Your Expert Witness Issue No.42 by DMMonline

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contents IN THIS ISSUE 7

Opening Statement

NEWS 9

Lawyers council caution in discount rate reforms

New Investigatory Powers Commissioner takes office

FORENSICS 10

Smart phones becoming more common in evidence gathering

A guiding hand in the digital maze

Forensics experts make the most of evolving technologies

ANIMAL WELFARE & BEHAVIOUR

Breeding defects biggest cause of concern for vets

Slaughterhouse CCTV proposals to extend to Scotland

BUILDING & PROPERTY 14

Conveyancers in firing line over ground rents

CULTURAL, RELIGIOUS & ETHNIC ISSUES 15

Female genital mutilation – a cultural phenomenon

WILLS, LEGACIES & CHARITABLE BEQUESTS

Lawyers and charities welcome consultation on wills

Surgery saves lives

Horses’ plight sparked the beginning of a dream

Radio star puts the Yo-ho-ho! into legacy giving

Education through the power of play

Seeing Dogs – providing a choice

Probate fee hike may be back on the agenda

Holidays help boost confidence of young cancer patients

Supporting the maritime community

Funding helps enhance quality of life

If you Will, we will

Data protection: statement of intent precedes Bill

Legacies – the gift of life

Charity carries on the work of its founder

Summit will debate fundraising help for small charities

Fundraising conference will address latest challenges

Help for those with failing sight

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MEDICAL ISSUES 29 Medical Notes

NEWS 31 Audit Office report reveals soaring cost of negligence claims 31 Colne Road investigation: CQC appoints chair 33 Mixed response to prescribing errors initiative 33 Jail terms for dodgy meds sellers 35 Doctors welcome ‘pragmatism’ of training report 35 Litigation body appoints specialist advisors PAIN 37 Common pain conditions seen in medico legal claims CARDIOLOGY 38 Pacemaker patch will foil potential hackers 38 Public health body urges joined-up approach to CVD prevention

HEARING LOSS 39 CJC publishes NIHL report OBSTETRICS & GYNAECOLOGY 40 Claim settled following stillbirth 40 Clinicians voice concerns over labiaplasty report 41 Ovarian cysts: guidelines are there to be followed OPHTHALMOLOGY 43 Government seeks evidence on laser pointers 43 Visual impairment certificate overhauled

DENTAL NEGLIGENCE 45 Dentists urged to join recording revolution 45 Boys at risk of oral cancer because of flawed research data, says BDA 46 Hammers, nails and the small matter of opinion PLASTIC SURGERY 49 New guidance aims to limit harm caused by acid attacks 49 Survey highlights need for lip filler regulation, says BAAPS PSYCHIATRIC & PSYCHOLOGICAL ISSUES 51 Scars fade faster than their effects 51 Antidepressants: RCPsych responds 52 BPS issues calls to action on suicide prevention A to Z WEBSITE GUIDE 26 Our A to Z guide to the websites of some of the country’s leading expert witnesses.

EXPERT CLASSIFIED 53 Expert Witness classified listings 55 Medico-legal classified listings www.yourexpertwitness.co.uk

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Opening Statement [

SEPTEMBER HAS BECOME the month when charities urge us to consider leaving a legacy to good causes when we die through the annual Remember A Charity Week. This year the event was aimed at the so-called baby boomers – those born in the heady years following World War Two. To drive the message home, legendary 60s DJ Emperor Rosco was conscripted to reprise his heyday aboard the pirate radio ship Caroline. • It was a charitable bequest, fought through the courts on behalf of an estranged family member, that sparked the furore over exactly what a will means and whether there are circumstances where it should be disregarded by the courts. The result has been a consultation on modernising what even the Ministry of Justice has described as Victorian law that is out of date. The consultation has been embraced by the legal fraternity, which is keen to make will-making more straightforward and, consequently, more popular. • It’s not possible for everything in the garden to be rosy, however. Reforms to the charges for probate, which threatened huge increases for some estates and which were suspected to be a back-door way of funding the court system, were put on hold when the General Election was announced. There is a widespread suspicion that David Lidington is about to resurrect the proposals, prompting visions of Banquo spoiling the feast. Legacy managers reckon the move could cost charities up to £18m per year in lost income. • While the baby boomer generation may be settled in their freehold homes, many younger families have woken up to the fact that their homes are subject to ever-increasing ground rents. It is an issue that is the subject of a major controversy and could be harbouring an avalanche of negligence claims, according to one expert. • Regular readers will be aware that a number of charities profiled in the legacies section of the magazine are involved in various aspects of animal welfare. It is an inevitable fact that for many agricultural animals the abattoir is their final destination. That is no excuse for treating those animals with cruelty during their final journey. There have been too many examples of mistreatment of animals at abattoirs recently, leading to a commitment to the installation of CCTV in slaughterhouses in England. The Scottish government is to hold a similar consultation and there is pressure on the Welsh government to follow suit. • CCTV has become an increasingly valuable tool in detecting wrongdoing. It has more potential, however, than simply placing someone at a particular place at a particular time. Modern methods of analysis allow all sorts of information to be extrapolated from the simple image, including whether that person was driving a car at speed. Similarly, by analysing such day-to-day data as mobile phone records and sat nav data, it is possible to deduce whether someone was where they said they were. • Impending legislation regarding data collection has been billed as the next big issue in personal injury claims – at least by certain IT experts. The implementation of the General Data Protection Regulation is keeping database managers in both private and public sectors awake at night. According to pessimistic interpretations of the likely legislation, the ‘right to be forgotten’ may include the right to erase evidence of wrongdoing from history – something some commentators claim is already happening in Italy. It appears the evil that men do may henceforth no longer live after them. • On a more optimistic note, the MoJ appears to have taken note of general consternation regarding the adjustment of the discount rate for damages, announced earlier this year. Proposals for a new policy to restore fairness have been cautiously welcomed by the legal profession. q

Ian Wild

Ian Wild, Director of Business Development Your Expert Witness

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Lawyers council caution in discount rate reforms [ THE LAW SOCIETY has responded to the new discount rate

policy, announced by the Ministry of Justice on 7 September. The MoJ claims the reforms will make sure personal injury victims get the right compensation and could also see significant savings for the NHS – as well as for motorists through lower car insurance premiums. Changes mean the rate would be set by reference to ‘low risk’ rather than ‘very low risk’ investments as at present, better reflecting evidence of the actual investment habits of claimants, the MoJ says. The rate will also be reviewed at least every three years – and the expertise available to the Lord Chancellor in carrying out the reviews will be extended by the creation of a role for an independent expert panel in the process. Lord Chancellor and Justice Secretary David Lidington said: “We want to introduce a new framework based on how claimants actually invest, as well as making sure the rate is reviewed fairly and regularly.

New Investigatory Powers Commissioner takes office

“In developing our proposals, we have listened carefully to the views of others, and we will continue to engage as we move forward.” Responding, Law Society president Joe Egan said: “For people catastrophically injured through someone else’s negligence this technical process is a very important part of our justice system. “A regular review of the discount rate every three years clearly makes sense and will be of benefit to both claimants and defendants. We welcome the inclusion of an independent panel of experts assisting the Lord Chancellor.” However, Mr Egan warned against allowing the reforms to undermine the principal of 100% compensation. He said: “Those who have suffered lifelong injury need to have reassurance that the sum the wrongdoer is ordered to pay will genuinely be sufficient to meet their needs for the whole of their lives and will not run out, leaving them unable to afford necessary treatment and support. The needs of people seriously injured through another’s negligence should be considered to at least the same extent as the interests of defendants and the public purse.” He also championed claimants’ right to choose on how they receive compensation, saying: “Claimants who are successful should be given the right to choose how they manage their compensation. In some cases lump sum payments are more appropriate and in others periodical payment orders are more suitable. Either way, claimants should always have a choice between a lump sum and a periodical payment order.” q

[ ON 1 SEPTEMBER Lord Justice Fulford began his new

role of overseeing the police, law enforcement and intelligence agencies’ use of investigatory powers, as set out in the Investigatory Powers Act. The role replaces the oversight roles previously undertaken by the Chief Surveillance, Interception of Communications, and Intelligence Services Commissioners, by establishing inspection and oversight functions in a single body. Home Secretary Amber Rudd said: “The Investigatory Powers Act offers a world-leading oversight regime to ensure the powers the security and intelligence agencies and law enforcement use to investigate crimes and protect the public are used responsibly and proportionately. “In commencing his oversight responsibility, Lord Justice Fulford is playing a vital role in providing the enhanced safeguards we set out in the act.” The Investigatory Powers Commissioner’s Office takes over the inspection and oversight functions carried out by the previous commissioners’ offices, and takes on responsibility for the pre-approval of certain police activities authorised under the Police Act 1997. Further powers, including the judicial ‘double-lock’ requiring warrants issued by the Secretary of State to also be approved by a Judicial Commissioner, will be introduced ‘in due course’. Lord Judge, formerly the Chief Surveillance Commissioner, and Sir Stanley Burnton, formerly the Interception of Communications Commissioner, are standing down. Sir John Goldring, formerly the Intelligence Services Commissioner, will take on a new role as Deputy Investigatory Powers Commissioner. q www.yourexpertwitness.co.uk

Smart phones becoming more common in evidence gathering [

IN THE LAST ISSUE of Your Expert Witness we reported on the setting up of websites by police to allow witnesses to upload pictures and videos of the terrorist attacks in Manchester and London. The actions demonstrate the embracing by police of people’s digital lives and the increasing importance of technology in evidence gathering. The moves follow a statement last year by then-Home Secretary Theresa May on the subject. She said: “Citizens increasingly capture what is happening around them on video, generating potential evidence of crimes. Policing has not yet caught up. “The most common means of contacting the police remains the telephone. Police forces must follow the example of banks and retailers and do more to connect with citizens who increasingly live their lives online.” A further illustration was given by the Chief Constable of Sussex, Giles York. Speaking to the BBC’s Today programme, he explained that, following the tragedy at the Shoreham Air Show, the Sussex force was “…very easily able to get six to seven hundred pieces of either video or photographs from the public into the investigation.” The BBC themselves report they are sent around 20-30 videos after a major incident. More and more forces are providing facilities for the public to upload videos and photographs of incidents that can be used by forensics experts to piece together events and assemble evidence. Technology is also being used more extensively for reporting crime. Self Evident is an app developed by charity Witness Confident to both report crimes and upload evidence to a secure site that is then passed on to the police. q

A guiding hand in the digital maze [THE AREA OF digital forensics is becoming more and more

important as a means of gathering evidence in an increasingly digital world. The sector involves a wide range of processes, from computer investigations – or e-forensics – to CCTV, mobile phone and satnav analysis. One company that specialises in the area is Griffin Forensics, which was founded in 2006 to provide a high-quality, cost-effective and jargon-free digital investigation and data recovery service. Griffin specialises in data recovery, including tape, RAID (redundant array of independent disks) and all other digital media. They also provide bespoke e-forensics training and can offer secure data destruction. Digital forensics clients include solicitors and law enforcement agencies – including police forces and trading standards – as well as individual clients. Their data recovery service caters for individuals, SMEs and large corporates. The company also acts as a consultant for a number of investigative agencies. In addition to acting for the prosecution, Griffin Forensics regularly provide defence reports in criminal proceedings. They examine police reports and digital evidence to produce reports for court and, where necessary, give evidence of their findings. An essential element of the company’s offering is that it is ‘jargonfree’. Forensic director Chris Watts explained: “We understand that many of our customers may find technical jargon both intimidating and confusing and we therefore aim, as far as possible, to provide a jargonfree service.” A digest of recent cases shows the breadth of work undertaken. For example, as part of an international investigation, Griffin Forensics assisted in the recovery of $19m that had been fraudulently obtained from a client. It involved examining thousands of emails and their meta data to identify fraudulent emails and where they originated from. In another case, as part of a multi-agency operation, they attended business and private premises to advise on and secure digital evidence from mobile devices and computer equipment. The items were subsequently processed and evidence provided to enable law enforcement agencies to press charges for trade mark infringement, counterfeit goods and fraud. When a law enforcement agency was unable to access a computer hard disk drive that they believed contained evidence of child abuse, analysts at Griffin were able to secure a forensic image from the damaged hard drive and produce the evidence ready for court. Away from the courts, Griffin Forensics examined computers and external storage devices to identify proprietary data that had been copied from a company’s server prior to an employee leaving to set up his own business. They then securely deleted the ‘unauthorised’ data from the exemployee’s systems. In another work-related case an employee had complained that a colleague was sexually harassing her at the workplace and also online. Using open-source social media, Griffin Forensics were able to identify and preserve evidence of the online harassment and then provided the employer with a written report and interview advice for a disciplinary hearing. As part of a company liquidation, Griffin were tasked with securing forensic images of 29 computers and mobile telephones over a single weekend. Two copies of each hard disk drive were secured in a 36-hour period and, together with mobile phone downloads, were ready for collection on the Monday morning. In the area of cyber security, they recently visited a client to identify sources of potential forensic evidence should they become the victim of cyber-crime. A policy was then written to enable the client to safeguard the potential evidence. Guidelines were provided to enable them to safeguard evidential material when an incident was identified. q • For further information visit www.griffinforensics.com

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Forensics experts make the most of evolving technologies

[

ONE OF THE consequences of technological advances in forensics is that practitioners are constantly improving and adapting their techniques and adding new strings to their bows. A discovery in one area can even lead to new discoveries in other areas. That has certainly been the experience of leading audio and video analysts at Audio Video Forensics. A recent tragic case involving a fatal traffic accident in Scotland illustrated the range of technologies available to the expert in these matters. The victim had been hit and killed by a car shortly after getting off a bus at night. By combining analysis of satellite

maps and ‘street view’ scenes to accurately pinpoint and measure distances, with analysis of brake light patterns derived from the camera system on the bus, AV Forensics’ analysts could pinpoint not only which car had hit the victim, but also the fact the vehicle was exceeding the speed limit resulting in a successful civil case. Technology moves on apace, however, and even more accurate analysis is now available. AV Forensics now operates an unmanned aerial vehicle (UAV), or ‘drone’, to create their own aerial views. This allows up-to-the-minute analysis of distance speed, even down to measuring the distance between cat’s eyes in the road. A further advantage is that, by controlling the time of day a flight is made, measurement of shadows cast by buildings etc can help determine the height of objects or people on CCTV footage. Knowledge of a person’s height from CCTV can be used to compare them to a suspect and added to available evidence. That use of a range of techniques and technologies is not always appreciated by lawyers as it could be, according to AV Forensics’ principal Iain McArthur. “People maybe think in quite narrow terms of what we do,” said Iain, “video enhancement or audio enhancement. But the scope of work and what is available – the tools if you like – are so much more.” Moving forward into the future, Iain sees the advantages of enhanced video as providing a tool to help juries understand what has happened. With modern split-screen techniques jurors will be able to see CCTV footage of an event at the same time as an aerial view of the scene. q

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Breeding defects biggest cause of concern for vets

[ A SURVEY OF VETS has revealed that their biggest concern in

the area of animal health and welfare is the issue of breeding and hereditary defects in puppies. The number of vets citing it as a pressing issue has more than doubled in the past two years, according to the figures, released by the British Veterinary Association (BVA) during Puppy Awareness Week at the beginning of September. According to the BVA’s Voice of the Veterinary Profession survey, which polled almost 700 vets across the UK, there has also been a significant rise in the levels of concern with regard to conformational deformities and pedigree breeding, particularly of brachycephalic breeds such as pugs and French bulldogs. Nearly half (45%) of companion animal vets surveyed included them among the three welfare issues that concern them most. Poorly bred puppies can suffer diseases, health problems and poor socialisation that can lead to behaviour problems, while brachycephalic dogs suffer serious health and welfare problems including struggling to breathe due to their flat-faces, which are a ‘characteristic’ of the breed. During Puppy Awareness Week, the BVA and Animal Welfare Foundation (AWF) encouraged prospective pet owners not to buy a brachycephalic breed and to consider healthier breeds or cross-breeds instead. They should also always consider how a puppy has been reared and cared for in its first few weeks to ensure a happy, healthy dog in later life. BVA president Gudrun Ravetz said: “Anyone thinking of getting a new puppy should speak to their local veterinary practice for advice on the right dog for them and use the free Puppy Contract that gives prospective owners all the information they need to ensure they are buying a healthy, happy and well-socialised puppy. “If a seller is not willing to provide the information listed in the Puppy Contract, or allow you to see the puppy interacting with its mother, then you should walk away otherwise you risk perpetuating irresponsible dog breeding and lining the pockets of people who care more about profits than puppy welfare.” The Puppy Contract has been developed by AWF and the RSPCA and is an invaluable ‘go-to’ tool to enable pet owners to ask all the right questions when choosing a puppy, helping them to avoid the problems that can arise from buying a puppy from an irresponsible breeder. q

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Slaughterhouse CCTV proposals to extend to Scotland [ WITH CONSULTATION ON CCTV in slaughterhouses closing

on 22 September, the Scottish Government has announced plans to introduce a similar consultation as part of its Government Programme for Scotland 2017/18. The decision has been widely welcomed by the veterinary profession and follows campaigning to include the measure in Scotland alongside the model for England announced by Michael Gove in August. Melissa Donald, president of the Scottish branch of the British Veterinary Association (BVA), said: “We’re delighted that the Scottish Government is looking seriously at introducing mandatory CCTV in abattoirs. Although a high percentage of abattoirs in Scotland already have CCTV, there are no rules governing how the footage is used or kept, and it is essential that Official Veterinarians have unrestricted access so they can fully monitor animal health and welfare throughout the slaughterhouse. “Following Defra’s announcement last month I wrote to the Cabinet Secretary urging the Scottish Government to follow Defra’s lead in order to maintain Scotland’s reputation for high animal welfare from farm to fork.” Environment Secretary Michael Gove announced the consultation as part of a series of measures to strengthen animal welfare standards in England. The proposals are aimed to deliver a manifesto commitment for CCTV to be required in every slaughterhouse in England in all areas where live animals are present, with unrestricted access to footage for Official Vets, thus reassuring consumers that high welfare standards are being effectively enforced. Michael Gove said: “We have some of the highest animal welfare standards in the world and the actions I am setting out today will reinforce our status as a global leader. As we prepare to leave the EU, these measures provide a further demonstration to consumers around the world that our food is produced to the very highest standards.” Under the new plans for CCTV, footage would be accessible to the Food Standards Agency’s (FSA) Official Veterinarians (OVs), who monitor and enforce animal welfare standards in the slaughterhouse. The FSA has strict processes in place for the approval of slaughterhouses and OVs carry out checks to make sure the welfare of animals is protected throughout their time there. If breaches are found a slaughterhouse can be given a welfare enforcement notice, have licences suspended or revoked or be referred for a criminal investigation. FSA chairman, Heather Hancock, said: “The Food Standards Agency takes a zero tolerance approach to any breaches of animal welfare standards in slaughterhouses. Last year we concluded that it was time to make CCTV compulsory in slaughterhouses, progress on voluntary adoption having plateaued. “I and the Board of the FSA warmly welcome Defra’s consultation about making CCTV mandatory. We look forward to the introduction of a comprehensive requirement for using, accessing and retaining footage from CCTV in abattoirs. We see CCTV as an invaluable management tool for business owners to help with compliance with official controls and to improve animal welfare standards across the industry.” The BVA has also called on the Welsh Government to implement a similar proposal. The president of its Welsh branch, Sarah Carr, declared: “We were disappointed last year that the Safeguarding Animal Welfare at Slaughter Task and Finish Group’s report concluded that there was not a ‘sufficient basis’ for making CCTV in Welsh abattoirs mandatory. With plans now underway to introduce mandatory CCTV in all slaughterhouses in England, with

full and unrestricted access to footage for Official Veterinarians, we are urging the Welsh Government to implement concurrent measures in Wales.” The UK Government has also confirmed it will raise standards for farm animals and domestic pets by modernising statutory animal welfare codes to reflect enhancements in medicines, technology and the latest research and advice from vets. The codes will remain enshrined in law and the first to be updated will cover chickens bred for meat. A consultation on the Code of Practice for the Welfare of Meat Chickens and Meat Breeding Chickens is running alongside that on CCTV in slaughterhouses and will close on 6 October. q

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Conveyancers in firing line over ground rents [IN RECENT WEEKS there has been

a deal of press and public indignation over ground rents that can double or more overnight. It is an issue that may be harbouring an avalanche of negligence claims against solicitors, according to Joshua Munro, a barrister at Hailsham Chambers. He writes: “Purchasers of long-leasehold interests in property may regard themselves as the ‘owners’ of the property. However, many thousands have discovered that they are subject to covenants in favour of freeholders. “When the true position is found out as to increasing ground rent liabilities, it is very likely that the long-leasehold owners will want to make claims. The problems are often remediable, via leasehold enfranchaisement and acquisition of a share of freehold, or an extension of the long lease’s term with reduction of ground rent to a peppercorn. However, the remedies come at a cost of professional fees, the monies payable to the freeholder, and also the time and hassle of going through the necessary legal processes, and if appropriate garnering the support of sufficient numbers of fellow long-leaseholders.” The conveyancing solicitor may be the ‘first in the firing line for claims’. Mr Munro quotes the handbook of the Council of Mortgage Lenders, which requires conveyancers to check any specific conditions relating to ground rent in a lease. He continues: “Conveyancers, also of course, will be liable unless they have given sufficient advice to the purchaser clients and many may not have given any advice on ground rent clauses. The relevant leases also often have other clauses which may be considered unreasonable and in respect of which inadequate advice may have been given, for example fees for remortgaging or making structural changes. “Furthermore, there are potential claims

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that are more complex as to the adequacy of advice in respect of leaseholds with short terms that will need to be extended, often at high cost.” Other professionals may also find themselves caught up in the storm. “Valuers may find themselves in the cross-hairs,” says Munro, “although many will not have been properly instructed as to the tenants’ covenants and therefore will escape liability.” He councils: “Obtaining careful and considered expert evidence is of course necessary to make a claim for diminution in value. The expert should consider the availability of mortgages for the next purchase of the property and how that affects value. If leasehold enfranchaisement is available it may well be more straightforward to claim the cost of cure and consequential losses.” He offers a lifeline to conveyancers in the

form of limitation, adding: “Claimants in many cases will struggle to make out s14A Limitation Act 1980 arguments, deliberate concealment, or other attempts to extend the six-year period.” His conclusion is gloomy, however: “Historically, residential conveyancing has generated the largest number of claims on solicitors’ professional indemnity policies. That number is likely to swell as claims arising from leasehold issues come to light.” q

Female genital mutilation a cultural phenomenon By DR BASHIR QURESHI FRCGP FRCPCH Hon FFSRH-RCOG AFOM-RCP Hon MAPHA-USA Hon FRSPH • Expert Witness in Cultural, Religious & Ethnic issues in Litigation • Expert Witness in GP Clinical Negligence • Expert Witness in Community Paediatrics – infant, child and school pupil healthcare.

[FEMALE GENITAL MUTILATION (FMG) is the removal,

trimming or modification of the clitoris in a female – usually a child – and is illegal in Western countries such as the UK. It is also known as ‘female circumcision’ and is still practised in some Eastern subcultures, particularly in North African countries. It is a cultural phenomenon and approved by no religion, although some religious preachers look the other way so as not to upset their followers. The practice of ‘female circumcision’ began in ancient Egypt under Pharaonic rule, long before the birth of Judaism, when different tribes followed various local faiths. People lived short lives – less than 30 or 40 years – as infections were common and there were no antibiotics or effective remedies. The followers of one dominant faith believed in many gods, which they believed were bisexual. They believed that these gods needed to be pleased so that they would stop devils from killing people. To please their gods they decided that they must themselves become unisexual. Men would remove their prepuces – symbols of femininity – from their penises and women would get rid of their clitorises, which were seen as symbols of manhood. To enforce the custom they made these criteria mandatory for arranged marriages and family inheritance of property and wealth. These old beliefs dig deep and old habits die hard. In 1989 I reviewed a book, Prisoners of Rituals: An Odyssey Into Female Genital Circumcision in Africa for the Journal of Medical Ethics. The author was Hanny Lightfoot-Klein, an American social psychologist. She observed many hidden facts during her six-year trek through the Sudan, Kenya and Egypt by living with African families. There is a cultural curtain between the East and the West and she overcame it. African girls were so poor they could not marry – and survive – unless they adhered to this ancient custom. I estimate that there are about three million women in the world, especially in North Africa, who have undergone female circumcision. I use this book as research evidence, in addition to my own experience as a community paediatrician and school medical officer in London, when writing impartial expert witness reports and giving evidence in court on the subject. Female circumcision is a custom based on cultural traditions and psychological beliefs, along with fears of becoming cursed, in African society. Whether to allow people to continue with these traditions, or force them to do what we do, was a basic question the courts had to consider in Britain and the West. In the East, only parents are responsible for the care of their children but in the West this care is shared between the state and parents. Many immigrants to Britain are not aware of this fact and they should be informed. Awareness of these cultural differences by Europeans would help to improve mutual understanding. Many Africans have become Westernised and have given up the custom. The vast majority obey British laws as they came here to earn money and help their extended families in Africa. Some, however, take their infants to Africa for the procedure becuase they

believe it is essential for an arranged marriage. Sometimes the procedure may involve only trimming, or a small skin removal, as a token to satisfy their tribe in Africa. I observe that the British have a cultural custom of expecting foreigners to behave as they do; but there is none, or not enough, education and training for immigrants to learn British customs. Some teachers do now educate foreigners in the British way of life, English language and expectations in council-run courses. However, some immigrants feel that the British ask them to integrate but keep a considerable distance themselves. If they like you, they move the goal-posts towards you; if they do not like you they move them away and keep moving. No one, but no one, is above the law, but immigrants should be taught before being judged. It would be nice if we could have our cake and eat it. Let us try to improve the situation nationally. q

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It’s September and time for the annual Remember A Charity Week. This year the campaign was aimed at the so-called ‘baby boomer’ generation of the immediate post-war period. It involved the recreation of a pirate radio station of the 1960s. Will-writing has been in the news for a number of reasons. A consultation on modernising the whole process is drawing to a close, while probate fees have raised their collective head again. Together with the implications of the General Data Protection Regulations, it promises to be a busy time for charities.

Lawyers and charities welcome consultation on wills [

THE CONSULTATION by the Law Commission on reforming the law governing wills ends on 10 November. The commission launched the consultation in July, saying that the Victorian laws are out of step with the modern world. With an estimated 40% of adults dying each year without a will, it’s also thought that the laws could be putting people off writing one. That means there is no guarantee that estates are distributed as the deceased intended.

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In the consultation paper the commission proposes: • Giving the court power to recognise a will in cases where the • formality rules haven’t been followed but the will-maker has made • clear their intentions • An overhaul of the rules protecting those making a will from being • unduly influenced by another person • Applying the test of capacity in the Mental Capacity Act 2005 to the • question of whether a person has the capacity to make a will • Providing statutory guidance for doctors and other professionals • conducting an assessment of whether a person has the required • mental capacity to make a will • Giving the Lord Chancellor power to make provision for • electronic wills • Lowering the age at which people are able to make a will from 18 to • 16 years old Law Commissioner Professor Nick Hopkins said: “Making a will and passing on your possessions after you’ve died should be straightforward. But the law is unclear, outdated and could even be putting people off altogether. “Even when it’s obvious what someone wanted, if they haven’t followed the strict rules courts can’t act on it. And conditions which affect decision-making – like dementia – aren’t properly accounted for in the law. “That’s not right and we want an overhaul to bring the law into the modern world. Our provisional proposals will not only clarify

Surgery saves lives

things legally, but will also help to give greater effect to people’s last wishes.” A will is only valid if the person writing it understands what they are doing; however the law uses a Victorian test which takes no account of modern medical understanding. It focuses on ‘delusions’ of the mind, doesn’t reflect the understanding of conditions like dementia where mental capacity can be changeable and differs from the modern test for capacity in other areas of decisionmaking – the Mental Capacity Act 2005. Many people might also not be aware of some of the law of wills; for instance, when someone gets married that process revokes any previous wills. So if someone had made specific provisions in their will – to support children from a previous marriage, for example – these would be ignored and the new spouse would receive the bulk of the estate. In its consultation the Law Commission also asks the public what they see as the main barriers to people making a will and about their own experiences of disputes over wills following the death of a loved one. The paper also asks whether the rule that marriage revokes a will should be retained or abolished. The move has been welcomed by the Law Society of England and Wales as a step forward. Its president, Joe Egan, said: “Making arrangements for after we pass away is something we all have to do, and something solicitors assist their clients with every day. “While the basics of how we make wills have stood the test of time, other aspects are in urgent need of updating to reflect modern life, and this will be a welcome opportunity for solicitors to help shape a new, fit for purpose wills law. "Our wills and equity expert committee has been working closely with the Law Commission throughout this project, and will continue to do so through the consultation process. “Some of the proposals, such as allowing the court more flexibility when there are harmless errors in a will but the deceased person's wishes are clear, show immediate promise and are likely to get a positive response from solicitors. Others, such as enabling wills to be made electronically in the future, raise important but challenging questions – especially on how safe electronic wills would be from fraud or undue influence against vulnerable people.” The possibility that the changes would encourage more people to make wills was also welcomed by the charities umbrella group Remember A Charity. Its director Rob Cope commented: “When you consider that hundreds of thousands of people in the UK die intestate each year, leaving no clear guidelines as to how any assets should be divided among their family, friends and good causes, it is long overdue that the will-writing process is made more accessible, helping to ensure that people’s final wishes will be met. “If the legal sector succeeds in making it easier for people to write a will, while putting adequate safeguards in place for the public and minimising the opportunity for contested wills, this could be a critical step forward for legacy giving. “Ultimately, the more people that write a will the greater the potential for including a charitable donation. Even if just a small percentage of people who die intestate were to leave a gift in their will, this could help close the gap between those that have the desire to give through wills – 35% according to the latest research – and the 6% of people that leave a charitable legacy. That could potentially raise millions for good causes each year.” q

[

SURGEONS SAVE AND improve the quality of people’s lives every day. Patient care and wellbeing is the heart and drive of the Royal College of Surgeons (RCS). They are a registered charity, independent of the NHS, and for more than 200 years have safeguarded the standards of clinical practice. There are many reasons why you may find yourself under the care of a surgeon – few people have not benefited, either directly or indirectly, from advances made in surgery. The charity’s work is not limited to specific illnesses or areas of disease but supports better care for all ages, from minor day surgery and the removal of cancer, to life-saving emergency procedures and trauma care. In every case, the patient places their trust in the hands of the surgeon. Although this trust is well founded, there is a need to invest continually in education, research and training to ensure that surgeons – and the care they provide is – the best in the world. While the medical world continue to strive for the cure to many diseases and cancers, in many cases surgery remains the most effective treatment. The RCS relies heavily on donations and legacies to develop and maintain its varied programme of clinical research, surgical education and heritage conservation. Operations are now safer, less invasive and more effective with better outcomes. Surgery saves lives and a gift will help those who put theirs in the hands of a surgeon. q

www.yourexpertwitness.co.uk

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Horses’ plight sparked the beginning of a dream [

THE YEAR IS 1983 and it is the coldest winter for 20 years. Stories of ponies and cobs being abandoned by their owners on Rainham Marshes in Essex were hitting the headlines. Doctor’s receptionist Paula Clark, who was involved in raising money for a number of sanctuaries, was sitting at home in tears after reading the story of these poor horses. When her husband Ernie returned home from work Paula showed him what was happening and they vowed to take action and help the animals that needed them. The story of Hopefield Animal Sanctuary had begun. They went to the marshes where 16 horses were already dead and others were starving. They took tanks of water to them, also bales of hay and feed. They even got a vet to examine some of them. Paula and Ernie started to raise money to buy the horses and move them to other sanctuaries and helped those sanctuaries to raise funds. They then put out a call out for some land to start up their own sanctuary. A lady from nearby Pitsea had half-an-acre to offer, so Paula and Ernie started their dream: Hopefield. They began taking horses with the intention of fostering. They would bring the horses back to health and then find them nice homes. The first horse they fostered out was Pye. Soon after they heard that the fosterers were trying to sell him, so Ernie took them to court, which cost £4,000. Ernie finally got Pye back in a terrible state, and both Paula and Ernie promised they would never rehome again: the animals had a home for life. As the sanctuary grew Ernie and Paula both gave up their jobs to look after the animals that so badly needed them. They soon moved to a piece of land in Langdon Hills and were there for three years. Hopefield was still growing, so they knew it wouldn’t be too long before they would have to move to an even bigger piece of land. Paula put another call out for land and they came across the land that Hopefield sits on today. It is owned by Tesco, who kindly let Hopefield use it for a peppercorn rent. Through the years Paula and Ernie had their ups and downs, but never gave up. Their work was recognised by a number of awards, including MBEs for both of them. Their hard work has inspired many people and saved hundreds of animals’ lives. Sadly, Paula died of cancer in September 2009. Ernie kept his promise to Paula to continue their work, but also sadly died of cancer two years later. Since their passing the work has continued with four new trustees. They include music star Leona Lewis, as well as Paula and Ernie’s son Lee, plus David Schlaich and Nicola Carson. There is also a general manager, Lianne Angliss. Said Lianne: “We have continued to rescue horses and farm animals, but have found that over the years the type of animals we are having to help has greatly changed, with people getting more and more into exotic species. We have opened a reptile room, which soon filled up, and have also taken in many exotic mammals, including raccoons, tanukis, a skunk, marmosets and many more. We also now have birds of prey as well.”

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Music star Leona Lewis is one of Hopefield's trustees The sanctuary is now open more to the public and has become a visitor attraction as well. That generates funds that go directly to the animals, making the future more secure. It also helps with educating people about the correct care the animals need. Said Lianne: “We will continue to make Hopefield grow and to help as many animals that we can.” q

Radio star puts the Yo-ho-ho! into legacy giving

[

THE ANNUAL Remember A Charity Week launched on 11 September, with charities and supporters across the UK sharing their stories on the nation’s first dedicated legacy radio station. In the most ambitious legacy giving campaign to date legendary 60s DJ Emperor Rosko returned to the airwaves to inspire legacy giving. The former Radio Caroline DJ and his colleague from pirate radio days Tony Prince toured the country with a digital radio station, Last Pirate FM, encouraging people to have their say on the world they want to pass on to future generations. The aim of the campaign was to get people talking about gifts in wills, with content specifically developed to appeal to the ‘baby boomer’ generation. It is hoped that, by celebrating the legacy of Radio Caroline, the baby boomer generation who grew up with the likes of Emperor Rosko and Tony Prince will be encouraged to leave their own legacy to the next generation by leaving a gift in their will. The radio station featured interviews with charities, supporters and celebrities, discussion shows, music from the 60s and on-air discussions with the public. Member charities created their own charity jingles. It travelled to a different city each day of the week,

beginning in London on the Monday and ending in Edinburgh on Friday 15 September. Rob Cope, director of Remember A Charity, the umbrella group that organises the week of activities, said: “Remember A Charity Week is a great opportunity for charities across the country to get legacy conversations started with their potential supporters and to showcase the real impact of gifts in wills. “This year’s campaign is very different from anything we have done in the past and is only possible due to the involvement of so many charities. Working collaboratively, we can really champion the importance of gifts in wills, creating a cultural change that will take us one step closer to making legacy giving a social norm.” Announcing his return to the airwaves from a replica Caroline – the ship that hosted the famous off-shore ‘pirate’ station – on the Thames, Emperor Rosko (real name Mike Pasternak) commented: “I am delighted to be back in the UK to launch Last Pirate FM. I loved my time here in the 1960s and 1970s, so the chance to come back to do a radio roadshow that celebrates the best of that era was too good an opportunity to turn down. “I look forward to visiting some of my old UK haunts and encouraging people to have their say on the world they want to pass on.” q

Education through the power of play

[

ACTION FOR SICK CHILDREN is currently focusing on its two main projects – Dental Playbox and Magical Power of Play Appeal. The Dental Playbox project is a preventative programme to educate the under fives, through the powerful medium of play, in the importance of good oral hygiene, sensible eating and drinking – along with visiting the dentist on a regular basis. In this, its 10th anniversary year, the aim is to educate at least 10,000 children! The Magical Power of Play Appeal supports the invaluable work of health play specialists by providing play resources for hospitals across the UK. These resources help to improve the hospital journey for sick children through distraction and recovery. q www.yourexpertwitness.co.uk

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Seeing Dogs

providing a choice [

THE SEEING DOGS ALLIANCE has made steady progress since it started operations in 2001. It was launched, and is supported, mainly by guide dog owners who want a competitor charity – as is available to blind and partially sighted people in most developed countries. Seeing Dogs’ successful rearing and training programme continually includes several dogs either being puppy reared or receiving their ‘seeing dog’ (their term for guide dog) training. Except for the highly skilled final training, the Alliance depend on volunteers. In this way, with careful monetary control, it costs them about £15,000 to train each dog and owner, about a third of what would otherwise be expected. Seeing Dogs’ clients are usually trained in their home environment, although their target is to have a dedicated training centre. When residential training has been required, they have used hotels. Puppies remain with the puppy rearers till they are 12-14 months old, during which time they are familiarised with all the circumstances they are likely to encounter as Seeing Dogs – such as crowded streets, heavy traffic, buses, trains, cars, cafés, restaurants, stairs (although not escalators), lifts and swing doors. An allowance is available to cover the expenses of this very important pre-training work. Seeing Dogs like their puppy rearers to take their charges to puppy training classes which helps with obedience training and socialisation with other dogs. They provide them with a reference manual and visit them from time to time to check on the puppy’s progress. They are also always at the other end of a phone to give advice or to obtain it for them. Currently, waiting lists for trained dogs are such that some clients wait months or longer to be trained with a dog. This is particularly serious for elderly people waiting for replacements. If they are without a dog for a period, they can lose the mobility needed to complete their training when a dog becomes available. Seeing Dogs urgently need funds to change this situation. With twenty owner and dog partnerships qualified, they have proved that they produce trained dogs to the very high standard required, at a price well below the norm. q • For further information on donating to this charity tel 01483 765556, email info@seeingdogs.org.uk or visit their website at www.seeingdogs.org.uk.

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Probate fee hike may be back on the agenda [

REPORTS HAVE EMERGED that the Ministry of Justice may be planning to reintroduce proposals to restructure probate fees, which could lead to massive increases for larger estates. The proposals were put on hold in May following the announcement of the General Election. A Parliamentary committee had already issued the opinion that the rises were potentially unlawful and had the ‘hallmarks of taxes rather than fees’. In July the Institute of Legacy Management said in a blog: “It has

Holidays help boost confidence of young cancer patients

“

For me the charity has not only allowed me to rebuild the loss of confidence but has enabled me to do so in a safe and homely environment with like minded peers – that has a support group effect

”

recently come to our attention that the proposal remains dormant and could be reactivated at any time. We want to ensure that MPs and Lords understand the full implications of these proposals, so have brought together a consortium of interested parties to sign a joint letter, which was sent to MPs earlier this week and has subsequently been picked up by several publications.” The letter was published in The Times on 12 July. In it the signatories say: “We are concerned that new fees would significantly reduce income for charities reliant on legacy gifts – to the tune of £18m a year – because many organisations are struggling to meet increased demand for their services.” One of those signatories was Legacy Link, which offers outsourcing services and consultancy on legacies. It blogged: “Despite overwhelming criticism from the legal and charity sector on the proposed move to a banded fee structure, the Ministry of Justice seem intent on pressing ahead with this change. This legislation change was put on hold due to the snap general election, but it appears this may now resurface. “If it goes ahead, we understand that the impact on charitable legacy gifts could be in the region of £18m a year. That is, £18m that donors would have intended to be used towards saving lives or conservation or their local community will instead be taken in tax. That is on top of any tax they would have paid in their estate, and in their lifetime. “We feel strongly that the government should reconsider its position on the proposed rise in probate fees, or consider ways to exempt charities from any increase.” q

[THIS QUOTE FROM Dave sums up the value of the work undertaken

by the Youth Cancer Trust. The organisation provides free therapeutic activity holidays for teenagers and young adults – those aged between 14 and 30 – from the UK and Ireland who are suffering from cancer. The young people who stay at the Trust are often depleted and lacking in confidence from the effects of cancer and its treatment. The service helps promote well being and encourages independence – which in turn helps boost self esteem. Being with other people of a similar age, who understand what it’s like to have cancer, helps reduce the sense of isolation which often accompanies a cancer diagnosis as a young person. The charity receives no government funding and relies entirely on donations, such as those from legacies, to help support the needs of young cancer patients like Dave. q • For more information visit www.youthcancertrust.org.

Supporting the maritime community [

SEAFARERS UK has been helping people in the maritime community for 100 years, providing vital support to seafarers in need and their families, as well as to those in education or training who are preparing to work or serve at sea. They do this this by giving grants to organisations and projects that make a real difference to people’s lives, across the Merchant Navy, Fishing Fleets, Royal Navy and Royal Marines. Last year they gave grants totalling £2.5 million to over 70 maritime welfare charities. Seafarers UK receives no government funding and is heavily dependent on public donations and legacies to maintain its grant-making. q • To support Seafarers UK or to find out more about their work, visit www.seafarers.uk or email seafarers@seafarers.uk www.yourexpertwitness.co.uk

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Funding helps enhance quality of life

[

FUNDING AN ever-changing variety of projects which enhance and enrich the lives of vulnerable people with learning disabilities is the function of Camphill Foundation UK and Ireland. The foundation provides the financial support that can enable new initiatives to start-up, help to create or improve facilities, or provide vital opportunities for creative and fulfilling work. It often provides that extra bit of help needed to enhance quality of life. Independence and freedom of choice are fine ideals, but they can only become a reality with the right level of support, both financial and personal. True quality of life means combining individual choice and fulfilment with social belonging and responsibility. The projects supported by Camphill Foundation improve and enrich that quality of life for people with learning disabilities by providing new work or social and cultural opportunities which enhance the development and wellbeing of both the individual and the community. For further information on leaving a legacy, enabling that work to continue, visit www.camphillfoundation.net q

If you Will, we will [LEGACIES MEAN SO much to the team at Last Chance

Animal Rescue. These wonderful gifts have helped them to rescue, rehabilitate and re-home so many abandoned, abused and unwanted dogs, puppies, cats, kittens, rabbits and guinea pigs who otherwise would have had no future. The charity understand the wishes of its kind benefactors who have considered them in their Wills. A spokesperson said: “We know they want their generous gift to us to be used directly to save lives, provide the very best of care and to find loving homes. “Legacies really do provide the gift of life and Last Chance Animal Rescue can now, after much planning and prudent use of funds, offer our life saving services to so many more needy pets. We are delighted to announce we now have a second rescue and re-homing centre in Kent, giving hope and a true A new friend for Alan last chance to so many. “Sadly we cannot thank those who have enabled this wonderful achievement but are extremely grateful to all those who are currently considering helping us now and in the future to continue our work.” q

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Data protection: statement of intent precedes Bill [IN AUGUST THE government issued a statement of intent,

committing it to updating and strengthening data protection laws through a new Data Protection Bill. The new law is expected to come into force in May next year. According to the statement, research shows that more than 80% of people feel that they do not have complete control over their data online. Under the plans individuals will have more control over their data by having the right to be forgotten and ask for their personal data to be erased. This will also mean that people can ask social media channels to delete information they posted in their childhood. The reliance on default opt-out or pre-selected ‘tick boxes’ to give consent for organisations to collect personal data will also become a thing of the past. Matt Hancock, Minister of State for Digital, said: “Our measures are designed to support businesses in their use of data, and give consumers the confidence that their data is protected and those who misuse it will be held to account. “The new Data Protection Bill will give us one of the most robust, yet dynamic, set of data laws in the world. The Bill will give people more control over their data, require more consent for its use, and prepare Britain for Brexit. We have some of the best data science in the world and this new law will help it to thrive.” The statement was welcomed by the Institute of Fundraising (IoF), which represents charity fundraisers.

Daniel Fluskey, the IoF’s head of policy and research, declared: “The relationship between charities and their supporters is vital for the good work that they do. Being honest and transparent in respecting individuals’ communication preferences is at the heart of charities communicating effectively with supporters and forms the building blocks for strong relationships between the public and the causes they support. “Charities are working hard in recent years to make sure that their donors have the best possible experience of fundraising, including preparing for many of these new legislative requirements. We look forward to the publication of the Bill and working to ensure that any issues specifically affecting charity fundraisers are considered in the new legislation.” A briefing to explain the new requirements to charities is being held by Third Sector magazine at the Regent Street Cinema on 26 September. Speakers will include representatives from the Fundraising Regulator, the Direct Marketing Association and leading lawyers Mills and Reeve LLP. Delegates will also be given the opportunity to anonymously submit sections of their GDPR communications – such as sections of privacy policy, consent statements and refresh consent emails – to a panel of experts who will dissect them and provide constructive feedback to ensure they are on the right track. q

Legacies – the gift of life [

ANIMAL CHARITY Wild Futures rescues and offers sanctuary to monkeys who have suffered abuse and neglect. They are dedicated to protecting primates and their habitats worldwide – they are endangered due to climate change, habitat destruction and the bush-meat and pet trades. For some species, it is too late. The future of all that remains lies in our hands, so leaving a legacy to Wild Futures is the gift of life and a future for primates and our wonderful planet. Wild Futures’ holistic approach makes them unique – providing sanctuary to rescued

monkeys, supporting projects overseas, campaigning for primate welfare, educating to protect primates worldwide and promoting a sustainability and ethical ethos. They receive no government funding, so the generosity of those that remember Wild Futures is essential to enable them to continue their work. A legacy can be the gift of a life worth living and a wild and safe future for all. q • For more information call 01503 262532, email giving@wildfutures.org or visit the webiste at www.wildfutures.org.

www.yourexpertwitness.co.uk

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Charity carries on the work of its founder [

FOR OVER 30 YEARS the famous animal hospital known as Tiggywinkles has been working to rescue, treat and rehabilitate sick, injured and orphaned British wildlife. Over that time they have proved beyond doubt that most wild animal and bird casualties can be saved and returned to the wild. Although they specialise in hedgehogs – indeed, they derive their name from St Tiggywinkles, the name of their specialist hedgehog ward, inspired by the animal character created by Beatrix Potter – their wealth of expertise in the care of a wide range of species can now be passed on to others. In addition, their commitment to practical education plays a vital part in the conservation of wildlife. As an accredited centre, opportunities are available for students aged 16 and over to gain a City and Guildsapproved qualification via their Apprenticeship in Animal Care scheme. Tiggywinkles was founded by Les Stocker, who sadly passed away in July 2016. In a tribute, Les was described as ‘…a steadfast ambassador, achieving his goal to turn wildlife rehabilitation into a profession’. In another he was referred to as the ‘the spiritual heart of Britain’. He was awarded an MBE by The Queen and given the title Laureate in the 1990 International Rolex Awards for Enterprise, for his work in wildlife conservation and establishing Europe’s first wildlife teaching hospital. More recently, he gained the prestigious Honorary Associateship of the Royal College of Veterinary Surgeons. The charity is happy to commemorate all who generously remember the Wildlife Hospital Trust in their will by inscribing their name on a plaque in its Remembrance Garden. Gifts are also welcome in the form of a donation or by becoming a Friend of Tiggywinkles. q

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Summit will debate fundraising help for small charities [

THE Institute of Fundraising (IoF) is to convene a summit between small charities, funding organisations and infrastructure bodies to identify ways to increase fundraising mentoring, advice and training initiatives for smaller charities. The announcement was made in June on the release of the IoF’s Fundraising Support for Small Charities report and marked the launch of a campaign calling for more to be done to help small charities to grow their fundraising skills and capacity in the long-term. The IoF says that there is an acute need for more support for smaller charities, with many reporting that they lack the necessary skills to be able to effectively raise the funds they need. That comes at a time when 70% of charities expect an increase in demand for their services over the next 12 months. Mike Smith, the IoF’s head of external affairs, commented: “Fundraising is one of the most effective ways for many small charities to raise the money they need to continue their amazing work. However, they need more help and support to do so. By launching this campaign, and holding the summit later in the year, we want to kick-start action to ensure the long-term support for smaller charities to be able to raise funds in a sustainable way for the causes they work on.” Among the reports recommendations are: • Increasing funding from government, local authorities and foundations for fundraising training for smaller charities • Grant, contract and project funding for smaller charities should more often include support for capacity building, including fundraising

• Central, devolved and local government should produce long-term plans for how they will help to strengthen capacity building, including fundraising, for smaller charities Rebecca Bunce, policy and engagement manager at the Small Charities Coalition, explained: “Diversification of income is key to ensuring a sustainable future for small charities. However, this requires new skills and strategic approaches from already overstretched small charities. We know that those organisations with under £1m in income are facing significant funding challenges, particularly with the fall of public sector grants and small contracts. As such, we welcome this

call from IoF to ensure that small charities are given greater support in their fundraising efforts and assisted in planning for the future.” q

Fundraising conference will address latest challenges [

THE HOLIDAY INN in Bloomsbury will be the venue for the Institute of Fundraising’s Legacy Fundraising Conference on 9 October. Sponsored by the Law Society, Opportunity or obstacle: legacy fundraising in the era of consent will help charities to ensure that their legacy fundraising activities are fit for purpose and ready for the challenges of 2018 and beyond. With sessions from a range of speakers representing charities large and small, the day promises to be the ‘must-notmiss’ event of the legacy fundraising calendar. According to the IoF: “The fundraising sector has been through an unprecedented period of change over the last two years and like all areas of fundraising, legacy fundraising has had to change also. The challenges legacy fundraisers face are set to continue with the introduction of the GDPR in 2018 and the rise of a new, discerning generation of legacy supporters.” Delegates will learn from the sector’s most innovative and inspirational legacy campaigns and find out how they can adapt new ideas into their own context. They can also put their concerns about GDPR to an expert panel and hear what the latest research tells us about who gives and why. q

Help for those with failing sight

[

FAILING EYESIGHT is nothing short of a personal catastrophe. Do you have a family member, friend or neighbour who is gradually losing their sight? Reading, recognising friends and living skills are all affected as your sight is going – and it’s much harder if you live alone. The National Federation of the Blind of the UK (NFBUK) keeps its members in touch with general information, help and updates on what’s going on. The charity produces bi-monthly news magazines and circulars in audio, braille or electronically, which members can read independently. It also encourages blind and partially sighted people to play a fuller part in society. q • For further information contact NFBUK on 01924 291313, email admin@nfbuk.org or vist www.nfbuk.org. www.yourexpertwitness.co.uk

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Welcome to our A to Z guide of the websites of some of the Expert Witness field’s leading players. If you are one of our many online readers simply click on any of the web addresses listed below and you will be automatically directed to that particular website. To get your website listed on this page just give us a call on 0161 710 3880 or email ian@dmmonline.co.uk Mr Jeremy P Crew MA MD BChir FRCS Translations and Interpreting for the Legal Profession since 1997. Specialists in Personal Injury and Clinical Negligence.

Consultant Urological Surgeon Medical reports on all legal aspects of urology. Reports in some cases based on hospital notes only.

www.abc-translations.co.uk

www.oxfordurology.co.uk

Mr Antony M. Visocchi

Dr Joshua Adedokun

Independent Dental Expert Witness • Emergency care • Diagnosis and treatment planning • Issues of consent • All routine treatment

Chronic pain expert following personal and occupational injuries. Wide experience in medical negligence claims.

www.dentalexpertwitness.co.uk

www.expertpainreports.co.uk

Mr Chris Makin

Dr Lars Davidsson (LSM) MRCPsych MEWI

• Chartered Accountant • Accredited Civil Mediator • Accredited Expert Determiner

Consultant Psychiatrist and Accredited Mediator Reports within most areas of general adult psychiatry. Specialist in PTSD, anxiety disorders & mood disorders.

www.chrismakin.co.uk

www.angloeuropeanclinic.co.uk

David Berry PhD FRC Path MFSSoc MRSC

Mr Marcus Ornstein

Independent Toxicology Consultant Specialist in toxicology with particular emphasis on drugs (both prescribed and illicit) and alcohol.

Senior Lecturer (teaching) and recently retired general surgeon with expertise in general surgery, breast disease, hernia and abdominal trauma. T: 020 8423 8236 E: markornstein@gmail.com

www.toxicologyservices.co.uk

www.marcusornstein.co.uk

Dr David Usher BSc DPhil FCIEHF

Mr Mark Duxbury

Consultant Ergonomist: Identifying ergonomic issues behind work-related injuries. Assessing the equipment provided and the risk management system in place.

Consultant Surgeon – medicolegal work relating to general and laparoscopic surgery, specialist liver and pancreatic surgery, and hernia and gallbladder surgery

www.interactionofbath.com

www.markduxbury.info/medicolegal

Emma Ferriman Ltd

MD5 Ltd

Consultant Obstetrician and Fetal Medicine Specialist • Prenatal diagnosis • Obstetric ultrasound • First trimester screening • Multiple pregnancy and high risk obstetrics

Expert analysis of digital evidence stored on computers, phones and other digital devices

www.emmaferriman.co.uk

www.md5.uk.com

Expert in Mind

Medicolegal Associates Limited

Providing high quality medico-legal reports within the ﬁeld of mental health

Expert Witnesses in Pain Medicine for both clinical negligence and personal injury cases acting for the defendant and claimant. T: 0207 118 0650

www.expertinmind.co.uk

www.medicolegal-associates.com

FHDI - Kathryn Thorndycraft

Mr Michael Hodge

Examining documents & handwriting – to determine authenticity • to expose forgery • to reveal aspects of origin

Maxillofacial and Oral Surgeon. • Personal Injury • Criminal Cases • Clinical Negligence

www.fhdi.co.uk

www.consultantoralandmaxillofacialsurgeon.co.uk

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Mr Michael Thompson

Sector Forensics Ltd

Specialist in bowel cancer and the effects of delay in diagnosis on survival.

• Computers • e-Disclosure • Compliance • Indecent Images • Mobile Phones • e-Discovery • Intellectual Property • Fraud

www.expertcolorectalsurgeon.co.uk

www.sectorforensics.co.uk

Dr Nigel Kellow MB BS FRCA MBA

Mr Simon Bramhall

Consultant in Anaesthesia & Pain Medicine • Spinal cord and nerve injuries • Complications relating to anaesthesia • Fibromyalgia • CRPS • Back & neck pain

Consultant General/Upper GI and HPB Surgeon. Signiﬁcant medico legal work undertaken in his area of expertise.

www.kellow.com

www.simonbramhallhpbsurgeon.co.uk

Premex Group Ltd

Stockport Psychology Services

A leading provider of independent medical reports Choose from a panel of experts providing national coverage in every specialism

Specialising in Public & Private Family Law, Personal Injury, Clinical Negligence & Criminal cases

www.premex.com

www.sps.uk.net

Robert Hensher FRCS FDSRCS

Dr Thomas C M Carnwath

Consultant Oral and Maxillo-Facial Surgeon Subspeciality interests: • Dental Implantology • Salivary Gland Surgery • Temporomandibular Joint Replacement

Consultant Psychiatrist and expert witness in medical negligence and personal injury cases.

roberthensher@gmail.com

www.tomcarnwath.co.uk

www.yourexpertwitness.co.uk

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MEDICAL NOTES [THE PRESS – and indeed the public – have been occupied recently with a sudden and huge increase in the

number of so-called acid attacks, where a corrosive substance is thrown or squirted onto the victim, in particular the face. From being isolated cases, often where the victim is known to the perpetrator – who deliberately aims to disfigure – they now appear to be the weapon of choice of mugging gangs who are more and more likely to be caught if they carry other weapons. A quick response is essential on the part of bystanders, as is the correct response. The British Association of Plastic, Reconstructive and Aesthetic Surgeons has launched a campaign to educate the public, around the slogan Report, Remove, Rinse. • In addition to the burns and disfigurement, such attacks can leave lasting scars. Living with those scars can have profound and debilitating psychological consequences in addition to the physical legacy. Indeed, scarring from any source, whether inflicted deliberately or the consequence of negligence or carelessness, can carry long-term psychological consequences. That harm can be taken into account in the assessment of any award of damages. A number of factors come into play, such as age and, significantly, the sex of the victim. • While scarring from attacks is the result of deliberate action, and those resulting from road or workplace accidents are often clearly culpable, scarring can be the result of clinical action. Whether or not that is the result of negligence or the inevitable consequence of clinical procedure is less clear cut. Nevertheless, accidents do happen and the NHS spends an eye-watering amount on settling claims. The National Audit Office has revealed that spending on settling claims has quadrupled in only 10 years. • Dentists, meanwhile, are taking the lead in utilising modern techniques to ensure they are singing from the same hymnsheet when it comes to keeping records – a key starting point in clinical negligence defence. The initiative was launched at the Health and Care Innovation Expo in Manchester by the Chief Dental Officer. It was one of a number of announcements made at the conference. Another was an initiative to integrate prevention and care of cardiovascular disease, which can lead to heart attack and stroke, by early diagnosis and community preventative efforts. • One area of clinical hiccup that is exercising Health Secretary Jeremy Hunt is that of errors in prescribing. According to Mr Hunt, one in 12 prescriptions contains an error of some sort. It is a truism that no-one can read a doctor’s writing and the move towards electronic prescribing, or EPS, will help to eliminate most problems. However, some prescriptions are still hand-written – mostly in situ in the home or social care setting – and these are the most vulnerable to errors. • There are medical conditions leading to claims that are not the result of clinical negligence, but negligence at work or in the community. One such is noise-induced hearing loss, and a working party of the Civil Justice Council seems to have pulled off the impossible by producing a report that pleases everybody. The report by Andrew Parker on improving claims management and costs has been applauded by the judiciary and lawyers alike. • Another of the senses that is vulnerable to the senseless is sight. The latest craze in that respect is to shine powerful lasers into people’s eyes – particularly airline pilots and emergency services personnel. A consultation is underway on whether it should be a specific criminal offence. q

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Audit Office report reveals soaring cost of negligence claims [THE GOVERNMENT NEEDS to take a stronger and more

integrated approach if it is to rein in the increasing cost of clinical negligence claims across the health and justice systems, according to a report from the National Audit Office (NAO). The report, Managing the costs of clinical negligence in trusts, was published on 7 September. In it the NAO reveals that spending on the Clinical Negligence Scheme for Trusts has quadrupled over the past 10 years – from £400m in 2006-07 to £1.6bn in 2016-17 – while the number of successful clinical negligence claims where damages were awarded has more than doubled, from 2,800 to 7,300. The cost of clinical negligence claims is rising at a faster rate year-on-year than NHS funding, adding to the financial pressures already faced by many trusts. That can have an impact on patients’ access to services and quality of care. In addition, trusts spending a higher proportion of their income on clinical negligence are significantly more likely to be in deficit. In 2015-16, for example, all 14 trusts which spent 4% or more of their income on clinical negligence were in deficit. The increasing number of claims accounted for nearly half (45%) of the increase. The other half was accounted for by the increase in amounts per claim of both damages and legal costs. The fastest percentage rise was in claimant legal costs, which has risen from £77m to £487m over the same time period. That is mainly due to an increase in both the number of low and medium-value claims – those of less than £250,000 – and their average cost. In

Colne Road investigation: CQC appoints chair [

THE CARE QUALITY COMMISSION has announced it has appointed Sir Paul Jenkins KCB QC (Hon) to lead the independent investigation into its own regulation of 14 Colne Road Care Home in London. The independent investigation will examine all aspects of CQC’s regulation of Colne Road, a home for people with learning disabilities in North London at which a resident is alleged to have raped another resident in November 2015. Sir Paul (pictured) specialises in the conduct of independent investigations and inquiries for corporations and governments in the UK and internationally. He was formerly Head of the Government Legal Department and Permanent Secretary to the Attorney General from 2006 to 2014. He will report his findings and recommendations publically to CQC’s Board. The investigation is expected to conclude by the end of this year. Sir David Behan, chief executive of CQC, said: “Although we took action to close this care home, it’s clear that we should have acted more quickly in response to the provider’s failings in order to make sure people were safe. We’ve commissioned this independent investigation because, as a public body, it’s important that we understand what we got wrong and how we can do better – and that we’re as transparent as possible about this process.” q

2016-17, the claimant’s legal costs exceeded the damages awarded in 61% of claims settled. According to the NAO, the Department of Health and NHS Resolution’s proposed actions to contain the rising cost of clinical negligence claims are unlikely to stop the growth, although those organisations have taken action to contain the rising cost of clinical negligence claims. For example, NHS Resolution has reduced the average cost per claim of its claims operations. It also challenges excessive charges of claimants’ legal firms, saving £144m in 201516 by challenging claimants’ legal costs. A number of further schemes are proposed to contain the costs; however, even if successfully implemented, these will only save some £90m a year by 2020-21. By contrast, the spending on the Clinical Negligence Scheme for Trusts is expected to double to £3.2bn by 2020-21. In its report the NAO says: “The government lacks a coherent cross-government strategy, underpinned by policy, to support measures to tackle the rising cost of clinical negligence. The Department and NHS Resolution, working with others including the Ministry of Justice, have identified many of the factors contributing to the rising costs of clinical negligence. But some of the biggest factors influencing costs fall within the remit of more than one government department or are largely outside the health system’s control. They include developments in the legal market and the increasing level of damages awarded for high-value claims.” NAO head Amyas Morse commented: “The cost of clinical negligence in trusts is significant and rising fast, placing increasing financial pressure on an already stretched system. NHS Resolution and the Department are proposing measures to tackle this, but the expected savings are small compared with the predicted rise in overall costs. Fundamentally changing the biggest drivers of increasing cost will require significant activity in policy and legislation: areas beyond my scope.” q

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Mixed response to prescribing errors initiative [

CONFIRMATION THAT Health Secretary Jeremy Hunt is to launch an initiative to reduce prescribing and medication errors in the NHS was met with a mixed response from bodies representing the pharmacy sector. The move was confirmed by Pharmacy Minister Steve Brine MP in his speech to the Royal Pharmaceutical Society’s annual conference in September. Mr Brine said that studies currently indicate that up to 8% of prescriptions have a mistake in dosage level, course length or medication type. He said: “Patient education and safe management of information will be at the heart of our efforts to tackle this serious issue. For example, we will need to improve how we use electronic prescribing, as well as how we transfer information about medicines between care settings, where there is significant scope for errors.”

Responding to the announcement, the General Pharmaceutical Council said: “The GPhC welcomes this initiative to explore ways to improve medication safety still further. Pharmacists and pharmacy technicians play a vital role not only in ensuring the safe supply of medicines, but also in working with patients, carers and other healthcare professionals to guard against a range of medication-related risks, including those to do with prescribing. “We look forward to learning more about NHS England’s plans and how our work with the pharmacy professions and other regulators can complement this important initiative.” The chief executive of the Pharmaceutical Services Negotiating Committee (PSNC), Sue Sharpe, said: “It is unfortunately inevitable that some errors will occur in prescribing – medicines will be omitted, doses may be unintentionally altered and on rare occasions the wrong

medicine may be prescribed. Tackling these must not be a question of blame; we must instead focus on ensuring that safeguards are in place to minimise errors and to spot and correct any that do occur.” The PSNC represents community pharmacies on the high street and in health centres. Ms Sharpe said of their role: “Community pharmacy teams keep records of their patients’ medication and so can spot some errors and resolve the problems with patients’ GP practices. Their expertise in medicines, combined with a knowledge of the patient, is an important part of the system that minimises risks of system errors, and local pharmacies will continue to work with NHS colleagues to help protect patients.” The Mirror was more forthright. Its headline read: “With nurses demoralised and staff leaving in droves why is Jeremy Hunt's priority reducing prescription errors?” q

Jail terms for dodgy meds sellers [

TWO PROSECUTIONS IN as many days have seen jail terms imposed for the selling of unlicensed medicines. On 8 September a man from Southall was jailed at Isleworth Crown Court on eight counts of possession and supply of significant quantities of unauthorised and unlicensed medication. Investigators from the Medicines and Healthcare products Regulatory Agency (MHRA) raided a property belonging to Gurinder Bharaj in Ealing, where more than 100,000 individual doses of unlicensed erectile dysfunction medicines worth more than £30,000 were uncovered and seized. A smaller quantity of prescription medication was also seized. Following an initial hearing Mr Bharaj pleaded guilty to all charges and was sentenced to 20 months imprisonment with immediate effect (concurrent to all counts). He was also ordered to pay a £75 victim surcharge. The previous day David Antley was sentenced at Liverpool Crown Court for the importation and supply of substantial quantities of unauthorised medicines. When MHRA investigators raided Antley’s property they seized more than 13,900 doses of unlicensed erectile dysfunction medicines worth more than £40,000. Antley pleaded guilty to the charges and was sentenced to 20 weeks imprisonment (concurrent to all counts). MHRA is currently running a #FakeMeds campaign to warn people against buying potentially dangerous or useless unlicensed medicines sold by illegal online suppliers. Its head of enforcement, Alastair Jeffrey, said: “Selling unlicensed medicines is illegal and can pose a serious risk to health. The fact that a medicine is unauthorised means that it has not been subjected to the regulatory scrutiny and quality assurances required to get a license. These products can be dangerous as their contents are unknown and untested and the consequences for your health can be devastating. “Criminals involved in the illegal supply of medical products aren’t interested in your health - they are only interested in your money. MHRA will continue to track down and prosecute those who put the public’s health at risk.” q www.yourexpertwitness.co.uk

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Doctors welcome ‘pragmatism’ of training report [

THE BRITISH MEDICAL ASSOCIATION has given a cautious welcome to the latest Shape of Training report, published by the UK Shape of Training Steering Group in August. The steering group was set up following the publication in October 2013 of Professor Sir David Greenaway’s report into postgraduate medical training in the UK. The report was commissioned to ‘consider whether the current arrangements for training doctors are sufficiently focussed on the needs of the population both now and in the future’. Dr Jeeves Wijesuriya, BMA’s junior doctors’ committee chair (pictured), said: “We welcome a pragmatic approach from today’s report from the UK Shape of Training Steering Group, which has listened to, rather than undermined, professional bodies for doctors in the UK. We want to reassure patients and doctors that we continue to oppose any changes which devalue the high standard of medical training in the UK or compromise patient care. “The report acknowledges that decisions regarding the regulation of health professionals are not within the group’s remit. The government’s recent statement on NHS workforce expansion committed to consulting on any proposal to move the point of registration. The BMA has resisted attempts to move the point of registration, which would require significant changes to undergraduate medical curricula, compromising the quality of doctors' training and patients’ care. “We have argued robustly to preserve the current specialty training structure, and for maintaining the Certificate of Completion of Training (CCT). We insisted that amendments to training pathways, if needed, should be made by the Royal Colleges and Faculties. We have also argued for a model of credentialing that does not undermine the CCT or the coherence of training programmes. Any move that weakens the current standard of specialty training risks reducing the quality of patient care, and is therefore unacceptable to doctors.”

A joint statement from the four health ministers of the UK, issued on the publication of the Shape of Training report, said: “As health ministers across the UK, we are clear that advances in technology, changing models of care and the difficulties faced in caring for an increasing aging population requires the healthcare system to adapt. It is important that medical education and training programmes

keep pace with changes in both professional standards and social expectations. “We welcome the report from the UK Shape of Training Steering group, and commend the combined efforts of the group, not only in fulfilling their task of analysing the key recommendations of David Greenaway’s report, but in outlining a pragmatic and proportionate way forward.” The General Medical Council also welcomed the report. Its chief executive Charlie Massey said: “We share the belief that medical education and training has to be responsive to the evolving and changing needs of patients and the profession. To that end we are already working with doctors in training, medical royal colleges and others to make training more flexible while at the same time ensuring high standards are maintained.” q

Litigation body appoints specialist advisors [NHS RESOLUTION HAS appointed two senior clinical advisors to its early notification

scheme of brain injury at birth. They are Professor Tim Draycott, a consultant at Southmead Hospital and the University of Bristol, and Supervisor of Midwives Rebecca Wilson-Crellin. Since April trusts are required to report all maternity incidents which are likely to lead to a severe brain injury to NHS Resolution. Its senior clinical advisors will fulfil two main functions. The first is to provide an initial assessment on liability, which will be used in conjunction with a trust’s own assessment to determine how the case will be handled. Secondly, they will assist in supporting good quality internal investigations, identifying and analysing learning points, to be fed back to trusts and collated for wider dissemination across the NHS. Professor Draycott trained in London and the South West of England, with time spent working in France, Sweden and South Africa. He has been a consultant obstetrician at Southmead Hospital since 2002 and a Health Foundation Improvement Science Fellow since 2012. He helped to develop the obstetric training programme that has been associated with significant improvements in clinical outcomes. Ms Wilson-Crellin Dip Midwifery MSc RM qualified as a midwife in 2003 from Keele University. In addition to qualifying as a Supervisor of Midwives, she was appointed as a CQC Specialist Advisor and has been awarded a Masters in Integrated Governance in Healthcare Communities from Westminster University. q

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Common pain conditions seen in medico legal claims By DR CHRISTOPHER JENNER MB BS FRCA FFPMRCA, Consultant in Pain Medicine at Medicolegal Associates Ltd and Imperial Healthcare NHS Trust

[THE FIVE MOST COMMON pain conditions that are seen in medico

legal claims tend to be Fibromyalgia Syndrome, Complex Regional Pain Syndrome, lumbosacral pain, neck pain and abdominal and pelvic pain. It is helpful to understand these conditions and the related complications that can present in a claimant.

Fibromyalgia Syndrome (FMS)

FMS is a type of nerve (neuropathic) pain that can occur all over the body and has no known cause or cure. It is characterised by widespread body pain, poor sleep, tiredness, fatigue, cognitive disturbance and a constellation of other symptoms. It is thought to be experienced by around two in every hundred people, so it is not uncommon. Claims involving FMS are on the increase, mostly due to individuals who have developed the condition following physical trauma of some kind. Other possible causes are psychological trauma or infectious disease. Earlier pain theory labelled FMS as a psychosomatic disorder and it continues to be difficult to diagnose given its subjective, complex nature. This complexity requires careful medical exploration looking specifically at pain trigger points, fatigue and sleep and cognitive disturbance, along with approximately 40 associated symptoms. Current treatments to manage the symptoms of FMS include antineuropathic medication, opiates, physical therapy and alternative therapies such as acupuncture and deep tissue massage. More advanced treatments attempt to target the ‘trigger points’ at the nerve roots using injections of local anesthetic and anti-inflammatory medicine or Botox.

Complex Regional Pain Syndrome (CRPS)

CRPS is an incredibly painful and debilitating condition. Like FMS, it is a chronic neuropathic pain condition but, unlike FMS, it isn’t widespread, tending to affect a single limb. CRPS symptoms almost always develop after a clear physical trauma, such as a fracture. Immobilisation in a cast is the most common cause of CRPS. Diagnosing CRPS is largely through the process of elimination to rule out other conditions with similar symptoms – such as Lyme disease and arthritis. As with FMS, a thorough examination by a consultant in pain medicine who specialises in diagnosing and treating CRPS is vital. Treating CRPS can in some cases be quite similar to FMS. Other treatments include spinal cord stimulation and neural stimulation.

Lumbosacral pain

Lumbosacral pain (lower back pain) involves the lumbar spine and the sacrum. Given that this is the most widely experienced healthrelated complaint in the world, as well as the leading cause of disability, it’s not surprising that we deal with it so often. Many if not most of the cases we cover involving lumbosacral pain conditions are personal injury claims, especially following a car accident. There are too many causes of lumbosacral pain to go into here, but in the case of car accidents the impact strains the ligaments and muscles in the back, and the facet joints bear the brunt of the force. This can result in

several injuries, including disc herniation, compression fractures and spondylolisthesis (‘slipped’ vertebra). It is sometimes the case that immobilisation following a physical trauma can result in lumbosacral pain – in such cases, it must be shown in court that the back pain is a result of the trauma and restricted mobility post-incident.

Neck pain

This is another common pain condition in medico legal cases, also most often involving a personal injury claim following a car accident. Neck pain symptoms include pain that spreads to the shoulders, upper back and down the arms. The actual value of the claim is usually based on the injuries, well supported by medical evidence. This relies heavily upon the opinion of a medical expert. The most common type of neck injury is whiplash, which is caused by sudden movement of the head forwards, backwards or sideways. Common whiplash symptoms include neck pain or stiffness with difficulty moving the head, headaches, muscle spasms and pain in the shoulders and arms. There may also be tiredness, dizziness, memory loss, pins and needles in the arms and hands and irritability. Treatments for chronic neck pain conditions include manual therapies, medication, and surgery.

Abdominal and pelvic pain

Abdominal (stomach) pain involves any pain that is felt from chest to pelvis and pelvic pain is any pain felt in the area of the pelvis. The abdominal and pelvic pain cases we see usually follow a surgical procedure or treatment that has resulted in chronic pain – these are usually clinical negligence claims. In order to establish whether chronic abdominal or pelvic pain has occurred as a result of surgery these criteria must apply: • The pain must have developed after a surgical procedure • The pain must have lasted for at least two months following the • procedure • Other possible causes for the pain must have been excluded • The possibility that the pain is from a pre-existing condition must be • excluded. Treatments for chronic abdominal pain include medication, diet changes and surgery. Treatment for chronic pelvic pain conditions includes physical therapy which focuses on tension release and core restoring exercises, as well as medication and surgery. q • Chronic pain is a complex and often wholly subjective condition that requires an expert in pain medicine with the correct specialism to establish cause, impact and optimum treatment requirements either when defending or bringing a claim. Dr Jenner has extensive experience of treating these conditions successfully and has been preparing medico legal reports for both claimant and defendant for the past 14 years. www.yourexpertwitness.co.uk

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Pacemaker patch will foil Public health body urges potential hackers joined-up approach to [ CVD prevention ABBOTT LABORATORIES have released an update to its implantable pacemakers in response to fears that the devices – made by St Jude Medical which Abbott acquired in January – could be vulnerable to hacking by unauthorised persons using radio frequency equipment. The non-invasive firmware patch should resolve the problem, said Abbott Laboratories, although no reports have come to light of any successful or attempted hacks of pacemakers. Abbott told the British Medical Journal: “In some cases, doctors and patients will decide that the risks that could be associated with installing the new update for a patient may outweigh the benefits.” q

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[

SOME FIVE-AND-A-HALF-MILLION people in England have undiagnosed high blood pressure and nearly half-a-million have undiagnosed atrial fibrillation: conditions associated with cardiovascular disease (CVD). Both are usually symptomless conditions that substantially increase the risk of stroke, heart attack, dementia and limb amputations. Treatment of CVD is effective at reducing this risk, but under-treatment is common even among those who are diagnosed. New analysis from Public Health England shows the scale of the prevention opportunity across England over three years if treatment of these conditions is optimised. For example, achieving optimal treatment in all people with diagnosed high blood pressure has the potential to avert up to 9,710 heart attacks and 14,500 strokes, saving up to £274m. In addition, achieving optimal treatment of those diagnosed with atrial fibrillation has the potential to avert up to 14,220 strokes, saving £241m. Duncan Selbie, chief executive of Public Health England, told the Health and Care Innovation Expo in Manchester: “High blood pressure is the invisible killer. We want people to be as familiar with their blood pressure numbers as they are with their credit card PIN or their height. “Too many people are still living in poor health and dying from a largely preventable disease. The good news is that we know how most heart attacks and strokes can be avoided. Scaling up CVD prevention locally is a major part of reducing the overall burden on individuals, families and the NHS, and will help to ensure a person’s health is not defined by where they live.” q

CJC publishes NIHL report [ THE CIVIL JUSTICE COUNCIL (CJC) has published the long-awaited report of its working group

looking into fixed recoverable costs and improvements to claims management in noise-induced hearing loss (NIHL) cases. The working group was chaired by eminent lawyer and CJC member Andrew Parker. The chairman of the CJC, Master of the Rolls Sir Terence Etherton, said: “The CJC’s working group is to be congratulated on having produced a comprehensive report that offers a fixed costs regime on which leading players for both the claimant and defendant sides have reached agreement. “These claims present with special characteristics. Their complexity and the importance of having a timely resolution point to their needing a specific fixed costs regime that is complementary but not identical to a more general fixed costs system as proposed by Lord Justice Jackson in his recent review. “The group’s recommendations go beyond fixed costs, with a number of proposals to streamline the processes for such claims and encourage earlier settlement or resolution of cases. These cover both the pre- and post-litigation stages. “The CJC warmly welcomed and endorsed the report at its last meeting, and we are very grateful to the expert practitioners who served as members, and Andrew Parker the CJC member who chaired and led the group. “I have written to the Lord Chancellor to commend the report and ask for its recommendations to be considered as part of the forthcoming wider review of fixed costs.” In his introduction to the report, Andrew Parker observed: “It is in both claimants' and defendants’ interests that these claims are handled efficiently by both sides in the initial pre-issue stages, to avoid unnecessary costs being incurred and to ensure that all parties get the earliest possible resolution of a claim.” He continued: “Inevitably the scope of those cases covered by the fixed recoverable costs proposals is a compromise. We found as negotiations progressed that we made more progress by excluding non-standard cases or those which were more likely to involve greater costs or complexity. The resulting scope is still expected by all sides to cover a significant majority of NIHL claims which succeed.” q

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Claim settled following stillbirth [

SPECIALIST CLINICAL NEGLIGENCE lawyers BL Claims report a cautionary tale of the possible consequences of not following agreed procedures during a pregnancy. Their team includes ex-midwife Patricia Wakeford, who advised in a case involving a client who had suffered a stillbirth. Ms Wakeford reported: “Mrs E had a troubling medical history when it came to pregnancy and childbirth. She had suffered the devastating loss of two babies in mid pregnancy after the placenta detached from the uterine wall, causing her to suffer significant bleeding and for her babies to arrive stillborn. She had two live children, but both of those had resulted in emergency deliveries due to problems during labour.” Following an appointment with the consultant who had been involved with all four of her previous children it was decided that, if Mrs E did try for another baby, he would consider delivering at 30 weeks if problems arose at that time. Mrs E agreed to try for another baby on the proviso that, if there were concerns around the 30 week mark, she would be delivered. At 30 weeks pregnant she developed raised blood pressure and began to have concerns that her pregnancy was following the same pattern as her previous four pregnancies. She did ask to be delivered

but was told her baby was doing well and growing well and needed to remain inside. At 32 weeks she saw her consultant and again asked to be delivered. She was advised that the baby was doing very well and was a good size. Patricia Wakeford continued: “At just over 33 weeks Mrs E attended the hospital complaining of abdominal pain. On admission to the ward the foetal heart was not heard. An abruption was diagnosed and Mrs E suffered significant bleeding. A normal delivery was attempted but, due to haemorrhage, a caesarean section was performed and her baby was tragically delivered stillborn.” Mrs E suffered severe psychological symptoms as a result of the failure by the trust to follow the plan agreed prior to her pregnancy. Liability was denied, however, on the basis that the consultant who had cared for her was concerned about a premature delivery. An attempt was made to settle the claim before the issue of court proceedings but the trust rejected the offer and refused to negotiate. Court proceedings were served and statements were ready to be exchanged. However, an offer was then received by the trust in settlement of the claim. Further negotiations took place and a five figure settlement sum was agreed. q

Clinicians voice concerns over labiaplasty report [

THE Royal College of Obstetrics and Gynaecology (RCOG) and the British Society for Paediatric and Adolescent Gynaecology (BritSPAG) issued a joint statement in July regarding concerns over young women and girls under 18 seeking labiaplasty. It follows a report by the BBC’s Victoria Derbyshire Show. The programme reported that in 2015-16 more than 200 girls under the age of 18 had

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labiaplasty on the NHS, more than 150 of whom were under 15. Professor Janice Rymer, a consultant gynaecologist and vice president for education at RCOG, said: “We are alarmed by anecdotal reports of adolescent girls requesting labial reduction surgery for cosmetic or other reasons. These decisions are not always based on informed understanding of the normal variations that exist, but are influenced by images in popular culture, such as the mass media, adverts for cosmetic surgery and pornography. “It is important that clinicians inform and reassure girls and, where appropriate, their guardians about labial anatomy, development and variation, and ways to manage labial discomfort.” Dr Naomi Crouch, consultant obstetrician and gynaecologist and chair of BritSPAG, added: “There is no scientific evidence to support the practice of labiaplasty and the risk of harm is significant, particularly for adolescents who are still in stages of development both physically and psychologically. There is no medical requirement for labiaplasty, either for discomfort or for appearance. The distress experienced by some of these girls should not be underestimated. It is important for clinicians to provide accurate and sensitive advice and guidance rather than unnecessary and irreversible surgery.” NHS England told the BBC that it did not carry out the operation for cosmetic reasons, only for clinical conditions. However, there is evidence that girls are exaggerating their symptoms to gain acceptance for the procedure. q

Ovarian cysts: guidelines are there to be followed By JEREMY TWIGG MD FRCOG, consultant gynaecologist and gynaecological oncologist

[

GREEN-TOP GUIDELINES from the Royal College of Obstetricians and Gynaecologists (RCOG) guide doctors in the management of ovarian cysts found in women at ultrasound scan. The National Institute for Health and Care Excellence (NICE) has also published guidance on how doctors should manage women with suspected ovarian cancer. RCOG guidance issued in November 2011 states that up to 10% of women will have some form of surgery for the presence of an ovarian mass in their lifetime. In premenopausal women almost all are benign; however some will have malignancy as the cause. Differentiating between them can be difficult. Around 10% of ovarian masses are nonovarian in origin, for example paratubal cysts and appendiceal abscesses. RCOG Green-top Guidelines recommend the use of specific tumour markers (AFP, HCG and CA125), along with a calculation of a risk of malignancy index (RMI), to help doctors determine what is the most likely cause of a cyst. GPs are doing more ultrasound scans as government policy moves toward increasing

the availability of diagnostic services in primary care. To not undertake such tumour marker levels can be seen as a breach of duty for doctors trying to elucidate the likely aetiology of an ovarian mass. The risk of malignancy index is a calculation of the likelihood of ovarian cancer, based on the ultrasound appearance of the cyst along with the value of the CA125 level. In addition to ultrasound scans and tumour markers, other investigations can help determine the nature of an ovarian mass. Most hospital radiology departments will have a protocol in place for the management of patients who undergo an ultrasound scan that shows a complex pelvic mass. For example, if the cyst is less than 50mm and simple, no ultrasound follow-up is required. If it is between 50-70 mm a re-scan in 12 weeks will be recommended. Above that threshold gynaecological referral will be advised. Where the cyst is complex with features of multilocularity, solid areas, metastasis, ascites and bilaterality, then a Doppler ultrasound will be conducted. Gynae referral will be then recommended. It is the responsibility of the GP to ensure that the

referral takes place â&#x20AC;&#x201C; most often to a twoweek wait/rapid access clinic in the local diagnostic unit, under the suspected cancer referral guidelines. If the clinician in secondary care is concerned, then the womanâ&#x20AC;&#x2122;s case would be expected to be discussed at the gynaecological oncology MDT, to determine the need for surgery and the place where it should happen. Sometimes it is possible to undertake surgery using keyhole incisions, but where a mass is at high risk of being malignant then open operation is the gold standard. The reason for this is the concern that spillage of an ovarian cyst which is malignant may lead to further metastases within the abdominal pelvic cavity. If a cyst is cancerous then once it has been removed it is most likely the patient will be offered six courses of combination chemotherapy. q â&#x20AC;˘ As a gynaecological oncologist, Jeremy Twigg has 20 years of experience in the management of patients with ovarian cysts and is able to provide expert opinion on the care received by women diagnosed with an ovarian cyst on ultrasound scan.

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Government seeks evidence on laser pointers [THE GOVERNMENT HAS

issued a Call for Evidence to gather data and information on high-powered laser pointers and is interested in gathering evidence from the ophthalmic community on patients seen with retinal injury and consequent vision loss, the Royal College of Ophthalmologists reports. According to the RCOphth, the government is concerned that in recent years there have been an increased number of reported incidents of the deliberate misuse of laser pointers, with consequences which could have been fatal. Examples include shining laser beams into the cockpits of aircraft as they take off and land and young children suffering permanent eye damage as the result of having beams from ‘toy’ pointers shone directly into their eyes. A UK survey of ophthalmologists reported 159 incidents of eye injuries since 2013, mainly affecting young children.

Visual impairment certificate overhauled

The Department for Business, Energy and Industrial Strategy (BEIS), the Home Office and the Department for Transport are working together to consider what action the government should take to tackle this problem. BEIS, the department responsible for product safety, is considering whether further measures would help tackle the problem. Options include restrictions on advertising, greater awareness-raising and introducing controls relating to the supply, ownership and/or use of laser pointers. According to BEIS: “Last year an air ambulance helicopter pilot was rendered temporarily blind by a laser attack that could have had catastrophic consequences. “The Call for Evidence considers updating regulations governing the import and trade of laser pointers, as well as potential solutions involving licensing arrangements, restrictions on supply, and the introduction of a specific criminal offence for ‘laser attacks’ on planes or vehicles.” Consultant ophthalmologists Fahd Quhill and Simon Kelly have campaigned on the issue and are urging colleagues to participate in the Call for Evidence about ‘this important ocular public health matter’. Evidence can be submitted online at www.gov.uk/government/ consultations/laser-pointers-call-for-evidence and the closing date for submissions is 6 October. q

[WORKING IN PARTNERSHIP with The Royal College of

Ophthalmologists, RNIB and others, the Department of Health in England has updated the Certificate of Vision Impairment (CVI) form and revised the Explanatory Notes for consultant ophthalmologists and hospital eye clinic staff in England. Key objectives have been: • To simplify the form, collecting only essential information • To make it easier and quicker for ophthalmologists and eye • clinic staff to complete • To have a single CVI form for both adults and children • To provide better information to patients and their carers • about sources of support For England, Wales and Northern Ireland it has been acknowledged that the previous ‘work test’ is no longer relevant or appropriate and the criteria for certification, based on visual acuity and visual field, have been clarified in the Explanatory Notes, emphasising – importantly – that these are for guidance only. The change allows consultant ophthalmologists flexibility in their professional judgement whether to certify a person as sight impaired or severely sight impaired. The notes also explicitly remind doctors of their duty to take action where patients continue to drive when they are not safe to do so. q www.yourexpertwitness.co.uk

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Dentists urged to join recording revolution [

MORE THAN 18,000 NHS dentists are being urged to give their views in a nationwide survey as part of plans to reform record keeping standards. At the Health and Care Innovation Expo in Manchester on 11 September the Chief Dental Officer for England, Sara Hurley, launched plans for a survey of NHS dentists across England that will use an innovative technique – known as the Delphi method – that is designed to ensure that every response counts and a process that leads to a consensus view based on a wide body of professional opinion. Based on clinical examination and record keeping guidelines from the Faculty of General Dental Practice, the survey will canvas responses on areas such as patients’ contact details, treatments and payment histories. It will also assess views on whether information should be recorded at initial, recall or urgent appointment stages. The survey will explore views on rating elements of treatments and patients’ records. The survey results will be used to develop a new set of guidelines on record keeping by the Office of the Chief Dental Officer, created in line with the principles of the NHS Regulatory Framework. Sara Hurley said: “We are inviting dentists across the country to give us their views as part of plans to improve clinical record keeping. This nationwide survey takes an innovative approach, where every view will help shape these future changes. “I’m urging everyone to take part so we can develop guidelines that are genuinely collaborative and reflect the consensus view of dentists.” The link to the survey will be sent directly to NHS dentists in primary care via the NHS Business Services Authority from

mid-September. Once evaluated the new record standards are expected to be introduced by April next year. The Delphi method addresses two thresholds: essential record keeping standards which can measure performance and aspirational standards to help clinicians with their personal quality development. Ian Brack, chief executive and registrar at the General Dental Council, added: “The GDC is committed to working with our partners to work to maintain patient safety and public confidence in dental service, which will improve dental regulation in the UK. This work is an important opportunity for the dental sector to develop a consistent set of record keeping standards for dentistry – providing clarity for professionals and improving patient protection. I would encourage dental professionals to take part, and I look forward the outcomes.” At the conference Sara Hurley also set out the ‘clear and compelling’ economic case for integrated oral health. Sessions led by the Chief Dental Officer included Dollars, Diabetes and Dental Disease, which demonstrated how patients can improve their glycaemic control and reduce their glycaemic index whilst reducing pharmaceutical bills, and Putting your money where your mouth is, which detailed the evidence from the introduction of the Mouth Care Matters initiative across 13 trusts, including healthcare system savings and social benefits. q

Boys at risk of oral cancer because of flawed research data, says BDA [

DENTIST LEADERS HAVE accused the Joint Committee on Vaccination and Immunisation (JCVI) of leaving 400,000 boys a year at risk of cancer, after using opaque and apparently flawed modelling as a basis to reject blanket vaccinations against the human papillomavirus (HPV). The JCVI made an interim decision on 19 July, launching a consultation on its ruling that closed on 31 August. The British Dental Association (BDA) understands the committee has withheld vital information from publicly-funded studies, because authors of the models wish to keep their work confidential until they can publish it in academic journals. Of the two models considered by the JCVI, one has not even been subjected to peer review, so its validity has not been established. Based on the limited information supplied by the JCVI, the BDA has said that the models are likely to give an over-conservative estimate of the benefit of vaccinating boys and have led the JCVI to a misguided conclusion on cost-effectiveness. HPV has emerged as the leading cause of oropharyngeal cancer – especially among young people – and rates are rising steeply overall. It is linked to 5% of all cancers worldwide, including some that affect only men. Dentists are often the first to spot the tell-tale signs of oral cancer.

Currently only school-age girls are covered by the vaccination programme. A recent survey conducted by the BDA showed 97% of dentists would back a gender-neutral approach. q

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Hammers, nails and the small matter of opinion By TOBY TALBOT BDS MSD (Washington) FDS RCS

TOBY TALBOT is a specialist in restorative dentistry, prosthodontics, endodontics and periodontics. He has over 20 years experience as an expert witness with a specific interest in dental negligence litigation claims. In this issue he considers why clinical opinions differ so widely when the diagnosis of a particular patient remains constant.

[

IT IS POORLY UNDERSTOOD by patients that visiting a surgeon or physician can result in so many different choices and widely different treatment strategies that complicate the decision-making process. Where a clinician has trained, and by whom, will invariably influence their strengths and weaknesses, their knowledge and their skill base. Particular personal interests will also contribute influence. The authority of teachers and mentors will leave a lasting impression strong enough to sway opinion – the robust and passionate authoritative presentation of a professor can easily leave an influential legacy in a clinician’s professional life. Of course, science should prevail and clinicians should constantly review the literature and temper their opinions accordingly. But let’s consider an example. A patient is seen by his dentist with a complex problem associated with the failure of a bridge. Is the tooth restorable or not? Uncertainty prevails as the x-ray only gives limited information. Referral to an endodontist who specialises in root canals is recommended. The appointment is made, but then subsequently cancelled, and the patient is then seen by an oral surgeon. Extraction of the tooth is recommended and an implant supported crown is prescribed. The patient is finally seen by an endodontist. Following removal of the bridge and investigation of the tooth it is proposed to save the tooth and avoid the costly and unnecessary surgery of an implant. What on earth is happening here? The surgeon has a dental degree, with knowledge and skills honed to perfection for the removal of teeth atraumatically, and the deft placement of implants. It’s what he does best. It’s what he likes doing. It reflects his skill set. No surprise then that it’s what he recommends. The endodontist has a dental degree and an armamentarium of tiny Swiss-made drills and files with which to burrow into canals so small she works with a microscope on the end of her nose. Of course, the tooth can be saved. It’s what she knows. It’s what she does best. It’s what she recommends. So, who’s right? Well, both potentially. Or they’re both wrong because another dentist, a specialist in restorative dentistry perhaps, may consider the third option of root amputation. What are the drivers for the patient? How important is this tooth to them? Is it a purely functional issue? Is it a cosmetic issue? Or is it a wholly emotional issue whereby (don’t scoff) the loss of the tooth is seen as loss of self – perhaps one more nail in the coffin? Or is it a combination of all these things? In other words, which of these treatment plans fits the patient’s expectations and preferences or resolves their specific concerns?

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This clutter of possibilities becomes a problem, and a source of litigation, if the patient is informed that a tooth cannot be saved and an implant is the only treatment open to them. The oral surgeon will believe that. Note that few general dentists will contradict the authority of the oral surgeon. If, at a later date, the patient has the implant treatment and this fails, or there are any number of subsequent unforeseen consequences, then it’s not surprising, if the patient later discovers that the tooth could have been retained, that it leads to a civil action for compensation. In this case, the failure in duty of care is a failure to obtain clear consent. The Montgomery case moved the goal posts from an emphasis on informed consent following advice from one of any number of competent professionals, to that of informed choice – all treatment options must be given with all the attendant benefits and risks outlined. However small a risk might be, if its consequences are potentially significant, the patient must be informed. Of course, this relies on all clinicians being aware of all the options available – and all the risks. But is this really possible? Just how much time does any clinician have to read up on every research publication and to keep abreast of all subjects. I may find myself totally knackered at the end of a busy day in surgery. Will I go home and read an article on the latest method of restoring a tooth? Or will I prepare myself a G & T before dinner and fall asleep in front of the television? The public may like to think that all general dental practitioners will read their British Dental Journal cover to cover each month. As a specialist in my own field I read several publications every month and constantly review other specific publications of personal interest. But I’m single – and an OCD nerd. I have no kids and I’m totally immersed in my work. It’s my vocation. If this is the standard the general public expects of all clinicians, then I’m afraid they must dream on. Some years ago, a simple research project was carried out in a postgraduate dental hospital. A dental patient with quite complex problems was presented to 10 dentists with a variety of training and experience. Each was invited to conduct a consultation and examination of the patient and devise a treatment strategy. The outcome was interesting. Only seven practitioners even agreed on the diagnosis, and every one of the treatment plans differed. It was concluded that this was due to the individual training and experience of each individual clinician. Every one of the clinicians defended their individual treatment strategies as being the best for that particular patient. Were they all right? Or would the researcher supervising the exercise actually contradict every one of them? Probably the latter.

A patient travelled hundreds of miles to ask me for a third opinion after two treatment proposals were provided by her general dentist and an oral surgeon. My treatment option differed widely from both the others. She was disappointed because she was hoping I was going to endorse at least one of them. Now she’s even more confused about which direction to take All the clinicians have dental degrees. The patient remains constant. None of the treatment plans bore any resemblance to each other. Should she now seek a fourth opinion? Or should she attend the most enthusiastic – or the most convincing? Actually, she chose the treatment strategy from the clinician she ‘liked most’. I see a parallel in politics during elections – never mind the content of their wellprepared manifestos, crosses in boxes are often earned because ‘he seemed like a nice man.’ Let’s look at another example. That of patients who asymptomatically find themselves with an elevated PSA level. Is it prostate cancer or just innocent benign hypertrophy? Off they trot for an MRI. A discrete lesion within the gland is recorded. No lymph node involvement. Then they trot once more for a general anaesthetic for multiple template biopsies. Gleason score 3+4=7 indicates a moderately staged cancer that appears contained macroscopically within the capsule of the gland. Now what? Three consultations follow because the patient has the intellectual capacity and time to review the scientific literature and explore his options. Consultant #1, based in a provincial city, wants to carry out curative ablation surgery. In other words, chop it all out. Job done. Cured, but guaranteed impotence and bladder incontinence for life. Consultant #2, based in a dedicated, private prostate cancer unit in the US, wants to carry out brachytherapy and external beam radiotherapy with concomitant female hormone or testosterone blocking medication that gives a 40% chance of impotence and three months of needing ‘diapers’. Lovely. Consultant #3, based in a European centre of excellence run by an internationally established professorial unit dedicated to prostate cancer treatments, wants to carry out just brachytherapy. No external beam radiotherapy, no hormones, no surgery. No impotence or bladder dribbling anticipated. Seems a no-brainer, but what about the ‘fit’? The male, living alone, aged 80 years, who is already impotent and has been getting out of bed throughout the night for years for a pee, doesn’t view the morbidities as an issue. The sexually active, vigorous 65-year-old with a young partner most certainly does. So, what’s the problem? The first patient elects option 1 or 2, the second patient elects option 3. Simple, surely? Consultant #1 is a brilliant technical surgeon. He’s been playing with his robotic Da Vinci kit for years and he’s honed it to perfection because that is what he loves doing. He is the consummate technician. But he

hasn’t got any radiotherapy kit because it costs £50 million to set up. He also doesn’t have the oncologist and physicist support and radio-nuclear knowhow. But where he may fail in his duty of care is by not telling the patient about the other philosophies and alternative options, even if he hasn’t the knowledge or kit. Interestingly every one of the above clinicians is convinced they are offering the best cure rate or ‘survivability’. But, at what cost to the patient? Have they spent enough time with the patient to ensure their particularly treatment plan is the right fit for the patient? So, where do you go to get a consensus of opinions that do not contradict each other? That’s easy. But unfeasible. Go to any dental or medical school and consult with any one of the recently qualified clinicians. They will all have been indoctrinated by their teachers and, at that point in their careers, few of them actually have opinions that they can call their own. The vast majority will mostly agree, most of the time. If, at that time they start to contradict their ‘masters’, they will be regarded as either dangerous mavericks or geniuses – or both. One month out of their schools, their opinions will begin to diverge. So, aside from the risky use of inexperienced but helpfully unopinionated youngbloods, what to do? Patients, and their counsel should it come to it, need to accept the ‘art’ of healthcare provision. Medicine and surgery are not just sciences. Irrespective of choices and outcomes, if the clinician is a good listener and establishes a good relationship with the patient, then the patient will be convinced that they have been looked after – even if the results are less than hoped for. No patient, in my 20 plus years of experience of medico-legal work, has ever sued a clinician for being too nice. The nature of the consultation will invariably influence the final treatment strategy proposed. This is the art of medicine. The brilliant consultant who is also good communicator is much more likely to get it right. A consultant with communication skills on the autistic spectrum, might be the more brilliant technician, but is more likely to get it wrong. In the case of the prostate patient mentioned earlier, the first consultant, a brilliant surgeon with the technical abilities of a Swiss watchmaker, failed to listen to his younger patient and proposed radical surgery despite the patient emphasising that functionality was more important than the cure. If all you have is a hammer, everything is a nail. And every nail is potentially a staple in the corner of a law suit. q • All the views and opinions expressed by the author are personal but I would welcome public debate on all the issues included. For further information visit www.tobytalbot.co.uk.

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New guidance aims to limit harm caused by acid attacks (BAPRAS) [THE British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)

has joined with the British Burn Association, the NHS and leading burns surgeons in issuing first aid guidance to help ensure victims of acid attacks get the right help fast. fast. The assistance for victims comes as new data from NHS England show the number of people requiring specialist medical help for this type of assault is on the rise. In 2014, 16 people required specialist medical advice, rising to 25 in 2015 and increasing further to 32 last year. The level of demand for specialist burns help so far in 2017 suggests there will be another rise in patient numbers this year. So-called ‘acid attacks’ – where corrosive substances are used as part of a violent assault or robbery – have become increasingly prominent, with a series of highprofile incidents this year. As well as significant harm caused to individuals, the NHS estimates that the average cost of care for a victim requiring specialist burns treatment, eye care, rehabilitation and mental health treatment is £34,500. The new guidance – under the slogan Report, Remove, Rinse – has been developed with specialist BAPRAS burns and trauma surgeons, who have treated victims of these attacks. People are advised to take three simple steps in the event that they witness or are the victim of an attack: • Report the attack – dial 999 • Remove contaminated clothing carefully • Rinse skin immediately in running water BAPRAS president, Mr David Ward, commented: “The minutes after an acid attack are critical for helping a victim. This guidance BAPRAS has published with NHS England gives the important, urgent steps a victim or witness can take to help reduce the immediate pain and damage, and long-term injuries.” q

Survey highlights need for lip filler regulation, says BAAPS [A POLL BY WhatClinic.com has shown that

42% of web traffic to lip augmentation pages were from visitors aged 18-24. The clinics surveyed stated unanimously that they would not provide lip filler to under-18s; however, most would provide fillers to under-21s. The survey credits the increase in demand to the impact of social media and reality television. That echoes the sentiments of the British Association of Aesthetic Plastic Surgeons (BAAPS), which has been urging the Government to put in place stronger regulation of dermal fillers and other nonsurgical treatments for the past 15 years. BAAPS cautions that the results of the poll do not adequately convey the unethical way aesthetic treatments are being marketed to millennials, nor the danger of the current situation with fillers – which the association has previously described as ‘the next PIP crisis waiting to happen’. In a statement, BAAPS said: “Dermal fillers remain unregulated in Britain – meaning anyone wielding a syringe can order them off the internet and have a stab at a 'lucrative

career' – despite two out of five surgeons seeing patients presenting with complications stemming from the treatments in 2016. “While the Advertising Standards Authority will not allow clinics to advertise cosmetic surgery as prizes or to make misleading claims in adverts, they admit that they do not have the resources to police social media: resulting in a murky grey area where lip fillers are frequently used by unscrupulous practitioners to encourage new clients for non-surgical treatments, which are often performed in unsterile, non-clinical environments, in people's homes or even the local pub.” Rajiv Grover, consultant plastic surgeon and former BAAPS president, said: “The findings from the WhatClinic poll are interesting, but do not accurately tell the whole story. One only has to look at the constant stream of cautionary tales of botched filler stories in the media to see that the current landscape of unregulated nonsurgical treatment is absolutely dire, with no regulation in sight.

“The complications arising from dermal fillers – which can include very serious infections, skin necrosis and blindness – can often not be recognised, much less be treated, by amateur injectors, leaving the problems on the doorstep of the overstretched NHS. “Furthermore, many prominent and established clinics continue to flout recommendations for best practice in ethical marketing – deliberately enticing young patients through offers on social media where they know they will not face consequences from the ASA. “If larger companies are putting profits before patients with impunity, and the Government has not intervened, what is to stop these cowboys and amateur injectors from lining their pockets by offering dermal fillers to anyone, irrespective of their ages? If these findings are indeed correct, we have a duty to protect young and vulnerable people from making potentially irreversible decisions that risk affecting their lives.” q www.yourexpertwitness.co.uk

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Scars fade faster Antidepressants: than their effects RCPsych responds [ONE PHYSICAL PHENOMENON that can result in long-term

psychological effects is scarring. According to NHS Choices: “Scarring is part of the body's natural healing process after tissue is damaged. Although scars are permanent, they can fade over a period of up to two years. It's unlikely they'll fade any more after this time.” The NHS recognises, however, that a scar is more than just the sum of its physical symptoms. A scar can have profound and debilitating consequences psychologically. NHS Choices continues: “A scar, particularly if it's on your face, can be very distressing. The situation can be made worse if you feel you're being stared at. If you avoid meeting people because of your appearance, it's easy to become socially isolated. This can lead to feelings of depression.” Dr Patricia Price is a psychologist based at the Wound Healing Research Unit at Cardiff University. Writing on the Scar Information Service website, she says: “One thing that has become very clear to me is that there are a wide range of things which influence how we feel about scars, including the location of the scar, our age and sex and how the scar occurred. Facial scars can be very distressing but other less visible scars can also be very upsetting. “If we feel that people are reacting differently to us because we have a scar, it can cause embarrassment and a lack of selfconfidence; some people eventually feel angry and isolated as a result of such experiences.” Where the scar has been caused by negligence or even criminality there may be a case for compensation. Stoke-on-Trent specialists Your Personal Injury Partner advise: “Some scarring can leave permanent distressing physical and psychological effects so the amount of scar compensation you could receive varies. Compensation is calculated following consultations with plastic surgeons and psychologists. “Consideration is given not only to the initial trauma and repair, including reconstruction, but also how much further surgery and after-care is needed.” q

[

THE ROYAL COLLEGE OF PSYCHIATRISTS has responded to reports in the press and television regarding severe side effects of antidepressant drugs. The college’s president, Professor Wendy Burn, said: “The reality is that antidepressants are taken by millions worldwide without any negative consequences, or with only mild side effects. “For many milder episodes of depression, talking therapies will be recommended as the first line of treatment. For moderate to severe depression, antidepressants are an evidence-based treatment. Their prescription should be reviewed regularly, in line with clear national guidance. We know that more of the people living with mental illness now seek medical advice and we believe this explains the increase in the number of people being prescribed antidepressants. For many, these drugs have had a beneficial effect on mood and have helped reduce suicidal thoughts or self-harm. “In all treatments – from cancer to heart disease – medicines which do good can also do harm. This applies in psychiatry. Current evidence from large-scale studies continues to show that for antidepressants the benefits outweigh the risks, which is why it is important to highlight that the experiences raised by case-studies in the recent media coverage is extremely rare. “Any patient who is unsettled by this media coverage, or feels pressurised to stop taking an antidepressant drug, should not abruptly discontinue their prescribed treatment. Instead, they should make an appointment with their family doctor or mental health professional to discuss any concerns they might have. They should together make a joint decision about whether to continue antidepressant treatment.” q

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BPS issues calls to action on suicide prevention [

THE British Psychological Society (BPS) has published a call to action on how best to identify and support those at risk of suicide. Suicide is preventable, says the BPS, and early identification and effective action are key to ensuring people get the care they need. This is one of the calls to action from the society as part of its new position statement: Understanding and preventing suicide: A psychological perspective. Professor Rory O’Connor of the University of Glasgow was chair of the working group which produced the position statement. He said: “No civilised and caring society should tolerate this level of despair, hopelessness and avoidable tragedy. The early identification of suicidal thoughts and behaviour and effective care for those of us at risk are crucial in ensuring people receive the care they need and deserve. Action at an early stage is core to any strategy for suicide prevention.” As well as calling for more government investment into public mental health interventions and research into psychosocial solutions, the BPS urges the governments across the UK to ensure that those

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discharged from hospital following self-harm or a suicide attempt receive a follow-up appointment within three days. Professor O’Connor added: “It’s unacceptable that over 5,688 people in the UK died by suicide in 2016. Despite that, suicide and suicide prevention research receive nowhere near the level of financial investment they need. Understanding the thoughts behind suicidal thinking and the factors that lead to people acting on their thoughts of suicide is vital to the development and implementation of effective prevention and intervention techniques.” The other calls to action include: • Individuals attending hospital following self-harm should be received by staff with compassion and understanding

• Improved training and education in health, social care and educational settings are needed to understand better the barriers to asking for help • The Royal College of General Practitioners should consider the development and introduction of mandatory GP training on identifying signs and symptoms of suicide ideation and behaviour, together with appropriate referrals and immediate support • Education departments across the UK should develop appropriate psychologically informed curriculum content for children and young people • UK Research and Innovation should establish increased funding for research into the causes of suicide and trials into suicide prevention, especially in vulnerable groups. q

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