friend with.

4. Offer practical support

  • If your friend has young children, offer to occasionally look after them for a few hours.
  • Offer to help with tasks such as grocery shopping, travelling, cooking or form-filling.
  • When buying gifts for your friend, consider practical things that can help them on a regular basis, such as a journal or personal organiser if they have memory problems.

5. Out and about

  • Fatigue can be a particular issue during or after outings. Try to therefore keep outings short, and encourage your friend to rest beforehand and afterwards.
  • If your friend struggles in busy, noisy environments, consider going somewhere quieter or visiting one another’s house.
  • While you cannot tell your friend whether or not they can drink, do remind them that alcohol can worsen the effects of their injury, especially behavioural effects.
  • Ask your friend whether they would like you to explain that they have had a brain injury to others when you are out.
  • Try to set a particular day and time for activities you do together on a regular basis, as this can be helpful if your friend has memory problems or difficulties with organising and planning.
  • Try not to take offence if your friend cancels on a plan at the last minute or does not socialise as much as they did before the injury.
  • Try to include your friend in activities that you do as a group. You could explore new or modified activities that are safe and enjoyable for everyone, including the survivor.

If you need support with a brain injury claim, please contact Lanyon Bowdler’s team of brain injury specialists who are experienced at handling serious cases.

Inquisitive about Inquests? Five Common Misconceptions of the Inquest Process

An inquest may be your first ever real world encounter with the legal profession. Whether that be as a witness giving evidence, a family member of a deceased relative or to give your medical expertise. However with that unknowing comes confusion about what happens at an inquest. Some may believe they are going to be staring up at a wig wearing Dickensian figure. Some may believe they will be pestered furiously by a lawyer demanding whether you ‘ordered the code red’ (A few good men).

This is not the case.

This blog will take you through and demystify five misconceptions of the inquest process. For ease sake, any referral to he shall mean he/she.

1. It will just be like a criminal courtroom

An inquest is not like criminal proceedings.

An inquest is a public hearing to establish who, when, where and how a person died. This is not an adversarial process, meaning a battle of two sides. An inquest is an investigation. Its purpose is to look at the facts themselves and conclude what has happened.

There is no prosecution or defence in inquests. The people you see being represented at inquests are called ‘interested parties’. These can be the deceased’s family or a hospital trust for example. To become an interested party, you have to be invited by the coroner.

And most importantly, wigs and gowns are not worn in the Coroner’s Court.

The one similarity that may be seen is that some inquests have a jury. However this is quite rare.

2. The inquest will say if someone is negligent or liable

It is not an uncommon misconception to believe an inquest is the arena to find a hospital negligent or decide if a crime has taken place. However, an inquest is not the place where those conclusions can be reached. There needs to be neutrality and the many inquest procedural rules tightly control this neutrality.

Let’s give a few examples:

  • No witness has to answer a question that may incriminate themselves;[i]
  • The coroner (or jury as mentioned earlier) cannot make conclusions that indicate liability.[ii]
  • The coroner and jury can only express an opinion on who the deceased was, how, when and where the deceased came by his death and if needed, any extra information required under the Births and Deaths Registration Act 2003, such as their place of birth.

Because of the nature of these investigations, it is inevitable that some questions will be asked that stray into negligence territory. For example, why a certain course of conduct was not taken. While these questions may be asked, liability would still not be stated at the end of proceedings.

Neutrality is key.

In potential criminal matters, if it appears that a death is likely to be caused by a homicide offence and that someone could be charged, the coroner will notify the crown prosecution service [iii]. If this is the case, an inquest will usually be suspended pending the outcome of a criminal trial [iv].

Inquests may therefore stray into liability matters. But, any conclusion will be neutral.

3. An inquest has guilty and not guilty verdicts

In the Criminal Justice System, judges give verdicts. Coroners on the other hand, do not give ‘verdicts’; they make ‘conclusions’. This change in terminology was made because people were associating inquests with criminal law. They are not to be compared. As mentioned, an inquest is not adversarial.

But what does ‘conclusions’ mean in a legal sense?

There are two main types of conclusion available to a coroner; short form conclusions and narrative conclusions.

There are nine usual short form conclusions that a coroner may pick from. These are:

1. Accident/Misadventure
2. Alcohol/Drug Related
3. Industrial Disease
4. Lawful/Unlawful Killing
5. Natural Causes
6. Open Conclusion (meaning they cannot be sure how)
7. Road Traffic Collision
8. Stillbirth
9. Suicide

Coroners are encouraged to keep to these 1/2 word set conclusions. [v]

The other type is called a narrative conclusion. These are usually a brief, neutral and factual statement of what happened[vi] e.g. ‘Mr Bloggs was injected with x drug that caused a severe allergic reaction.’

4. Everything has to be proven beyond reasonable doubt

Unlike the criminal world, not every conclusion must be reached on the standard of ‘beyond reasonable doubt’ (99%). Usually, a coroner will work on the civil standard, ‘on the balance of probabilities’ (51%).

There are exceptions to this. Lawful and unlawful killing conclusions must be reached on the criminal standard because matters may stray into criminal proceedings.

Suicide, until recently was also considered on the criminal standard. This was changed recently to the civil standard[vii].

5. Every death has to be dealt with by a coroner

Inquests will only be called in specific circumstances. These may be when cause of death cannot be found by a post mortem or the death is unnatural. For example, if there are questions about what factors caused a death or someone died in violent circumstances in custody. Such circumstances will then be referred to the coroner.

The coroner has the independence to investigate without being under the control of the State. This ensures a fair and impartial process. A coroner will also be in charge of their own court (subject to certain legislation) and will spend most of the time during an inquest asking the questions and doing the investigations. He will decide what evidence is to be called, who he wants to hear give evidence and ultimately, will run the inquest how he feels is most appropriate.

Therefore a coroner does not investigate every death. However if he is referred a death to investigate, he will have near complete discretion on how to go about that.

Concluding Remarks

If you have been asked to appear at an inquest, either to give evidence or as an interested party to the proceedings, it is natural to feel nervous about the prospect. However, with these five myths debunked, you may be able to go into that Coroner’s Court with a little less mystery about the inquest process.

There are a bundle of resources available. Please find below a set of links to them. These institutions are here to help.

[https://www.avma.org.uk/help-advice/inquests/]


[i] Rule 22 of the Coroners Inquest Rules 2013

[ii] Section 10 (2) Coroners and Justice Act 2009

[iii] Rule 25 (4) Coroner’s Inquest Rules

[iv] Paragraph 1/2 of Schedule 1 of the Coroners and Justice Act 2009

[v] Chief Coroner’s Guidance No 17, Para 26 “ Wherever possible coroners should conclude with a short form conclusion. This has the advantage of being simple and accessible for bereaved families and public alike but also clear for statistical purposes

[vi] Jamieson

[vii] R v Maughan

What is a Nasogastric Tube?

Nasogastric intubation is a medical process involving the insertion of a plastic tube (known as an NG tube) through the nose, past the throat and down into the stomach. The decision to pass the tube must be made by two competent professionals and inserted by a suitably trained doctor or nurse. Around 17,000 NG tubes are used by the NHS each year.

They are used primarily for feeding in those unable to take in oral nutrition, e.g. stroke patients who are unable to swallow, but also for administering drugs in liquid form. The type and size is determined by the medical practitioner. The length of time an individual would require the tube varies but only small bore tubes should be used for long term feeding and these usually have guidewires to help with insertion.

Inserting a nasogastric tube

Before insertion the tube is measured from the tip of the patient’s nose, looped around the ear and then down by one to two inches below the bottom of the breastbone. The tube is then marked at this level to ensure that it has been inserted far enough into the patient’s stomach. It is then secured in place to prevent it from moving. It is the responsibility of the clinical staff to document the insertion of the NG tube, and the measurements taken.

Great care must be taken to ensure the tube has not passed down the windpipe and into the lungs. In order to test this, fluid is aspirated through the tube and tested with pH paper to determine the acidity of the fluid. If the pH is four or below, the tube is in the correct position. If this cannot be verified then an x-ray of the chest/abdomen must be taken. Most hospitals these days do take an x-ray to confirm the NG tube position. The x-ray is then checked by a doctor who will confirm whether the position is correct.

As tubes can be dislodged the position should be checked by using the ‘acid test’ before each feed is given.

A gravity based system is employed for feeding whereby the liquid feed is placed higher than the patient’s stomach. Sometimes the tube is connected to an electronic pump which can control and measure intake and flag up any interruption in the feeding process.

Nasogastric tubes can also be used to aspirate (remove by suction) gastrointestinal fluids and air from the stomach. Examples of this use are intestinal obstruction, (where there is a blockage in the intestines) as preparation for gastrointestinal surgery and incidents of poisoning when toxic fluid needs to be removed from the stomach.

If the tube is to be used for continuous drainage the tube is attached to a receptacle (usually a collector bag) and placed below the level of the stomach.

NG tubes should not be inserted in patients with severe neck and facial fractures or strictures of the oesophagus. There is also a risk to patients with bleeding disorders.

Possible complications of nasogastric tube insertion

Minor complications of NG insertion include nose bleeds and a sore throat. More serious problems can occur such as erosion of the tissues anywhere along the passage of the NG tube.

Most significantly if the tube has been incorrectly placed in the lungs, this can lead to collapse of the lung. If a feed is given via the incorrectly placed tube into the lung, fatal pneumonia can occur.

Between 2005 and March 2011 it is reported that 21 deaths and 79 cases of harm occurred due to misplaced NG tubes. Misplacing of NG tubes is described as a ‘never ‘event in NHS Trusts (i.e. something that should never happen).

Lanyon Bowdler is a leading law firm in Shropshire and Herefordshire. Our clinical negligence team have dealt with a number of cases involving NG tubes including failing to insert one when necessary, as well as the complications as outlined above.

World Sepsis Day - Friday 13 September

Today (Friday 13th September) is World Sepsis Day. World Sepsis Day is held every year and provides an opportunity for people worldwide to unite in the fight against sepsis. It is all about spreading awareness of the condition to ultimately help save lives. Sepsis is a condition that unfortunately affects around 700 people in the UK every day.

Lanyon Bowdler’s award winning clinical negligence team have acted for many clients who have been significantly injured or whose loved ones have died as a result of sepsis. Therefore we recognise the importance of early diagnosis and treatment of sepsis. You can find more information on the sepsis page of our website.

What is Sepsis?

Sepsis is a life threatening condition that is the result of a massive immune response to a bacterial infection that gets into the blood. It an often be referred to as septicaemia or blood poisoning. The reason that it leads to life threatening circumstances is that it can often lead to organ failure or injury. Early recognition and treatment of sepsis reduces the mortality by 50% and it can be prevented by vaccination and clean care.

Symptoms

Sepsis can be hard to spot and the symptoms can vary between babies/young children and adults/older children. Below are lists of symptoms split into the specified age groups to help you spot the signs of symptoms, should you or someone close to you experience any of the symptoms below (not necessarily all of the symptoms) then you should call 999 or attend your local A&E department.

Baby or Young Children:

  • Blue, pale or blotchy skin, lips or tongue
  • A rash that does not fade when you roll a glass over it, the same as meningitis
  • Difficulty breathing, breathlessness or breathing very fast. Also you may notice grunting noises or their stomach sucking under their ribcage
  • A weak, high-pitched cry that is not like their normal cry
  • Not responding like they normally do, or no interest in feeding or normal activities such as play
  • Being sleepier than normal or difficult to take

Adults or Older Children:

  • Acting confused, slurred speech or not making sense
  • Blue, pale or blotchy skin, lips or tongue
  • A rash that does not fade when you roll a glass over it, the same as meningitis
  • Difficulty breaching, breathlessness or breathing very fast.

The importance of asking: “Could it be Sepsis?”

Don’t be afraid to ask any medical professional this important question as sepsis can be overlooked.

There are a variety of other symptoms which could indicate sepsis but similarly could be something such as flu or a chest infection. Should you, your child or someone you know experience any of the following you are encouraged to contact 111.

  • feels very unwell or like there's something seriously wrong
  • has not urinated all day (for adults and older children) or in the last 12 hours (for babies and young children)
  • keeps vomiting and cannot keep any food or milk down (for babies and young children)
  • has swelling, redness or pain around a cut or wound
  • has a very high or low temperature, feels hot or cold to the touch, or is shivering

Treatment and Recovery

As previously mentioned, early treatment is vital in sepsis cases as if not treated early, it can turn into septic shock and cause your organs to fail.

Upon your admission to hospital you should get antibiotics within one hour of arrival. You may need other tests or treatments such as treatment in an intensive care unit, a machine to help you breathe (ventilator) or surgery to help remove areas of infection. These treatments will be dependant on your symptoms.

You may need to remain in hospital for several weeks and many people can make a full recovery from sepsis, it just takes time. Should you experience any long-term effects, otherwise called post-sepsis syndrome your GP can advise you on the most appropriate treatment.

More information is provided on sepsis by the UK Sepsis Trust, which is a charity who works hard to raise awareness and ultimately help save lives. Please visit www.sepsistrust.org for more information.

If you or a member of your family have been affected by sepsis and believe there was an issue with your treatment or diagnosis then our expert team will listen and carefully advise you whether you are within your rights to explore a claim for compensation. You can contact our team for free advice on 0800 652 3371.

The Movement Centre - Loss of NHS Funding

The Movement Centre is a UK charity and specialist treatment centre. They support children living with movement disabilities and their families.

They provide a specialist therapy called Targeted Training to help children gain movement control. Targeted Training therapy can enable children to develop new skills and become far more independent.

Through a course of Targeted Training therapy children can gain head control, so they can interact with their family; it can help children develop the skills to sit unaided, so that they can play with their friends. For some children it can enable them to walk!

For more information about the Movement Centre visit their website.

Sadly, The Movement Centre has recently lost all NHS funding. Last year NHS funding paid for 20 out 74 patients’ treatment. Funding from the NHS has been in decline over many years, but the complete withdrawal can hit a charity hard. Read the full story in the Shropshire Star here.

Fortunately, The Movement Centre is working harder than ever at fundraising to ensure they can keep funding treatment for children with movement difficulties. There are so many success stories, some of which you can see by visiting their website or their social media pages.

As a Corporate Partner of The Movement Centre, Lanyon Bowdler is committed to continuing to assist them. The Movement Centre is also one of the charities that we have personally supported having completed fundraising events such as a skydive, a chocolate ban and the fastest zip wire, along with taking part in events run by The Movement Centre such as their annual 5k and virtual walk. There are a number of activities to participate in.

Now more than ever, The Movement Centre needs public support in order to raise the money to continue the amazing work that they do. Current chair of Trustees, David Vicary has set up an emergency fund via a Just Giving page to try and raise some of the money lost from the NHS cuts. He will also be running the Lake Vyrnwy Half Marathon this September in aid of The Movement Centre. To donate to The Movement Centre emergency fund please follow this link: https://www.justgiving.com/fundraising/davidvicary

You can also hold your own fundraising events or take part in any of the events run by The Movement Centre which can be found on their website. They are grateful for any support that can be given.

Lanyon Bowdler Attend Kidz to Adultz Wales & West 2019

During my first week at Lanyon Bowdler, I had the pleasure of attending the Kidz to Adultz Wales & West exhibition in Bristol, hosted by Disabled Living, along with my colleagues Lucy, Kayleigh and Amber from our Hereford clinical negligence team.

The exhibition brought together over 100 providers and specialists from a vast array of fields to present a wide range of products and services, including different charities that support those living with or caring for someone with a disability.

Attending for the second year in a row, the team were accompanied by our LB Bear mascot who had a blast presenting our services to those who may need it, meeting our old friends such as The Movement Centre, and making many new friends during the day.

We are corporate sponsors of The Movement Centre who specialise in ‘targeted training therapy’ which helps children with movement disabilities gain control over their movement.

Our LB Bear enjoyed meeting the frog from Abacus, while Amber had the honour of meeting the team at Creative Care Limited, who create landscape beds, as well as seeing the bespoke OT aids made by Remap.

Remotion wowed Kayleigh with their innovative Mollii suit which stimulates targeted muscles in its user to relieve muscle tension, imbalances, spasticity and other motor disabilities.

Our LB Bear described the event as, ‘a very humbling experience’ and ‘an event that prides itself on supporting disabled children and their carers from all walks of life’.

You can read more about this invaluable event and future events on the Kidz to Adultz website.

We look forward to attending again next year!

The Discount Rate

On 15 July 2019 the Lord Chancellor announced a new discount rate of -0.25% for all personal injury and clinical negligence claims. The Association of British Insurers (ABI) was swift in its criticism of the rate and renewed existing arguments that the new rate would lead to a rise in insurance premiums and pressure on public services such as the NHS, which would have knock on effects on the taxpayer.

The aim of compensation

As we have explained in previous blogs, the aim of compensation in a clinical negligence case is to put a claimant in as close to the position that they would have been in, but for the negligence. This is not always possible, for example in a case where a child has suffered a brain injury in the form of cerebral palsy, the compensation is used to ensure that they are able to achieve their full potential during their lifetime, by ensuring that they can afford the care and support they need for life.

What is the discount rate?

Generally, all compensation payments consist of at least some element of a lump sum, which is awarded for past and future losses. However, the future loss element is discounted at the point of payment to reflect the fact that the compensation could be invested by the claimant and they could actually make money on it. If it were not discounted, this could be unfair since in reality the claimant could be overcompensated for their loss. The idea of discounting is therefore that when the claimant invests their money, the only money they will make is the amount of compensation that was deducted when they received it.

Until 2017, the discount rate was set at 2.5%; the assumption being that interest could be earned at that rate. For example, if a man aged 37 at the time of the negligence sustained a loss of £30,000 a year that would continue until he reached the age of 65, the discount rate would be applied and his claim would be for £606,300. We would not simply multiply his loss by the 28 year period and then claim back £840,000 because the law assumed he would earn a good rate of interest during that 28 years.

Why was it unfair?

Unsurprisingly, defendant insurers and the NHS were happy with this arrangement as they did not have to pay out as much in compensation as the claimant deserved. They happily ignored the fact that, in reality, it is almost impossible for a claimant to earn the necessary rate of interest to make up the shortfall in their compensation. This meant that claimants were being undercompensated.

In 2017, the government recognised this and implemented a new discount rate of -0.75%. This meant the loss of earnings claim in the above scenario changed to £935,100. It recognised that claimants would not be able to earn interest on their compensation. It also provided an advance top-up of their compensation to reflect the fact that over time the value of their money would actually go down as the cost of living goes up (inflation), as a further safeguard against under compensation.

However, defendants were unhappy with this as it meant they had to pay out more in compensation. They argued that claimants were now being overcompensated and that this would increase the burden on taxpayers where the NHS was paying and insurance premiums where insurers had to pay out.

The government accepted that a closer review was required and set the groundwork for this in the Civil Liability Bill 2018. It was then a waiting game as to what the new rate would be.

The new discount rate

In the wake of massive cuts in legal aid and other changes in the way in which clinical negligence claims are funded (which it is fair to say did not go the claimant’s way), claimant solicitors were not optimistic about what the new rate would be.

However, the new discount rate of -0.25% announced by the Lord Chancellor on 15 July 2019 was welcomed as it still reflected a fair and balanced approach to the calculation of compensation. The ABI however is not happy and has denounced the rate as unfair. They argue that higher compensation pay outs will mean higher premiums and taxes, but appear not to appreciate that the gentleman above would now only receive £870,000 for his lost earnings, which is less than before the rate changed and is much more in keeping with his actual loss.

Amidst all of the figures which fly about in the context of negligence claims, it is to be applauded that the government has recognised that there are real victims behind the figures in the media, who deserve just compensation for their injuries. It is hoped that this recognition will continue when the discount rate is reviewed again in five years’ time.

In the meantime, it is unfortunate that out of something positive has come more scaremongering and criticism of claimants and their solicitors. We agree that insurers and the NHS should not have to pay out huge sums in compensation, but not because of the cost of it. We agree because cases of negligence should not be happening and this is why we campaign for lessons to be learned from mistakes that have been made to prevent the same from happening to someone else in the future.

Understanding Pathological Fatigue

With Action for Brain Injury Week having just gone, I wanted to take a look at some of the daily struggles people with brain injury have to overcome.

A brain injury can have devastating effects on the victim, their family and friends. Some of the effects are obvious, but what about those which are harder to see from the outside?

The problem

We all know how difficult being tired can make things. It makes you feel irritable, unable to concentrate and unwilling to socialise. Usually a good night’s sleep will be the remedy to freshen us up to face the rigours of everyday life again but what about if sleep didn’t help? What if you had that feeling all the time? How do you explain to someone that you feel this way despite having a full night’s sleep? This can be the life of someone who suffers with pathological fatigue.

Pathological fatigue is unfortunately a common issue in those with brain injury. This has been explored in a recent study by Headway Brain Injury Association, as part of their Brain Drain – Wake up to Fatigue campaign. Responses to the study report that 87% of those who suffered a brain injury stated pathological fatigue has a negative impact on their life.

Despite it being so common amongst those who suffer with a brain injury, 80% of respondents felt that others had an insufficient understanding of the impact of pathological fatigue, with 69% saying they feel they have been unfairly judged as a result of the lack of understanding.

Understanding the condition

Sadly, it can be all too easy to dismiss this debilitating condition as ‘whinging’ or ‘staying up too late’ and to simply tell someone to ‘get over it’. Even those closest to the victim can often misunderstand the nature of their illness, with 75% of respondents reporting this to be the case.

Peter McCabe, Chief Executive of Headway, believes this is a pervasive issue;

“As a society, we need to wake up and recognise the debilitating effects fatigue can have on people living with the long-term effects of brain injury.

“We all get tired from time-to-time, but for brain injury survivors fatigue can have a debilitating impact on every aspect of their lives. Even seemingly straightforward tasks such as going to the shop can drain a brain injury survivor of all their energy.”

Victims of pathological fatigue can find their lives changed dramatically, being unable to do tasks they were previously able to do with ease; this can lead to conflict for an individual and those around them. Peter McCabe firmly believes “…a lack of understanding of the underlying cause can lead to problems with relationships, work and social life, and the self-esteem of the brain injury survivor.”

Contact us

At Lanyon Bowdler we understand the need for specialist knowledge when working with those that have suffered a brain injury as a result of medical negligence. We work closely with professionals who broaden our understanding of these complex issues, ultimately allowing us to better address our clients’ needs and achieve the best result for them.

Lanyon Bowdler are proud to be corporate members of Headway and are listed in the Headway Head Injury Solicitors Directory.

If you are affected by any of the issues raised in this blog, you can contact a member of our team who will be happy to help you. Alternatively you can read more about the campaign at Headway Brain Injury Association.

Warfarin in a Nutshell

Warfarin is a blood thinner otherwise known as an anticoagulant. It’s a very interesting drug as, just like penicillin, it was discovered by chance. The advancing knowledge and understanding of these drugs have altered how modern medicine is practised, which has saved many lives. However each drug has the capacity in certain situations to have catastrophic consequences. People can have a life-threatening reaction to penicillin, and warfarin needs to be strictly monitored, as it has important drug interactions which can change its effect - making the blood thinner or more at risk of clotting.

The discovery of warfarin

Warfarin was discovered in the early 1920s in the USA and Canada, where cattle were bleeding torrentially, with some dying, after minor surgical procedures e.g. dehorning. The problem was traced to mouldy clover meadow hay. A fungus within it was metabolising a naturally occurring compound called dicoumarol in the mouldy hay and turning it into an anticoagulant.

After many years of research and further refining of the compound, Karl Link, a chemist from the University of Wisconsin, managed to synthesise a more potent anticoagulant from dicoumarol. The drug was named warfarin. Warfarin comes from an acronym WARF – Wisconsin Alumni Research Foundation and arin, from coumarin, which was the molecule present within dicoumarol.

In the 1940s, WARF funded the research into couramin based rodenticides and from this research it was concluded that warfarin could be used medically.

Which conditions can be treated with warfarin?

Warfarin is used for a variety of clinical conditions where the blood is prone to clot. These include:

  • Atrial fibrillation - an irregular heart rhythm caused by the two smaller heart chambers contracting in an erratic way
  • Patients with artificial heart valves
  • People with previous clots or embolisms
  • Strokes
  • Cardiomyopathies – heart muscle problems
  • Medical conditions at a greater risk of clotting e.g. Kawasaki disease

Warfarin acts by interacting with vitamin K clotting factors and its effect can therefore be reversed by giving vitamin K.

How warfarin affects the blood differs from one person to the next. It is difficult to predict its effect and it has to be monitored regularly by a blood test called the INR (international ratio). The same dose can cause widely different anticoagulant effects from person to person and this can be described as a narrow therapeutic index. A small change in dose can make a big change in the INR or no / little change; hence the blood becomes thinner and less able to clot with devastating effects, or the dose may not make the blood as thin as predicted. Monitoring is essential, therefore the INR blood test needs to be performed regularly so the level of anticoagulation is established to be within the agreed range needed for the patient’s specific condition. A normal INR range lays around one.

Can certain drugs and food impact the effects of warfarin?

Many people are not aware that warfarin’s actions can be affected by certain foods and drugs– i.e. there is an interaction.

Certain drugs and foods can potentiate the effects of warfarin, increasing the INR and making a person potentially more prone to bleeding or haemorrhage.

These include:

  • Cranberry juice, mangos, grapefruit, grapefruit juice, grapefruit seed extract, or pomegranate juice
  • Alcohol
  • Certain antibiotics e.g. metronidazole, erythromycin and clarithromycin, ciprofloxacin
  • Some antifungals e.g. fluconazole
  • Non-steroidal anti inflammatories
  • Some laxatives
  • Some heart drugs e.g. amiodarone

Certain drugs and foods can decrease the INR making the blood more prone to clot. These include:

  • Foods high in vitamin K – leafy green vegetables, including spinach, kale and swiss chard
  • Cruciferous vegetables e.g. broccoli, brussels sprouts and cabbage
  • Cholestyramine
  • Barbiturates, rifampicin, carbamazepine

Other drugs that make the patient more likely to bleed without interfering directly with the plasma concentration of warfarin but affect clotting include:

  • Antiplatelets: clopidogrel – aspirin in low doses – dipyridamole
  • Non-steroidal anti inflammatories

The importance of regularly monitoring warfarin treatment

It is always important to inform a treating clinician that warfarin is being taken to try and avoid any deleterious drug interactions. If the INR is too low the patient is more prone to clot and if it is too high the patient is more prone to bleed. Both may have a harmful effect for the patient such as increasing the likelihood of a haemorrhage e.g. from cuts, wounds and abrasions, or spontaneous bleeds such as a haemorrhagic stroke / bleeding from ulcers within the gut system. If the INR reduces it can make the patient more likely to clot, which increases the chance of ischaemic brain strokes, deep vein thrombosis or pulmonary embolism.

It helps considerably if a patient on warfarin is aware of the above information and the importance of careful monitoring by the GP or hospital. Unfortunately, accidents do happen and we have acted on behalf of patients, who have suffered injury as a result of a failure to monitor their warfarin and INR levels.

Breech Baby Scan