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No Such Thing as a Free Divorce

I doubt I am the only one suffering from “election fatigue” and longing for 9th June. However, I was amused by the exchange during Wednesday’s televised debate, when Leanne Wood of Plaid Cymru pointed out to Paul Nuttall of UKIP that there is no such thing as a free divorce (in relation to the plans outlined for the UK’s departure from the EU).

Turkey voting for Christmas

To take her entirely literally, she has a point! Even if that turns out to be the only accurate thing said by any politician in the whole lead-up to the election (and I’ll leave you, Dear Reader, to be the judge of that) it’s fair to say that the people involved in divorce proceedings do nevertheless have a significant role to play in keeping the costs of the process as low as possible. The expression “turkey voting for Christmas”, to keep up the election theme, might spring to mind when a lawyer writes an article about how to pay your lawyer less, but essentially the solicitor should be as motivated to help the parties emerge with their dignity intact and a sense of mutual goodwill, especially when children are involved, as with the size of the bills delivered. This is common and commercial sense, in the short and long terms.

Mutual understanding

Whilst certain expenses, such as Court fees, Land Registry search fees, etc are largely unavoidable there is scope for sensible agreements to be reached over whether these should be split between the parties and in what proportion.

Forming a mutual understanding of what you both want to achieve before seeing the solicitor can also be a huge bonus in terms of everyone saving money later (even if meeting face-to-face is too emotionally fraught or impractical, polite and respectful email / text exchanges can help foster good communications that pave the way for sensible negotiations once a solicitor becomes involved). I am not suggesting that everything has to be agreed and tied-up before involving the solicitor since neither person should commit themselves to anything before getting advice, but even being able to identify the points on which you cannot agree is a useful exercise which reduces the amount of time spent in protracted meetings and correspondence with and between lawyers.

Mediation & Collaborative law

Mediation is a great tool for working through issues to try to reach agreement and the Courts now require parties to attempt it. The costs of a mediator are usually lower than a solicitor’s hourly rate, although both parties will need to seek legal advice on any agreement they reach in mediation, and there are proper measures in place to ensure the parties are physically safe.

Collaborative law serves a similar purpose and we are fortunate to have two collaboratively-trained lawyers in our Family Law team.

Dealing sensibly

However, with the best will in the world, sometimes it is simply not possible to reach agreement. Whilst that is not necessarily an indication that one or both are being unreasonable, starting court proceedings in such cases to deal with finances or children can, as counter-intuitive as it sounds, be helpful. Instead of funds being spent on correspondence and meetings which seem to be leading nowhere, those resources can be ploughed into getting a Court timetable and ensuring all the steps required are dealt with fully and thoroughly in order that the Court has everything it needs to be able to assist the parties. Dealing sensibly with Court proceedings and being open with your information can help to bring about settlements at the first, rather than third or fourth, Court hearing with very obvious financial advantages for both parties.

Personalised pricing structures

At the end of the day (to return to an expression much-favoured by politicians), whatever is spent unnecessarily on fractious proceedings simply means there is less available, financially and emotionally, for the parties to be able to move on and re-build after a difficult time.

We offer personalised pricing structures to give clients options and help them make the right decision about their case and their priorities.

If it sounds too good to be true, then it probably is!

I recently represented somebody whom I will refer to as ‘Dave’. I had previously represented Dave on unrelated matters and he had been very happy with the outcome I achieved on that occasion.

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Drink driving

Dave was recently arrested for Drink Driving. Rather than ask a local firm of solicitors, whom he knew and trusted, Dave went on Google and was ‘sold’ by a solicitors firm advert effectively promising to ‘get him off’.

£9,000 plus VAT

As a single father of two, in his desperation to avoid the conviction and subsequent mandatory disqualification, Dave was convinced into parting with his money. Clearly it was worth it to keep his driving licence. He was quoted £9,000 plus VAT for the case. He begged his mum to loan him an initial £1,500 which she reluctantly gave him, even though she wanted him to speak to me first.

After paying the initial instalment, Dave could not then afford the balance and therefore his solicitors, having effectively done nothing to assist his case, ceased to act for Dave leaving him high and dry.

In full view of the police

A worried Dave then contacted me, days before his trial which he would now potentially have to run himself, for a second opinion. I bluntly advised him that he ‘did not have a leg to stand on' and was bound to be convicted of the offence.

In simple terms he had consumed alcohol and driven his car the wrong way down a one way street in full view of a police officer! There was no defence!

Sympathetic Magistrates'

I was subsequently able to represent Dave at court, charging him a fraction of his initial outlay for my expertise, and he entered the correct plea, something he should have done months earlier.

Fortunately the Magistrates’, whom I know very well from regularly appearing before them, were sympathetic when I explained Dave’s tale of woe to them. They were persuaded to sentence him to the minimum penalty available to them.

Dave has given me permission to write this blog so that other people don’t make the mistakes he did! The moral of the story is….if it sounds too good to be true then it probably is!!!

#ifitsoundstoogoodtobetruethenitprobablyis #sometimeslocalisbest

Give Mental Health the Funding it Needs

On average, one in four people will experience a mental health problem each year. Mixed anxiety and depression is the most common mental disorder in the UK, and whether as a result of bereavement, financial worries or relationship issues, that’s around 16 million people affected in the UK every year.

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Funding

Despite the prevalence of mental health issues and arguments to the contrary, mental health problems appear to be low down on the list of priorities, and certainly not parity to physical health issues. The charity Mind reported that local authorities spend on average, less than one percent of their public health budgets on mental health. This means that in 2016-2017, when the Government’s budget for local authorities’ public health expenditure was £3.32m, less than £30,000 was spent on mental health. It seems unsurprising then that only two out of more than 50 mental health trusts in England have received outstanding ratings by the Care Quality Commission, given the apparent lack of resources.

In January of this year, Prime Minister Theresa May had pledged to tackle the stigma surrounding mental health with the implementation of new initiatives for schools and employers to provide mental health support. However, only around £23,000 per parliamentary constituency was promised in support of these plans and critics remain sceptical about the Government’s attempt to improve mental health services without a significant amount of extra funding to match. And, whilst money certainly isn’t everything and we should not underestimate the power of raising awareness, the level of funding allocated to mental health provision remains an unresolved part of the agenda.

Royal discussions

Mental health is not just a current topic of conversation for politicians though. In a recent interview with the Daily Telegraph, Prince Harry revealed his own struggles with his mental health following the death of his mother Diana, Princess of Wales in 1997.He spoke openly about the negative impact that burying his emotions for almost 20 years and refusing to process his grief had on his mental health.

Together with the Duke and Duchess of Cambridge, Prince Harry was seen at the recent London Marathon promoting the Heads Together mental health campaign, which was the marathon’s charity of the year. The Heads Together project is a partnership between several charities and their hope is that others suffering from mental health issues will feel encouraged to talk about them and break the stigma that unfortunately still surrounds such issues.

Raising awareness is the first step to normalising conversations about mental health and the Telegraph reported that since Prince Harry’s interview, mental health charities had double the amount of people contacting them the following week seeking help and information.

Minds matter

And it’s not just the Royal family getting involved in the conversation. Stars such as Tom Hardy, David Tennant and Olivia Coleman have taken to social media to support the #1in4 selfie campaign as part of the BBC’s Minds Matter season to encourage people to normalise conversations about mental health.

It’s difficult to stress just how important raising awareness can be. It’s the first step to opening up a national dialogue for mental health discussions and dispelling the stigma so often associated with it. With the snap general election looming, an increase in mental health coverage could prompt party candidates to make it a part of their manifestos and give it the funding it undeniably needs.

PIP - Costing An Arm & A Leg

In 2013, the government launched Personal Independence Payment (PIP) to replace Disability Living Allowance (DLA) for individuals between 16 and 64 who require financial assistance to help with the extra costs caused by long-term ill health or disability.

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In certain circumstances, payments can be made to assist with mobility. Individuals are assessed to establish whether they qualify for either the standard or enhanced rate (previously the lower or higher rate, under DLA) for their mobility needs.

Whilst the rates have remained the same between DLA and PIP, the eligibility criteria have changed, resulting in over 50,000 people losing their specially adapted vehicles. This has cost numerous individuals their jobs and their independence. Due to the change in the criteria, the effect has been particularly detrimental to those who have suffered a lower limb amputation.

Motability Scheme

Individuals can spend their mobility allowance as they wish to best accommodate their needs. For example, someone who travels only short distances may spend their allowance on taxis, whilst others who travel further, such as to their place of work, may require their own (often specially-adapted) transport.

The Motability Scheme allows disabled people to lease a new car, scooter or powered wheelchair for three years by exchanging their mobility allowance if they receive either the higher rate mobility component of DLA or the enhanced rate mobility component of PIP. Anyone who is ineligible for the enhanced rate will not be able to get a vehicle.

Change in criteria

Under PIP, only those who can stand and then move less than 20m will qualify for the enhanced rate. The PIP Assessment Guide states that ‘‘Standing’ means to stand upright with at least one biological foot on the ground with or without suitable aids and appliances’. Aids and appliances may include walking sticks, crutches and even prostheses. Previously, an individual who could move no further than 50m would qualify for the higher rate under DLA.

The consequences of this change have been severe for many. To put it in real terms, consider an individual who is able to move, with aids, around their house and to their car but requires a wheelchair once at their destination. Previously, someone in this situation would have qualified for the higher rate and, subsequently, the Motability Scheme but is unlikely to be eligible under PIP.

If that wasn’t enough, there is also now a requirement under PIP that a claimant’s health condition or impairment must have been present for at least three months at the time of their assessment and be expected to last for at least a further nine months.

Why are the changes such a problem for lower limb amputees?

The best way to demonstrate the true effect of the changes is by way of an example.

Suppose you are unfortunate and find yourself in a road traffic accident. Up until that point, you were healthy and had no disabilities – you visited family, socialised with friends and worked Monday to Friday. Life was very 2 point 4. As a result of the accident, your right foot is amputated.

It takes no stretch of the imagination to begin to understand the difficulties you will face getting around. In the early stages, you may not be allowed to use crutches and will rely on a wheelchair to move about. Your leg will need to heal before you can be fitted for a prosthetic limb and, even then, the process can take some time. During this period, how will you get out of the house, visit friends and relatives, take your children to school? What about grocery shopping or even going to work?

Under DLA, you would have qualified for the higher rate mobility payments, being unable to walk further than 50m. You could have applied to the Motability Scheme to lease a specially adapted vehicle during your recovery and lived your life as independently as possible.

Even if you are initially unable to move further than 20m, you will probably struggle to satisfy the PIP time requirements to claim any benefit. Three months before the accident, you had no disability. In nine months’ time, it is most likely that you will have a prosthetic limb or at least be competent to get around using crutches and move more than 20m. You will not qualify for the enhanced rate mobility payments under PIP and you will be barred from the Motability Scheme. You will have no specially adapted transport and you will therefore be unable to go out. If you have been affected by the loss of a limb you could be entitled to Amputation Compensation and should contact our Serious injury Laywers

Is this fair?

It is imperative that people who suffer from a lower limb amputation do not lose their independence. Being confined to one’s house will not aid any recovery and preventing someone from getting to work, and potentially losing their job, benefits no one.

The media will often espouse the view that people take advantage of disability benefits and the system needs reforming so that only those who really need help receive it.

Following the 2013 reforms and introduction of PIP, someone who has suffered such a life-changing event as losing part of their leg is apparently no longer deserving of this help. Does society really begrudge an individual, in such a devastating situation, the best opportunity to recover, maintain their independence and lead a normal life?

PIP - Costing An Arm & A Legs

In 2013, the government launched Personal Independence Payment (PIP) to replace Disability Living Allowance (DLA) for individuals between 16 and 64 who require financial assistance to help with the extra costs caused by long-term ill health or disability.

In certain circumstances, payments can be made to assist with mobility. Individuals are assessed to establish whether they qualify for either the standard or enhanced rate (previously the lower or higher rate, under DLA) for their mobility needs.

Whilst the rates have remained the same between DLA and PIP, the eligibility criteria have changed, resulting in over 50,000 people losing their specially adapted vehicles. This has cost numerous individuals their jobs and their independence. Due to the change in the criteria, the effect has been particularly detrimental to those who have suffered a lower limb amputation.

Motability Scheme

Individuals can spend their mobility allowance as they wish to best accommodate their needs. For example, someone who travels only short distances may spend their allowance on taxis, whilst others who travel further, such as to their place of work, may require their own (often specially-adapted) transport.

The Motability Scheme allows disabled people to lease a new car, scooter or powered wheelchair for three years by exchanging their mobility allowance if they receive either the higher rate mobility component of DLA or the enhanced rate mobility component of PIP. Anyone who is ineligible for the enhanced rate will not be able to get a vehicle.

Change in criteria

Under PIP, only those who can stand and then move less than 20m will qualify for the enhanced rate. The PIP Assessment Guide states that ‘‘Standing’ means to stand upright with at least one biological foot on the ground with or without suitable aids and appliances’. Aids and appliances may include walking sticks, crutches and even prostheses. Previously, an individual who could move no further than 50m would qualify for the higher rate under DLA.

The consequences of this change have been severe for many. To put it in real terms, consider an individual who is able to move, with aids, around their house and to their car but requires a wheelchair once at their destination. Previously, someone in this situation would have qualified for the higher rate and, subsequently, the Motability Scheme but is unlikely to be eligible under PIP.

If that wasn’t enough, there is also now a requirement under PIP that a claimant’s health condition or impairment must have been present for at least three months at the time of their assessment and be expected to last for at least a further nine months.

Why are the changes such a problem for lower limb amputees?

The best way to demonstrate the true effect of the changes is by way of an example.

Suppose you are unfortunate and find yourself in a road traffic accident. Up until that point, you were healthy and had no disabilities – you visited family, socialised with friends and worked Monday to Friday. Life was very 2 point 4. As a result of the accident, your right foot is amputated.

It takes no stretch of the imagination to begin to understand the difficulties you will face getting around. In the early stages, you may not be allowed to use crutches and will rely on a wheelchair to move about. Your leg will need to heal before you can be fitted for a prosthetic limb and, even then, the process can take some time. During this period, how will you get out of the house, visit friends and relatives, take your children to school? What about grocery shopping or even going to work?

Under DLA, you would have qualified for the higher rate mobility payments, being unable to walk further than 50m. You could have applied to the Motability Scheme to lease a specially adapted vehicle during your recovery and lived your life as independently as possible.

Even if you are initially unable to move further than 20m, you will probably struggle to satisfy the PIP time requirements to claim any benefit. Three months before the accident, you had no disability. In nine months’ time, it is most likely that you will have a prosthetic limb or at least be competent to get around using crutches and move more than 20m. You will not qualify for the enhanced rate mobility payments under PIP and you will be barred from the Motability Scheme. You will have no specially adapted transport and you will therefore be unable to go out.

Is this fair?

It is imperative that people who suffer from a lower limb amputation do not lose their independence. Being confined to one’s house will not aid any recovery and preventing someone from getting to work, and potentially losing their job, benefits no one.

The media will often espouse the view that people take advantage of disability benefits and the system needs reforming so that only those who really need help receive it.

Following the 2013 reforms and introduction of PIP, someone who has suffered such a life-changing event as losing part of their leg is apparently no longer deserving of this help. Does society really begrudge an individual, in such a devastating situation, the best opportunity to recover, maintain their independence and lead a normal life?

Spoiler Alert... Peter Kay's Car Shares

I apologise in advance for fans of Peter Kay and the hit BBC show Car Share which concluded last night.It is based on two friends commuting to and from work and films them chatting in the car.

Peter Kay, who plays John Redmond, has confirmed that there will not be a third series citing he is “getting out whilst the going’s good”.

However, the legal brain in me feels there might be more to it than that…..towards the end of the programme, John is seen sending a text message from behind the wheel (which turns out to be a song request to Forever FM)…..could it be that he has been prosecuted, and as of 1st March 2017, obtained at least a £200 Fixed Fine and six points on his licence?

What if it was a second relevant offence meaning that he has now been disqualified from driving? He would then not be able to drive for potentially six months, thereby ruining the plot!

So if you, or Peter Kay need any legal advice, or indeed the scriptwriters need my input…..contact me on 01743 280280.

Spoiler Alert... Peter Kay's Car Share

I apologise in advance for fans of Peter Kay and the hit BBC show Car Share which concluded last night.It is based on two friends commuting to and from work and films them chatting in the car.

Peter Kay, who plays John Redmond, has confirmed that there will not be a third series citing he is “getting out whilst the going’s good”.

However, the legal brain in me feels there might be more to it than that…..towards the end of the programme, John is seen sending a text message from behind the wheel (which turns out to be a song request to Forever FM)…..could it be that he has been prosecuted, and as of 1st March 2017, obtained at least a £200 Fixed Fine and six points on his licence?

texting_at_the_wheel.jpg

What if it was a second relevant offence meaning that he has now been disqualified from driving? He would then not be able to drive for potentially six months, thereby ruining the plot!

So if you, or Peter Kay need any legal advice, or indeed the scriptwriters need my input…..contact me on 01743 280280.

A “Do-it-yourself Divorce” – Is it worth it?

Statistics released on 5 December 2016 by the Office of National Statistics revealed that, overall, the amount of divorces have been decreasing (demonstrated by a 3.1% decrease in 2014 compared with 2013, and a decline of 27% from a peak in divorces in 2003). Great news!

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However, despite the statistics, it is still an unfortunate reality that some marriages will come to an end, resulting in divorce. Going through a divorce is one of the most stressful life events an individual can experience, and will have an emotional, financial and legal impact on a person’s life.

There are costs associated with getting divorced too. The current fee to issue your divorce petition with the court is £550 (although you may be entitled to a partial/full fee remission, dependent on your income), and there are further court costs associated with resolving the related financial matters. It does not come as a surprise, therefore, that some individuals consider embarking on a “Do-it-yourself Divorce”, rather than instructing solicitors to act on their behalf. lawyers can see the thinking behind this decision – why would you want to pay a solicitor to do something that you may be able to do yourself, given the abundance of information available online? We have even discovered DIY Divorce Kits both in high street stores and on the Internet, costing between £19.99 – £40!

However, a “Do-it-yourself Divorce” may present unforeseen pitfalls. The following points are worth your consideration:

  • You will already be going through an emotional and stressful experience. By instructing a solicitor, you gain the advice and support of an expert acting purely in your best interests, and providing you with clear and realistic guidance which, in turn, should reduce stress for you.

  • Solicitors are not emotionally invested in your divorce or financial proceedings. We remain objective and sensible, offering the benefit of years of training and experience, without our judgement being clouded by emotion.

  • Divorce and related matters are technical legal proceedings. There are a number of rules and protocols that must be adhered to, including specific timings in relation to certain stages of your divorce or financial settlement. Solicitors will be well versed in these rules and protocols, thus avoiding any unnecessary delays or expense that otherwise may be incurred should you proceed without a solicitor. Without a solicitor, you may inadvertently be landed with an order for costs or fail to seek full costs and financial claims. Such mistakes can be expensive to rectify.

  • You can only rely on 1 of 5 facts to prove that your marriage has irretrievably broken down. Choosing the most appropriate fact, and ensuring that sufficient particulars are provided to prove that fact, is not always straightforward. We can advise on the best approach to ensure that your divorce is able to go through without problems.

  • A solicitor acting on your behalf can advise on whether alternative, non-court based ways to resolve financial and children matters are suitable. There are options such as mediation and collaborative law to support such situations and these processes keep costs down. Unfortunately, it is not always the case that matters remain amicable and a solicitor acting on your behalf means that you do not have to communicate directly with your ex-partner. We can ensure that you have a process suited to your needs, thus reducing the acrimony and stress experienced during the resolution of issues.

  • We are able to advise on financial claims within your divorce. For example, you may be entitled to a share of your ex-partner’s capital or pension, or even entitled to ongoing financial support (maintenance). A solicitor acting on your behalf will be able to advise how best to obtain a favourable outcome in relation to your finances, and protect you from what may be an inadequate of unfair outcome.

  • It is important that individuals consider reaching a financial settlement to deal with how the matrimonial assets are to be split. Even if you have agreed a financial settlement with your ex-partner, it would be difficult to guarantee that your ex-partner will comply with the agreement without a court order that is carefully drafted to reflect your intentions. Furthermore, failure to formalise a financial settlement by way of a court order may mean that your ex-partner is able to return at a future date and make a claim on your finances, even several years after Decree Absolute has been pronounced.

  • The formal court order reflecting your financial settlement is called a consent order. It is a complicated (and non-standard) legal document that should be drafted by a family law expert, and cannot be purchased off the shelf.

  • In summary, completing your divorce without the assistance of a solicitor means that you will miss out on receiving the expertise and knowledge that is essential when dealing with something as crucial as the breakdown of your marriage.

Lanyon Bowdler has a strong and dedicated team of family law experts with over 100 years of combined experience in family law. Most of our lawyers are members of Resolution and on the Law Society Family Law Panel. Two of our lawyers are collaboratively trained.

We offer affordable pricing options, with the choice of either hourly charges, fixed fees or a Pay As You Go arrangement. We will regularly update you in relation to the costs of your case, and are able to offer staged payment plans, should this be necessary. We will progress your divorce proceedings at the best pace possible whilst negotiating a fair financial settlement on your behalf. We will do the hard work for you, and will be with you every step of the way.

Fortunately, divorce is the least likely outcome for a marriage with the most recent statistics suggesting that 58% of marriages will not end in divorce. However, if you sit within the remaining 42%, the family solicitors at Lanyon Bowdler are here to support you. We have family law experts in each of our offices in Bromyard, Hereford, Ludlow, Oswestry, Shrewsbury and Telford, all of whom are ready to listen and provide clear advice in relation to your specific circumstances. We are here to achieve the best possible outcome for you whilst helping to make your divorce as stress free as possible.


*All data retrieved from the Office of National Statistics - https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/divorce/bulletins/divorcesinenglandandwales/2014

Tougher Speeding Penalties come into Effect

As of midnight today, new, tougher speeding penalties have come into effect.

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Previously accepting a Fixed Penalty Notice for speeding would have resulted in three penalty points on your driving licence and a £100 fine.

If however the speed was sufficiently high enough to end up in court, the penalties increased to a maximum fine of £1,000 (£2,500 on the motorway).

This has now changed with the introduction of speeding bands.

Band A – Covers low level speeding which will result in three points and a Fine of up to 50% of weekly income - up to 30mph in a 20mph zone, up to 40mph in a 30mph zone, 55mph in a 40mph zone, 65 in a 50, 80 in a 60 and up to 90mph in a 70mph zone.

Band B – will attract four - six penalty points or a ban of 7 - 28 days together with a Fine of up to 100% of weekly income, and covers more serious speeding - 31mph to 40mph in a 20mph zone, 41mph to 50mph in a 30 zone, 56mph to 65mph in a 40, 66 to 75 in a 50, 81-90 in a 60 or 91mph to 100mph in a 70mph.

Band C – is reserved for the most serious speeding offences. The court will impose six penalty points or a driving ban of between 7 - 56 days together with a Fine up to 150% of weekly income. This covers 41mph+ in a 20mph zone, 51mph+ in a 30mph zone, 66+ in a 40, 76+ in a 50, 91+ in a 60 and finally 100mph+ in a 70mph zone.

The Sentencing Court will also be assisted by a non-exhaustive list of aggravating and mitigating features to take into account when determining the punishment and level of Fine.

Baby Death Cluster at Shrewsbury & Telford Hospital NHS Trusts

It was announced on 12 April that the Health Secretary, Jeremy Hunt, will be investigating a cluster of baby deaths at the Shrewsbury and Telford Hospital NHS Trust. This was reported nationwide with seven babies and their families being identified. We have acted for some of these families who have had to fight hard to have their questions answered about the circumstances in which the deaths occurred.

Avoidable

Investigations will be specifically looking at failures to appropriately monitor babies’ heart beats during pregnancy and labour which was a contributory factor in at least five of the deaths deemed avoidable. The relevant period was September 2014 to May 2016 and all of the deaths were considered “avoidable”, according to Coroner verdicts at Inquests and within the course of legal action brought against the Trusts.

Training

I understand that one of the allegations is the failure to keep midwives training updated at the Trust. The guidelines for the interpreting of CTG scans have been changed and improved twice in recent years by NICE (National Institute for Health and Care Excellence), but it is all important for midwives and doctors to be carefully trained so that they are able to work within the guidelines.

As the head of the clinical negligence department at Lanyon Bowdler I have long been concerned about the amount of cases referred to us, arising out of alleged mistakes made by the Trust in the delivery of babies causing death and permanent injury.

Fetal heart rate monitoring

One important point to make, however, is that the media has only focused on the babies who have died as a result of failures by the Trust. There are many babies who have survived a traumatic birth, where monitoring has been substandard, but suffered permanent brain damage and most of their cases are probably still being investigated by specialist clinical negligence lawyers.

If a baby’s heart rate is not monitored carefully during labour then the baby can become distressed because of problems such as insufficiency of the placenta or umbilical cord compression, or indeed for unexplained reasons. Fetal heart monitoring is essential so that action can be taken and if necessary babies are delivered quickly if they become compromised.

Not learning from mistakes

At Lanyon Bowdler we are acting for many children who were starved of oxygen during labour and have suffered permanent brain damage. They haven’t tragically died, but many will not be able to live a normal life, without the prospect of employment and a normal family life, relying totally on the support of their families and commercial or state provided care.

A separate analysis of all the NHS Trusts in England last year rated Shrewsbury and Telford as one of the worst in the country when it came to learning from mistakes and incidents, describing the Trust as having a poor reporting culture. In my view learning from a mistake is absolutely essential in any organisation responsible for the safety of individuals.

I am very dismayed to hear that the medical director at the Trust, Dr Edwin Borman, apparently told BBC News that the Trust’s mortality figures were no worse than anywhere else. Does he really think this provides any reassurance to the local community? Culture could be changed by encouraging hospital staff to speak up and warn of situations where there may be safety issues, so that remedial or preventative action can be taken before a patient is injured.

There should be a no blame culture like in the aviation industry so that the focus is on ensuring constant improvement through learning. This would prevent such terrible mistakes happening again and again.

Baby Death Cluster at Shrewsbury & Telford Hospital NHS Trust

It was announced on 12 April that the Health Secretary, Jeremy Hunt, will be investigating a cluster of baby deaths at the Shrewsbury and Telford Hospital NHS Trust. This was reported nationwide with seven babies and their families being identified. We have acted for some of these families who have had to fight hard to have their questions answered about the circumstances in which the deaths occurred.

Scan.jpg

Avoidable

Investigations will be specifically looking at failures to appropriately monitor babies’ heart beats during pregnancy and labour which was a contributory factor in at least five of the deaths deemed avoidable. The relevant period was September 2014 to May 2016 and all of the deaths were considered “avoidable”, according to Coroner verdicts at Inquests and within the course of legal action brought against the Trusts.

Training

I understand that one of the allegations is the failure to keep midwives training updated at the Trust. The guidelines for the interpreting of CTG scans have been changed and improved twice in recent years by NICE (National Institute for Health and Care Excellence), but it is all important for midwives and doctors to be carefully trained so that they are able to work within the guidelines.

As the head of the clinical negligence department at Lanyon Bowdler I have long been concerned about the amount of cases referred to us, arising out of alleged mistakes made by the Trust in the delivery of babies causing death and permanent injury.

Fetal heart rate monitoring

One important point to make, however, is that the media has only focused on the babies who have died as a result of failures by the Trust. There are many babies who have survived a traumatic birth, where monitoring has been substandard, but suffered permanent brain damage and most of their cases are probably still being investigated by specialist clinical negligence lawyers.

If a baby’s heart rate is not monitored carefully during labour then the baby can become distressed because of problems such as insufficiency of the placenta or umbilical cord compression, or indeed for unexplained reasons. Fetal heart monitoring is essential so that action can be taken and if necessary babies are delivered quickly if they become compromised.

Not learning from mistakes

At Lanyon Bowdler we are acting for many children who were starved of oxygen during labour and have suffered permanent brain damage. They haven’t tragically died, but many will not be able to live a normal life, without the prospect of employment and a normal family life, relying totally on the support of their families and commercial or state provided care.

A separate analysis of all the NHS Trusts in England last year rated Shrewsbury and Telford as one of the worst in the country when it came to learning from mistakes and incidents, describing the Trust as having a poor reporting culture. In my view learning from a mistake is absolutely essential in any organisation responsible for the safety of individuals.

I am very dismayed to hear that the medical director at the Trust, Dr Edwin Borman, apparently told BBC News that the Trust’s mortality figures were no worse than anywhere else. Does he really think this provides any reassurance to the local community? Culture could be changed by encouraging hospital staff to speak up and warn of situations where there may be safety issues, so that remedial or preventative action can be taken before a patient is injured.

There should be a no blame culture like in the aviation industry so that the focus is on ensuring constant improvement through learning. This would prevent such terrible mistakes happening again and again.

Breast Screening: Do We Need More Transparency About Breast Density?

On average, one in eight women will develop breast cancer during their lifetime. As with all cancer, early detection is vital, and the NHS breast screening programme plays a central role in this. Currently, the NHS invites women between the ages of 50 to 70 to go for a mammogram every three years. It may be, however, that mammograms are not the most effective means of detecting breast cancer in up to 50% of these women, due to a significant proportion having “dense” breasts.

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An increased breast density reduces the sensitivity of mammograms and makes it much more difficult to spot tumours. This is because dense breast tissue and tumours both appear white on the imaging; something that has been likened to trying to spot a polar bear in a snow storm.

What is “breast density”?

Generally, younger women will have denser breast tissue than older women, and breast density tends to decrease with age, usually declining during and after the menopause. Having “denser” breasts means a higher percentage of fibro-glandular tissue is present, as opposed to fatty tissue. This is something that can be a hereditary trait.

The Breast Imaging Reporting System (BI-RADS) adopted by the American College of Radiology, identifies four tiers of breast density. The lowest tier includes breasts which comprise less than 25% fibro-glandular tissue and the highest, or “extremely dense” tier, will include breasts comprising more than 75% fibro-glandular tissue. Breast density is not something you can accurately determine from a physical examination, and can only properly be confirmed by imaging techniques. It seems however, that in the UK not all women are advised of their breast density after mammogram screenings.

Increased Risk of Breast Cancer

It is thought that around 40 - 50% of women over the age of 40 could fall into the higher two tiers of breast density. This brings into question the effectiveness of mammogram screenings for almost half of those women under the NHS screening programme. 

Breast density is associated with an increased risk of developing breast cancer. This is twofold; research indicates that there is an increased risk generally in women with denser breast tissue, but the risk is also increased because of the fact that the cancer is harder to detect in the first place, particularly with mammogram imaging.

Research suggests women with dense breasts could be four to six times more likely to develop breast cancer than those women with more fatty tissue. A recent study led by the University of California, San Francisco, involving more than 200,000 women between ages 40 – 74, found that breast density was the most prevalent risk factor, more than other risk factors, including family history.

Screening

In the US, in about 27 States, legislation requires breast density to be reported to patients with annual imaging reports. Next steps vary between States, but emphasis is placed on follow up discussions and consideration of additional or alterative investigations for women with a higher breast density. Advocacy groups such as areyoudense.org are campaigning for the introduction of legislation in the remaining US states, and to educate the public on the impact of dense breast tissue on screening methods and delayed diagnosis of breast cancer.

No alternatives?

On the flip side, critics argue that there is little point worrying a woman about increased breast density, particularly if no further action is going to be taken. Perhaps this is the position here in the UK, but if so, why would no further action be taken? A knowledge of increased breast density may lead to anxiety amongst women, and possibly unnecessary follow up investigations and “false positives”, but surely an unnecessary biopsy is preferable to an avoidable delay in a diagnosis of malignancy?

NHS screening currently uses mammogram technology. Perhaps alternative imaging techniques, such as ultra sound or MRI, ought to be considered for those women identified with higher breast density. For women with extremely dense breast tissue, is there any point in undergoing mammograms at all? Perhaps the age limit also needs to be lowered to 40, like in the US, and screenings offered at more regular intervals, particularly for those with higher breast density.

It is likely the NHS will argue that it is simply just not cost effective for the NHS to be able to offer additional tests/screening to women, and it may not be justifiable to offer additional or alternative investigations to only some women, and not all. There is logic in this approach and if additional or alternatives are not available on the NHS, women may have to explore more expensive options and go private, meaning those women without the financial means lose out.

Encouraging Transparency

Every patient is different and will have unique circumstances and risk factors, but if mammogram imaging reveals a high level of breast density, surely a discussion about any increased risk is warranted, and at least a consideration of additional or alternative investigations, including blood tests and/or imaging techniques. Clinicians should discuss risks and options with patients, and patients should be encouraged to broach the topic of breast density if they are worried about the implications. 

It cannot be stressed enough how important early detection is with breast cancer, and the NHS screening programme plays such a pivotal role in this. I cannot speak for all women, but as someone who has been recommended to undergo early breast screening, I will definitely be asking about breast density, and whether a mammogram is the most effective approach for me.

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