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Patients Recalled Following Negligent Shoulder Operations

Up to 600 patients are to be recalled by Walsall Manor Hospital after persistent complaints about negligent shoulder operations performed by orthopaedic surgical consultant, Mr Shah.

The BBC reports that in the years between 2010 and 2018 there have been 21 clinical negligence claims relating to Mr Shah’s surgery.

The Express and Star have detailed that although he was complained about to the General Medical Council by a Ms Aldridge in 2016 following her 2010 operation, they declined to investigate the incident as it had been over 5 years since it occurred. Her virtual inability to use her dominant arm following the procedure reportedly did not amount to anything out of the ordinary, which would have allowed them to extend this limitation period. They had also given him a clean bill of health following a revalidation process in 2014.

In 2020 Walsall Healthcare Trust (“the Trust”) contacted the Royal College of Surgeons (RCS) and they carried out a general review of surgery, then more specifically looked into his individual work. After which a recall of his patients was recommended by the RCS. The Trust have confirmed they are not aware of any complaints in regard to Mr Shah’s hip or knee joint operations, and have provided a hotline for any complaints which is 01922 604 631.

The surgeon was given an interim order by the Medical Practitioners Tribunal Service in 2021, in which he was prevented from performing Latarjet procedures (which are used to treat recurrent dislocated shoulders) or shoulder joint replacements, without supervision. This interim order has now been extended.

This news comes three years after Walsall Manor Hospital were taken out of special measures by the CQC after improving standards in their emergency and maternity departments.

Mr Shah also practiced at Spire Little Aston who have confirmed that he has not practiced there since March 2020 and they are actively reviewing whether they need to contact individuals who had specific treatments with Mr Shah.

As nationally recognised clinical negligence solicitors, we at Lanyon Bowdler represent a wide variety of clinical negligence claims, including negligently performed surgeries and procedures. If you, or anyone you know, are affected by the above, please do get in touch with our team here.

Concerns Over Maternity Units in England Failing to Meet Basic Safety Standards

Victoria Vallance, the Director of the Care Quality Commission, the independent regulator of social care in England has today expressed that she is ‘worried’ and ‘concerned’ about the number of maternity units in England that are failing to meet basic safety standards.
The comments follow a BBC analysis of official statistics published by the CQC which reveal that alarmingly, 7% of the 137 maternity units in England pose a high risk to their patients whilst 48% require safety improvement. Although 62% of units were found to have ‘good’ safety ratings, no unit was found to be ‘outstanding’ for safety.

At Lanyon Bowdler, we represent families all over England and Wales who have suffered due to failings in their maternity care and we have previously provided comment on the maternity scandals that have been identified at Morecombe Bay, East Kent, Nottingham and Shrewsbury and Telford. The CQC’s findings reveal that there are far more maternity units giving rise to concern and what the Chief Executive of the Royal College of Midwives has termed an ‘ongoing crisis in maternity services’.
Whilst the experience of most families on maternity units is positive, when things go wrong, the consequences can be catastrophic. It is therefore concerning that despite specific problems being identified within maternity units which pose a risk to patients, little improvement is being seen within maternity units to reduce those risks.

Consistent problems are being identified across all services such as lack of staff training and failure to manage the risk of women who are deteriorating. Inadequate funding and staffing levels have been identified as root causes in many Trusts but despite plans for improvements and Government investment of £127 million to expand the NHS maternity workforce, on top of the £95 million per year being spent to boost maternity staff numbers, few changes have been seen in practice and the pace of improvements has been described by the CQC as ‘disappointing’.

If you are concerned about the standard of care you have received from your maternity unit, do not hesitate to contact our specialist team for advice.

What is a Best Interests Decision and how are they made for People who Lack Capacity?

When a person lacks capacity; this could be by reason of a disability, a mental health condition, illness or injury, they are not always able to make decisions for themselves, particularly when it comes to complex and important decisions.

However, the Mental Capacity Act 2005 provides a legal framework and practical guidance for making decisions when a person lacks capacity. People that have to adhere to this framework include Deputies, Attorneys, local authority social services teams, medical professionals, advocates and the Courts themselves.

Therefore, when there is a decision that needs to be made regarding someone who does not have capacity, or is suspected to not have capacity, there are two stages. Firstly, there needs to be a mental capacity assessment, because you cannot assume someone lacks capacity without sufficient medical evidence. If it is judged that the person lacks capacity to make a certain decision, then the second stage would be a ‘best interests decision’.

When it comes to best interests decisions, there will be a best interests ‘decision maker’, this could be a Deputy, Attorney, a local authority, social care staff or the Court. A ‘decision maker’ is someone who is acting within their authority to make a particular decision on behalf of the person lacking capacity. This person must make all decisions in the best interests of the person that the decision relates to.

When the decision maker is making these decisions, the Mental Capacity Act sets out the factors which they must have regard to. This is known as the ‘best interests checklist’. These factors include:

  • Considering all relevant circumstances.
  • Considering whether the person will regain capacity and if the decision can be postponed until then.
  • Considering the person’s past and present wishes and feelings, including beliefs and values that would be likely to influence the person’s decisions if they did have capacity.
  • Consulting relevant individuals where it is appropriate. This would include family or friends, anyone named as someone to be consulted or anyone engaged in caring for the person who lacks capacity.

Sometimes there will be disagreements about what is in the person’s best interests. When this is the case, there are several routes that can be taken in order to make a decision, including negotiation and mediation. Where it is appropriate, an application can be made to the Court of Protection for the Court to make a best interest decision. Where an urgent or emergency decision is needed, the Court can deal with this on an emergency basis.

At Lanyon Bowdler, we act as professional Deputies and Trustees and make carefully considered best interest decisions in line with legislation and case law on a daily basis. We also assist people applying to become Deputy or Attorney for their family members or friends. We also provide legal guidance for people who are having to make best interest decisions for loved ones and want to ensure they do so with due regard to the law.

Joint Tenants or Tenants in Common?

Often people will find that purchasing a property with someone is an exciting but daunting process. As part of the conveyancing process, you will be asked whether you would prefer to hold the property as ‘joint tenants’ or ‘tenants in common’. This may not be a consideration that is at the forefront of your mind but it should be a decision which is not taken lightly as each option can result in very different outcomes.

Differences between Joint Tenants and Tenants in Common:

Share of the property:

Joint Tenants

  • Both of you will have equal rights/shares in the property, no matter what your individual contribution is towards the deposit.

Tenants in Common

  • You own specific shares in the property and you have the option to hold the property in unequal shares.
  • A declaration of trust can be prepared to set out the share each co-owner holds in the property.

Right of Survivorship:

Joint Tenants

  • You are not able to leave your share in the property to anyone else in your Will.
  • Your share will automatically pass to the other joint tenant, by right of survivorship.

Tenants in Common

  • Your share in the property will pass to your estate on your death (and not automatically to the other person with a share in the property)
  • It is therefore important that you have a Will in place to stipulate who will inherit your share in the property.

Care Home Fees:

Joint Tenants

  • If the other joint tenant has sadly died, their share of the property will have passed to you by right of survivorship.
  • This means the whole value of the house can be means tested for care home fees and could result in you being liable to pay your own care fees in full.

Tenants in Common

  • If you hold your property as tenants in common and have a specific Will in place that considers care fees, there are options available to you to reduce the capital that can be taken into account by the Local Authority.

How to sever a joint tenancy?

If you currently own your property as joint tenants but would prefer to hold it as tenants in common, this can be facilitated by way of a Deed of Severance (and can be done with or without the agreement of the other joint owner).

If you would like further information or advice on any of the above, please contact our Private Client Team.

Right to Work Checks

Employers are required to verify the lawful immigration status of job applicants prior to employment. Following an initial check, rechecking is required for individuals who have time-limited permission to work in the UK.

A failure to perform appropriate checks may result in the employer being liable for a civil penalties, and criminal penalties for hiring an illegal worker can include a jail term of five years and/or an unlimited fine. Performing an appropriate check provides a statutory defence to prosecution for hiring an illegal worker.

The Home Office launched its online Right to Work Checking Service in April 2018. This allows employers to conduct online right-to-work checks on eligible individuals, as an alternative to in-person checks: those with EU, EEA, or Swiss immigration status who can provide a valid share code.

All other right-to-work checks – including for UK and Irish nationals – had to be carried out in person until 30 March 2020, since when, as a result of the coronavirus outbreak, it has been open to employers to perform adjusted checks remotely over a video call. However, this option will no longer be available after 30 September 2022.

From 6 April 2022, employers have been able to make digital identity checks on holders of in-date biometric British and Irish passports and Irish passport cards through an accredited Identity Service Provider (IDSP): a certified identification document validation technology service provider. (Out-of-date British and Irish passports are not permitted for digital checks, but can be accepted as evidence of right to work if they are checked manually.) This option is to remain available going forward.

The Government’s up to date guide on right to work checks is here.

Medical Treatment - Have I Really Given Consent?

It is common knowledge in the UK that patients have a right to accept or refuse medical treatment, placing an obligation upon healthcare professionals to obtain their patients’ consent prior to undertaking any tests or procedures, but the validity of consent will be nullified if certain essential elements of the consent process are not present. This can have obvious implications for those who have suffered injuries as a result of treatment and may be considering pursuing a claim for clinical negligence.

How is informed consent obtained?

Consent need not be in writing, and for minor tests and procedures of a straightforward nature, verbal consent would typically be given following an explanation by a healthcare professional about the procedure and the reasons for it. Alternatively, you may imply your consent through your actions, e.g. attending your GP with some form of sickness implies that you wish to be treated for it.

For a more significant procedure, such as an operation in hospital, you would be asked to sign a consent form prior to the procedure being undertaken. A signed consent form will not constitute valid consent unless certain obligations have been met by the healthcare provider to ensure, that when consent is obtained, the patient has given their “informed consent”.

To do this, the patient must be fully advised about the need for the procedure, what it involves and any potential risks, side effects and possible outcomes. There may be alternative treatments or approaches to treatment, which the patient may prefer or may be in the patients’ interests to have instead, which must be discussed with the patient. Additionally, the implications of refusing treatment must also be discussed.

The aim is to ensure that when a patient does give their consent, they do so from a position of fully understanding all of their potential choices and consequences.

Notably, in Montgomery v Lanarkshire Health Board (2015) the patient was not fully informed regarding the risks and alternatives to a vaginal delivery for her child, who sadly suffered a severe and catastrophic hypoxic brain injury as a result.

A second essential element of informed consent is giving the patient sufficient time to fully reflect upon the information they have been given, so that when/if they do consent to treatment, they can be satisfied it is the right decision for them. It is unacceptable for medical professionals to rush or coerce patients into making a decision. Indeed, a person would not agree to buy a house or car without taking the time to consider their options – why would choosing whether to have surgery be any different?

Who can and cannot consent to treatment?

The vast majority of patients are able to make decisions regarding their own health and medical treatment.

However, there are situations where a patient is unable to give consent, such as when the patient does not have mental capacity. Consent is then typically given by a family member, or someone who holds Lasting Power of Attorney for them. For certain mental health conditions, treatment can be given without a patient’s consent.

Similarly, when consent is required for a child to undergo treatment, discussions surrounding treatment will be had with those who have parental responsibility so that they are fully informed about the treatment options, before being asked to provide consent on behalf of their child.

A child under 16 may wish to undertake treatment without their parent’s knowledge or against their wishes, but this is only possible if the child is of sufficient age and maturity; has full comprehension of proposed treatments; and is therefore considered legally able to consent to treatment (so-called Gillick-competency).

Finally, there are emergency situations where a patient may be too ill to give their consent to treatment and in such a situation healthcare professionals are able to provide treatment under the doctrine of best interests or to save/preserve life.

Implications

Healthcare professionals have a professional and ethical duty to ensure their patient always consents to treatment from a fully informed perspective. If the approach to the consenting process is not scrupulous, the ability of patients to make logical decisions about their treatment can be significantly impaired, with potentially life-changing consequences.

Agricultural Wages in Wales

We reported on 12 April 2022 on the Agricultural Wages (Wales) Order 2022, which came into effect on 22 April 2022 and applied retrospectively from 1 April 2022.

We highlighted that the published rates were subject to the qualifier that national minimum wage rates must be paid if they are higher. Now, the Agricultural Wages (No 2) (Wales) Order 2022 has been made and applies retrospectively from 1 April 2022, revoking and replacing the previous Order, subject to some changes and a transitional provision.

The new grading structure introduced by the previous Order has been maintained but the minimum hourly rates have increased, in some cases to bring them in line with the national minimum wage (which employees were entitled to in any event) and in others (marked with an asterisk below) beyond the minimum rates which employers were required to pay prior to the implementation of the new Order.

As well as hourly rates, the new Order includes provisions about sick pay, time off, holiday pay and bereavement leave.

The annual leave entitlement and payments in lieu of annual leave have not changed since the previous Order.

The rates of pay and other allowances that are payable are set out below.

Grade Rate per hour

A1 – Agricultural Development Worker (16-17 years) £4.81

A2 – Agricultural Development Worker (18-20 years) £6.83

A3 – Agricultural Development Worker (21-22 years) £9.18

A4 – Agricultural Development Worker (23 years+) £9.50

B1 – Agricultural Worker (16-17 years) £4.81

B2 – Agricultural Worker (18-20 years) £6.83

B3 – Agricultural Worker (21-22 years) £9.18

B4 – Agricultural Worker (23 years+) £9.79*

C – Agricultural Advanced Worker £10.08*

D – Senior Agricultural Worker £11.06*

E – Agricultural Manager £12.13*

Apprentice Year 1 £4.81

Apprentice Year 2 (aged 16-17) £4.81

Apprentice Year 2 (aged 18-20) £6.83

Apprentice Year 2 (aged 21-22) £9.18

Apprentice Year 2 (aged 23+) £9.50

Other Allowances

Dog Allowance £8.53 Per Dog Per Week

Night Time Work Allowance £1.62 Per Hour of Night Work

Birth Adoption Allowance £67.09 For Each Child

The new Order can be accessed here.

For further information and advice in relation to employment law specific to the agricultural sector in Wales, please contact me or another member of the Employment team.

Are Family Law Courts and Associated Bodies Working to their Limits?

Scarcely a week goes by when a solicitor has clients unaffected by the impact on the courts and public services regarding cuts and COVID-19. Sir Andrew McFarlane, President of the Family Division, commented back in March that the family law courts and associated bodies were working at the limit of their capacity. His concerns were reiterated and emphasized on 24 July when the President urged separating families to resolve their disputes elsewhere, rather than through the courts.

This is something family law solicitors largely strive for and have done so long before the present public health and economic situation, but we can only work within the boundaries presented by our clients who, in turn, are often affected by social and economic factors that further limit their choices.

These constraints could be said to fall under two headings, although they are by no means mutually exclusive:

Social Factors

  • There was a time not so long ago when (for example in North Shropshire) funding was available for specialist domestic abuse workers to go into schools and work with even the youngest children, in an age-appropriate way, to develop an understanding of healthy, respectful relationships. That funding has disappeared.
  • It remains apparent that girls and young women remain prone to messaging and factors that foster a sense of being undervalued – such as period poverty, revenge porn and body-shaming – which go on to affect how they participate in relationships.
  • Despite the great work being done by many organisations to de-stigmatise mental health issues in young men, the “big boys don’t cry” message impacts negatively on how some men may feel about expressing their emotions in a healthy way when relationship issues arise.

Financial Factors

  • Under-funded agencies are simply not able to offer the interventions needed for families having difficulties, in a timely fashion or at all. The President himself recently compared family law cases to bread dough which continues to grow and feed upon itself, even when it is left on the shelf to prove. When a case is ongoing and itself subject to delays there can be further difficulties in accessing assistance from other agencies, relatively minor issues at the outset of a case can become explosive. One example of this is the withdrawal of the Domestic Abuse Perpetrator Programme, which was previously available at no cost, if ordered by the court.
  • Private providers such as counsellors and therapists exist but, with the best will in the world, they are simply not accessible to many families, financially or geographically, especially in rural areas where financial poverty is compounded by poverty of basic services, lack of public transport, etc.
  • Legal aid is still available for family law cases where a person qualifies financially and can prove the existence of domestic abuse. The emphasis on proving domestic abuse can shift the focus unhealthily so that behaviours which, whilst unacceptable, were not “deal-breakers”, must necessarily be pushed to the forefront and assume a level of importance that detracts from other issues within the case. Having qualified for legal aid the person is then under financial pressure from the Legal Aid Agency to bring the case to court, or risk running out of funding.
  • Mediation can be carried out under legal aid without needing to prove domestic abuse, and there is also some government funding available for mediation on children issues where a person cannot access legal aid. However, a mediated agreement may still need to be put before the court for approval, and will go through the same process as contested cases at the outset, adding to the backlog.
  • Where resources are tight, and the other party in a case is not able (perhaps for one of the social factors set out above) to engage constructively in negotiations, then the solicitor may feel that an application to court is the only way of achieving some sort of timetable and “end-date” enabling the client to have a broad indication of what the case might cost.

It is worth mentioning ADR (Alternative Dispute Resolution) at this stage which, whilst not an outright solution to the financial issues, since it must still be paid for, can give people a good deal more certainty and control over the situation than they might have through the courts. However, since it is largely voluntary it still relies on a degree of goodwill and cooperation from both parties.

The President’s observation is entirely correct and a reduction in the number of matters coming before the court is something we need to aspire to. However, the court service is merely a cog in a large wheel designed to move society forward, and unless there is concerted and joined-up Governmental effort to tighten the other cogs (through availability of vital services and a cultural shift starting with very young people), then the wheel will simply fall off altogether.

Dementia Friends

Working in the Court of Protection department I regularly interact with clients who lack capacity to manage their property and affairs, or other aspects of their daily life. Some of our clients may have sustained traumatic brain injuries due to personal injury or medical negligence, or they may have a disease which affects their brain, such as a type of dementia. As with everything in life, there isn’t a one size suits all approach that you can take when supporting people, so I decided to attend a Dementia Friends Webinar to ensure I can tailor my approach in the most appropriate way.

Dementia Friends offer free online, or in person, sessions to educate people about dementia. They have short pre-recorded videos you can watch immediately, or you can sign up to attend a virtual or in person webinar run by a Dementia Champion. Due to living in Shropshire I chose to sign up to a virtual session which lasted around one hour. If you would like to attend a session, and I would highly recommend this to everyone, you can do so here.

Dementia is an umbrella term and covers diseases such as Alzheimer’s disease, Lewy body dementia, vascular dementia and frontotemporal dementia. The Alzheimer’s Society published in December 2021 that there were 900,000 people living with dementia in the UK with this figure forecast to rise substantially over the next 20 years.

Whilst living with dementia is not without its challenges, there are many negative connotations strongly linked with the diagnosis. Although dementia is degenerative it is easy to forget that there is more to a person than dementia. The Dementia Friends session was very much focused on addressing and changing the stigma associated with dementia.

As with anything in life it is easy to get trapped focusing on the negatives, but there are things we can do as individuals to help change the stigma. Of course this will vary depending on the situation and the individual, but multiple small changes can make a large difference.

Understanding

Dementia doesn’t solely affect someone’s memory, it can affect their motor skills such as being unable to use a knife and fork when eating. Someone living with dementia may have difficulty with sequencing and struggle with tasks such as getting dressed. They may have difficulty communicating or with their visual perception. Understanding how dementia affects the individual means you can learn how to assist them. For example, if you were to ask someone living with dementia if they wanted orange or blackcurrant squash to drink they may not be able to communicate with you, however, if you had a picture card with both on they may be able to understand the question and communicate which they would like. Something as simple as slowing down your pace when you talk, and simplifying sentences to someone living with dementia, could make a difference in their ability to communicate.

Change

Change doesn’t have to be big to make an impact. It may be that a setting is familiar and leaving things as they are is what’s best for a person living with dementia, however, for some a small change may make their life easier. This could be something as simple as changing the layout of the kitchen so it is easier to make a sandwich or hot drink, or the layout of a wardrobe making it easier for them to get dressed in the morning.

Awareness

This is twofold: we need to be aware that we can help even in small ways and also the need to spread awareness. There is more to a person than their dementia diagnosis whether they are in the early stages or more advanced stages. It is easy for people to see or hear of a diagnosis and make an assumption. Sadly we witness these assumptions far too frequently, but with education and raising awareness hopefully they will become less frequent.

We understand that a diagnosis of dementia doesn’t automatically mean someone lacks capacity, and if they do lack capacity regarding certain decisions it doesn’t mean they lack capacity to make any decision whatsoever. If you or a loved one have been diagnosed with a disease that affects the brain, have an acquired brain injury, or have been assessed as lacking capacity, that doesn’t mean access to legal help is no longer available. The Court of Protection department at Lanyon Bowdler specialise in mental capacity law and are happy to assist you with any enquiries.

Farm Diversification – Tax Considerations and Consequences

Diversification can lead to new sources of income, and may also be an attractive business project for younger generations of farming families looking for long-term financial stability. With the number of UK residents opting for ‘staycations’ since the COVID-19 pandemic, diversification has become an increasingly desirable tool for farmers and land owners to access new means of revenue. However, diversification can have a negative impact on your inheritance tax (IHT) position and could exclude the availability of valuable IHT reliefs. Before making any changes, it’s important to consider what tax implications might lead from diversification, to ensure your family doesn’t end up with a large and unwanted tax bill in the future.

Agricultural Property Relief (APR)

Many farms benefit from Agricultural Property Relief (APR), which can reduce, or completely wipe out, IHT on farm land and buildings. Briefly speaking, APR requires that the land or buildings must be occupied and used for agricultural purposes. This can include farmland, barns and storage buildings, farmhouses and farm cottages. When considering the availability of APR, HMRC will look at the different uses of the land or property and the way it is used and occupied.

Changing the use of such land and property from agricultural to non-agricultural use risks the asset in question no longer qualifying for APR and therefore becoming subject to IHT.

One popular method of diversification in recent years has been converting existing agricultural land or buildings into holiday lets, or camping and glamping sites. However, applying the above rules, these assets would no longer benefit from APR. Diversification by a tenant of your land away from agricultural use can also affect your eligibility for APR as the landowner.

Business Property Relief (BPR)

Some diversified assets may qualify for Business Property Relief (BPR), which can also reduce or eliminate IHT. In order to benefit from BPR, the asset, land or buildings must be used for ‘trading’ rather than ‘investment’ purposes. Therefore assets owned for the purpose of collecting rental income without much management, or any extra services, will likely be considered to be ‘investments’ and therefore less likely to qualify for BPR.

Common diversification projects on farms that are likely to be deemed ‘investment’ activities include holiday lets. If the level of additional services provided is particularly high, then HMRC can consider the business as ‘trading’ rather than ‘investment’, however, this is difficult to judge and each case must be treated on its own facts.

Is there a quick solution?

There is no ‘right’ answer when it comes to diversification. All farms and all families are different, with individuals having their own preferences and motivations, so there is no “one size fits all” approach. There are options when it comes to mitigating the potential IHT bill, such as insurance policies to cover IHT bills and making lifetime gifts, however, these are not without their own consequences and as a result no one should take such steps without speaking with a qualified advisor first. As with everything in life, the best option will depend on your individual circumstances.

If your diversified business is likely to include trading and investment activities, then it’s important to discuss the potential tax consequences with a specialist advisor, such as one of our Private Client solicitors.

Deborah James' Campaign Increases Bowel Cancer Awareness

Deborah James, also known online as Bowelbabe, sadly passed away recently at the age of 40 from terminal bowel cancer. Deborah was diagnosed with bowel cancer in December 2016 after experiencing a six month change in bowel habit including passing blood in her stool, opening her bowels more frequently and losing weight.

At the time of diagnosis, Deborah’s cancer was stage 4 - the most advanced stage - meaning it had spread to other parts of the body. She underwent extensive treatment, including numerous invasive surgeries, and spent the rest of her time campaigning and raising awareness about her condition, by sharing her story via the BBC “You, Me and the Big C” podcast and her social media platforms. Set up in the weeks preceding her death, her fund for Cancer Research UK reached over £7.3 million.

In the weeks following Deborah’s death, NHS chief executive Amanda Pritchard reported that thousands more people had checked bowel cancer symptoms on the NHS webpages. On Wednesday 2 July 2022, the number of visitors to these pages increased tenfold from 2,000 to 23,274, compared with the day before.

Bowel cancer affects almost 43,000 in the UK each year and it is the fourth most common cancer in the UK. Depending on where the cancer starts, bowel cancer is sometimes called colon or rectal cancer.

More than 94% of cases are diagnosed in people over the age of 50, whilst 59% are diagnosed in people aged 70 or over. However, it is important to remember that bowel cancer can affect anyone of any age, as in Deborah James’ case, and more than 2,600 new cases each year affect people under the age of 50.

Bowel cancer is treatable and curable, especially if diagnosed early. However, survival rates drop significantly as the disease progresses. Sadly, only one in 10 people with stage 4 cancer (the most advanced stage) survive for more than five years after their diagnosis. Bowel cancer is currently the second leading cause of cancer deaths in the UK.

Symptoms

According to the Cancer Research UK website, possible symptoms of bowel cancer can include:

  • bleeding from the back passage (rectum) or blood in your poo
  • a change in your normal bowel habit, such as looser poo, pooing more often or constipation
  • a lump that your doctor can feel in your back passage or tummy (abdomen), more commonly on the right side
  • a feeling of needing to strain in your back passage (as if you need to poo), even after opening your bowels
  • losing weight
  • pain in your abdomen or back passage
  • tiredness and breathlessness caused by a lower than normal level of red blood cells (anaemia)

These symptoms can also be caused by a number of other, less serious conditions, but it is important you get checked by your GP if you have any of these symptoms. The chances are that you do not have bowel cancer, but given the importance of the early diagnosis in bowel cancer cases, it is better to consult your GP if you have any concerns.

Treatment

If you are unfortunate enough to be diagnosed with bowel cancer, your treatment will depend on a number of factors including the location of your cancer, the type, the stage (i.e. the size and whether it has spread), and the grade (i.e. the appearance of the cancerous cells under a microscope).

In most bowel cancer cases, the first course of treatment is surgery to remove the cancer. For small, early stage bowel cancer, you may be able to have the cancer removed from the bowel lining, along with a border of healthy tissue. This is called a local resection. For larger cancers, you might undergo a procedure called a colectomy, which involves removing the part of the bowel containing the cancer and joining the two ends of the colon back together. The amount of bowel that is removed will depend on the size of the cancer.

For people with bowel cancer in the very early stage 1, surgery alone may be curative. However, others may also need to undergo chemotherapy to lower the chance of the cancer coming back after surgery (also known as recurrence). Those with advanced stage 4 bowel cancer may, in addition to surgery and chemotherapy, receive targeted and specialised immunotherapy drugs and radiotherapy to reduce their symptoms.

One of the targeted drugs for advanced bowel cancer is Cetuximab (also known by its brand name Erbitux). It is a type of monoclonal antibody which seeks out cancer cells by targeting particular proteins on the cell surface. Cetuximab may be offered alongside a normal chemotherapy programme.

Chemotherapy is delivered in cycles and after each round of treatment you have a break to allow your body to recover. When patients have a break from chemotherapy, they continue to receive Cetuximab alone. Treatment breaks in England from Cetuximab beyond six weeks were prohibited under NHS rules, despite evidence from a clinical trial that showed a break in Cetuximab does not have a negative impact on patient outcome. For any breaks longer than this, funding for treatment was no longer provided by NHS England, which meant patients had to pay for this potentially life-extending medication themselves.

However, Queen's University Belfast in collaboration with Bowel Cancer UK recently carried out a historical analysis of both intermittent and continuous Cetuximab treatment, to determine their impact on quality of life and treatment costs. The research found that a treatment break approach with Cetuximab does not have any negative impact on a patient's quality of life and outcome, but could potentially save up to £1.2 billion for the NHS in England. This research helped to bring about a temporary policy change, which remains in place today, removing treatment break restrictions that occurred during the COVID-19 pandemic. The treatment break rule does not apply elsewhere in the UK

Bowel cancer patient Steve Clark started a petition to scrap the rule completely, something which Bowel Cancer UK are also campaigning for. The rationale behind scrapping the rule is that patients are often forced to discontinue their treatment due to being unable to afford to pay for the treatment privately, even though many need a break longer than six weeks to recover from side effects like painful rashes and nausea, or they require surgical treatment for an unrelated condition such as a hernia, which requires them to stop Cetuximab for more than six weeks.

As well as the seemingly positive impact this would have for patients, the money that could be saved in allowing breaks from Cetuximab is significant, and in a time when the NHS is being pushed to its limit, any money that could be saved and redirected to staffing, training and other resources is surely a good thing.

Coming to terms with a cancer diagnosis is difficult, particularly when there are questions about the standard of care someone has received. If you or a family member considers your care has been affected by a delay in diagnosis of cancer, it is important to explore all the options available to you. Our Clinical Negligence team at Lanyon Bowdler have experience handling such cases and are happy to discuss the matter with you and guide you through the process sensitively.

Advantages and Disadvantages of Appointing Lanyon Bowdler to act as Executors in your Will

Lanyon Bowdler are often asked by clients to act as executors in their Will.

It is important you are aware of both the advantages and disadvantages of appointing a professional executor, in order to make an informed decision about the appointment and its related costs. Below is a non-exhaustive list of the advantages and disadvantages.

You have a choice of appointing either a professional, a lay person (such as a family member or friend), or a professional executor. A beneficiary in your Will may be an executor. It is not compulsory to appoint Lanyon Bowdler as your executor when you instruct the firm to prepare your Will.

A lay executor may engage the services of a professional to assist with the administration of the estate.

However, there are often circumstances where a professional executor is in the best interest of both you and your estate. This will depend on the constitution and complexity of your estate and those who will benefit under the terms of your Will.

Advantages

  • Your estate will be dealt with professionally in accordance with the law. The team at Lanyon Bowdler have years of experience in administering estates in an efficient manner.
  • Your executors will act impartially between all beneficiaries. Any family conflict can be managed fairly, as Lanyon Bowdler are not personally involved. An appointment of a less robust lay executor may be problematic where there is an overbearing beneficiary or where one executor is likely to dominate and overrule the other.
  • If the estate is contested, Lanyon Bowdler have a specialist Contentious Probate team who can advise the executors.
  • The role of an executor can be complex and time consuming at what can be a very difficult time for family and friends. Lanyon Bowdler can remove the worry and strain from lay executors.
  • An executor is personally liable for any negligence in an estate. This may cause concern for a lay executor about getting something wrong. If something goes wrong, your beneficiaries would be insured against any financial loss due to Lanyon Bowdler’s professional indemnity.
  • The team at Lanyon Bowdler would have worked with you drafting your Will. You can be assured that we will carry out your wishes in your Will.
  • The team have years of experience which will mean the executors understand the “legal jargon” in the Will.
  • The administration of an estate involves the consideration of tax implications in an estate, such as income tax, capital gains tax and inheritance tax. Lanyon Bowdler can advise any tax planning opportunities to ensure your estate is distributed in the most tax efficient manner.
  • The team would be able to offer advice to beneficiaries on Deeds of Variations if they wish to vary their entitlement in the estate. This can be used as a tax planning strategy for the beneficiary
  • If a Trust is created in your Will, the trustees can obtain up to date advice from the firm’s specialist Trust team on whether the Trust needs to be registered at HM Revenue & Customs, along with their ongoing legal responsibilities.
  • The executors will have access to Lanyon Bowdler’s panel of trusted professionals to assist in the administration of an estate; such as accountants, independent financial advisers, tracing agents, genealogists, estate agents and clearance companies.
  • If a lay executor dies before you, who deals with your estate may be out of your control.

Disadvantages

  • Where a professional executor acts they will be entitled to charge for services under the terms of your Will. Generally, a lay executor would not charge. However, Lanyon Bowdler provide clear and transparent information on their charging structure. The charging structure does vary from time to time. Our costs for probate and administration services are advertised on our website and we encourage you to review these before making a decision on the appointment of executors in your Will.
  • Circumstances may have changed from when you prepared your Will. The reasons why you appointed a professional executor at the time of your Will may no longer be relevant, eg. the size and nature of your estate, family dynamics or locality. Under these circumstances, your family may ask Lanyon Bowdler to renounce as executors. A professional executor is not required to do so. However, Lanyon Bowdler will consider whether, at the date of death, circumstances have changed and what is now in the best interests of the estate.
  • Professional executors are often not personally involved in your affairs prior to date of death. They may not be aware of your financial affairs and family situation. However, Lanyon Bowdler do recommend you leaving a comprehensive asset and information schedule with your Will. Lanyon Bowdler would also work together with your family, friends and attorneys to ensure they have this information at the outset of the administration of the estate.
  • With some executorships, there may be a continuing role for the executor to act as a trustee. This could lead to ongoing trustee fees.

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