Your Expert Witness No. 69

7 Opening Statement

8 Perfect storm brewing as rising numbers represent themselves, Law Society says 9 Conference comes to a fabulous conclusion

11 More inept expert witnesses (and solicitors)……and an annoyed judge

12 What happens at an arbitration tribunal? A guide for experts

13 Understanding valuation reports: what to look for

15 Accountants’ response to HMRC consultation emphasises public interest

15 Arrests made in care home investigation

17 Five jailed following ‘largest benefit fraud investigation’

19 Report reveals SMEs’ concerns about resisting corruption

19 Law Society’s Money Laundering Task Force gets name change

COMPUTER FORENSICS

21 Cyber security centre offers protection from attacks during the election run-up

CONSTRUCTION & ENGINEERING

23 Making time stand still: some top tips for standstill agreements

25 Second conference takes forward thinking on building safety

27 Civil engineers urged to confidentially report bridge problems

FIRE INVESTIGATION

28 Waste fires lead to prosecutions

29 Lithium battery causes truck fire at council waste depot

THE OIL & GAS INDUSTRY

31 Record fine issued for gas venting

31 New licences will help cut reliance on imported gas

TREE CARE

32 ‘Wash up’ hedgerow legislation welcomed

32 Councils must consult on street tree felling

33 The Duty of Care when managing trees: some key elements

34 Who pays when a tree falls and causes damage or injury?

JAPANESE KNOTWEED

35 Supreme Court puts six-year knotweed case to bed

ANIMAL WELFARE

36 Brexit enables passing of animal export law

36 XL bully neutering deadline approaches

ROAD TRAFFIC ACCIDENT INVESTIGATION

37 E-scooters: understanding the risks and the law

TRANSLATING & INTERPRETING

39 Humans vs neural machine translation: how close does AI come?

MARITIME DISPUTES

40 Do marine surveys tick all the right boxes?

40 Ripples from Suez blocking continue

MEDICAL ISSUES

45 Medical Notes

NEWS

46 Royal College’s concerns over surgical procedures by unqualified practitioner

49 Better teamwork can lead to better patient outcomes, research finds

51 Martha’s rule: roll-out begins with 143 hospitals

53 Never again! Health Secretary shocked by Langstaff Report

53 Palliative care charities set out their election demands

55 Unregistered doctor sentenced

55 Inquiry to be held into care home residents’ deaths

56 Changes to Welsh negligence scheme put access to justice at risk, lawyers claim

57 So you want to be an expert witness?

NEUROSURGERY

59 Epilepsy patients to benefit from ‘game-changing’ laser surgery

59 Closure of head injury clinic to be challenged

61 Brighton neurosurgery department under investigation

HEARING LOSS

62 Failures in primary care can lead to lifelong consequences

62 Scottish review prompts English follow-up

PSYCHIATRIC & PSYCHOLOGICAL ISSUES

63 Psychiatrists’ body calls on election parties to prioritise mental health

65 Drug and alcohol deaths on the rise in Scotland

65 New 10-year strategy welcomed by psychologists

67 How prevalent is complex PTSD in asylum seekers?

68 Regulatory bodies v professional bodies for experts: understanding the distinction

69 Discrimination against people with severe mental illness is cutting lives short

CARDIOLOGY

71 Cardio conference unveils latest research

72 GIRFT guidance for aortic stenosis introduced

OBSTETRICS & GYNAECOLOGY

73 Report on birth trauma welcomed across the board

MEDICAL DEVICES

74 How to navigate the complexities in medical and healthcare cases

OPHTHALMOLOGY & OPTOMETRY

75 How to lose your expert witness

77 Cataract surgery is getting safer, audit shows

79 Royal College sets out the way forward for AI in eye care

79 Optometrists welcome headlight glare research

PLASTIC, RECONSTRUCTIVE & HAND SURGERY

81 Nottingham centre brings together hand surgery expertise

81 Specialty group draws down funding for research

81 Bristol research paves the way to alleviate scarring

83 BAAPS audit shows decline in UK cosmetic procedures

83 A posh address is no guarantee of quality

DENTISTRY & MAXILLOFACIAL SURGERY

84 Oral cancer: the medicolegal implications of delayed diagnosis and treatment

89 GDC reviews implication of ‘top-up’ ruling

89 Best practice decontamination guidance for Scotland published

89 Sodium chloride solutions recalled

VASCULAR SURGERY

91 Deep vein thrombosis: the aftermath

ORTHOPAEDICS

93 Spinal cord injury is twice as prevalent as previously thought

93 NICE accredits new thumb arthritis guidelines

95 Major parties commit to improved osteoporosis support

95 Study compares shoulder replacement methods

97 Beyond ChatGPT: the power of MAI Motion in musculoskeletal motion analysis

99 Best practice pathway for non-ambulatory fragility fractures is now available

Opening Statement

[ IN CASE ANYBODY hasn’t noticed, we have a General Election coming up on 4 July. While the dissolution of Parliament has meant there are no longer any MPs, the job of running the country carries on and the people who aim to become the next Parliament are busy putting their views forward.

All of those people are if anything more at risk from cyber attacks than ever – particularly in view of the identification by the government of activity by actors from Russia and China – and in need of even more protection. For that reason the National Cyber Security Centre is offering a service to protect those groups from threats. The offer was unveiled at Birmingham’s CYBERUK conference.

• When we go to the polls our election system requires us to only tick one box on the ballot paper. It’s a simple system that has served this country’s democracy for centuries.

Simple systems such as a YES/NO box-ticking exercise don’t always serve their purpose, however. The surveying of maritime vessels is a case in point. Two experts from the International Institute of Marine Surveying give us the example of the information that a tick-box can and cannot give us.

The example of a bilge pump may seem a minor issue (I was reminded of a sloop I used to help sail in the 1980s – it had a bilge pump, but it didn’t work!) but more serious failing could result in a major accident. A surveyor who hadn’t gone beyond the tick-box could find themself in hot water.

• Having a comprehensive knowledge of your systems is paramount in many fields. A record fine has been levied on a gas producer in the North Sea for venting considerably more gas than it had permission for. The company concerned had systems in place to detect when it was venting more gas than it should – but no way of doing anything about it! You couldn’t write it.

• The need for vigilance when it comes to protecting us all from potential disasters cannot be understated. An obvious case is that of bridges. The news bulletins will jump on the visually notable scenes of spectacular bridge collapses; however, the events are more frequent than we may imagine – there have been 66 fatal collapses since 2000, claiming over 1,200 lives. Now, engineers have a way of reporting problems with bridges anonymously. The question springs to mind of why such essential information should need to be reported anonymously.

• On a more everyday level, the aftermath of Grenfell continues to be felt across the construction industry, with the Building Safety Regulator continuing to bring more and more high-rise buildings within its ambit. In May it held its second conference, reporting on progress made and explaining the role the regulator has, not only in ensuring compliance but promoting safety to everyone.

• On an even smaller scale – but nonetheless just as cogent for those affected – the law concerning responsibility for trees and what happens when they fail is a specialism in itself, as two of our contributors explain.

When councils decide to fell much-loved trees in the pursuit of some grand improvement scheme, the public backlash can become a national campaign. As a result, councils must now consult the people who voted for them before bringing in the tree fellers.

• Public opinion has been the driver of two new pieces of legislation, this time concerning animals. The law to ban the live export of animals for slaughter is now in effect, as is the requirement for XL bully dogs to be neutered. q

Ian Wild

Ian Wild, Director of Business Development Your Expert Witness

PERFECT STORM BREWING AS RISING NUMBERS

REPRESENT THEMSELVES, LAW SOCIETY SAYS

[ RISING NUMBERS of litigants in person (LiPs), combined with increasing backlogs, delays and chronic lack of investment, is creating a perfect storm in the family justice system. New figures analysed by the Law Society show that, in private family law cases, the areas worst hit are Central London, East London, Essex and Suffolk, and Manchester.

Law Society of England and Wales president Nick Emmerson said: “Private family law cases where both parties are unrepresented have almost trebled since the government brought in the Legal Aid, Sentencing and Punishment of Offenders Act 2012, which cut large areas from legal aid overnight. Removing legal advice led to many more people going straight to court instead of seeking to resolve their cases through mediation.

“As the figures show, thousands of people are being forced to take on their case on their own, as they have no access to free legal advice. Means test eligibility has not been uprated for years, meaning people on lower incomes – and sometimes those living in poverty – are unable to access justice. It is extremely concerning to see the rise in the number of people representing themselves in these kinds of cases.

“Family law cases are high stakes by their very nature. Cases deal with children being placed into care, domestic abuse victims or children finding out who they will live with as their parents divorce. Family solicitors are highly skilled and handle sensitive cases every day and can provide guidance and comfort to their clients.

“The rise in litigants in person is creating further pressure on a system already in crisis. Court desks – which are a key resource for face-to-face engagement, accessing information, engaging with

relevant court staff and general support – are closing, removing essential visible access points for court users.

“Meanwhile, the family court system is facing rising backlogs and delays. Data from the Ministry of Justice shows that more than 100,000 children were trapped in the backlogs in 2023, leaving children without the stability they need to thrive.

“Statistics also show that, for children involved in private law proceedings, rates of depression are 60% higher and rates of anxiety are 30% higher than their peers in comparison groups.

“The UK government has made some strides to improving the family justice system by choosing to invest in an early legal advice pilot and pledging to introduce a new online information and guidance tool to support earlier resolution of family disputes. However, further action is needed to make our family law justice system fit for purpose.”

The Law Society is calling on the government to increase civil legal aid fees so that legal aid providers remain viable and people can access their right to legal advice, as well as to uprate civil legal aid means test eligibility so more people on lower incomes can access justice. It is also urging an increase in fees for the Qualified Legal Representative scheme – which was brought in to safeguard victims from being cross-examined by their alleged perpetrator – so more solicitors can take part.

Nick Emmerson concluded: “We hope that these findings will encourage the government to ensure its Civil Legal Aid Review examines the effect decades of underinvestment is having on the family justice system and why so many people are representing themselves.” q

CONFERENCE COMES TO A FABULOUS CONCLUSION

The Annual Conference of the Expert Witness Institute took place online on 17 May. Two speeches marked the opening and closing of the event, with breakout sessions in between. In this abstract, the EWI’s Simon Berney-Edwards describes both addresses.

[THE KEYNOTE SPEECH was delivered by The Rt Hon Sir Keith John Lindblom (right). Focusing on the role of expert witnesses in a justice system that is embracing change and new technology, Sir Keith drew on his 30 years in practice at the Planning and Environmental Law Bar, his work as a judge in the King’s Bench Division and the Court of Appeal, and most recently his responsibilities as Senior President of Tribunals.

In his opening speech, Sir Keith delved into the concepts of honesty, impartiality and sticking to one’s own expertise, analysing how they all fit together in the context of being an expert witness. He went on to look at how these basic principles apply in the modern justice system, asking: “How is the role of the expert witness changing as the justice system transforms itself?”

Sir Keith tackled this question by giving particular consideration to two key elements in the modern justice system: ADR and the integration of technology, digital and the growth of AI into ways of working.

Expert witnesses have an important part to play in ADR, Sir Keith explained: “Despite the differences between parties’ engagement in ADR and in a formal conflict before a judge, the feature common to both is that experts perform an impartial function and their expertise facilitates a just resolution of the issues in dispute.”

He considered the impact of AI on the role of the expert witness, stating: “That the role of expert witnesses will be reduced to merely interpreting the findings of our AI overlords is not a prospect I would accept…but it would be wrong to think that AI will have only a marginal impact on the role of expert witnesses.”

The Hon Mrs Justice Bacon delivered her closing address on how the role of the expert witness has evolved in modern litigation and the challenges this presents for experts, those instructing them and judges alike.

In a fascinating address, Mrs Justice Bacon drew on the history of the expert witness – did you know the earliest recorded use of an expert was back in 1554? – to frame present-day challenges.

Drawing on her extensive experience as a barrister and judge, she identified four key areas that often present difficulties for experts and gave her recommendations on how to mitigate them.

“A real problem which faces many trial judges is the amount of material presented to the court,” she observed. “An important question for the courts when they are case managing trials with expert evidence is how to

ensure that the expert reports are produced in a proportionate and efficient way.”

Mrs Justice Bacon highlighted that expert witnesses come under a further type of pressure, known as allegiance bias, when they are instructed by one party in a case.

“How, then”, she asked, “to resolve the dilemma of the expert who is expected to be a paragon of objectivity but who is subject to unavoidable biases?”

In some fields, the production of the expert report requires a high level of involvement by the lawyers. But too much involvement from lawyers can present challenges of its own, including the risk of experts losing their objectivity. Mrs Justice Bacon suggested methods that experts can consider to clearly define where the lawyers’ roles begin and end.

Have you heard the analogy about the hedgehog and the fox?

“A hedgehog-like witness tends towards a single central thesis which is approached with unwavering commitment,” Mrs Justice Bacon explained. “A fox-like witness tends towards self-doubt, questions their own view and considers alternative explanations. Of course, the real world is not binary like this, but a continuum. And real-world experts will fall somewhere along that continuum.”

But when it comes to giving your expert evidence in court, should experts be striving towards hedgehog or fox? q

MORE INEPT EXPERT WITNESSES (AND SOLICITORS)

…...AND AN ANNOYED JUDGE

By CHRIS MAKIN, chartered accountant, accredited

mediator

and accredited expert determiner

[ THOSE WHO HAVE READ my articles and blogs in recent years will recognise that I have a ‘thing’ about inadequate or incompetent experts. This ‘thing’ developed over many years; as an expert chartered accountant I found it tiresome to have as the opposing expert a chartered accountant who may have been a good general practitioner, but who found it sexy to do a bit of court work between audits and didn’t have the first idea of how to perform.

I tried to solve the problem in two ways. First, I served for 14 years on the Forensic Committee at ICAEW where we devised a scheme of accreditation for forensic accountants and expert witnesses. Out of a total membership of over 155,000, only about 100 of us have reached the necessary standard.

Second, I have sat on the Investigation Committee at The Academy of Experts for many years, and one of our tasks is to assess the performance of Academy members who have been criticised by a judge. The Academy gives excellent training for experts of many professions and I am pleased to say that cases where our members have been criticised by a judge are vanishingly rare.

The lesson is obvious: if you wish to practise as an expert witness, you must be an outstanding member of your primary profession, but you must also have taken the trouble to train for your second profession, as an expert.

Moral for solicitors: when appointing experts, ask them what training and accreditation they have as experts. I am a fellow at The Academy, one of only about 60 worldwide. You can be confident my reports will comply fully with CPR or equivalent, that I will not crumble under cross-examination, and so on. These matter to the success of your cases.

Let’s turn to this recent case where things didn’t go smoothly. It is Scarcliffe v Brampton Valley Group Ltd [2023] EWHC 1565 (KB). The facts are simple: Scarcliffe was a tree surgeon who injured his lumbar spine in an accident, couldn’t work again and suffered from intense pain. There were arguments about pre-existing medical conditions and about whether his career would in any event have been shortened.

The claimant’s Schedule of Loss included claims for loss of earnings and for care, and the total claim was a staggering £6,189,507.

At least four things went wrong.

First, there was a complicated situation at home, with three children before the accident and a further two by the time of the trial, several of them with special needs. Did the need for childcare arise as a direct result of the accident?

Second, the judge found that the evidence of Mr Scarcliffe and of his wife was not credible about the home situation before and then after the accident so that the claims in the Schedule for loss of earnings and for care were ‘unsustainable’.

Third, the claimant’s orthopaedic expert had changed his opinion several times, so that his evidence was rejected.

Fourth – and this is where we see the main lesson to be learned by both experts and instructing solicitors – the pain experts had not been informed that the orthopaedic expert had changed his mind, so they attended trial and gave evidence without knowing that the report on which they had based their opinions was no longer in evidence. The two lessons to be learned were obvious: instructing solicitors must advise their experts if the evidence changes, and experts must constantly ensure that their opinions are still valid, and

civil

inform those instructing them if their opinions change.

Let me spell this out. A condensed wording is in CPR

Part 35, but the wording from the Ikarian Reefer is even clearer: “If, after exchange of report, an expert witness changes his view on a material matter having read the other side’s expert report or for any other reason, such change of view should be communicated (through legal representatives) to the other side without delay and when appropriate to the court.”

The trial judge Mr Justice Cotter, a judge very experienced in multi-million pound personal injury and clinical negligence cases, took the exceptional step of writing to the experts to ask them if their opinions were still valid. They went blindly into the witness box anyway.

There were other weaknesses in the claimant’s case which came out at trial. One was to ask whether all the aids and appliances were really necessary. Another was to ask if a claim was being made for care which would in any case have been given by the wife, or childcare by the grandparents. And – this a real bloomer – the claim for childcare had been quantified up to the claimant’s expected retirement date, when the children needing help with the school run would have been in their late twenties! Yet the care expert ran the cost of the school run up to retirement date, and the solicitors blindly copied that into the Schedule of Loss. Cotter J was not amused.

After all these unsafe elements of loss had been weeded out at trial, the final award of damages was £275,063, a mere 4.4% of the original claim. The judgment I have seen does not speak of the costs awarded, but I anticipate there would be little to fund the claimant’s loss of earnings and care costs.

Lots of lessons here, for experts and for solicitors. q

[CHRIS MAKIN was one of the first 30 or so chartered accountants to become an Accredited Forensic Accountant and Expert Witness –see www.icaew.com/about-icaew/find-a-chartered-accountant/find-anaccredited-forensic-expert

He is also an accredited civil and commercial mediator and an accredited expert determiner. Over the last 30 years he has given expert evidence at least 100 times and worked on a vast range of cases. For CV, war stories and much more go to the website at www.chrismakin.co.uk – now with videos! q

WHAT HAPPENS AT AN ARBITRATION TRIBUNAL? – A GUIDE FOR EXPERTS

By Roger Emmott, managing director of Roger Emmott Associates Ltd

[ IF DISPUTES cannot be resolved, they move to arbitration tribunals. These can be held in person, online or hybrid – a combination of both. I have experience of all of them as an expert in metals. The principles are generic.

Most tribunals take several days. Case management hearings may be held beforehand to determine and resolve issues relating to disclosure, evidence, procedure and key dates, and are worth attending to understand the wider context of the case.

Tribunals start with an introduction from the arbitrator – or chair/president, if there is more than one. Claimant’s counsel makes the opening address setting out the claimant’s case in detail, followed by the respondent’s counsel making theirs. Next, the fact

witnesses are cross-examined, usually claimant then respondent. Finally, the expert witnesses are cross-examined, in the same order. They are then followed by closing statements by each side. The exact format, and time allocations, are usually agreed by all parties prior to the start. The above sequence has always been adopted for tribunals I have attended.

It is helpful to attend the entire tribunal if that is possible. Once the tribunal is formally opened, everything is recorded and transcribed. The transcript is normally available live on screen, with just a few seconds delay, so that all parties have immediate access to the formal record. The transcript becomes an important piece of evidence and is used by both sides during the tribunal and in their legal closings.

When you are called to the witness stand, you will be asked to swear an affirmation that your evidence will be truthful. Your counsel will give ‘examination in chief’, usually very brief as you verify that your reports are your own work. Opposing counsel will then cross examine you. There is insufficient space here to provide a full guide, but I will make some key points.

You must be extremely well prepared. You are likely to be cross-examined on your personal background and experience. Inconsistencies in that will be probed thoroughly. It is likely that the opposing team will have gone through everything that you have in the public domain, including any websites, your LinkedIn profile and elsewhere. Any inconsistencies, contradictions or weaknesses are likely to be probed. Google yourself and check.

Your own experience and credentials as an expert will be tested. You may be asked about any possible conflicts of interest and it is much better to disclose those to your own legal team well in advance so there are no surprises later.

The cross-examination will then probably turn to your reports and to the opposing team’s reports – and to some of the many documents that have emerged from the disclosure process. You need to be as familiar as you can be with all of those and not be tripped up by unexpected material appearing. Ask for any complex questions to be broken down into shorter ones. Ask for the question to be repeated if necessary. The cross-examination will be mainly closed questions with yes/no answers. You can qualify answers with yes, and… or no, but… as required.

After the cross-examination, your counsel will be given the opportunity to ask re-direct questions. If those occur, they will likely be brief.

It is useful to practise, but your lawyers are not allowed to coach you. There are firms that do that, but they must not use live case data.

There is no doubt that giving evidence can be stressful and difficult. You must answer questions truthfully and accurately. Prepare well, don’t be intimidated; and don’t take anything personally. Ultimately, be yourself. q

UNDERSTANDING VALUATION REPORTS: WHAT TO LOOK FOR

By David Stears, director and head of valuations at Buzzacott LLP

[

VALUATIONS OF

BUSINESSES and shares can vary in complexity, meaning that some reports may be relatively easy to digest while others may appear bafflingly complex. Any valuation report will consider numerous matters but should, at the least, address the following key points.

Definition of value

There is usually no single unitary concept of an item’s value. Instead, value can be defined in numerous different ways which may depend upon the context. For example, should the valuation consider the specific circumstances of the transacting parties (equitable value) or ignore them altogether (market value)? A failure to consider this question adequately – including in instructions to the expert witness – may result in a materially inappropriate outcome.

Future performance

While a valuation may refer to historical performance, that will only be appropriate if actual results provide meaningful indications of future performance. Forecasts will often

be used, where available, and while that necessitates a degree of crystal-ball gazing, it aligns with the underlying principle that current value should reflect the risk-adjusted expectation of future returns.

Market evidence

Businesses do not exist in a vacuum, and so prevailing market forces should be appropriately reflected. Evidence may also exist from prior trades of the same assets: where it does, the valuer should be asking whether it is suitably current and reliable as the basis for value or, if not, whether some form of ‘calibration’ exercise might be informative instead.

Valuation approach(es)

There exists a broad suite of approaches which a valuation professional can draw on. That decision will be influenced by considerations as to the nature of the business and sector in which it operates, the availability of forecast data and the capital structure. Where feasible, the use of a secondary approach will enhance the conclusions.

Capital structure

When a company has more than one class of share – or a partnership has differing class rights within the partnership structure –that cannot be ignored. Options or warrants may also have a value impact on issued shares. Such scenarios will add complexity, potentially requiring specialist valuation approaches and expertise.

The nature of the interest

Whether the interest being valued is over a controlling or non-controlling stake, or whether it is less ‘liquid’ than any referenced benchmark data, should be reflected.

In conclusion

All this may seem to be common sense once written down, but it remains possible, for example, to see valuation experts relying upon past results with little or no regard to their relevance to future earnings potential. Clear consideration of the above points is a must, for both valuers and for users of their reports. q

ACCOUNTANTS’ RESPONSE TO HMRC CONSULTATION

EMPHASISES PUBLIC

INTEREST

[ANY CHANGE to the regulation of the provision of tax advice must be made in the public interest, the ICAEW insists.

Responding to the consultation on raising standards in the tax advice market, ICAEW said that the chosen approach must raise technical and ethical standards among tax practitioners and protect consumers from incompetent or unscrupulous practitioners, without increasing costs to the extent that taxpayers cannot afford professional advice.

In its response, the institute said that, while there are issues with all of the approaches suggested, its preference would be for mandatory membership of a professional body. However, ICAEW emphasised that its current entry requirements would not change, so in practice it would be unlikely that many of the current unaffiliated tax practitioners would seek to join it.

Alan Vallance, ICAEW’s chief executive, commented: “It is paramount that any change made to the regulation of people and firms in the tax advice market must be made in the public interest.

“While we think there are issues with all of the proposed options, if HMRC does decide to introduce tax regulation our preference is for mandatory membership of a professional body; but only if the model is appropriately designed and scoped.”

ICAEW said that, for a regulatory regime to be effective, there should be a level playing field for all people and firms providing tax advice and

services, which includes those already subject to statutory regulation, such as solicitors. Additionally, changes to the regulatory framework should extend to all tax practitioners and not just to agents who interact with HMRC systems.

An increase in monitoring requirements, or the creation of new oversight bodies, could risk significant costs being pushed down to taxpayers. Tax advice and services could then become unaffordable for the majority of taxpayers, therefore undermining the objective of regulation. q

ARRESTS MADE IN CARE HOME INVESTIGATION

[IN MARCH the Serious Fraud Office raided two sites and made three arrests across the South of England as part of a new investigation into an alleged £76m fraud involving luxury care homes.

The raids in St Leonard’s, Hampshire and Aylesbury, Buckinghamshire are part of an investigation into the UK-registered property developer the Carlauren Group, which collapsed into administration in November 2019, requiring some elderly residents to vacate their homes and leaving over 600 investors out of pocket.

Over four years, the Carlauren Group purchased 23 properties across the UK – mostly former hotels including the historic Windlestone Hall in Durham – offering an annual 10% return on investment in its renovation of the properties into high-end care homes. Only nine of the properties were ever operational and some continued to be run as hotels instead of homes.

Over 600 people and companies invested in the scheme via purchase of rooms that were to be rented out to elderly residents, in facilities that boasted of swimming pools, room service and other luxury amenities.

Nick Ephgrave QPM, director of the Serious Fraud Office, said: “Today’s arrests are a major development in our investigation and a step towards getting the answers so many people need.” q

FIVE JAILED FOLLOWING ‘LARGEST BENEFIT FRAUD INVESTIGATION‘

[ FIVE MEMBERS of an organised criminal gang which falsely claimed more than £53m in Universal Credit in the largest benefit fraud in England and Wales, have been jailed.

Bulgarian nationals Galina Nikolova, Gyunesh Ali, Patritsia Paneva, Stoyan Stoyanov and Tsvetka Todorova were all jailed on 30 May at Wood Green Crown Court after pleading guilty to fraud and money laundering-related offences for their involvement in a multimillion-pound scam on the benefit system.

Over a four-and-a-half-year period, between October 2016 and May 2021, the organised crime group made thousands of false claims for Universal Credit using either real people or false identities. The claims were supported by an array of forged documents, including fictitious tenancy agreements, counterfeit payslips and forged letters from landlords, employers, schools and GPs. If the claims were rejected, the fraudsters would try again and again until they were granted.

The investigation identified three ‘benefit factories’ in London, from where repeated false claims for benefits originated. The businesses claimed to assist people with obtaining a national insurance number and benefits to which they are entitled.

However, it was found that many of the applicants travelled to the UK for the purpose of making claims for benefits through those sources. After making their claims they returned to their country of origin, leaving their claim in the hands of the organised crime group. The money gained from these fraudulent claims was then laundered

as it was moved between a number of accounts through numerous transfers and withdrawn in cash.

Arrests of the five defendants were first made on 5 May 2021 and a number of properties were searched. During the searches hundreds of ‘claim packs’ containing forged and false documents were found and seized, as well as bundles of cash stuffed in shopping bags and suitcases, a luxury car and designer goods that included watches, jackets and jewellery.

Ben Reid, specialist prosecutor for the CPS, said: "This case is the largest benefit fraud prosecution ever brought to the courts in England and Wales. For a number of years these defendants conspired to commit industrial-scale fraud against the Universal Credit system, costing the taxpayer more than £53m. Submitting thousands of false claims, the organised criminals enriched themselves from government funds designed to protect and help the most vulnerable people in our society.

“This was a complex and challenging case which required close and effective working between CPS prosecutors, the Department for Work and Pensions and our international partners in both Bulgaria and through the UK desk at Eurojust, to dismantle and successfully prosecute the organised crime group. The guilty pleas entered by all five defendants reflected the strength of the evidence against them.

“The CPS Proceeds of Crime Division and DWP will now pursue confiscation proceedings against the defendants, to remove from them any available criminal benefit from this enterprise.” q

REPORT REVEALS SMEs’ CONCERNS ABOUT RESISTING CORRUPTION

[A NEW ACCA REPORT, Bribery and corruption: The hidden social evil on your doorstep, delves into the true extent of how bribery and corruption impacts SMEs across the world, highlighting the pressing need for enhanced transparency and robust regulatory frameworks.

The research shows a high prevalence and deep concerns about the damaging impact of bribery and corruption on SMEs, with 59% of SMEs and their advisers believing that standing up to bribery and corruption will cost them business trade or opportunities.

But the survey also reveals a strong understanding of the benefits of standing up to bribery and corruption, with 77% agreeing that having a strong anti-bribery policy boosts customer confidence in their business, and 68% saying it increases their chances of getting lucrative contracts with big businesses and public sector bodies.

Jason Piper, ACCA’s head of tax and business law, explained:

“Corruption is a poison; it distorts markets, stunts economic growth and deters investment. Many very small businesses don’t have the bargaining power to refuse when small bribes are demanded of them. Entrepreneurs

LAW SOCIETY’S MONEY LAUNDERING TASK FORCE GETS NAME CHANGE

[THE Law Society of England and Wales’s Money Laundering Task Force has taken on a new name as the Economic Crime Task Force, to reflect its current scope and role.

“Over the last few years, there has been a considerable expansion across the compliance landscape,” said Law Society president Nick Emmerson. “This includes not only anti-money laundering, but also sanctions, bribery and corruption and the Economic Crime and Corporate Transparency Act 2023, which has meant there is a wider focus that includes promoting the prevention and detection of economic crime.

“The name change will provide for an increased scope of membership expertise to be recruited directly to the Task Force and wider network, add clarity to internal and external stakeholders on its role and simplicity on the scope of support it can provide to members.

“Consistency in terminology will also be achieved, providing flexibility in providing material and content relevant to members.” q

have to choose between paying the bribe or losing the business – and often that is no choice at all for someone trying to support a family.

“Our report aims to arm businesses and regulators with the necessary insights and tools to root out corruption and foster an environment of transparency and trust. This could include the use of the latest digital tools. Just as technology is being used by criminals, so regulators and enforcement agencies should embrace it in the battle to detect, prevent and respond to them.”

Drawing from a broad spectrum of global data, expert opinions and real-world case studies, the report explores the multifaceted impacts of corrupt practices on SMEs and economic development. It highlights the severe consequences that businesses can face, including legal penalties and severe damage to their reputations.

The report also considers the effectiveness of current anti-corruption laws and policies across different countries, suggesting that while some progress has been made, much remains to be done to align international efforts.

Jason Piper added: “As global markets become increasingly interconnected, the imperative for accountability and ethical business practices becomes more pronounced.”

ACCA said it hopes the report will serve as a catalyst for change, encouraging entities across all sectors to evaluate their practices and align with the best standards of business conduct. It is recommended for business leaders, policymakers and regulatory bodies worldwide who are committed to uprooting corruption and fostering a fairer business environment. q

CYBER SECURITY CENTRE OFFERS

FROM ATTACKS DURING THE ELECTION RUN-UP

[POLITICAL CANDIDATES, election officials and others at high risk of being targeted online have been given access to unparalleled new support from the UK’s cyber experts to help boost their digital security.

The National Cyber Security Centre – part of GCHQ – has introduced a cyber defence service to help prevent those individuals from falling foul of spearphishing, malware attacks and other cyber threats.

The Personal Internet Protection service provides an extra layer of security on personal devices by warning users if they try to visit a domain which the NCSC knows to be malicious and by blocking outgoing traffic to those domains.

The opt-in service, launched at CYBERUK 2024 in Birmingham on 15 May, forms part of a wider package of cyber support on offer ahead of the next general election to individuals and organisations that play an important role in our democracy.

It follows the government’s announcements in recent months of attempts by the Russian Intelligence Services and China state-affiliated actors to carry out malicious activity targeting UK institutions and individuals, including Parliamentarians.

To coincide with CYBERUK, the NCSC and international partners from five other countries have also produced new advice for civil society groups, whose work advancing democratic values puts them under threat of transnational repression by state-sponsored actors.

Jonathon Ellison, NCSC Director for National Resilience and Future Technology, said: “Individuals who play important roles in our democracy are an attractive target for cyber actors seeking to disrupt or otherwise undermine our open and free society.

“That’s why the NCSC has ramped up our support for people at higher risk of being targeted online to ensure they can better protect their accounts and devices from attacks.

“In this significant year of elections around the world, I urge individuals eligible for our services to sign up and to follow our guidance now to bolster their defences.”

The NCSC assesses that the personal accounts of candidates and election officials, as well as their official work accounts, are almost certainly attractive targets for cyber actors looking to carry out espionage operations.

The Personal Internet Protection offer for high-risk individuals builds on the NCSC’s Protective DNS service which was developed principally for use by organisations. Since 2017, PDNS has provided protection at scale for millions of public sector users, handling more than 2.5 trillion site requests and preventing access to 1.5 million malicious domains. Individuals at higher risk are also encouraged to sign up for the Account Registration service – another opt-in service which allows the NCSC to alert individuals if malicious activity is detected on their personal accounts – and to follow NCSC advice for high-risk individuals.

In addition, the new guidance aimed at supporting civil society groups is designed for a community which faces a heightened threat of targeting by malicious cyber actors and are more likely to have limited resources to combat the threat. That includes elected officials, journalists, activists, academics, lawyers and dissidents.

Its publication follows a gathering of agencies from 10 countries at CYBERUK for the second Strategic Dialogue on the Cyber Security of Civil Society Under Threat from Transnational Repression.

The initiative is co-chaired by the NCSC and the United States' Cybersecurity and Infrastructure Security Agency (CISA), and there was agency representation at the session from Austria, Canada,

At the latest session participants provided updates on the progress being made in their countries to safeguard civil society groups from cyber attacks, and agreed to continue working together to raise collective resilience of global democracy.

The new guide Mitigating Cyber Threats with Limited Resources: Guidance for Civil Society can be read on the CISA website. q

Denmark, Estonia, Japan, New Zealand, Norway and Romania.

MAKING TIME STAND STILL: SOME TOP TIPS FOR STANDSTILL AGREEMENTS

by Hannah Gardiner, managing associate in Womble Bond Dickinson’s Construction and Engineering team

[ THE POPULARITY of standstill agreements is showing no signs of abating: especially in the post-Grenfell, Building Safety Act 2022 era, after that Act implemented an unprecedented extension to limitation by extending the time for bringing claims under Section 1 of the Defective Premises Act 1972 from six to 30 years retrospectively.

Increasingly, design and build contractors are receiving preliminary notices of defects and claims from developers or building owners in relation to construction projects that had been on the cusp of the expiry of the limitation period, which is commonly 12 to 15 years but could be significantly shorter.

That requires the design and build contractor to urgently review the contracts and appointments of its design team, who are further down the contractual chain, and potentially request a standstill agreement in order to preserve its rights to pursue those parties later. And those parties often agree to the request, as the alternative would be for the contractor to issue proceedings against them to stop the time to bring a claim from running out.

What is a standstill agreement and what does it say?

In a nutshell, a standstill agreement is a written contract in which the parties agree that the claimant can have additional time in which to issue proceedings – either in court or by way of arbitration, for example – if the claimant ultimately decides to do so.

The standstill agreement usually operates to either extend the amount of time a claimant has or, more commonly, suspend time running (ie stops the clock) for an agreed period defined within the agreement, with periods of six to 12 months commonly agreed.

The terms of the standstill agreement should define the issue or dispute in relation to which time is to stop running for limitation purposes, the period for which time is suspended – or, less commonly, the date to which time is extended – and the mechanism by which the standstill will be brought to an end. Failure to do so could result in a ‘self-inflicted complication’ – using the words of Mr Justice Coulson, as he then was, in Russell v Stone and others – resulting in unhelpful satellite litigation about the terms of the standstill agreement.

Points

to bear in mind for your standstill agreement

While standstill agreements generally follow a standard format, they do still require bespoke drafting, and there are different considerations depending on whether you are the claimant or defendant.

Some common but essential points to remember when drafting and negotiating are:

The parties – make sure the right organisations are party to the agreement. It sounds like a simple one, but bear in mind that the parties to the agreement are not necessarily the same as the parties under, or involved with, the original contract: for example, a company may have changed name or been taken over.

If a parent company of a defendant gave a parent company guarantee, consider whether they should also be a party to the standstill agreement, in order that any potential claim under the guarantee is also preserved.

The dispute and what is being preserved – explain the precise scope of the standstill agreement, either by reference to a class of defects, for example all fire safety defects at a site or in a building, or, if you are the claimant, it may be possible to obtain a standstill in relation to any and all issues and defects arising out of a defendant’s

works or contract.

Generally, though, you will find that the party bringing the potential claim will want a wide catchall definition, as it preserves limitation across the project –including other potential latent defects – whereas the party defending the claim will want a narrow definition of the dispute in order to provide additional time only in relation to a limited issue or defect.

The additional time granted – set out the precise period of time for which the parties agree that time stands still by being suspended or is extended. The parties usually agree that they will not raise any limitation defence which relies on time running or limitation expiring during that defined period. The period usually starts on the date of the agreement until a long stop date or until one party takes a step, such as giving 30 days notice to the other party that the running of time is to recommence or by issuing proceedings.

Termination of the agreement – the agreement usually continues until either the long stop date is reached (although the parties may negotiate a further extension), a party issues court or arbitral proceedings (which itself stops time and negates the need for a standstill agreement) or a party issues a notice which states that time will restart running within, say 30 days. Those provisions require negotiation.

A claimant will usually seek to avoid giving the defendant the ability to restart time running by the issue of the notice, as otherwise the claimant may be caught on the backfoot and find it has to promptly issue proceedings to preserve its claim. Clearly such a provision is advantageous to the defendant and can be used tactically if the defendant considers the claimant is simply seeking to preserve its claim indeterminately without justification.

Above all, it is important to be commercial. It is usually of benefit to both parties to avoid the issue of proceedings, which can bring with them a swift and sharp rise in legal costs, and agree a standstill agreement to allow the issue or dispute to be resolved economically and efficiently.

Be careful and plan ahead

While standstill agreements are a relatively standard form of agreement, they can nonetheless prove contentious and it can therefore take time to get them agreed with the other side. Don’t leave it to the last minute if at all possible – although it is sometimes unavoidable – and be realistic about the terms of the agreement.

While it may be desirable for a claimant, a defendant will often reject a draft standstill agreement which seeks to define the dispute too widely in relation to which time is being preserved. Likewise, a claimant may simply elect to issue proceedings if a defendant will not agree to a sensible standstill period. Negotiating a multitude of short extensions is rarely helpful and only serves to increase the parties’ costs and frustration with the situation.

As with almost all agreements, the devil is often in the detail: so speak to your lawyer if you think a standstill agreement is required or if you have received a request to enter into that type of agreement. q

SECOND CONFERENCE TAKES

THINKING ON BUILDING SAFETY

[ THE BUILDING SAFETY REGULATOR (BSR) held its second industry conference in Birmingham in May. The conference marked a major milestone for BSR as the new building safety regime was fully established in law in April.

With over 1,300 delegates in attendance, the conference provided a platform for industry leaders, regulators and resident representatives to discuss the on-going transformation of the building safety landscape. The event showcased BSR’s resident-centric approach, with several sessions dedicated to industry accountability and empowering residents to ensure their voices are heard in building safety decisions which affect their homes.

Sarah Newton, chair of HSE, and Philip White, HSE’s chief inspector of buildings and director of building safety division, opened the conference, highlighting BSR’s achievements and outlining its future priorities.

Sarah Newton said: “We are committed to putting residents at the heart of everything we do. At HSE, we understand that building safety is not just about regulation and compliance; it is about people – their lives, their homes and their communities.

“The new building safety regime is designed to give residents a stronger voice and for industry to ensure that their homes are safe. Today gave those on the building safety frontlines the chance to share our knowledge and collaborate on solutions to translate the new regulatory framework into actionable steps, ensuring the safety of both existing and future buildings.”

Philip White said: “So much has happened in the last year, and at such pace: showing how much we can achieve together when we have a common goal.

“More than 12,000 buildings have been registered with the regulator and many of our conference delegates, along with others across the UK, have already registered as building inspectors and demonstrated their competence.

“Building control professionals play a critical role in ensuring the safety and quality of our built environment – and above all, being regulated will raise industry standards and increase public trust.”

The conference was also addressed by Minister for Housing Lee Rowley, who acknowledged the significant progress made during a time of great change for the industry.

Other key topics discussed at the event included:

• Industry accountability and ownership in delivering safe buildings

• BSR’s firm but fair approach to enforcement

• The critical role of building control professionals in raising standards

• A need for continued collaboration between industry, regulators and

• residents.

Panel discussions were hosted with the Construction Leadership Council, emphasising the importance of building safety as a strategic priority for the entire industry.

The conference also extended beyond the UK with Dan O’Brien, CEO of Cladding Safety Victoria in Australia, attending as part of an information-gathering visit. His attendance highlighted the vital international collaboration and knowledge-sharing currently taking place in the field of building safety.

The conference sessions and materials will be available online in the coming weeks. q

CIVIL ENGINEERS URGED TO CONFIDENTIALLY REPORT BRIDGE PROBLEMS

[ BRIDGE DESIGNERS, constructors and maintainers are urged to support a new partnership aimed at preventing future bridge collapses around the world. The Institution of Civil Engineers (ICE) has joined forces with the UK Bridges Board (UKBB), the Bridge Owners’ Forum (BOF) and the Infrastructure Client Group to highlight the importance of reporting near misses and close calls to CROSS-UK.

CROSS-UK – which stands for Collaborative Reporting for Safer Structures UK – is a voluntary occurrence safety reporting scheme jointly run by the ICE and the Institution of Structural Engineers.

Preventing future collapses

Bridge collapses around the world happen with alarming regularity. Indeed, in the last month the collapse of the Francis Scott Key Bridge in Baltimore, USA hit the news worldwide. It was far from an isolated incident. Since 2000 there have been 66 reported fatal collapses, claiming over 1,200 lives.

Preventing such collapses is crucial for the civil engineering profession. A key way in which that can be achieved is through sharing lessons from near misses and close calls – more formally known as precursor events.

If those precursors can be recognised they are vitally important to forecasting and preventing more serious incidents in the future.

Reporting near misses

The new partnership aims to encourage engineers and other professionals from across the world to confidentially report precursors that they have observed through CROSS.

Making a report to CROSS is simple. More about the short process of submitting a report online is available on the CROSS website.

For bridges, examples of precursors could include:

• The unexpected failure of a bridge element, including structural

• support to bearings, joints and parapets

• Structural cracking which appears or reopens after repair

• Other symptoms of distress which cannot be explained

Reporting those precursors will help ensure the safety of structures.

“Bridges and other highway structures are crucial parts of our transport networks,” said ICE director of engineering knowledge, Mark Hansford. “The ICE has been a joint owner of CROSS since its inception, and we welcome this endorsement from BOF and UKBB.

“The information shared as a result of this partnership will be an important element in helping create safer infrastructure.”

Importance of maintenance

The initiative comes at a crucial time, said ICE. Last autumn’s second National Infrastructure Assessment from the UK’s National Infrastructure Commission (NIC) highlighted that good road and rail transport links between cities are essential to economic growth, yet have been underinvested in.

The NIC’s report added that road and rail infrastructure is likely to cost more in the future due to increased demand, ageing assets and climate change.

The NIC argued that maintenance must therefore be a top priority. But with budgets constrained, concerns are growing that the investment will not be made and that asset condition cannot be maintained. It’s hoped that with strong engagement in the bridge reporting initiative, an evidence base can be built that makes the case for sustained investment in asset maintenance.

“By establishing this partnership, the UK Bridges Board are facilitating the sharing of best practice in the design and management of bridges,” said Hazel McDonald, chair of the UKBB. “We strongly encourage bridge owners, managers and all those working in the sector to confidentially submit reports to CROSS.” q

WASTE FIRES LEAD TO PROSECUTIONS

[

SEVERAL WASTE SITE OPERATORS have been successfully prosecuted over a number of environmental offences, persistent fire risks and repeatedly ignoring advice from the Environment Agency (EA). The defendants were sentenced at Teesside Crown Court on 20 May following an EA investigation across three separate waste sites in Liverton, Teesside and County Durham. Jonathan Waldron, Laura Hepburn and Jonathan Guy Brudenell each had varying roles in the running of the sites, where issues around the storage and management of waste were identified, posing significant fire risks and leading to two fires in April and August 2020.

In January 2019, Selective Environmental Solutions Ltd, which first operated the Liverton site with Waldron as the director, was found to be in breach of its waste exemption storage limit of 500 tonnes. It is understood that a fallout led to Hepburn taking over the site in February 2019 as the director of Greenology (Liverton) Ltd.

A fire broke out on 5 April 2020, lasting nine days, which spread through the baled plastic waste and the building and destroyed the site.

Hepburn was also the director of another Greenology site in Teesside, which stored waste tyres. In June 2021, EA investigators discovered that the number of tyres at the site exceeded the limit of the site’s waste exemption, thus posing a significant fire risk. The EA stated that Hepburn had repeatedly claimed that a pyrolysis plant would be built to recycle the tyres that had reached their end of life; however, no plant was ever built.

The second fire occurred at the County Durham site, which was found to not comply with its environmental permit and was continually storing excessive volumes of waste. EA investigators ordered remedial action to be taken and issued an enforcement notice, requiring the site to remove waste and create fire breaks.

The notice was breached prior to a fire starting in August 2020 that continued burning for many days.

As reported by the Yorkshire Post , during the sentencing at Teesside Crown Court the defendants were fined more than £103,000 in total. Additionally, collective custodial terms of over six years were handed out.

Area environment manager for the EA in the North East, Gary Wallace, said: “All of those sentenced have shown a complete disregard for environmental laws, which are there to protect people and the environment.

“They could have been in no doubt that the sites were operating illegally and posed a significant fire risk, but repeatedly ignored our officers’ warnings about bringing the sites back into compliance and making them safe.

“The walls of waste resulted in two major fires, impacting on the environment and causing misery for local residents.

“Waste criminals cause distress to our communities and can destroy the environment, and this case demonstrates that we’ll do everything in our power to ensure they are brought to justice for their crimes.” q

LITHIUM BATTERY CAUSES TRUCK FIRE AT COUNCIL WASTE DEPOT

[ RESIDENTS ARE BEING REMINDED to dispose of their batteries in the correct manner after a fire broke out in a recycling vehicle due to a suspected ruptured lithium battery.

Just before noon on 21 May, emergency services were called to a fire in a HGV vehicle just outside of the waste transfer station in Haslingden, Lancashire.

The HGV driver spotted smoke rising from the truck early and safely manoeuvred the HGV away from nearby buildings, before uncoupling the trailer from the vehicle and calling emergency services. The recyclables were safely tipped onto the yard floor at the waste depot. Emergency services managed to swiftly extinguish the fire.

The cause of the fire was thought to be a ruptured lithium battery, which caused the ignition of paper and card that had been collected for recycling, while being loaded into the vehicle prior to dispatch.

According to the Fire Protection Association: “Lithium-ion battery cells combine a flammable electrolyte with significant stored energy, and if a lithium-ion

battery cell creates more heat than it can effectively disperse, it can lead to a rapid uncontrolled release of heat energy, known as ‘thermal runaway’, that can result in a fire or explosion.

“Thermal runaway can result in the ejection of a range of flammable and toxic gases from battery casings. The flammable gases generated often ignite immediately, but may also spread out unignited until an external ignition source is encountered, resulting in an explosion.”

Cllr Shaun Turner, cabinet member

for environment and climate change at Lancashire County Council, said: “This incident highlights how just one small battery which has not been recycled properly can cause such a big impact.

“Had the HGV driver not noticed the fire very early, the whole HGV could have gone up in flames, putting the driver, local infrastructure and others’ lives at risk.

“Any battery, no matter how big or small, can cause fires at our depots and in our vehicles, which is why it is so important to dispose of them correctly.” q

RECORD FINE ISSUED FOR GAS VENTING

[

ON 30 APRIL the North Sea Transition Authority (NSTA) announced that Perenco UK Ltd had been fined £225,000 – the highest-ever financial penalty handed out by the NSTA – for venting 59 tonnes of gas for over a month from its Dimlington onshore gas processing plant without consent.

The company had permission to vent 235 tonnes from 1 January - 31 December 2022, but exceeded that limit on 6 November and vented the extra gas until a new consent was issued on 14 December 2022.

Perenco stated that it had systems to track the daily volumes of gas it emitted; however, there was an absence of internal mechanisms to ensure that any risks identified through that system were appropriately actioned.

The central objective of the financial penalty in that case was deterrence, with the penalty being set at a sufficient level to reflect that and the seriousness of the breach, as well as Perenco’s delayed engagement with the NSTA in the lead-up to identifying that a breach had occurred.

In a statement the NSTA said: “The NSTA aims to eliminate unnecessary or wasteful flaring and venting of gas. The Oil and Gas Authority Strategy includes a requirement for industry to reduce greenhouse gas emissions from sources such as flaring

NEW LICENCES WILL HELP CUT RELIANCE ON IMPORTED GAS

[

OFFSHORE ENERGIES UK, the offshore industry trade body, says the offer of 31 new oil and gas licences to operators by the North Sea Transition Authority strengthens energy security and business confidence across all sectors as the expansion into wind, hydrogen and carbon capture and storage accelerates.

The licences are chiefly for gas extraction from the Southern North Sea, with the potential to come on stream to power and heat the UK’s businesses and homes within the next five years. They will make the UK less reliant on imported gas.

The third tranche of the 33rd licensing round has seen 31 licences offered after rigorous environmental checks. A total of 82 offers to 50 companies have now been made in the round, which attracted 115 bids from 76 companies across 257 blocks and part-blocks. The licences offered in the round have the potential to add an estimated 600 million barrels of oil equivalent (mmboe) up to 2060, or 545 mmboe by 2050.

Offshore Energies UK’s CEO David Whitehouse commented: “New oil and gas licences benefit every sector in the UK. They will help to bring secure supplies of homegrown gas into our grid, reducing our reliance on more carbon intensive imports from overseas. These licences will help to protect jobs and power and heat the nation’s firms and homes as we build the next generation of low carbon infrastructure here in the UK.

“We all recognise that our energy mix must change, and our sector is ramping up renewables and accelerating the drive to net zero. But this journey will take time. Meanwhile, our North Sea basin is naturally declining. We have over 280 oil and gas fields, but by the end of the decade 180 of them will have stopped producing. We need the churn of licences for an orderly transition that supports jobs and communities across the country and meets our energy needs.” q

and venting to assist the drive to net zero.

“To support that, the NSTA monitors performance and works with industry to reduce emissions. In September 2023 we reported that North Sea emissions had been cut for three years in a row, and there had been a 23% drop in total emissions since 2018.”

Jane de Lozey, NSTA director of regulation, said: “Reducing greenhouse gas emissions, while maintaining UK energy supply, is essential and we acknowledge industry’s response to both of those challenges.

“Operating within consent, and prompt engagement with the NSTA, helps maintain confidence in the sector. However, as today’s fine demonstrates, we will take firm action for any failures to meet regulatory obligations.”

Earlier in the month the NSTA reported that NEO Energy Production UK Ltd had been fined £100,000 for breaching its combined vent consent for the Donan, Lochranza and Balloch fields, around 200km northeast of Aberdeen.

The venting consent issued for 1 January - 31 December 2022 allowed for 1.035 tonnes of venting per day, equivalent to an annual limit of just under 378 tonnes. But on 1 November 2022 the company admitted that the venting consent had been exceeded on 21 March of that year, and that it had exceeded the maximum annual venting consent by approximately 1,200 tonnes.

The NSTA investigation carefully assessed the breach and the reasons for it. The NSTA found that, at the outset of 2022, NEO incorrectly allocated cold flare (venting) volumes to its flare consent. The issue remained undetected by NEO until October 2022. NEO engaged openly with the NSTA following its identification of the issue and applied promptly for a revised consent. NEO has co-operated with the investigation. q

‘WASH UP’ HEDGEROW LEGISLATION WELCOMED

[THE TREE COUNCIL has welcomed the passing of UK Government legislation to protect hedgerows in England, including a cutting ban between March and the end of August.

In April the government announced its intention to introduce hedgerow protections, which had lapsed as cross compliance with European rules ended at the beginning of the year. Now the Management of Hedgerows (England) Regulations 2024 has been made into law, effective from 23 May, providing a legal baseline for hedgerow management practices. The legislation passed into law as part of the ‘wash up’ process prior to the dissolution of Parliament.

The new measures include:

• A two-metre buffer strip, measured from the centre of a hedgerow, where a green cover must be established and maintained. Also, no cultivation or the application of pesticides or fertilisers should take place within this buffer strip.

• A hedgerow cutting ban from 1 March to 31 August inclusive

Annie Heslop, hedgerow lead at The Tree Council, said: “The Tree Council welcomes the introduction of UK government legislation to protect hedgerows in England. These regulations put into law important hedgerow management practices to protect nesting birds and boost biodiversity and carbon storage in our hedge margins.”

The new legislation broadly mirrors the previous approach under cross compliance, which should make it straightforward for farmers and others who are familiar with the requirements.

The government says the regulations will be enforced by the Rural Payments Agency (RPA) in ‘a fair and proportionate way’ and the RPA has been talking to farmers and others about the best approaches. From day one, the RPA says it will take an ‘advice-led approach’, with stronger actions in only the worst cases.

The RPA will hold a public consultation on how to implement and

enforce the protections in due course.

Annie Heslop added: “The consultation on hedgerow protection, to which The Tree Council contributed, revealed very high levels of support across sectors for maintaining hedgerow protections, so we are optimistic they will be welcomed and followed.

“We look forward to working with the RPA on its consultation around the implementation and enforcement of the new regulations.” q

COUNCILS MUST CONSULT ON STREET TREE FELLING

[ON 30 NOVEMBER last year it became a statutory duty under the Environment Act 2021 for all local authorities in England to consult with local residents on the felling of street trees – except where certain exemptions apply.

According to Jim Smith, the national urban forestry adviser at the Forestry Commission: “This new duty is the government’s response to a number of high-profile street tree felling programmes by some local authorities – programmes that proved to be very unpopular with many residents. It seeks to address the public’s concern about these removals by ensuring local authorities base their decisions on arboricultural principles taken by the relevant professional experts who had access to all the information required to make an informed decision on whether or not a street tree should be removed.”

The issue came into public consciousness during a prolonged dispute between residents of a street in Sheffield and the city council over the felling of what residents described as viable trees, with arrests made and contractors resorting to felling trees in the middle of the night.

Jim Smith continued: “The duty balances the need to provide all residents with free and unhindered use of the highway while at the same time ensuring good-quality and healthy trees are retained for all the benefits they bring to the local area, even when they may be causing minor, but resolvable, issues with their surroundings.”

Among the exemptions are:

• Trees that are dead or subject to a Plant Health Act 1967 Notice

• Trees that require removing to implement a valid planning consent

• Trees that are dangerous or likely to become dangerous prior to

• the next scheduled inspection

• Trees needing to be removed so that a statutory undertaker may

• undertake emergency operational works

The guidance was developed in conjunction with local authority highway and tree officer associations. q

THE DUTY OF CARE WHEN MANAGING TREES: SOME KEY ELEMENTS

By Mark Chester of Cedarwood Tree Consultants

[MANAGING TREES in the context of the Duty of Care their owners owe to others is a high-profile function of the arborist. Local authorities employ teams of surveyors to ensure their trees are maintained in a safe condition, and other landowners commission surveys of their stock to demonstrate a compliance with legislation. However, there are notable variations in standards of surveying and approach. By using some key elements, it is possible to have a defendable tree management plan.

Over the past decade or so, I have surveyed tens of thousands of trees across a diverse range of situations, including both public and private sector land. That has included trees in parks, across housing associations, on golf courses, within schools, on business parks, on private estates and for homeowners. I have re-surveyed trees surveyed by others, and also reviewed my own work.

The right mindset

When surveying trees for safety, mind-set is important: the process can be complex. As I survey a tree for that purpose, I assess the structural condition of the tree, looking for evidence of decay, of cavities and of any potential failure points within the trunk and branches. Alongside that I assess whether there are any targets within falling distance of the tree, the nature of such targets and level of occupancy. Some targets, such as a bench, may be possible to move; others, such as a home or office, cannot. Can the tree be pruned to minimise the potential impact if it failed?

One of the key skills here is to appreciate risk on a species-specific basis. Trees with sound timber, such as oak, beech and London plane, are less likely to suffer trunk failure, and it may be possible to retain them in the earlier stages of decline. Others, such as willow, poplar and ash, can offer less reassurance.

The safety mind-set is different from that needed to manage trees for timber, or ecology. For one estate I reviewed the surveying of trees undertaken by specialists with expertise in forestry – albeit with some arboricultural guidance. An observation regarding a row of poplars by a busy road, with a ditch behind them, that the trees could be felled and the area re-stocked, was telling. When one of the trees was subsequently blown over in a storm the landowner employed the services of a specialist arborist experienced in tree risk management.

Ecology is important, and the retention of ecological habitats such as standing dead timber is a valuable management tool, providing it is used appropriately. When I re-surveyed trees on one site previously surveyed by an arborist specialising in ecology and without specific training in tree risk management, the recommendation to retain several trees with extensive dead wood was commendable in one way. However, the trees were near a busy part of the site, and the presence of fallen dead branches in the vicinity indicated that the balance between ecology and public safety was not correct.

Modern arboriculture is informed by science; however, we need to be careful to remember that the readers of survey reports are likely to be lay people. Complex text can be bewildering, even if it is accompanied by detailed explanatory notes. Reading through risk evaluations identifying risks of 1:100,000 or 1:1,000,000, and recommendations of work to reduce the risk for several sites, can be challenging for the arborist, let alone the tree owner.

If recommendations for works – or the absence of a need for work –are not easy to follow, there is a high chance that such work may not be implemented. In one template where I re-surveyed, the need for works was ticked in one box, with a description elsewhere on the same page, making it much harder to follow. In another situation, the list of works

was on a separate page. Those charged with undertaking works, or even re-surveying, may not be provided with the full report, making implementation much harder.

Is absence of evidence, evidence of no need for works?

When I did my training in tree risk surveying, my trainer, also the author of the course, emphasised that there should be an entry in the ‘recommendations’ section of the survey. That demonstrates that the surveyor has looked at the tree and consciously decided that no work was needed. In the landmark legal case of Cavanagh v Witney Parish Council, a central point was whether the surveyor had actually looked at the tree in question, the entry for it in the survey sheet being blank.

It is important that records are in a place and condition where they can easily be accessed. Computer databases are excellent at storing information, but if the tree data is on a database to which the landowner doesn’t readily have access, that can be a problem. It can be an issue, especially for organisations such as schools which were formerly managed by a local authority. For one school, no longer managed by their local authority and without access to the software licence, the details of previous surveys were unavailable and I needed to survey the trees without that benefit, and provide a new document for the management team.

In 2023, Newcastle City Council was fined by the HSE for breaching health and safety legislation following the death of a pupil in a school run by the local authority, when a tree fell. The tree had been surveyed and the need for works identified, but an update to the survey software deleted that instruction.

Keeping a list of works actioned is also important, as it indicates that the landowner has fulfilled their Duty of Care. For one site where the landowner had not done that, I found myself walking across fields in search of trees needing works, and on one occasion found the stump indicating that felling, as recommended, had been undertaken!

Sadly, some landowners conclude that commissioning the report is sufficient, without reading through and implementing at least the priority works. In fact, not doing so may be worse than not commissioning the report to start with.

How often is a survey needed?

The issue of the re-survey is regularly raised with me. Some landowners cite guidance from the Department of Transport in 1975, stipulating that highways inspectors should inspect trees on highways on a five-year cycle. More recent court cases indicate that annual to triennial inspections may be appropriate, depending on issues such as site usage and public access.

A safety survey is a snap-shot of the condition of a tree on a specific day, when the surveyor is looking for evidence that there may be a need for action. A range of factors, including unseen decay, strong winds and wet ground conditions affecting root anchorage, can lead to tree failure. The key element in dealing with any claims relating to damage caused by tree failure is whether the failure was foreseeable. That assessment requires a specialist eye.

Tree safety need not be overwhelming, provided it is done in an informed manner and on a sufficiently regular basis for the setting, with written records being kept in an accessible place and updates on works undertaken being made. Employing a surveyor skilled at the task is highly beneficial, as well as identifying any more urgent work which needs to be implemented. Evidence of process is key for the courts. q

WHO PAYS WHEN A TREE FALLS AND CAUSES DAMAGE OR INJURY?

By Dr D P O’Callaghan and Giles Mercer

[

TREES PROVIDE many benefits to people, communities and society. However, trees can cause harm: injury, death, property damage or disruption of activities. But in fact the risk of harm from trees in quite low. Each year in the UK falling trees kill about five to six people, which makes the risk of a fatality per person about one in 150 million for all trees in the UK – and about one in 10 million for trees close to or in areas of high public use. The risks also vary locally from the national average.

The risks from trees are tolerated because the benefits of trees outweigh those risks. When trees fail and cause injury, death or property damage, or when trees are implicated in subsidence damage, lawsuits inevitably follow. So, when a tree – or parts of a tree – fail there is usually a reason or cause of the failure. Often the initial cause of the failure is ascribed to wind and those affected will often state that there were high winds at the time of the failure; but it’s not as simple as that. Trees have what is termed a ‘normal wind environment’. That is the range of wind forces to which the tree has been exposed since it was planted or self-seeded; the winds to which the tree has become adapted over its lifetime. In Britain the ‘normal wind environment’ is wind forces of up to 47-54 mph: Force 9 on the Beaufort Scale or Strong Gale.

Sound, healthy trees are not expected to fail within the normal wind environment. If trees do fail within that environment, it is more than likely that there is another reason(s) for the failure, such as disease, wood decay, etc. In that scenario the wind is not the ‘cause’ of the failure but is a ‘trigger’ for it. When tree failure cases proceed to court, the first question that is common to all cases is: “What was the cause of the failure?”; and following on from that: “Was the failure reasonably foreseeable?” The former question (which is typically agreed) can usually be answered based on available evidence, that is was the tree in good physiological

and structural condition or was it flawed in some way?

Did the tree owner discharge their Duty of Care? Three cases that are relevant are Cavanagh v Whitley Parish Council, Stagecoach Southwestern Trains v Hind and Selwyn-Smith v Gomples

Subsidence is an insured peril and in peak years insurers have typically had to pay out close to half-a-billion pounds in subsidence claims. During the dry summer months, low-rise buildings suffer subsidence damage caused by the activity of tree roots. That occurs in areas where the underlying soil is shrinkable clay: typically in the part of the country south and east of a line running from the Wash to the Avon, although pockets of clay do occur elsewhere in the country.

Subsidence claims become the subject of legal proceedings when an impasse develops between the tree owner/controller and the insurer. The dilemma is that a tree or trees have been positively implicated as the cause of subsidence. Refusal to remove implicated trees means that the building has to be underpinned, and that often results in the insurer suing the tree owner/controller to recover the costs. Two cases that are relevant to that aspect are Berent v Family Mosaic Housing and LB Islington and Pattichis v L B Enfield

It is hoped that this article emphasises the need to engage competent and qualified arboriculturists as experts in tree cases. q

• Dr D O’Callaghan is an arboricultural consultant practising through Arbor Expert. He has considerable experience as an expert and has given evidence is many cases in the English and Welsh courts, as well as the Scottish, Isle of Man and Irish courts.

• Giles Mercer is a qualified arboricultural consultant, practising through Arbor Expert and specialising in vegetation-related clay shrinkage subsidence.

SUPREME COURT PUTS SIX-YEAR KNOTWEED CASE TO BED

[ A CLAIM FOR DAMAGES for nuisance caused by Japanese knotweed reached its final stage at the Supreme Court in February, having begun at a County Court in Wales in 2018.

The case was that of Davies v Bridgend District Council. A Mr Davies brought an action against the council relating to claimed loss of value of a property because of the presence of Japanese knotweed which had spread from a council-owned property. The claim was that the continued presence of the knotweed was caused by a breach of duty on the part of the council. Mr Davies’s claim was for £4,900.

The case was originally dismissed by the judge at Swansea County Court, but allowed on appeal. The council appealed to the Supreme Court, which heard the case in February this year. The Supreme Court unanimously allowed the appeal.

In its press summary of the case the Supreme Court said: “In the tort of private nuisance involving encroachment of Japanese knotweed from the defendant’s land onto the claimant’s land, the claimant is required to establish that the defendant’s breach of duty did in fact cause the loss suffered.”

The court applied the conventional ‘but for’ test: would the diminution in value have occurred but

for the breach of duty of the defendant during the relevant dates of 2013-2018?

If the diminution in value would have occurred in any event, then the defendant’s breach of duty is eliminated as a cause of the diminution in value so that there would be no causal link between the defendant’s breach of duty and the diminution in value.

The court ruled that: “The diminution in value would have occurred in any event so that there is no causal link between the defendant’s breach of duty and the diminution in value claimed.

“Accordingly, the appeal is allowed on this ground so that no damages are awarded.”

Commenting on the implications of the

judgement, Andrew Bailey of KDL Law wrote: “From a landowners’ perspective, the Supreme Court decision should come as welcome news as it has determined that where a neighbouring owner has suffered damage to their property through the spread of Japanese knotweed, that does not automatically mean that the owner of the land from whose land the knotweed emanates will be fully liable for all losses that the affected neighbour may have suffered just because, at one time, the land owner was in breach of their duty in treating the Japanese knotweed.” However, as always with Japanese knotweed, if it is present, take all steps to deal with it! q

BREXIT ENABLES PASSING OF ANIMAL EXPORT LAW

[A NEW BAN on exporting live animals came into law on 20 May as the Animal Welfare (Livestock Exports) Act received Royal Assent, bolstering the UK’s position as a world leader in animal welfare standards.

The legislation delivers on one of the government’s manifesto commitments by banning the export of live animals – including cattle, sheep and pigs – for slaughter and fattening from Great Britain. The Act will ensure that animals are slaughtered domestically in high-welfare UK slaughterhouses, boosting the value of British meat and helping to grow the economy.

Environment Secretary Steve Barclay said: “We are proud to have some of the highest animal welfare standards in the world. Our new Act makes use of post-Brexit freedoms to deliver one of our manifesto commitments and strengthen these standards even further by preventing the export of live animals for slaughter and fattening, which we know causes animals unnecessary stress and injury.”

Chris Sherwood, chief executive of the RSPCA, added: “After more than 50 years of campaigning we are absolutely thrilled to see that live export of animals has been banned from Great Britain. This means British animals will no longer be sent on gruelling journeys abroad for further fattening and slaughter in cramped and poor conditions with little or no access to food or water.

“As one of the first countries in the world to abolish this practice, this vital step for animal welfare sends an important message globally and we hope to see other countries follow suit soon.

“As we mark our 200th anniversary as a charity and look to the future of animal welfare, it’s great to see this outdated practice is finally consigned to the past. This ban marks a huge step forward for animal welfare and further shows that we are a nation of animal lovers, who care for every kind.

“We’d like to say thank you to all our supporters, all those who have campaigned on this issue and to the UK Government for making this milestone moment for animals happen.”

Roly Owers, chief executive of World Horse Welfare, added: “Today is a defining moment in our nearly century-long and founding campaign. The passage of this law ensures that no horse, pony or donkey will legally be exported from Great Britain for slaughter; and while this is a monumental step forward, plenty more needs to be achieved to effectively combat the illegal export of equines from the country.

“This will rely on the new law being effectively enforced and the introduction of full traceability of all equines, and we look forward to working with Defra to achieve this.”

Live exports in other specific circumstances, for example for breeding and competitions, will still be allowed provided animals are transported in line with legal requirements which protect their welfare. q

XL BULLY NEUTERING DEADLINE APPROACHES

[ OWNERS OF REGISTERED XL bully dogs that were aged 12 months or older on 31 January must have their dogs neutered by 30 June in order for the Certificate of Exemption to remain valid. If owners do not submit the Confirmation of Neutering form to Defra by 26 July, the dog will no longer be exempt.

Strict controls have been implemented for XL bullies: they must be registered, neutered and kept muzzled and on a lead in public. These measures will enhance public safety while making sure that the existing population of XL bullies reduces over time.

Anyone found in possession of these dangerous dogs and not meeting the strict rules could have their dog seized and faces prosecution and a criminal record.

For XL bully dogs already neutered, a vet must complete and submit a Confirmation of Neutering VCN01 form with the owner.

At the end of May, UK Chief Veterinary Officer Christine Middlemiss reminded owners of the approaching deadline: “The legal deadline for XL bullies to be neutered is now only one month away. Do not risk leaving it to the last minute; owners should book in to get their dog neutered as soon as possible.

“If evidence is not provided that the dog has been neutered by the relevant deadline, owners will be breaching the legal requirements to keep an XL bully dog and it could be seized by the police.”

Owners can access the most up-to-date information on what action they need to take to neuter their XL bully on the dedicated web page at www.gov.uk/government/publications/ confirm-an-xl-bully-dog-has-been-neutered q

E-SCOOTERS: UNDERSTANDING THE RISKS AND THE LAW

By Gavin Dunn of Hawkins & Associates

[E-SCOOTERS are a common sight these days, particularly around cities and urban areas. Are they a convenient micro-mobility solution, or a scourge on the roads? Given the lack of rider protection and their relatively small size, e-scooter riders could be considered vulnerable road users; but are they themselves harmless?

Figures from the Department for Transport show there were 1,269 collisions involving e-scooters in the year to June 2023, with casualties including both e-scooter riders and pedestrians.

E-scooters are ‘motor vehicles’ as defined in the Road Traffic Act 1988. The legal position on their use is broadly divided into whether they are privately owned or part of an approved government trial running in certain areas.

Privately-owned e-scooters can only be used without legal restrictions on private land to which there is no public access and only with the landowner’s permission. It is illegal to use a privately-owned e-scooter on public routes, including pavements, footpaths, cycle tracks, cycle lanes on roads or other spaces dedicated to pedal cycle use only.

For a motor vehicle to be used lawfully on public roads several requirements must be met, including insurance, tax and licensing, and the use of safety equipment. Satisfying all of those requirements is difficult for a user of a privately-owned e-scooter, leaving few options for their legal use.

E-scooters that are part of a government trial are instead subject to the Electric Scooter Trials and Traffic Signs (Coronavirus) Regulations and General Directions 2020. Users must have a suitable driving licence. Motor insurance is arranged by the rental operators and the e-scooters are exempt from registration or vehicle excise duty.

E-scooters that are part of such trials are limited to a maximum design speed of 25 km/h (15.5 mph), in line with the speed restriction for electricallyassisted pedal cycles (EAPCs), with some limited to lower speeds.

Are the restrictions on trial e-scooters effective?

A trial e-scooter can weigh up to 55 kg. An independent study by crash test provider UTAC found an adult pedestrian impacted by an e-scooter at 15.5 mph could suffer moderate injury, with the injuries being highly likely to prove fatal if the pedestrian’s head hits the ground. Further testing was carried out utilising a smaller crash test dummy to represent a three-year-old child. It was found to have travelled more than 6.4 metres (21ft) from the point of impact as a result of the collision.

Privately-owned e-scooters may not be limited to 15.5 mph and some models have advertised top speeds of up to 60 mph. Also, e-scooters can be modified to increase their power and speed.

While the lawfulness of the use of an e-scooter is one aspect to be considered in the event of a collision, a full collision reconstruction is essential to fully understand the circumstances of the incident. Such

reconstructions consider vehicle condition, visibility, collision speeds and vehicle or pedestrian movements. q

• Gavin Dunn is a Chartered Mechanical Engineer, Member of the Institution of Mechanical Engineers and Member of the Institute of Traffic Accident Investigators, with over 14 years of experience in investigating all types of road traffic collisions from pedestrians to HGVs. Gavin has appeared as an expert witness in numerous criminal, civil and coroners’ courts, and undertakes investigations throughout the UK and Ireland

HUMANS VS NEURAL MACHINE TRANSLATION:

HOW CLOSE DOES AI COME?

By Hayley Cowle of Translate Hive

[COMPUTERISED TRANSLATIONS such as Google Translate are undoubtedly useful for mundane tasks such as navigating foreign locales during leisure trips or deciphering menus in unfamiliar dining establishments. However, their suitability for legal purposes remains a contentious issue. Despite the undeniable advantages of speed and cost-efficiency when compared to human translators, computer-generated translations invariably fall short in terms of precision, coherence and structural integrity when confronted with legal documents of significant import.

The emergence of advanced AI technologies –notably neural machine translation (NMT) – marks a significant milestone in the realm of translation. NMT algorithms are designed to assimilate human language patterns and employ logical frameworks to discern appropriate translations for words and phrases, thus promising more nuanced and contextually relevant outputs.

However, in the realm of legal or technical documentation, where even minor inaccuracies can have profound implications for legal proceedings, the imperative of clarity and accuracy within contextual frameworks cannot be overstated. Any discrepancies detected by opposing parties could cast doubt on the credibility of the translated text, potentially weakening one's legal position.

Machine translation encounters significant challenges in capturing the intricate nuances inherent in contextual cues, particularly within the domain of legal discourse. Ambiguous terms and subtle variations in language usage introduce substantial margins for error, underscoring the limitations of machine-based translations in contexts where precision is paramount.

While real-time language translation tools have found widespread acceptance in everyday communication, their limitations become readily apparent when confronted with complex content rich in contextual dependencies, idiomatic expressions or specialised terminology. Legal, medical and technical documents, in particular, demand a level of linguistic precision and contextual understanding that machines struggle to replicate.

In contrast, human translators possess a nuanced understanding of language and culture, leveraging visual context cues and diverse linguistic resources to navigate the complexities of translation. Beyond mere linguistic accuracy, human translators are adept at interpreting cultural connotations embedded within language, thereby mitigating the risk of culturally inappropriate translations.

Despite significant advancements in machine translation technology, machines and AI-driven tools are yet to fully supplant human translators. While machines excel at swiftly processing large volumes of content at relatively low cost, they falter when confronted with the intricacies of language, including nuanced contextual cues, idiomatic expressions and specialised subject matter.

Industries that prioritise precision and trust – such as the legal, medical and financial sectors – rely heavily on human translators to uphold standards of accuracy and integrity in translation. While machines and humans may complement each other in certain capacities, the complete replacement of human translators remains a distant prospect, given the nuanced interplay of language and culture that characterises translation. q

• For accurate and timely translations or interpretations, visit www.translatehive.com or call the team on 0845 505 9961

DO MARINE SURVEYS TICK ALL THE RIGHT BOXES?

[

TICK BOX marine survey reporting is becoming far more common than it used to be, but are tick box survey reports fit for purpose, or are they lazy reporting?

Peter Broad, president of the International Institute of Marine Surveying (IIMS), said: “I draw a clear distinction between an ‘inspection’ and a ‘survey.’ I would suggest that the level of training and experience to carry out a marine survey by a qualified surveyor is higher than that of an inspection carried out by an inspector. A tick box form may be useful for an inspection by a less qualified and less experienced person to gather information quickly on the status of a system, where a ‘Yes’ or ‘No’ answer can be given without any further explanation.

“The effectiveness of a tick box survey report depends on how it is used and the context in which it is applied to ascertain if it is fit for purpose.”

IIMS chief executive officer Mike Schwarz added: “A survey report should give the instructing client a clear and detailed overview of what has been surveyed, with a list of any defects and recommendations that have been found.

“A tick box survey does not necessarily meet that requirement and can leave the instructing client lacking in essential information. IIMS sees a number of tick box survey reports that are not fit for purpose.”

The pair cited the example of the question: Does the vessel have a bilge pump? YES/NO. A tick in the YES box does not provide an explanation as to whether the bilge pump works; if the piping system is in good condition; if it has an oily water separator; and if the oily water separator is certified and in working condition. Are the bilges clean and free from oil contamination? Are there any rags in the bilges?

Ultimately, a professional marine surveyor must remember that their survey reports are admissible as court documents if there is a legal case. Imagine if a vessel sinks and there is loss of life, and the subsequent marine accident investigation finds that the bilge pump was not working

properly. The last attending surveyor on that vessel who ticked the box only for the bilge pump and made no further comment could be potentially looking at a charge of gross negligence, or even worse. q

RIPPLES FROM SUEZ BLOCKING CONTINUE

[WHEN THE Ever Given blocked the Suez Canal in March 2021, leading salvage company SMIT and certain other parties assisted with the salvage, in part through the provision of two tugs Alp Guard and Carlo Magno. In Smit Salvage BV v Luster Maritime SA, the UK Court of Appeal considered whether there was a legally binding contract between the salvage company and the owner of the Ever Given and whether that substantially reduced the money payable to the salvage company.

Commenting on the case, Jamila Khan and Henry Stockley of international law firm WFW said: “In the case of the Ever Given, the owner agreed that SMIT had contributed to the salvage effort. However, the parties did not agree on how much money SMIT should receive. The owner said SMIT agreed to limit the payment in a contract on the Wreckhire 2010 form. This was because SMIT preferred an agreed payment, rather than possibly receive nothing at all.”

Mr Justice Baker held that SMIT could claim sums under the International Convention on Salvage 1989 and/or at common law.

The owner appealed, claiming that the judge was incorrect in his conclusion. The Court of Appeal dismissed the appeal, holding that no binding contract was concluded.

Jamila Khan and Henry Stockley said: “It is common for parties to agree to a Lloyds Open Form contract for salvage operations. This can be quickly agreed, without the need to negotiate its terms.

“That said, there might be obvious commercial reasons for salvors and owners to fix rates at an early stage, for example where there is no guarantee the ship will be saved.” q

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

Chris Dawson MS FRCS LLDip

Translations and Interpreting for the Legal Profession since 1997. Specialists in Personal Injury and Clinical Negligence. www.abc-translations.co.uk

Andrew F Acquier BA FRICS

Chartered Art & Antiques Surveyor

Expert witness reports and representation at court for matters involving: • Divorce settlements • Insurance valuation disputes • Arts litigation • Contentious Probate

www.andrewacquier.co.uk

David Berry PhD FRC Path MFSSoc MRSC

Independent Toxicology Consultant Specialist in Clinical and Forensic Toxicology with particular emphasis on drugs (both illicit and therapeutic) and alcohol. www.toxicologyservices.co.uk

Mr Timothy Burge MBChB FRCS FRCS(Plast) DMCC MSc

Consultant Burns & Plastic Surgeon

• Cosmetic and aesthetic surgery of the breast and trunk

• Burns • Trauma • Scars www.clifton-plastic-surgery.co.uk

Professor Frank Chinegwundoh MBE

Consultant Urological Surgeon specialising in Personal Injury and Medical Negligence cases on behalf of either claimant or defendant or as a Single Joint Expert. www.urologyconsultant.co.uk

Professor Paul J Ciclitira MB PhD FRCP MRCS FRCP AGAF

Professor of Gastroenterology with particular interest in food allergy, including Coeliac disease, peptic ulcer, inflammatory bowel disorder and hepatology. www.profpaulciclitira.co.uk

Mr Jeremy P Crew MA MD BChir FRCS

Consultant Urological Surgeon

Medical reports on all legal aspects of urology. Reports in some cases based on hospital notes only. www.oxfordurology.co.uk

Clarke Gammon

Chartered Surveyors with experience in All Aspects of Property • Residential property values

• Asset valuations • Land values and more www.clarkegammon.co.uk

Dr Lars Davidsson MRCPsych MEWI

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

Consultant Urologist with 20 years experience of medico legal report writing and expert witness work and has completed over 1,850 reports. He also regularly completes Fitness to Practice reports for the General Medical Council.

DRC Forensics Limited

DRC Forensics Limited offers the complete range of forensic accounting & litigation support: • Fraud • Money laundering

• Partnership disputes • Loss of profit • Professional negligence www.drcforensics.co.uk

Mr Mark Duxbury MA (Oxon) DM FRCSEd (Gen Surg)

Consultant Hepatobiliary, Pancreatic & General Surgeon

• General & emergency surgery • Hernia surgery

• Liver & pancreatic surgery • Gallbladder & biliary surgery

• Laparoscopic surgery • Hepatobiliary surgery www.markduxbury.info/medicolegal

Mr Roger Emmott CEng BSc(Hons) MSc/MBA MA FCMI FIC

Steel and iron ore expert with international arbitration and cross-examination experience in complex disputes

• Industry • Pricing • Contractual • Valuations

T: 07974 351704 E: roger@rogeremmottassociates.com www.rogeremmottassociates.com

Equip2Speak

Specialists in Brain and Spinal Injury. SLT & AT Consultants

• CUBS Certified Experts since 2012/2013 • Accident, Negligence and Criminal Cases • Experienced in High Value Claims • Claimant/Defendant/Joint Instruction

www.equip2speak.co.uk

Face Restoration

• Complications of cosmetic eyelid surgery

• Brow lift surgery • Ptosis • Non-surgical aesthetics

• Orbital diseases • Watery eyes • Thyroid eye disease www.facerestoration.com www.chrisdawson.org.uk

FHDI - Kathryn Thorndycraft-Pope

Examining documents & handwriting • to determine authenticity • to expose forgery • to reveal aspects of origin. Electro Static Detection Apparatus and Mi-Scope used. www.forensichandwriting.co.uk

Forensic Collision Investigation & Reconstruction Ltd

Specialists in the analysis of road traffic collisions

• Collision Reconstruction • Expert Witness

• Vehicle Examinations www.FCIR.co.uk

Formedecon Ltd

Forensic & Investigative Services to the Legal Profession

• All Aspects of Forensic Work Undertaken

• LAA and Privately Funded • Free Estimates www.Formedecon.com

Professor Parviz Habibi MB ChB PhD FRCP FRCPCH

Consultant in Paediatric Intensive Care & Respiratory Medicine. Specialist in treating respiratory conditions and sleep disorders as well as paediatric intensive care.

www.childrensrespiratorydoctor.co.uk

Griffin Forensics eForensics and Data Recovery Experts

• CCTV Recovery and Analysis • Computer Media Investigations • Mobile Phone Extraction and Analysis • Forensic Data Recoveries

www.griffinforensics.com

Mr Kim Hakin FRCS FRCOphth

Consultant Ophthalmic Surgeon and Expert Witness on ophthalmological matters

www.kimhakin.com

Haydn Jones MEng DipLaw FIET

Data Technologist & Digital Regulation Expert

• Injunctive relief • Money laundering

• Digital currency theft • Counter funding of terrorism

E: Haydn.Jones@kroll.com

Atul Khanna FRCS (Plast)

Consultant Plastic, Reconstructive and Hand Surgeon

• Hand surgery • Soft tissue injury • Burns management

• Medical negligence in cosmetic surgery www.atulkhanna.co.uk/expert-witness/

Dr Raj Kumar – Dental Expert

Causation and Liability and Condition and Prognosis Reports

• General dentistry • Cosmetic dentistry • Patient consent

• Dental implantology • Orthodontics • Facial aesthetics 07802 456 804 | info@dentalexpert.me | www.dentalexpert.me

Laird Assessors

The UK’s leading independent automotive expert witness firm supporting claimant, defendant and criminal solicitors. From instruction to court. www.laird-assessors.com

Kulvinder Lall Consultant Cardiothoracic Surgeon Instructions taken in cases relating to cardiac and thoracic surgery, including aspects relating to surgical care and those following trauma to the structures of the chest. www.kulvinderlall.com

Mr Chris Makin

• Chartered Accountant • Accredited Civil Mediator

• Accredited Expert Determiner www.chrismakin.co.uk

Matrix Forensic Accounting & Investigations

Matrix Forensics are an independent niche practice of Chartered Certified Accountants providing expert witness and alternative dispute resolution services. matrixforensic.co.uk

Mr Fredrik P Nath FRCS MBChB

Consultant Neurosurgeon • Head injury • Spinal injury

• Acoustic neuroma • Lumbar and cervical degenerative disease • Musculo-skeletal injury including whiplash www.neurosurg.co.uk

Mr Abraham Odumala

MBBS M.MedSci FWACS FRCS FRCS(Tr & Orth)

Consultant Orthopaedic Surgeon – Upper Limb Specialist. Expertise in all upper limb conditions and treatment. Shoulder, elbow, wristand hand injuries. www.yorkshire-upperlimb.co.uk

Mr Faz Page Bsc(Hons) Dip Registered Osteopath

Personal injury claims involving back, neck and joint pain as a result of road traffic accidents, work related injuries, occupational injuries and sports injuries. www.pageosteo.co.uk

Dr Shanthi Paramothayan

BSc PhD MBBS LLM MScMedEd FHEA FCCP FRCP

Consultant Respiratory Physician specialising in negligence cases relating to all aspects of respiratory medicine. www.paramothayan.com

Dr Stuart Porter Chartered Physiotherapist

PhD MCSP HCPC BSc Hons Grad Dip Phys MLACP PgCAP Cert.MHS SFHEA

Specialist areas of expertise include:

• Clinical negligence • Breach of duty • Allegations of inappropriate contact • Assessment of adults and children. stuartbporter@aol.com

Simon Quinton Smith BSc FRICS MI Hort

Expert Witness to the Garden Centre & Horticultural Industry

• Rent Reviews • Lease Renewals • Valuation • Planning • Compensation • Tax Issues

www.quintonedwards.co.uk

Professor Christopher Raine MBE

Specialist in paediatric and adult otology

• Medical negligence • Personal injury cases involving noise induced hearing loss. www.profchrisraine.co.uk

Mr Sameer Singh MBBS BSc FRCS Orth

Consultant Orthopaedic Surgeon • All aspects of trauma – soft tissue and bone injuries • Upper and lower limb disorders and injuries • Whiplash injuries • Expert Witness for defence and claimant Clinic locations – London, Milton Keynes and Bedford

www.orthopaedicexpertwitness.net

Andrew Smith FPC III CeMAP

Financial Conduct Authority Compliance & Risk Consultant Cases relating to FCA compliance in consumer credit and mortgage lending.

• Mediation • Arbitration • Adjudication • Expert Determination

www.paxen.co.uk

Prof. Elizabeth J. Soilleux MA MB BChir PhD FRCPath PGDipMedEd

Expert Witness Pathologist with a particular interest in haematopathology. Short reports on specimens, full court compliant reports and expert biopsy reporting. www.expertwitnesspathologist.co.uk

Mr Bernard Speculand MDS FDS FFD FRACDS (OMS) Consultant Oral and Maxillofacial Surgeon. Personal injury and clinical negligence cases for claimant, defendant and as Single Joint Expert. Special interest is TMJ Surgery.

Yvette Young (Secretary) T: 0121 605 1884 E: info@medsecadmin.co.uk www.birminghamtmj.co.uk

Dr Ian Starke MSc MD FRCP

Stroke Medicine and Medicine for the Elderly Reports and examinations for clinical negligence and fitness to practise cases in stroke medicine and geriatric medicine www.expertwitnessinstrokes.co.uk

Mr David Anthony Sykes (Tony Sykes)

BSc CEng CITP MBCS MIET FAE MEWI

Specialist in IT and Telecommunications. Expert witness and consultancy services to lawyers, insurers and loss adjusters. Experience in international arbitrations and the High Court TCC.

www.rocksideconsultants.co.uk

Target Psychology Ltd

• Public & Private Law Proceedings • Pre-Proceedings

• Immigration Proceedings • Criminal Proceedings

• Court of Protection Proceedings

• Personal Injury and Clinical Negligence www.targetpsychology.co.uk

Mr. William E G Thomas Bsc, MBBS, FRCS, MS Consultant Surgeon specialising in general surgery, hernia surgery, gastrointestinal surgery, hepatobiliary-pancreatic surgery, laparoscopic surgery and endocrine surgery

T: 0114 262 0852 E: wegthomas@btinternet.com W: www.wegthomas.com

UK Ophthalmology Experts

UK Ophthalmology Experts are a team of leading, independent ophthalmology experts covering all aspects of ophthalmology. www.ukophthalmologyexperts.co.uk

Dr David Usher BSc DPhil FCIEHF

Identification of ergonomic and biomechanical issues underlying injuries. Assessment of tasks, equipment, forces and postures. Civil & Criminal cases undertaken. www.interactionofbath.com

DR S V MEDICALS (Mr Sen Venkat)

MSc Ortho (London) FRCS Consultant Orthopaedic Surgeon

• Whiplash injuries • General trauma • Sports injuries

• Clinical negligence work • Joint replacement surgery of hip and knee • Hand, shoulder, elbow and wrist injury www.drsvmedicals.co.uk

WOODEXPERTS

Specialist Timber Consultancy and Training since 1991

• Site visits & investigations • Structural surveys

• Desktop analysis & review of documents

• Specialist reports • Species identification

www.woodexperts.com

Ms Leyla Ziyal MPhil AFBPsS CPsychol

HCPC Registered clinical Neuropsychologist

• Neuropsychological assessment and rehabilitation

• Depression • Occupational stress • PTSD • Anxiety www.accentpsychology.co.uk

MEDICAL NOTES

[THE MEDICAL PAGES of this issue are, unfortunately, largely concerned with the failings that seem to be endemic in hospital organisations. It seems that, despite the passing years during which society at large has progressed, and the manifold public scandals that have hit the headlines, some hospital departments, and the managers that lead them, are still rooted in the days of Sir Lancelot Spratt.

• Among the reports revealing the persistence of such archaic practices is one from the GMC, which is almost plaintive in its conclusions of what can be done to improve communication between people who should be working as colleagues, be it inside or between specialisms.

The researchers catalogue instances of what it describes as ‘intimidating, or often toxic or bullying cultures’. The fault lies, the researchers find, with the systems in place rather than individuals – although it is individuals who feel the effects, whether junior doctors unable to raise issues or the patients themselves.

• The effects of the culture identified by the GMC can be disastrous for patients. There are claims that ‘unnecessary deaths’ were caused by the toxic hierarchy at the Royal Sussex County Hospital in Brighton, in particular in the neurosurgery and general surgery departments. Police have been carrying out an investigation of a number of cases that occurred in the period between 2015 and 2021.

• Disrespect for the rules has even been carried to what can only be described as an astonishing degree at a hospital in Walsall, according to the Royal College of Surgeons (RCS). Apparently, a surgical care practitioner performed laparoscopic cholecystectomies – a procedure for which they are unqualified. While the recent introduction of new clinical positions in both primary and secondary healthcare can be confusing to the lay person or patient, that should not be the case with clinical managers. The RCS outlined what the position should be.

• The most disastrous episode of clinical decision-making going disastrously wrong is the infected blood scandal. No-one is suggesting that the original decision to import blood products was made maliciously, but the reality of the sources of the blood should have rung warning bells. The real scandal began when the presence of infected blood was discovered. That turned to outright disgrace when the realities of the situation were covered up. The scandal was ‘no accident’, according to Sir Brian Langstaff. There are calls for the police to be involved.

• The General Election has provided the opportunity for a number of organisations to browbeat the various parties into taking action to improve the position in their specialty. In particular a coalition of palliative care organisations has called for all the parties to commit to improvements in that area, while the RCSych has demanded action to improve mental health. A commitment to establish nationwide fracture liaison services was made prior to the dissolution of Parliament, following a press campaign, and matched by the opposition in time for it to be meaningful. A similar story has seen Martha’s Rule implemented in 143 hospitals.

• More good news has been seen in a number of specialities. A breakthrough in the treatment of patients with epilepsy that does not respond to drugs uses a technology called laser interstitial thermal therapy, using MRI imaging developed in the UK to guide the laser.

The use of new technology, specifically AI, is coming into its own in the area of ophthalmology, while an AI application is being used to rule out unnecessary heart surgery by detecting when someone has not had a heart attack.

AI also has a role in the medicolegal sphere, as explained by regular contributor Professor Paul Lee. q

ROYAL COLLEGE EXPRESSES CONCERNS OVER SURGICAL PROCEDURES UNDERTAKEN BY UNQUALIFIED PRACTITIONER

[THE Council of the Royal College of Surgeons of England has expressed alarm at the practices outlined in a recent paper highlighting the outcomes of a surgical care practitioner (SCP) performing laparoscopic cholecystectomies at Walsall Healthcare NHS Trust between June 2015 and November 2019.

SCPs should not undertake laparoscopic cholecystectomies with or without supervision, RCS England pointed out. The college’s council, which met on 9 May, voiced serious concerns about the impact and potential safety risks to patients – including how they were raised through patient consent – and potential medico-legal ramifications.

In 2022 the Royal College of Surgeons of England and the Royal College of Surgeons of Edinburgh published The Curriculum Framework for the Surgical Care Practitioner That unambiguously defines the expected technical skills for an SCP supporting a team undertaking a laparoscopic cholecystectomy as being restricted to understanding and supporting patient positioning, port site/exposure required, common complications and how to avoid these, and postoperative considerations. The previous iteration of the document, supported by RCS England, was also specific that laparoscopic cholecystectomies should not be carried out by an SCP.

RCS England’s council has reminded local consultants of their responsibilities when agreeing how surgical care practitioners work as part of surgical teams. Consultants must ensure their decisions align with the agreed scope of practice for SCPs.

Council also expressed concern about the impact of denying training opportunities for surgeons in training and speciality and associate specialist (SAS) doctors. It is essential that surgeons in training do not miss out on training opportunities and that their trainers have a clear focus on providing the best possible training.

In a statement published in the Annals of the Royal College of Surgeons of England, the RCS England outlined its position: “SCPs, along with surgical first assistants, typically have backgrounds in nursing or operating department practitioner roles. As such, they are well embedded and valued members of the surgical team who are regulated by their original professional body – the Nursing and Midwifery Council or the Health and Care Professions Council – and undertake post-registration clinical practice before undergoing further structured training to become SCPs.

“There is a clear curriculum and defined scope of practice for SCPs which underpins the MSc in Surgical Care Practice. That stands in contrast to physician associates (PAs), where the college is working with the other surgical royal colleges, specialty associations, Association of Surgeons in Training and the British Orthopaedic Trainees Association, to define a scope of practice with clear parameters.

“While our current focus is on the PA scope of practice, we recognise the importance of reviewing The Curriculum Framework for the Surgical Care Practitioner to ensure it is clearly communicated and remains tightly defined.” q

BETTER TEAMWORK CAN LEAD TO BETTER

OUTCOMES, RESEARCH FINDS

[DOCTORS UNDER PRESSURE are being prevented from working effectively in teams by power imbalances and negative hierarchies, a study published by the General Medical Council (GMC) has found.

Continuity, good communication and effective leadership all lead to greater team efficiency and were found to make it much easier to resolve issues – ultimately having a positive impact on patient outcomes.

The research, commissioned by the GMC and carried out by Hull York Medical School, based at the University of York, explored how doctors and other healthcare professionals work together and across teams, what factors contribute to effective team working and the elements that make it more challenging.

Perceived power imbalances and hierarchies, when structures are multi-layered and steep, and leaders are seen as being out of reach, were identified as major barriers, often leading to “intimidating, or often toxic or bullying cultures”. The research found that led to team members feeling unable to speak up, resulting in more errors and poor patient care.

Researchers found breakdowns in communication between specialisms which, they said, “clearly hindered effective teamworking”. High demands on services also played a significant role, with researchers describing the pressure to move patients through systems quickly, leading to stress, burnout and emotional exhaustion.

Charlie Massey, GMC chief executive, said: “We know healthcare teams across the UK are working under extraordinary pressures and facing ever more complex challenges. That can inevitably create friction and impact on effective teamworking. That’s why it’s vital every team member, regardless of experience, feels empowered to speak up.

“That doesn’t necessarily lie with individuals working within a team. It is a much bigger, cultural picture that all of us in the UK health systems must work harder to nurture and prioritise.”

Researchers spoke to doctors, healthcare professionals and teamwork experts across the UK to understand their experiences of working in healthcare systems. They looked at the type of teams doctors work in and how these can vary by career stage. They also explored factors by organisation, individual, team make-up and workplace environment. Those were separated into ‘enablers’ and ‘barriers’ for teamworking.

Enablers included:

• Ensuring time and structures are in place to allow teams to meet

• regularly

• Positive and supportive culture

• Effective communication

• Leaders who are understanding and approachable

• Clearly defined roles and respect for all team members

• Continuity and experience of those in newer roles

Barriers included:

• Power imbalances and negative hierarchy

• High service demand and work pressures

• A lack of stability through transitory and rotational roles

• Poor leadership

• Poor communication

• Lack of identification of roles and needs of the whole team, including

• equality, diversity and inclusion issues

The research suggested that employers should focus on nurturing supportive work environments – prioritising the ‘enablers’ – as well as strengthening staff development opportunities and following best organisational practices to encourage teamwork. It also said there should be more focus on teamwork during medical undergraduate training.

Charlie Massey continued: “We know open communication leads to better care: that’s why teamwork is so vital. Encouraging these environments where teamwork can flourish can only lead to better outcomes for patients: this research provides invaluable insights into how we can. All of us in the UK’s healthcare systems should take note of these findings and be prepared to act on them.”

Dr Paul Crampton, director of the Health Professions Education Unit at Hull York Medical School, who co-led the research, commented: “The research provided a real opportunity to gain insight into the experiences of healthcare professionals in a range of roles across the UK and the critical importance of effective teamwork. We hope that this research will help to inform policy and practice across the UK – improving patient experience and outcomes.” q

MARTHA’S RULE: ROLL-OUT BEGINS WITH 143 HOSPITALS

[THE NHS HAS ANNOUNCED the 143 hospital sites that will test and roll out ‘Martha’s Rule’ in its first year.

Martha Mills died in 2021, aged 13, after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.

In response to that and other cases related to the management of deterioration, the Secretary of State for Health and Social Care and NHS England committed to implement Martha’s Rule; to ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon.

Martha’s Rule is to be made up of three components to ensure concerns about deterioration can be swiftly responded to. Firstly, an escalation process will be available 24/7 at all the 143 sites, advertised throughout the hospitals on posters and leaflets, enabling patients and families to contact a critical care outreach team that can swiftly assess a case and escalate care if necessary. Secondly, NHS staff will also have access to the same process if they have concerns about a patient’s condition.

Finally, alongside that, clinicians at

participating hospitals will formally record daily insights and information about a patient’s health directly from their families, ensuring any concerning changes in behaviour or condition noticed by the people who know the patient best are considered by staff.

Evaluation of how the system works in these sites over the course of this year will inform proposals for Martha’s Rule to be expanded further across all acute hospitals, subject to future government funding.

NHS England is working with Martha’s parents to develop materials to advertise and explain the initiative in hospitals across the country, to ensure

it is something that all patients, staff and their families can recognise.

Professor Sir Stephen Powis, NHS national medical director, said: “Rolling out Martha’s Rule to over 143 NHS sites in this first phase will represent one of the most important changes to patient care in recent years, and we are pleased to have seen such interest from hospitals right across the country: all thanks to the moving and dedicated campaigning by Martha’ parents, Merope and Paul.

Responding to the NHS announcement, Dr Vishal Sharma, chair of the BMA consultants committee, said: “What happened to Martha Mills was tragic and we fully support the principle that there should be clear escalation processes in place to support patients who become unwell. The concerns of patients and their families must be listened to and responded to.

“However, the biggest issue impacting patient care is the chronic lack of funding and worsening conditions that have resulted in severe staff shortages across the NHS. The impact of important initiatives such as this will be impeded by the recruitment freezes and staff reductions that hospitals are being forced into.

“The workforce crisis must be addressed so hospitals can employ the doctors and staff they need, and the NHS can deliver the high quality of care that patients deserve.” q

NEVER AGAIN! HEALTH SECRETARY SHOCKED BY LANGSTAFF REPORT

[ SECRETARY OF STATE for Health and Social Care, Victoria Atkins, was contrite in her response to the Langstaff Report into infected blood, published on 20 May. She said her department will study the report to make sure lessons are learned.

“Yesterday we heard the harrowing conclusion of Sir Brian Langstaff’s inquiry on infected blood. The report lays bare the many failings of successive governments, including historic failings in my own department. As the Secretary of State, I apologise unreservedly for the actions which have hurt and harmed so many people, culminating in the damning conclusions of the report.”

In his report Sir Brian concluded that the scandal, which surrounded the infection of around 30,000 people with HIV and hepatitis from imported blood products, was "not an accident".

"The infections happened because those

in authority – doctors, the blood services and successive governments - did not put patient safety first," he said.

Victoria Atkins continued: “Instances of the destruction of records and withholding of information are shocking and unacceptable. This should not have happened and must

never happen again. We will study the report to make sure the lessons of Sir Brian’s Inquiry are learned and that these mistakes can never be repeated.

“I give my sincere thanks to all of the victims, families and campaigners for sharing their pain and for their fortitude in pursuing the truth over many decades, as well as to Sir Brian for his meticulous and comprehensive analysis. I am working with the NHS Business Services Authority to ensure that all those eligible receive a second interim payment of £210,000 as soon as possible.

“This terrible history of failures, experiments, disbelief and cover ups has stolen the lives of victims and their families; instead of birthdays, careers, freedoms and joy, the victims’ lives are measured in pain, mental anguish, the crushing burden of stigma and the agony of wondering what could have been. Never again.” q

PALLIATIVE CARE CHARITIES SET OUT THEIR ELECTION DEMANDS

[ ON 8 MAY the chief executives of the UK’s palliative and end of life care charities pre-empted the Prime Minister by uniting during Dying Matters Awareness Week to urge all party leaders to prioritise palliative and end of life care in their election manifestos and plans for government.

In the letter, chief executives from Hospice UK, Marie Curie, National Bereavement Alliance, Sue Ryder and Together for Short Lives said: “If you do nothing to fix the problems that dying people currently experience, hundreds of thousands will miss out on vital care and the trauma of seeing a loved one die without support will live in the minds of a generation. People who are dying, and their loved ones, deserve better.”

Up to 90% of adults who die would benefit from palliative and end of life care. And due to the UK’s ageing population, around 32,000 more people would benefit from palliative care at the end of the next parliament in 2029 compared to its start this year.

Matthew Reed, the chief executive of Marie Curie, commented: “Dying people do not have time to wait; the next government must prioritise fully funding end of life care. Too many people are dying in avoidable pain, frightened and without

the dignity they deserve. Families are left stressed, exhausted and traumatised.”

Toby Porter, CEO of Hospice UK, expressed that organisation’s concerns: “The next few years are critical for end of life care. We know that many people do not get the palliative care they need at the end of their lives, and we know that our ageing population means demand for care will continue to grow over the next decades. Hospices are ready to meet this challenge, but they need a new funding model and support from the next government to ensure they can continue to provide their brilliant care for everyone who needs it, whenever they need it.”

Children and young people in just a third of local NHS areas in England can access end of life care at home that meets National Institute for Health and Care Excellence standards.

Andy Fletcher, chief executive of Together for Short Lives, said: “It is unacceptable that families of seriously ill children are not getting the palliative and end of life care they need because of where they live. This is care that is clearly set out in standards, guidance and even the law. Time is short for seriously ill children and their families.

“It is vital that the next government oversees a step change so that children and families can finally access the high-quality, sustainable palliative care they need.” q

UNREGISTERED DOCTOR SENTENCED

[ ON 16 MAY Dr Fakher Fouad Gendy, trading as FEMAesthetics, was sentenced at Warrington Magistrates’ Court on a charge of providing regulated activities without being registered with the Care Quality Commission (CQC) to do so.

The charges relate to a labiaplasty that Dr Gendy carried out on 10 June 2023 under his company name FEM-Aesthetics. Neither Dr Gendy nor FEM-Aesthetics were registered with CQC to undertake any regulated activities, including surgical procedures. That is a criminal offence under Section 10 of the Health and Social Care Act 2008

The patient upon whom Dr Gendy performed the procedure as an unregistered provider has been caused severe emotional harm and physical distress.

Dr Gendy was sentenced to 16 weeks imprisonment, suspended for 12 months, and ordered to complete 200 hours of unpaid work within that timeframe. He was also ordered to pay £5,000 costs and £154 victim surcharge.

Ceri Morris-Williams, an interim deputy director at CQC, said: “I hope this outcome sends a clear message to others that, where we find providers operating outside of the law, we will always use our enforcement powers to protect people and hold them to account to stop poor and illegal practice.

“It is unacceptable that Dr Gendy, trading as FEM-Aesthetics, risked people’s safety by running a service without the benefit of CQC registration, so I welcome Dr Gendy's guilty plea to this offence.

“The registration process is important to appropriately assess services before they care for people. Services are then monitored and inspected to ensure that they continue to meet fundamental

standards of care that everyone should be able to expect.

“Unregistered services operate without oversight, putting people at risk of harm. When we find individuals operating unlawfully, we won’t hesitate to act to protect people, as we did in this case.” q

INQUIRY TO BE HELD INTO CARE HOME RESIDENTS’ DEATHS

[THE Crown Office and Procurator Fiscal Service (COPFS) in Scotland has lodged first notices with the Sheriff Court to begin the court process for a conjoined Fatal Accident Inquiry (FAI) into the deaths of David Donnelly and Robert Thomson.

David Donnelly died at Hairmyres Hospital on 14 January 2019, aged 83. Robert Thomson died at Hairmyres on 2 March 2021, aged 99. Both men had been residents at Lornebank Care Home in Hamilton.

A preliminary hearing will be held on 19 July 2024 at Hamilton Sheriff Court. Procurator Fiscal Andy Shanks, who leads on fatalities investigations for COPFS, said: “The Lord Advocate considers that the deaths of David Donnelly and Robert Thomson occurred in circumstances giving rise to significant public concern, and as such a joint discretionary Fatal Accident Inquiry will be held.

“The lodging of the first notice enables FAI proceedings to commence under the direction of the sheriff. The families will continue to be kept informed of significant developments as court proceedings progress.” q

CHANGES TO WELSH NEGLIGENCE SCHEME PUT ACCESS TO JUSTICE AT RISK, LAWYERS CLAIM

[ VICTIMS OF CLINICAL NEGLIGENCE

could face access to justice issues if changes to the NHS Putting Things Right (PTR) redress scheme in Wales go ahead, the Association of Personal Injury Lawyers (APIL) has warned.

The Welsh Government plans to double the value of claims that can be dealt with through the PTR scheme from £25,000 to £50,000. The scheme is how patients and their families can raise concerns and make complaints about NHS services, including hospitals, dentists, GPs and opticians. Compensation can be paid under the scheme, which helps injured patients to get their lives back on track.

APIL says increasing the value of claims in the scheme would mean complex and sensitive cases – such as delays to surgery or maternity cases – being processed through PTR, which would be wrong.

“Cases in which injured patients’ compensation needs are valued at up to £50,000 are usually more complex and time consuming to resolve than those which currently fall under the PTR scheme,” said APIL’s Welsh representative and Cardiffbased legal executive Pauline Roberts.

“Such complex cases generally require a great deal of work and detailed consideration to make sure victims receive the right amount of compensation to help them recover.

“In a case involving an avoidable delay to a patient’s surgery or a misdiagnosis, for example, which has caused significant harm, additional, detailed evidence is gathered and applied by the victim’s lawyer. Rehabilitation needs, provision for future therapies and the impact of lost earnings need to be accounted for. Patients will need independent and specialist legal representation throughout the process.

“But the extra time and resources needed to take on more complicated cases must be funded somehow, and the

Welsh Government’s proposed legal fees increases will not cover the costs of the extra work required in complex cases.”

She warned that lawyers may shy away from such cases. “Victims of NHS negligence in Wales face not having access to justice if lawyers are unable to afford to take on cases due to the cost implications,” she said.

“Not setting the fees at an appropriate level to remunerate for the work required in higher claims means there is a real risk the independent legal help will be scarce or insufficient in such a specialist field.”

In its response to a consultation by the Welsh Government on the potential changes to PTR, APIL said it supports proposals for mandatory ‘listening meetings’ which would allow patients to air their complaints or concerns with officials.

Pauline Roberts explained: “Such meetings will help foster a culture of transparency and accountability when things go wrong in the NHS. This way lessons can be learned and patient safety can improve, and hopefully some claims will be eradicated at the source – the negligence.” q

SO YOU WANT TO BE AN EXPERT WITNESS?

By Francesca Smith of Smith Medico-Legal

[AS AN EXPERT in your professional field, you play a crucial role within the UK judicial system by providing opinion evidence to assist courts in reaching informed decisions. In addition to having the relevant qualifications and experience, it is now regarded as essential for expert witnesses to undertake recognised training to develop the specialised skills required.

Expert witness training equips professionals with a comprehensive understanding of the legal framework, procedures and ethical obligations involved in providing expert testimony. That ensures experts are fully prepared to navigate the court environment, deliver impartial and objective evidence and withstand rigorous cross-examination.

Completing accredited expert witness training demonstrates a commitment to maintaining the highest standards of practice. That enhances the credibility of your evidence and strengthens the court's ability to rely on your expertise when making critical judgements.

The roles and responsibilities of an expert witness

An expert witness is someone who has experience in a specialised field. They are specialists. Ask yourself, what is your special field of interest or area of expertise and what is your specialist knowledge, training or experience? You have a duty to the court as an expert witness: that is a more complex area. The duty is to aid the court in matters within your expertise by delivering independent evidence.

That is the most critical part of being an expert witness – your duty to the court and independence. It is also important to understand that the court does not share your expertise and knowledge and that is why you have been instructed to give evidence: hence, the way in which the report is written must be digestible in layman’s terms.

Training to become an expert witness

Training is essential. It is essential because you are offering a professional service, and that service needs to be backed up with proper formal training and CPD.

Compliance is a big issue and the courts scrutinise the ability of expert witnesses to fulfil the role, that they know how to be experts in terms of what their roles and duties are, and are court-ready. There are consequences for experts who fail to meet the requirements.

How do you get expert witness work?

Getting instructions is obviously essential for your medicolegal practice and its success. Some ideas include registering with agencies and directories, such as Your Expert Witness, to get your name and expertise seen, and to contact solicitors to introduce yourself.

Connections via LinkedIn and colleagues and word of mouth are valuable and your website, CV and LinkedIn profiles should all be up to date, focussed and relevant.

Once you have delivered your report, that is your best marketing tool. It is seen by the courts, solicitors and other parties, and your name inevitably becomes known in the field as long as your report is clear and concise, knowledgeable and adherent to all the requirements. q

• If you would like to become an expert witness and you don’t know where to start, or maybe you just don’t have time to start, Smith Medico-Legal are expert consultants in business development and marketing within medicolegal practices. Get in touch to discuss your personal requirements

EPILEPSY PATIENTS TO BENEFIT FROM ‘GAME-CHANGING’ LASER SURGERY

[ THE NHS is rolling out world-leading laser beam therapy to help reduce seizures in a small number of people with drug-resistant epilepsy. Laser interstitial thermal therapy (LITT) targets the part of the brain causing seizures without the need for invasive surgery.

It will be offered to around 50 patients a year with drug-resistant epilepsy, and delivered at London’s King’s College Hospital and the Walton Centre in Liverpool.

LITT involves inserting a 1.5mm probe with a laser tip through a tiny hole in the skull. The surgical team use MRI scanning to navigate through the brain, and the laser reaches and destroys the epilepsycausing brain tissue by heating it from the inside.

James Palmer, NHS England’s Medical Director for Specialised Services and a consultant neurosurgeon, said: “This laser beam therapy is game-changing for patients and will offer new hope on the NHS to those for whom standard drugs are not effective in controlling their seizures.

“Not only will this world-leading technology help replace invasive surgery for patients – which can take months to recover from – it will

also allow clinicians to better target the parts of the brain causing the epilepsy, which dramatically reduces the risks and helps cut patients’ recovery time both in and out of hospital.”

The MRI technology for navigating through the brain to reach the affected tissue was developed at the Epilepsy Society’s Chalfont Centre. Professor Ley Sander, the society’s director of medical services, said: “This non-invasive form of neurosurgery could be groundbreaking for some people with brain lesions whose seizures do not respond to conventional treatment options, including more invasive epilepsy surgery.

“It will make surgery safer and faster and dramatically cut the recovery period for individuals. We are particularly proud that the sophisticated navigation system which guides this pioneering surgery was developed at the Epilepsy Society’s MRI unit.

“This enables the surgical team to navigate safely to the exact area of the brain that is affected, avoiding blood vessels and critical structures. This is a great advance in epilepsy surgery as a treatment option for lesional epilepsy.” q

CLOSURE OF HEAD INJURY CLINIC TO BE CHALLENGED

[ GOVAN LAW CENTRE (GLC) has accepted instructions and raised proceedings for judicial review in the Court of Session on behalf of a client of the Renfrewshire Head Injury Service (RHIS).

In February 2024, Renfrewshire Council and the Renfrewshire Health and Social Care Partnership – Renfrewshire Integration Joint Board (RIJB) – decided to decommission and end the unique services provided by the RHIS to adults and young persons with brain injuries.

Integration Joint Board are separate legal entities from both the NHS and the council. They are the main decision-making body for Health and Social Care Partnerships and have a legal duty to include key stakeholders in their decision-making processes.

The RHIS services are provided by the Scottish charity Quarriers. Proceedings are against both Renfrewshire Council and RIJB.

Decommissioning RHIS will have a significant adverse impact on service users who rely on the service for care, support and a sense of community. The majority of referrals come via NHS Scotland sites and there around 80 service users currently engaging with RHIS.

The legal challenges are focused on the failure of both respondents to properly exercise duties under Section 149 of the Equality Act 2010 in relation to the decommissioning of RHIS, the failure to carry out an Equality Impact Assessment which satisfied the requirements of the Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012, SSI 2012/162 and the failure to consult those affected at Scots common law.

The instructing solicitor is Lorna Walker, senior solicitor at GLC. GLC’s solicitor advocate Mike Dailly acts for the petitioner and Laura McDonagh, Partner at Drummond Miller LLP, acts as Edinburgh agents. The petition will require to satisfy the legal test for permission to proceed in terms of the 1988 Court of Session Act.

On hearing of the decision, Dr Ron Culley, CEO of Quarriers, said: “We are extremely disappointed that joint funders Renfrewshire Council and Renfrewshire Health and Social Care Partnership are unable to continue funding the Quarriers Renfrewshire Head Injury Service.

“The Paisley-based service has been a lifeline for individuals facing life-changing challenges after acquiring a brain injury.

Our service has been pivotal in supporting individuals and their families to navigate the complexities of what is often a new reality, providing crucial one-to-one support to assist them in rebuilding their lives. Quarriers has provided this service for 21 years.” q

BRIGHTON NEUROSURGERY DEPARTMENT UNDER INVESTIGATION

[SUSSEX POLICE are continuing their investigation of allegations of medical negligence at the University Hospitals Sussex NHS Foundation Trust, relating to neurosurgery and general surgery at the Royal Sussex County Hospital in Brighton in the period between 2015 and 2021.

On the police’s Major Incident Public Portal, the force says: “A number of cases from within the specified NHS departments and during the specified time period have been assessed and will form part of the on-going investigation.

“A dedicated team of specially-trained officers have been contacting those patients or families of patients whose cases will be included in the investigation and providing information to support them while the investigation is on-going. This specialist support will be available to them as our enquiries continue.

“The investigation is at an early stage and this does not necessarily mean this will lead to criminal prosecution. We are working closely with partner agencies and the University Hospitals Sussex NHS Foundation Trust is co-operating fully with our investigation.”

The police investigation began in the spring last year, and widened its scope in September. It follows allegations of malpractice and claims of a ‘gang culture’ by former staff who had been dismissed, and an inspection by the Care Quality Commission (CQC).

In its report the CQC said that in neurosurgery services, inspectors found: “The service did not have enough staff to care for people and keep them safe. Staff did not always feel respected, supported and valued. Staff did not always work well together for the benefit of people. Some consultants did not engage with people using services, including sharing information regarding their medical conditions.

“The environment and availability of equipment did not always support safe and effective care and treatment. For example, there were incidents of surgery being delayed due to a lack of imaging equipment.”

Deanna Westwood, CQC’s director of operations in the south, said: “We carried out this inspection of University Hospitals Sussex NHS Foundation Trust in response to concerns raised with us around culture and leadership.

“At the time of our inspection we found staff on the front line doing their best to provide safe and effective care and treatment, despite significant pressures and a challenging working environment. However, staff and people using services were being let down by senior leaders, especially the board, who often appeared out of touch with what was happening on the wards and clinical areas and it was affecting people’s care and treatment.”

The medical negligence team at Lime Solicitors posted: “It is reported that police are investigating at least 105 cases of alleged medical negligence at Royal Sussex County Hospital, which seemingly took

place between 2015 and 2021. Neurosurgeon Mansoor Foroughi and general surgeon Krishna Singh both raised concerns during their time working for University Hospitals Sussex NHS Foundation Trust.

“Both Foroughi and Singh raised their concerns with the chief executive and chief medical officer of University Hospitals Sussex NHS Foundation Trust. It took five years for the police to eventually start investigating in May 2023, following both surgeons’ claims that patients were dying unnecessarily.”

One of Lime’s negligence experts wrote: “From our experience, it is unusual for the police to become involved in investigating matters of alleged medical negligence. Therefore, the fact that there is an ongoing police investigation that spans a significant period of time and clearly involves many patients is hugely concerning from a patient safety perspective. Our thoughts lie with all of the families affected by this.

“It is not for us to comment upon the validity of the disciplinary actions taken against Foroughi and Singh. However, it is notable that the concerns they raised appear to be echoed independently by the Royal College of Surgeons and the CQC.” q

FAILURES IN PRIMARY CARE CAN LEAD TO LIFELONG CONSEQUENCES

[ LIVING WITH HEARING LOSS or tinnitus is difficult at the best of times, and most of us will experience some degree of hearing loss as we age; but when permanent hearing loss is caused by lack of appropriate treatment or misdiagnosis there may be a case to seek redress.

One area that has been identified as prone to giving rise to error is the initial primary care consultation. Jamie Green of Manchester law firm Fieldfisher has posted experience of a clutch of such cases.

“I have recently acted for three different people, each of whom suffered acute sensorineural hearing loss and none of whom received appropriate treatment,” wrote Jamie. “This has caused all of them to suffer permanent hearing loss and associated symptoms, and appears to highlight a knowledge gap in primary care services about how to treat acute hearing loss.” He pointed out that there are several potential causes of sensorineural hearing loss. Although treatable, if not treated correctly it can lead to permanent hearing loss or tinnitus.

“The claims I am currently investigating contain a catalogue of errors in assessing and treating my clients. One was wrongly diagnosed with Meniere's disease, despite not suffering from vertigo (a classic symptom for this diagnosis) and was told to stop taking the steroids correctly prescribed by his GP the day before.

“Others came across multiple GPs simply not following NICE guidelines and failing to urgently refer them to the local ENT or A&E department, and a nursing practitioner at an Urgent Care Centre failing to ask any questions about hearing loss or to perform a hearing test despite this being the reason for his attendance.

“In complaints correspondence I have seen for one of my clients, the GPs in question actually stated they were not even aware of the requirement to urgently refer a patient with acute hearing loss to the local ENT or A&E

department, as per the NICE guidelines.

“All three of my clients now have permanent hearing loss in one ear, require a hearing aid and have other associated symptoms such as hyperacusis, constant tinnitus and balance issues. Their personal and professional lives have been affected and they will permanently suffer from on-going symptoms.”

Jamie is now lobbying for appropriate training, so that future patients receive the right treatment and do not go on to suffer the lifelong consequences his clients have. q

SCOTTISH REVIEW PROMPTS ENGLISH FOLLOW-UP

[

FOLLOWING THE PUBLICATION of the expert review of audiology services in Scotland, CQC circulated all trusts in England to urge them to review their own services.

The letter states: “These findings led to a review of the service provided by four NHS trusts in England which found similar failing. A Paediatric Hearing Services Improvement Programme has been established by NHS England to support providers and integrated care boards to improve the quality of these services. The programme is undertaking work to understand the scale of the problem and the number of children who have been affected, and to develop the strategic tools and interventions to support sustainable improvements.

“CQC are working closely with NHS England to help understand the current situation across the country regarding the level of assurance boards have about the quality of hearing services for children that they commission or provide.”

The letter urges trusts to gain accreditation under UKAS’s Improving Quality in Physiological Services standard. q

PSYCHIATRISTS’ BODY CALLS ON ELECTION

PARTIES TO PRIORITISE MENTAL HEALTH

[THE ROYAL COLLEGE OF PSYCHIATRISTS has called on all parties in the General Election to prioritise the prevention of mental illhealth and recognise that there is ‘no health without mental health’.

In a statement launching its manifesto, the RCPsych said: “Many mental health conditions are avoidable and can be cured if treated early; and for those with enduring severe mental illnesses, high-quality treatment that is timely, safe and therapeutic can reduce the duration of episodes and minimise relapses.

“Excellent mental healthcare makes people more likely to be able to build strong relationships, achieve their potential and have fulfilling lives. That is why we have published a manifesto outlining how mental health can be a key part of any next government’s ambitions.”

The manifesto sets out five key areas the next government should focus on:

• Reducing the occurrence and, therefore, the prevalence of severe

• mental illness

• Reversing the mental health crisis

• Achieving parity of esteem between physical and mental health

• Supporting the mental health workforce

• Equitably funding mental health research and data collection to

• improve understanding and facilitate innovation

In the Foreword to the manifesto, RCPsych president Dr Lade Smith CBE writes: “The public mental health emergency is real. There is a clear need for cross-government prioritisation, with ministerial support, to prevent mental illness.

“We need investment in high-impact, evidence-based public mental

health interventions to catch behaviours indicating a developing mental health condition at the earliest possible stage, preventing them from persisting and impacting people for the rest of their lives.

“This is why we are calling on all political parties to prioritise the prevention of mental illness in their manifestos.” q

DRUG AND ALCOHOL DEATHS ON THE RISE IN SCOTLAND

[SUSPECTED DRUG-RELATED DEATHS in Scotland have increased by 11%, according to the latest quarterly data. However, drug-related hospital admissions are down by 24%, a monitoring report shows.

The data is contained in the quarterly Rapid Action Drug Alerts and Response (Radar) report from Public Health Scotland (PHS). The figures for suspected drugs deaths covered the period between December and February, while the hospital admission data covered October to the end of December 2023.

PHS’s report said the total number of suspected drug deaths during the period was 278, averaging 23 per week, based on reports and observations from police attending scenes of deaths.

While that was 11% higher than the previous period, it was stable compared to the same periods starting in December 2021 and December 2022.

Responding to the figures, Dr Susanna Galea-Singer, chair of the Addictions Faculty at the Royal College of Psychiatrists in Scotland, called for more ring-fenced funding to tackle drugs. She said: “While it’s encouraging to see hospital admissions down, the increase in drug deaths paints a very sad story because every death from addiction is a personal tragedy.

“Working on the frontline, our clinicians tell us they’d like to see more ring-fenced funding in health, social care and the third sector. This would

NEW 10-YEAR STRATEGY WELCOMED BY PSYCHOLOGISTS

[

IN MAY the government published a new 10-year drug and alcohol strategic workforce plan for England. As part of the strategy, the recruitment and retention of psychologists is outlined as a key priority, with a recommendation that trainees on doctoral programmes are offered placements within drug and alcohol services, supporting existing psychologists in the workforce.

Advice for the sector also includes forging links with universities to raise awareness of working in drug and alcohol treatment among potential new recruits.

Dr Sarah Stacey, chair of the Division of Clinical Psychology's Faculty of Addictions at the British Psychological Society, had a pivotal role on the Department for Health and Social Care's taskforce, which helped formulate the strategy.

Welcoming its launch, Dr Stacey said: "The plan recognises the vital role that practitioner psychologists hold in multi-disciplinary teams, supporting workforce development through clinical leadership, supervision and knowledge of relevant evidence.

“Psychologists and wider psychological professions also provide effective interventions that acknowledge the underpinning causes and contexts through which problematic drug and alcohol use and co-existing difficulties develop.

"In addition to the forthcoming capability framework and workforce calculator, the plan provides a strong foundation for delivery of training, supervision and accreditation, building on the passion and commitment of the sector.

"The focus on workforce wellbeing and career development supports the development of high-quality, effective treatment and recovery services. We look forward to collaborating closely with Office for Health Improvement and Disparities and NHS England colleagues and welcome the commitment to addressing training, recruitment, development and retention of psychologists in drug and alcohol services." q

increase access, choice and care for those people who so desperately need the right treatment and support.”

At the same time, campaigners have demanded action to tackle Scotland’s continuing ‘alcohol emergency’, as new figures showed the rate of drinkrelated deaths is still the highest in the UK.

New data from the Office for National Statistics showed alcohol-specific deaths across the UK had reached a record high, with 10,048 people dying in 2022. While there were 16.6 deaths per 100,000 people across the UK, in Scotland the rate was higher, at 22.9 deaths per 100,000.

There were 1,276 deaths in Scotland in 2022 –the highest total since 2008 – with the latest figures showing that 836 men and 440 women died as a result of alcohol.

Deaths among women were up from 361 in 2019 – an increase of almost 22% – while deaths among men were up by nearly 27% over the same period, rising from 659 in 2019.

Dr Galea-Singer said: “These latest statistics are truly alarming; but worryingly, they may only be the tip of the iceberg. Working on the frontline in addictions we know hospital admissions remain at an all-time high and the pandemic only exacerbated the problem.

“Minimum pricing may have reduced the number of hazardous drinkers but those who are dependent on alcohol will continue to drink – and this issue needs to be addressed.

“It’s clear we need more hospital and community addiction services that fully support individuals to maintain their states of recovery. But above all, we need to address once and for all, Scotland’s cultural relationship with alcohol.” q

HOW PREVALENT IS COMPLEX PTSD IN ASYLUM SEEKERS?

By Dr Muffazal Rawala, Consultant Adult Psychiatrist and member of the Expert in Mind panel

[

PSYCHIATRISTS, the general public and the courts are aware of the widely-used term post-traumatic stress disorder (PTSD). The psychological consequences of exposure to trauma were extensively researched in Vietnam War veterans, which led to the development of diagnostic criteria for PTSD.

In the 1990s, research into the experience of domestic violence in children and women suggested a meaningful clinical distinction may be made between single traumatic events and repeated, prolonged, interpersonal traumatic events occurring in the context of an authoritarian control. That clinical definition of complex trauma has since gone virtually unchanged: “…exposure to repeated or prolonged instances or multiple forms of interpersonal trauma, often occurring under circumstances where escape is not possible due to physical, psychological, maturational, family/environmental or social constraints.”

PTSD may present with a range of symptoms, including re-experiencing the trauma, avoidance, hyper-arousal, depression, emotional numbing, drug or alcohol misuse and anger, as well as unexplained physical symptoms. The symptoms of PTSD are extreme, encompassing more than just remembering the event or dreams, but a combination of disabling recall, dreams and memories. A large percentage of trafficked adults present with anxiety, depression or PTSD. PTSD sufferers may not present for treatment for months or years after the onset of symptoms, despite the considerable distress experienced.

Complex-PTSD is a subtype wherein those who have experienced repeated traumatic events like neglect, abuse or trauma over a longer time period may develop signs and symptoms of PTSD. ComplexPTSD is thought to be much more severe if the abuse and trauma happened early in life, was caused by a parent or carer, the person experienced repeated incidents over a number of years and felt entrapped with complete control of the abuser over the victim; for example, in the case of asylum seekers from totalitarian regimes or victims of human trafficking. Children with complex-PTSD could show behavioural problems or affected personality development, develop negative coping mechanisms and as adults may become socially isolated and unable to form trusting relationships.

It is a widely held view that traumatic incidents are an extraordinary life experience capable of causing a wide range of physical and psychological suffering. Most clinicians and researchers agree that the

extreme nature of the traumatic event is powerful enough on its own to produce mental and emotional consequences, regardless of the individual’s pre-morbid psychological status.

The psychological consequences of repeated trauma, however, occur in the context of personal attribution of meaning, personality development and social, political and cultural factors. It is important to recognise that not everyone who has been repeatedly abused develops a diagnosable mental illness. However, many victims experience profound emotional reactions and psychological symptoms. The emotional restriction and inability to consistently recall details of abuse do not lead to any dispute in either the authenticity of being a victim of abuse; nor does it question the diagnosis of complex-PTSD. The emotional withdrawal, defensive indifference to traumatic memories and inability to consistently recall all details during asylum interview or statements suggest a defence mechanism to safeguard from reliving and re-experiencing the horrific traumatic abuse: features commonly seen in victims of abuse and complex-PTSD rather than the feigning of symptoms.

In refugee samples, PTSD has been shown to be common among victims of human trafficking, domestic violence and torture, although complex-PTSD has received little attention in that area. Two small studies in non-refugee samples investigated German victims of torture and domestic violence – finding a high prevalence of complex-PTSD –while none have investigated human trafficking.

The effect of major human rights violations on the presence of complex-PTSD in asylum-seeking populations and victims of human trafficking, torture and domestic violence has not been consistently researched, although it is widely seen in the clinical practice of psychiatrists with experience of working with asylum seekers.

Many asylum seekers and refugees have fled their country of origin to escape the horrors of war, persecution, organised violence or torture. Psychiatrists with experience of working with asylum seekers routinely see that individuals would have difficulty in elaborating their statements, might have gaps in their history in their witness statements or make conflicting statements during their asylum interviews/hearings. That makes it crucial that such individuals are referred to specialist psychiatry services with knowledge and experience of working with asylum seekers and their ability to interview them in a supportive environment to help overcome the emotional constriction and guarded behaviour. q

REGULATORY BODIES V PROFESSIONAL BODIES FOR EXPERTS:

UNDERSTANDING THE DISTINCTION

By Lisa Crowther, Quality Assurance Manager at Carter Brown

[EXPERT WITNESSES play a crucial role in providing specialised knowledge and opinions to assist the courts in understanding complex issues. However, the qualifications and standards for expert witnesses can vary significantly depending on the jurisdiction and the nature of the case.

To ensure credibility and integrity, expert witnesses often align themselves with regulatory or professional bodies. In many cases, such alignment is mandatory and plays a key role in protecting members of the public. Understanding the difference between these two types of bodies is essential for both aspiring and seasoned expert witnesses and those instructing them.

Regulatory bodies

Regulatory bodies are governmental or quasi-governmental organisations tasked with overseeing and enforcing specific laws and regulations within a particular industry or profession. In the context of expert witness work, regulatory bodies set forth standards and guidelines that govern the conduct, qualifications and ethical obligations of individual disciplines of experts. At Carter Brown, we work with psychologists of various protected titles, psychiatrists and independent social workers. One of the primary functions of regulatory bodies is to establish minimum qualifications and eligibility criteria. Those criteria may include educational requirements, professional experience, specialised training and adherence to a code of conduct or ethics.

Regulatory bodies also play a critical role in disciplining and sanctioning expert witnesses who fail to meet the established standards or violate ethical guidelines. That ensures continued trust in the profession and public protection.

In the UK, psychologists are regulated by the Health and Care Professions Council. Both psychiatrists and paediatricians are overseen by the General Medical Council. While previously regulated by the Health and Care Professions Council, since 2 December 2019 social workers have been regulated by Social Work England.

Professional bodies

Professional bodies, also known as professional associations or organisations, are non-governmental entities formed by professionals within a particular field or industry to promote excellence, provide support and advocate for the interests of their members. Unlike regulatory bodies, professional bodies are typically not vested with legal authority to enforce compliance with standards or regulations.

In the expert witness field, professional bodies serve as communities of practice where individuals can network, access resources and engage in continuing education to enhance their skills and knowledge. Those organisations may offer certification programmes, training seminars, conferences and publications tailored to the needs of members who work as expert witnesses.

While professional bodies may establish their own standards and guidelines for members, their primary focus is on professional development

rather than regulatory oversight. Membership of a professional body can signal to legal professionals and potential clients that an expert witness is committed to maintaining high standards of practice within their field.

The British Psychological Society is the key professional body for psychologists working in the UK and works hard to uphold standards of education and training for its members. The Royal College of Psychiatrists performs a similar function for psychiatry experts, while the Royal College of Paediatrics and Child Health supports and oversees training routes for its members. BASW and NAGALRO both serve as professional bodies for independent social workers.

Key Differences

Authority: Regulatory bodies have legal authority to establish and enforce standards for experts within their individual disciplines, whereas professional bodies are voluntary organisations focused on professional development and support.

Enforcement: Regulatory bodies have the power to discipline and sanction expert witnesses for non-compliance, while professional bodies lack enforcement authority and rely on voluntary adherence to standards.

Focus: Regulatory bodies prioritise legal compliance and public protection, while professional bodies prioritise professional development and networking opportunities for their members.

Membership: Membership of a regulatory body may be mandatory for individuals practising in certain professions or industries, while membership of a professional body is typically voluntary.

In conclusion, regulatory bodies and professional bodies serve distinct but complementary roles in regulating and supporting expert witnesses. While regulatory bodies set and enforce standards to ensure the credibility and integrity of experts within their individual disciplines, professional bodies provide a platform for professional development and community engagement within the field.

Those instructing expert witnesses can benefit from understanding the roles and functions of both types of bodies in advancing their experts’ careers and maintaining the highest standards of practice. q

DISCRIMINATION AGAINST PEOPLE WITH SEVERE MENTAL ILLNESS IS CUTTING LIVES SHORT: UK’S TOP PSYCHIATRIST

[DR LADE SMITH CBE, President of the Royal College of Psychiatrists, has warned that outcomes for people with severe mental illnesses (SMI) will only get worse unless society champions their right to acceptance and support.

She said: “People with severe mental illness are discriminated against every day. They face outdated and old-fashioned stereotypes and tropes, which are simply wrong. Discriminatory attitudes have us believe that an SMI is somehow a negative character flaw, intrinsic to who people are, that can never be changed, rather than an illness that can be treated.

“Internalising this discrimination makes it much harder for people to accept their condition and believe they can be helped. Ultimately, this contributes to them delaying seeking treatment, and increases the risk of crisis.

“The reality is that people with SMI are some of the most marginalised and vulnerable in our society. Too often they are treated as pariahs: shunned and excluded. This makes it really hard to find employment, have meaningful relationships and secure somewhere safe and comfortable to live.

“They are also significantly more likely to die by suicide, and have a life expectancy that is 15-20 years lower than the population, because of avoidable physical health conditions.

“This is a travesty. There are highly-effective treatments that can help the majority of people with SMI get well. With holistic care that provides psychological and lifestyle support, including treatment for any associated substance use issues, they are also more likely to stay well.

“We cannot sit back and expect people living with conditions like bipolar illness, schizophrenia and other types of psychosis to constantly overcome barriers that society has put in their way. A concerted effort is needed to stamp out the discrimination against people with SMI, so they can achieve their potential, and have fulfilling lives, like everybody else.”

Bipolar disorder affects around 2% of the population – 1.3 million people – and schizophrenia affects around 1% of the population: 669,700 people. High-quality treatment that is safe, timely and therapeutic can reduce the duration of episodes and minimise relapses.

Treating people early is key to preventing lives from being cut short. It reduces the risk of crisis, improves long-term outcomes, and enables people to live a full life and engage in and contribute to society.

The president of the college was speaking out as the RCPsych believes urgent change is needed to tackle the discrimination. She is calling for everyone to take a moment to reflect on their own attitudes towards severe mental illness and strive for a more compassionate point of view.

Graham Morgan works to improve the lives of people with mental illness, having been diagnosed with schizophrenia aged 28.

Graham said: “Schizophrenia can be a horrific illness. It's hard to explain exactly how it affects me. Over the years, I've had nurses and doctors show me that when I have stopped taking my medication, a few weeks later, I end up in hospital. This shows that my condition can be well managed by my medication.

“I have a very idealistic vision of love, kindness and belonging. I think if people like me felt fully part of society and accepted, not tolerated, life would be very different.” q

CARDIO CONFERENCE UNVEILS LATEST RESEARCH

[OVER THREE DAYS in Manchester, scientists unveiled the very latest in heart and circulatory disease research at this year’s British Cardiovascular Society conference. Some of the brightest minds from the UK and around the world came together to share their latest work.

Research into two new AI systems dominated the headlines, each embracing the power of data to help doctors with their lifesaving work. One AI tool – Rapid-RO – could help tens of thousands avoid unnecessary hospital stays each year in the UK by rapidly ruling out heart attacks in people attending A&E, allowing them to be safely sent home. Another study showed that a new tool, named FIND-HF, is able to accurately predict who is at highest risk of developing heart failure by identifying tell-tale patterns in an individual’s GP records.

Using more ‘traditional’ technology, researchers part-funded by the British Heart Foundation (BHF) showed that thousands of patients admitted to hospital every year with suspected heart attacks could avoid unnecessary invasive angiograms if they have a routine heart MRI scan first. Researchers found that it could change how doctors treat at least half of patients.

Research funded by the BHF found that remotely monitoring patients after a heart attack could reduce hospital readmissions and improve patient outcomes. The study compared remote monitoring – known as telemedicine – to standard care following a heart attack.

Two papers shone a light on health inequalities facing heart failure patients from ethnic minority backgrounds. Analysis of data from over 16,700 patients revealed that ethnic minority patients with heart failure are at 36% higher risk of death compared to white patients after an average of 17 months.

When the researchers looked at people who also had atrial fibrillation, and controlled for factors like age, they calculated that ethnic minority patients were over twice as likely to die as white patients were during the 17-month follow-up period.

In particular, research using data from over 17,600 South Asians spanning over 20 years found that South Asians are almost twice as likely as White Europeans to develop coronary heart disease.

Award winning researchers

BHF-funded researcher Dr Rasha Al-Lamee of Imperial College London was the deserving winner of this year’s BHF Fellow Award, recognising her years of groundbreaking work trialling the best ways to treat heart conditions like angina, while this year’s Michael Davies Award lecturer was Professor Eylem Levelt, in recognition of her fantastic work looking into the best ways to treat heart problems in people with diabetes. q

GIRFT GUIDANCE FOR AORTIC STENOSIS INTRODUCED

[ AT THE END OF LAST YEAR, new guidance was issued outlining six key steps to implementing a single point of access (SPA) for aortic stenosis patients. Specialists from heart centres across England and Wales worked with the Getting It Right First Time (GIRFT) team to develop the guidance, with a view to ensuring patients are seen more quickly. It also includes good practice examples from centres who are demonstrating success.

Aortic stenosis (AS) is one of the most common causes of heart disease, with around 300,000 adults aged 55 years or older estimated to have severe AS in the UK. If untreated those patients have a poor prognosis: the five-year mortality rate of severe symptomatic AS has been estimated at 88%, worse than for many cancers.

GIRFT data shows that many patients are experiencing delays in the referral and treatment pathways, and therefore not receiving the timely treatment which can improve their chances of survival and their quality of life.

Establishing a SPA – ensuring cardiology teams can arrange the right care for urgent and non-urgent referrals – is widely acknowledged as a key step to improving treatment pathways. However, while some UK heart centres have implemented a SPA, the degree of success has varied, and many centres have yet to adopt the approach.

The new GIRFT guide is aimed at clinicians and heart centres working to optimise referral and treatment pathways for patients with severe AS. It is designed to be complementary to the British Heart Valve Society’s work and joint professional society guidance for cardiac multidisciplinary meetings, as well as GIRFT’s own best practice pathway for the management of aortic stenosis. q

REPORT ON BIRTH TRAUMA WELCOMED ACROSS THE BOARD

[ BOTH THE Royal College of Obstetricians and Gynaecologists (RCOG) and the British Psychological Society have welcomed the All Party Parliamentary Group (APPG) Birth Trauma Report, which highlights some of the key challenges and instrumental areas in which progress can be made. The RCOG submitted both written and oral evidence to help support the report’s development.

Overall the report highlights several key themes, including failure to listen to women, lack of informed consent, poor communication, lack of pain relief, lack of kindness, breastfeeding problems, postnatal care, the impact of COVID and medical negligence. The report includes many firsthand birth trauma experiences from women and highlights many of the challenges that currently face maternity services and perinatal care in the NHS.

The RCOG expressed its support for the call to recruit, train and crucially retain more midwives, obstetricians and anaesthetists in the report. The workforce across the health system also needs to be able to meet the needs of perinatal women and their families, including general practice support for postnatal checks and appropriately trained interpreters.

One key focus of the report was obstetric anal sphincter injury (OASI), also known as a severe perineal tear, which can occur during vaginal birth. To combat that the RCOG, with the Royal College of Midwives, has developed the OASI Care Bundle – a comprehensive set of interventions aimed at reducing the incidences of severe tears and improving outcomes for women.

The college also echoes the report’s calls for the implementation of NHS England’s Perinatal Pelvic Health Services’ specification in maternity units and would support further exploratory work around linking pelvic floor health clinics with maternal mental health services, as suggested in the report.

Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, said: “The college welcomes this important report from the APPG, which highlights the very moving stories of women who have been affected by birth trauma. Birth trauma is often overlooked, despite its life-changing impact, so we sincerely thank the APPG for its work to shine a light on this difficult yet important topic, and commend the bravery of the women who shared their stories.

“As the stories of women affected starkly show, physical birth trauma can also have a significant effect on a woman’s mental

health and well-being. Providing services in a joined-up way would potentially make it easier for women to get the holistic support they need.”

Responding to that aspect of the report, Dr Camilla Rosan, chair of the British Pyschological Society’s Faculty of Perinatal Psychology, said: “We applaud the bravery of everyone who shared their experiences with the inquiry. Experiencing a traumatic childbirth can be extremely distressing and has a devastating psychological impact if people cannot access therapeutic treatments when they are needed.

“Access to psychologically-informed perinatal care must not be a postcode lottery. The recent establishment of maternal mental health services in England is a welcome start, but it is clear from what we are seeing on the ground and from this report that these services are stretched too thinly.

“We must prioritise their establishment in all four nations, and where they already exist they need to be expanded with additional investment, including growing the maternal mental health workforce.

“Only then will we see the culture change needed within maternity services, which will ensure all parents have access to the care and support they deserve.” q

HOW TO NAVIGATE THE COMPLEXITIES IN MEDICAL AND HEALTHCARE CASES

By Jason Wilson, a director of Medical Explants Ltd

[THE UNITED KINGDOM’S healthcare system stands out as one of the best globally, serving millions and supporting individuals with birth to end-of-life care. However, issues can arise with products, surgeries or equipment, leading to legal claims involving medical devices, equipment or commodity products, as well as cases resulting in medico legal action or criminal charges. In this article I aim to highlight some of the areas which may require closer consideration going forward and others where changes may affect the choice of professional expert’s opinion.

The healthcare system comprises both the NHS and the private sector. Perhaps surprisingly, approximately half of primary hip and knee procedures occur in the NHS, while the other half take place in the private sector. That distribution results from various factors, including choose-andbook policies, self-funded patients and insured patients through private healthcare schemes, with long waiting lists contributing to the scenario.

As healthcare budgets tighten, manufacturers are compelled to streamline their supply chains. The international market introduces complexity, with products sourced through many channels – from raw materials to subcontractors. While lower prices from less expensive markets may seem attractive, they often come at the cost of quality, particularly with commodity products. While initially appearing similar, these products may not hold up to scrutiny in practice.

In recent decades, significant advancements have occurred in the development of medical devices and surgical techniques, driven by collaborative efforts among manufacturers, researchers, developers and clinicians worldwide. Those collaborations aim to improve patient

outcomes, foster innovation for competitive advantage, refine surgical techniques for consistency and embrace cutting-edge technology for personalised patient care. However, navigating that dynamic landscape presents challenges – requiring a fresh perspective on expert approaches in medico legal cases.

While many innovations aim to enhance healthcare and efficiency, the landscape has become increasingly complex. Some developments have caused major issues and attracted much media attention due to the patient suffering and where there have been other high-profile negative consequences.

Metal-on-metal hips, PIP breast implants, vaginal mesh and issues with substandard personal protective equipment (PPE) have not met the expected benefits in terms of outcomes. As the medical field progresses, the complexity of legal issues has grown, necessitating a comprehensive understanding and approach to the relationships among patients, surgeons, hospitals and manufacturers.

In particular, the Pinnacle Metal on Metal Hip Group Litigation (Gee & Others v DePuy International Limited) [2018] EWHC 1208 (QB) case highlighted that: “A product’s benefits, cost and avoidability were features which could, in appropriate cases, be taken into consideration when assessing whether a product is defective,” and that: “In an appropriate case, evidence of compliance with regulatory standards will have considerable weight.”

That complexity extends beyond the products themselves to encompass various factors, including patient health, surgical techniques (including robotics and personalised approaches), user training, product storage, equipment maintenance and interactions between products from different manufacturers. Thus, a holistic forensic approach is necessary when addressing legal cases involving medical devices, surgery or healthcare matters.

Transitioning from Medical Device Directives to Medical Device Regulations presents further challenges, with some manufacturers discontinuing older products in favour of newer, more profitable alternatives. That shift impacts on post-market surveillance efforts: essential for identifying issues and implementing improvements.

However, executing effective post-market surveillance can be complicated due to logistical challenges and regulatory requirements. Indirect factors such as information governance, patient consent and GDPR compliance also play integral roles in potential legal actions related to medical and health issues. The UK's differentiation between CE and CA markings adds another layer of complexity, making navigating the intricacies in complex cases involving medical devices and healthcare products challenging.

Furthermore, those involved in medical and healthcare cases should ideally possess some commercial expertise to understand product intricacies, potential errors, logistical considerations and regulatory hurdles. That broader perspective ensures a comprehensive assessment of relevant factors and a better understanding of the issues at hand.

Commercial expertise is crucial, as evidenced by a growing number of cases in the medical devices and healthcare industries. Professionals must consider product intricacies, potential surgical errors and the regulatory challenges surrounding the case. Engaging experts with knowledge about the complex landscape – beyond clinical expertise – ensures a comprehensive understanding and consideration of all relevant factors. q

• With over 30 years of experience in the medical device and healthcare industry, Jason Wilson exemplifies the importance of integrating commercial expertise into medicolegal cases. Contact jwilson@medicalexplants.com

HOW TO LOSE YOUR EXPERT WITNESS

By Professor Charles Claoué, head of chambers at EYE-LAW CHAMBERS

[CONSIDER THE THREE PARTIES: firstly the court, which needs help to make a judgement and depends on expert witnesses, since judges generally don’t know the technicalities of a case and have recently become much more demanding and critical of experts. Secondly solicitors, who desperately want the best outcome for their clients but have to manage expectations and funding and cash flow. They sometimes use agencies so that they don’t have to chase tardy experts and for their help with cash flow. Thirdly the expert witness, who is usually very busy within their speciality (we only accept applications from experts in active clinical practice at Eye-Law Chambers) and who expects to get paid for their expertise – by the solicitor and not the court! Pace: I haven’t forgotten the client; but, although they are sometimes disappointed by an expert opinion, they don’t usually figure in disputes.

What could possibly go wrong?

In 2020 Bond Solon published a report, Payment issues affecting expert witnesses. It made grim reading, with 96% of 285 participating experts having experienced ‘late payment’. That was overwhelmingly by law firms, which were twice as likely to be late than agencies. Over 50% of experts said this was a ‘regular’ occurrence.

Of course, I accept that the majority of solicitors are decent, honest, hardworking professionals with high standards, but it does look as though there is a pernicious minority who misbehave. Similarly, although serious expert witnesses are accredited, for example by The Academy of Experts, recent court criticism of a few experts does show that there is that pernicious minority who misbehave. The repeated phrase is not accidental.

So how do you lose your expert witness? Clearly money is likely to figure. With over 200 years of collective expert experience in Eye-Law Chambers, we have seen a number of situations which could justifiably lose the expert. The following examples are striking and some of them have been seen by more than one of our experts. Although all are based on real experiences, they have been anonymised.

“I won’t pay until I’ve read your report and see whether it is worth your invoice.” Leaving aside that this is just rude, it is up to the court to decide whether an expert report is adequate. If seriously sub-standard there are civil remedies available, but if an expert has done the work, it is reasonable for them to be paid and refusal doesn’t motivate them.

“Your report isn’t helpful to my client so I’m not going to pay you.” That is usually said on a telephone call rather than email, but is clearly an incentive to change the expert’s opinion and unethical. This isn’t as rare as it should be.

“I have taken your PDF report and converted it to WORD so that I could edit it. Please confirm that you agree to my edits.” This was one of my cases and came from a relatively junior solicitor. I had a very interesting conversation with the senior partner, who then took over the case.

“We have no funds to pay your invoice and you should approach the claimant/defendant/other party for your fee.” That led to proceedings being issued in Northern Ireland.

“Now you’ve done a screening report I don’t expect it will take more than an hour to upgrade it to a full CPR35-compliant report”. Seriously? You really don’t understand that a screening report doesn’t involve looking at more than a selection of documents?

“We will only pay you when the case settles.” And how exactly do you expect us to know?

From an agency: “Although I’m not medically qualified, nor have any professional qualifications, I want you to change your report as follows…” Seriously? Will you put your name to the report in front of a judge?

“The legal aid rate is £108/hr and that is all that you will be paid. We will pay you when we get paid.” We base our rates on the hourly rates of Home County solicitors and haven’t been able to find any charging £108/hr. We don’t have to do this work and expect a professional rate. If there are no experts, that is not in the interest of justice.

“Please agree to a 12-month/three-year deferment for your fees.” Sorry, but we are not registered with the FCA to provide credit.

This is of course a collection of rare events. We only see them because of our large number of experts in Eye-Law Chambers. The overwhelming majority of our clients are impeccably behaved and are happy to agree our robust Terms of Business – which we recommend to all expert witnesses – in return for a guaranteed four-week delivery time. We have a high rate of repeat instructions of which we are very proud.

So, what of the future?

We hope that all experts – and not just those in Eye-Law Chambers – will provide the highest possible quality reports which meet the expectations of the judiciary. We hope that solicitors and agencies understand that experts are serious and busy professionals who are trying to help with dispute resolution, but who expect to be paid a reasonable rate for their time.

It will be the adults in the room who ensure that bad behaviour by experts or solicitors or agencies is unacceptable and must not be tolerated. If we all have the same standards and expectations, we will see bad behaviour become a thing of the past. q

CATARACT SURGERY IS GETTING SAFER, AUDIT SHOWS

[THE SAFETY of cataract surgery in the UK is continuing to improve, results from the Royal College of Ophthalmologists’ latest National Ophthalmology Database (NOD) cataract audit have shown.

Data gathered from 177 centres over a 12-month period to 31 March 2023 indicate that fewer than one in 200 patients experience substantial reduction in vision following cataract surgery. The major complication of surgery, posterior capsule rupture or PCR, is occurring in less than 1% of operations.

Audit results also show that cataract surgery is being undertaken at an earlier stage in the disease process than ever before – possibly because of the increasing safety of the procedure – with many people electing to have surgery while still having vision good enough to drive legally. That has led to an expansion in the numbers of cataract surgeries being done nationally.

Dr John Buchan, Clinical Lead of the RCOphth NOD Cataract Audit, commented: “The increase in numbers and safety of cataract operations is encouraging for both patients and providers. The expansion has been achieved by the growth of high-volume consultant-delivered services, but this increase in low-complexity cases also represents an opportunity to improve surgical training, which has not yet been seized.

this or other robust methods of obtaining feedback on surgery must be constructed if we are to be confident in the quality of surgery that we are providing nationally.”

“The other main thing flagged up by this year’s audit is the need to build better data collection systems to capture the results of cataract surgery. With more patients being followed up in the community, hospitals are getting data on postoperative visual acuity and complications in less than two thirds of cases.

“Ophthalmic electronic medical record providers offer solutions to allow community optometrists to report the outcomes of surgery, but

The National Cataract Audit is a collaborative venture, and the RCOphth has thanked every hospital and clinician that contributes to making it the success it is. The college encourages the remaining hospitals who have not yet joined to work towards that goal in the next year, so that all NHS patients can be protected by the quality assurance and benefit from their data, driving quality improvement nationally and locally. q

ROYAL COLLEGE SETS OUT THE WAY FORWARD FOR AI IN EYE CARE

[WITH THE PREVALENCE of AI innovations in ophthalmology and the wider healthcare environment, the Royal College of Ophthalmologists (RCOphth) has set out the college’s stance on the issue, outlining the potential of AI tools to transform eyecare delivery in the UK. The position statement highlights considerations for policymakers and healthcare leaders to help ensure that AI serves as a catalyst for positive change in the field.

The RCOphth believes that AI can bolster the capacity of ophthalmology services, enhance diagnostic and treatment provision and widen access to specialised care.

Commenting on the publication of the policy, Anthony Khawaja, chair of the college’s Informatics and Audit Committee, said: “Ophthalmology is at the forefront of AI in healthcare. With AI tools poised to transform eyecare services, it is vital ophthalmologists continue to lead the way in shaping the development and implementation of these technologies for the benefit of all patients.

“I welcome the college’s advocacy for a safe, equitable and effective implementation of AI in ophthalmology, emphasising the need for sufficient workforce capacity, appropriate governance frameworks and better integrated digital systems including interoperable imaging standards.

“AI adoption is and will continue to be an iterative process requiring on-going audit and quality assurance, with clinicians –supported by AI-enabled tools – remaining central to patient care.

“The college will continue to collaborate with policymakers, industry, patients and our members to help ophthalmologists effectively and safely deploy AI-enabled tools.” q

OPTOMETRISTS WELCOME HEADLIGHT

GLARE RESEARCH

[THE COLLEGE OF OPTOMETRISTS and the RAC have welcomed a commitment from the government to commission an independent study into the issue of headlight glare, after RAC research showed an overwhelming majority of drivers affected – as many as eight in 10 –believe the problem is getting worse.

Baroness Hayter of Kentish Town, who has raised the issue in the House of Lords, commented: “This is a victory for all those drivers affected by glare who’ve complained to their MP, signed the parliamentary petition or indeed sought help from an optometrist – only to discover the problem was with headlights, and not their eyes.”

Rod Dennis, the RAC’s senior PR and public affairs officer, said: “The fact the government has listened to drivers’ concerns and heeded our calls to examine the complex issue of headlight glare in more detail marks a real turning point.

“Brighter headlights, while giving drivers a better view of the road ahead, are clearly causing other road users significant problems. As many as nine in 10 drivers tell us they believe at least some car headlights are too bright, while 14% of drivers aged 65-plus say they have stopped driving altogether as a result of being dazzled.

“We look forward to working with the Department of Transport to help ensure the study is as robust as possible and drivers’ voices are heard.” q

NOTTINGHAM CENTRE BRINGS TOGETHER HAND SURGERY EXPERTISE

[ THE Centre for Evidence Based Hand Surgery (CEBHS) is a collaboration between the British Society for Surgery of the Hand, The University of Nottingham and Nottingham University Hospitals NHS Trust, working with patients and the wider community of all those involved in hand surgery care.

The CEBHS core membership comprises clinicians, academics and researchers from academic orthopaedics, trauma and sports medicine and the Nottingham Clinical Trials Unit.

Research priorities

The CEBHS describes its activity thus: “We aim to undertake research into common hand conditions of direct relevance to patients, clinicians and the NHS. We support a collaborative approach to study design, with patients, medical staff and clinical

SPECIALTY GROUP DRAWS DOWN FUNDING FOR RESEARCH

[ CLINICAL TRIALS are the foundation for evidence-based medicine, but currently less than 2% of government funding for medical research goes into surgical areas – despite the fact that a third of hospital admissions involve surgery. In 2012 the Royal College of Surgeons of England launched a clinical trials initiative to increase the quantity and quality of clinical surgical research.

Since then, the proportion of National Institute of Health Research (NIHR) funding allocated to hand surgery has been rising. In the six years after 2013, NIHR funding for hand surgery research totalled £12.4m of the £2.5bn awarded overall.

The British Society for Surgery of the Hand (BSSH), along with the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), supported the clinical trials initiative by appointing a Surgical Specialty Lead. The Surgical Specialty Lead works with the six UK Surgical Trials Centres to develop clinical networks, train surgical investigators and deliver the clinical trials in a timely fashion.

Along with the Surgical Specialty Lead, the creation of the Reconstructive Surgery Trials Network (RSTN) in 2013 has enabled access to methodological support from the Surgical Trials Centres and established the infrastructure to deliver high-quality, multicentre studies. The RSTN has also provided a platform for surgical trainees to get involved in research, based on a collaborative model.

The BSSH has also funded a Clinical Professor of Hand Surgery at the University of Nottingham, who set up the Centre for Evidence Based Hand Surgery and Hand Fracture Research Group.

In 2017 the BSSH-funded James Lind Alliance Priority Setting Partnership on hand and wrist conditions published their top 10 research priorities. q

trial experts working together to develop high-quality studies to improve clinical practice.

“In order to summarise what is already known and identify gaps in knowledge, we conduct systematic reviews of the evidence. We bring surgeons, therapists and patients together to prioritise research uncertainties, which can then be addressed by conducting research studies, such as randomised trials.”

Patient and public involvement

The CEBHS aims to involve patients, carers and the public in all of its research activity. That will help to ensure that it focuses on research questions that are relevant to all and improve the care of patients in the NHS. It also tries to develop and signpost reliable and unbiased information about hand surgery. q

BRISTOL RESEARCH PAVES THE WAY TO ALLEVIATE SCARRING

[ RESEARCHERS AT the Scar Free Foundation’s lab in Bristol have published a new review about wound healing: from the cells involved to ways clinicians could intervene in the process. Dr Oscar Peña Cabello (above left) and Professor Paul Martin (above right) published the review, Cellular and molecular mechanisms of skin wound healing, in the journal Nature Reviews: Molecular Cell Biology – a publication dedicated to sharing robust, accessible overviews of complex scientific topics. The review is available for anyone to read on the journal’s website.

Oscar and Paul work at The Scar Free Foundation Programme of Wound Healing Research at the University of Bristol. Their work uses a unique research pipeline to speed up the process of finding and then testing possible scarring genes. By analysing huge gene databanks, the team are identifying genes that potentially influence how well – or poorly – we scar. Then, using gene-editing technology, they can tweak the same genes in zebrafish and measure the effect on wound healing.

The Scar Free Foundation’s research projects at the University of Bristol include:

• Integrating human and animal studies to investigate known clefting genes linked

• to wound healing. This project brings together two Scar Free Foundation research

• endeavours: the Cleft Gene Bank and Cohort Study and The Scar Free

• Foundation Programme of Wound Healing Research at the University of Bristol.

• Using large cohort studies to identify genetic variants for mechanistic testing in

• mouse and zebrafish models of wound healing. Heavy scarring can hugely impact

• people’s lives psychologically and physically through impairment of body function.

• This project seeks to identify the genetic differences which cause better and

• worse scarring outcomes.

The work being done by Oscar, Paul and all the other researchers at the lab could be the key to scar-free healing. If the genes that cause ‘bad’ scarring can be identified, patients could be screened in advance of treatment and bespoke treatments offered to those in danger of life-changing scarring. q

BAAPS AUDIT SHOWS DECLINE IN UK COSMETIC PROCEDURES

[ THE British Association of Aesthetic Plastic Surgeons (BAAPS) – the organisation dedicated to advancing safety, innovation and excellence in cosmetic surgery – has released its annual audit. According to the new figures, 25,972 surgical procedures took place in 2023: a 16% fall from 2022.

Women had 93% of all cosmetic procedures in 2023. The five most popular procedures for women were breast augmentation (down 26%), breast reduction (down 17%), abdominoplasty, also known as the tummy tuck (down 19%), blepharoplasty, or eyelid surgery (up 1%), and liposuction (down 17%). Face and neck lift surgery increased in popularity to 6th place in 2023.

Men had 7% of all cosmetic surgery procedures: a fall of 20% from 2022. The five most popular procedures among men were rhinoplasty (down 1%), blepharoplasty (down 9%), chest reduction (down 29%), liposuction (down 36%) and octoplasty, or ear correction (down 22%).

The president of BAAPS, Marc Pacifico, commented: “In 2022, we witnessed the most substantial yearly increase in procedures since the audit's inception in 2004. While we anticipated a decline to offset the surge in post-pandemic pent-up demand and the prevailing recessionary environment, it’s noteworthy that certain procedures such

A POSH ADDRESS IS NO GUARANTEE OF QUALITY

[THE BAAPS has launched a Discover the Distinction safety campaign to address the on-going issues surrounding the qualifications and credentials of practitioners in the field.

A significant challenge facing consumers is the misleading titles used by individuals lacking formal registration as specialist plastic surgeons, such as ‘cosmetic doctor’ or ‘cosmetic surgeon’. That exposes unaware consumers to potential risks associated with invasive procedures and unfavourable outcomes. Moreover, there’s a misconception that practitioners operating from renowned locations like Harley Street automatically possess superior skills and qualifications.

The president of BAAPS, Marc Pacifico, emphasised the importance of discernment when choosing a surgeon, stating: “Many people mistakenly believe that a Harley Street address automatically validates a doctor’s credentials. This assumption is not accurate, because anyone can rent rooms in Harley Street. The geographical location of the practice has no impact on the surgery’s outcome or the skill of the practitioner.

“Always do your due diligence: make sure your surgeon is a member of their appropriate governing body. For a surgeon this should be The Royal College of Surgeons and that they are a member of BAAPS.”

To assist consumers in making informed decisions, BAAPS recommends evaluating three key criteria before proceeding with cosmetic surgery:

• Is the surgeon listed on the GMC specialist register and

• affiliated with the Royal College of Surgeons or an equivalent

• professional body?

• Are they a member of BAAPS or BAPRAS?

• Is the clinic or facility Care Quality Commission registered? By ensuring affirmative answers to those questions, patients can proceed with confidence, knowing they are in capable hands for a comprehensive consultation with a qualified surgeon. BAAPS encourages consumers to utilise their database of Specialist Plastic Surgeons, who are all qualified to carry out aesthetic plastic surgery procedures through the Royal College of Surgeons. q

as breast and body surgeries experienced a significant double-digit decrease. Conversely, facial procedures including facelifts, brow lifts and blepharoplasty remained largely stable or exhibited only minor declines.

“This trend appears consistent with the increasing number of individuals opting to travel abroad, particularly to destinations such as Turkey, in search of cheaper options for popular surgical procedures like liposuction and breast augmentation. However, this choice comes with significant consequences, not only for the individuals undergoing surgery overseas but also for the NHS, which often bears the burden of correcting complications upon patients' return to the UK.”

Vice president Nora Nugent remarked, “We’re observing a trend where individuals travelling abroad for surgery tend to be younger, with a median age of 39: indicating that financial considerations influence their choice to opt for cheaper surgical options. Typically, these surgeries pertain to breast or body enhancements, aligning with the priorities of a younger demographic.

“Conversely, procedures such as face, neck and eyelifts are more common among individuals aged 50 and above, who likely possess greater financial flexibility and are less swayed by discounted offers.” q

ORAL CANCER: THE MEDICOLEGAL IMPLICATIONS OF DELAYED DIAGNOSIS AND TREATMENT

By Mr Zaid Sadiq, consultant oral and maxillofacial surgeon

[CANCER OF THE ORAL CAVITY is the most common malignancy of the head and neck. The disease occurs more frequently in men, although the current male-to-female ratio of 2:1 appears to be decreasing. While the disease is much more prevalent in patients who are middle-aged or older, there has been a recent increase in its occurrence in younger individuals.

The prognosis for patients is linked to the disease stage at diagnosis and has significantly improved over the past 40 years. That is equally true for both early- and late-stage tumours. In 1973, three-year survival rates were 78.0% for early-stage disease and 51.9% for late-stage disease. By 2014, those figures had increased to 92.2% and 70.3% – probably due to the increasing use of chemotherapy as an adjuvant therapy following surgery. However, there is some evidence that the survival rate is linked to ethnicity, with five-year survival rates in men of African-American origin being much lower than those in white men. However, there remains a risk of delay throughout the diagnostic process, from initial presentation by the patient to referral and biopsy. Despite the fact that the oral cavity is easy to examine without specialised instruments, around two-thirds of tumours are only detected at an advanced stage and metastases are present in around 40% of cases at diagnosis. The impact of that delay remains controversial, with some reports that a delay in diagnosis of more than a month results in more advanced stages of the disease being identified. That finding is not universal, though, as several studies have failed to find any association between delay, stage of disease and outcome.

Delays in the diagnosis of oral cancer are the commonest reason for litigation for alleged medical negligence and can result in large settlements. That is due to the cost of care and the potential impact on the patient, which includes pain, disfigurement, reduced quality of life and psychological distress. However, a poor outcome is not always indicative of medical negligence: it is dependent on many factors, including the characteristics of the patient and the individual biology of the tumour. For example, there is evidence of a link between the expression of MSH2, a DNA repair protein, and outcome in cancers of the head and neck. Patients with low MSH2 expression have poorer outcomes and a lower chance of survival.

Perhaps surprisingly, dentists are at least as likely as doctors to identify the initial signs of oral cancer. Despite that, fewer than two-thirds of dentists routinely examine their patients for the disease, while doctors report that they generally only perform a mouth examination when the patient experiences symptoms. Confidence in being able to accurately detect oral cancer is low in both professions. A proper diagnosis can only be made following a thorough examination of the mouth, appropriate testing and accurate interpretation of the results. That may necessitate referral to a more qualified or experienced practitioner.

It is important that the initial examination includes evaluation of the cranial nerves and cervical lymph nodes, as well as inspection of the soft tissues of the mouth. Even when an abnormality is detected and treatment initiated, proper monitoring of the effectiveness of the therapy is often lacking. Therefore, treatment may continue for some time, even when it is ineffective.

A major complication in diagnosis is the fact that not all pre-malignant conditions become cancerous. Even when they do, differences at the cellular level, both within and between tumours, mean that the rate of progression is not predictable.

Furthermore, precise differentiation between the various stages of premalignancy and cancer can be subjective and requires considerable expertise. Generally, symptoms that fluctuate are less likely to indicate a malignant condition, whereas persistent symptoms that get progressively worse should always be investigated further.

Once the disease has become more advanced, as well as the presence of a mass it may be associated with symptoms such as discomfort, localised sensory alterations, limited movement of the affected tissues, speech difficulties, ulceration or bleeding, swelling in the neck and weight loss. However, even in the presence of symptoms, diagnosis of oral cancer can be difficult and failure to do so may not necessarily imply negligence on the part of the doctor or dentist.

A major reason for delay in identifying oral cancers is that they can be very difficult to diagnose. In the early stages there are very few symptoms; and even if they are present they tend to be minor and non-specific and thus are often mistaken for other trivial conditions.

Previously existing symptoms, particularly the sore throat, cough and hoarseness often associated with smoking or alcohol consumption, may further obscure the early symptoms of oral cancer.

Even advanced tumours can be associated with limited symptoms. Lesions in the mouth can appear clinically innocuous, presenting as red or white patches that are apparently benign. As a result, patients and healthcare providers may not suspect cancer. That may lead to a considerable delay between the appearance of the first symptoms and the initiation of treatment. On average, it takes just over five weeks for referral to a specialist and a further five weeks for surgical treatment, or 10 weeks for radiation therapy. However, the longest delay is often due to the patient’s failure to visit their doctor when symptoms first appear, with the average time period being around 5-9 months.

The likelihood of making an accurate diagnosis is improved if the appropriate tests are conducted and their results correctly interpreted. Often, that will depend on the resources available and the training and experience of the clinician. Many investigations begin with a biopsy of the suspicious lesion. However, site selection, technique and quality of the specimen may all affect the interpretation of the results.

There is also evidence of inter- and intra-rater variability, which may influence the likelihood of a cancer diagnosis being made. That is also true of other tissue sampling techniques, such as exfoliative cytology, fine-needle aspiration and core biopsy. It also appears that often a biopsy is not performed at all: nearly half of all legal cases involving cancers of the head and neck allege that a biopsy was indicated but not carried out. Some biopsy results can be extremely difficult to interpret, particularly where the histopathologic diagnosis is not consistent with the clinical appearance of the lesion. In those cases it may be necessary to repeat the biopsy or refer on to a more specialised and experienced clinician. Imaging techniques such as computed tomography and magnetic resonance imaging can be extremely useful in determining the extent of the primary tumour, as well as regional and distant metastatic disease, but those may not always be available and interpretation of the results is dependent on the skill and experience of the clinician.

The COVID-19 pandemic is likely to have had a significant effect on oral cancer diagnosis rates. The British Dental Association estimates that in England alone, 14 million dental appointments were missed during lockdown. That means that thousands of patients have missed oral cancer examinations that would have taken place as part of a routine appointment, or have not undergone further investigation following referral.

Across the NHS, waiting times for all types of cancer have increased, with 20,000 patients failing to be seen within 14 days of referral by their GP. For oral cancer that means there is an increased likelihood that cases will not be detected until tumours are at a more advanced stage. It is also likely that the effects of the backlog of suspected cases on referral times, diagnosis and ultimately outcome will persist for several years.

The association of oral cancer with both the human papillomavirus and immunosuppression means that the epidemiology of the disease is changing, and it is now much more common in younger populations, who were previously thought to be at very low risk. Doctors and dentists need to be aware of this change when examining younger patients, even when minimal signs and symptoms are present. In addition, the separation of medicine and dentistry may make it more difficult for patients to access the required oral care.

Increased awareness of the importance of recognising the symptoms of oral cancer early is urgently needed, both in the medical and dental professions and among the general public. Delays in diagnosing oral cancer can have extremely serious consequences, both from the patients’ and legal perspectives. q

• Mr Zaid Sadiq is a consultant oral and maxillofacial surgeon at the Queen Victoria Hospital in West Sussex and is regularly available for medicolegal consultations in Harley Street, London. Mr Sadiq is qualified in both medicine and dentistry and has a keen interest in cancer, reconstructive surgery and tissue engineering.

GDC REVIEWS IMPLICATION OF ‘TOP-UP’ RULING

[

FOLLOWING THE RULING of the Court of Appeal in the case of General Dental Council v Williams [2023] EWCA Civ 481, that ‘top-up’ fees can be permissible under the NHS (General Dental Services Contracts) Regulations 2005 (The Contract Regulations), the GDC undertook to consider whether the judgment had implications for the outcomes of previous fitness to practise cases.

The Court of Appeal upheld an earlier High Court decision that the proper interpretation of the Contract Regulations allowed for top-up fees in certain circumstances. The GDC appealed that judgment to establish clarity about how the Contract Regulations should be interpreted for dental professionals, dental practices, NHS bodies in England and for the purposes of its own regulatory activities.

In a statement the GDC said: “We have carried out a review of 124 cases involving ‘top-up fees’ since the Contract Regulations came into force. Having reviewed all the circumstances of the relevant cases and engaged the services of independent legal counsel, no further action was required, as it was established that the outcomes in these cases did not depend on the interpretation of the Contract Regulations which was at issue in the Williams case.

“It is for the Department of Health and Social Care and NHS bodies in England, who have responsibility for the Contract Regulations and associated guidance, to consider necessary actions and communicate any implications for NHS dental charges to patients and dental professionals.” q

BEST PRACTICE DECONTAMINATION GUIDANCE FOR SCOTLAND PUBLISHED

[FOLLOWING EXTENSIVE CONSULTATIONS, new, more practical decontamination guidance for the management, equipment and process of the decontamination of dental instruments in a Local Decontamination Unit (LDU) in NHS Scotland came into force at the end of April.

The new best practice guidance replaces relevant parts of the Scottish Health and Technical Memorandum (SHTM) 2010 relating to small steam sterilizers, SHTM 2030 for washer disinfectors, other previous NHS Scotland dental decontamination guidance and the Scottish Dental Clinical Effectiveness Programme decontamination publications.

Dental professionals should refer to the document in full, but the key messages and changes in Part C are:

• Dental handpiece decontamination and lubrication should follow

• manufacturer’s instructions

• For washer disinfectors, potable water that meets manufacturer’s

• requirements is adequate, otherwise filtration is required

• Use of a washer disinfector is a requirement for compliant

• reprocessing of dental instruments in an LDU. An ultrasonic cleaner,

• while useful as an additional cleaning aid, may only be used as a

• back-up in the event of washer disinfector failure

SODIUM CHLORIDE SOLUTIONS RECALLED

[BATCHES OF Legency Remedies Pvt Ltd irrigation saline products manufactured between April and November 2023 are being recalled due to potential microbiological contamination.

The British Dental Association wrote: “Waterborne bacteria, such as R pickettii, have the potential to contaminate healthcare products. In individuals with compromised immune systems R pickettii can lead to opportunistic infections. It is important to note that cases of R pickettii in the UK are rare and, as of 3 April 2024, three cases of R pickettii have been confirmed, with a small number of other cases under investigation.

“The confirmed infections occurred in individuals who have multiple underlying health conditions and compromised immune systems. All confirmed cases received treatment and recovered, but as a precautionary measure against this, the company has recalled all 0.9% sodium chloride solutions intended for irrigation manufactured between April and November 2023.”

In its report the BDA itemised the batches affected and issued guidance on the actions to be taken by dental practitioners. q

• Sterile water for irrigation is preferred for use in sterilizers

• Equipment records are to be retained for the lifetime of the

• equipment plus 25 years

• Sterilizer Automatic Control Tests are required to be carried out

• weekly, no longer daily

• Policies and procedures should be reviewed and updated periodically

• with revisions noted

• Equipment testing schedules should follow manufacturer’s

• instructions or, if unavailable, the schedules recommended in Part C The guidance can be downloaded from www.nss.nhs.scot q

DEEP VEIN THROMBOSIS: THE AFTERMATH

By Philip Coleridge Smith DM MA BCh FRCS

Consultant Vascular Surgeon, Medical Director of the British Vein Institute and Emeritus Reader in Surgery at UCL Medical School

[ I AM OFTEN ASKED to advise in cases where deep vein thrombosis (DVT) has occurred, commonly after trauma to the lower limb. Claimants who suffer injury in road traffic collisions may experience lower limb fractures, necessitating surgical intervention or perhaps just immobilisation of the lower limb.

The injury itself may damage the veins of the lower limb, but the need for surgery to repair injuries combined with immobilisation of the limb are strong factors which may provoke deep vein thrombosis. Orthopaedic surgeons are well aware of this potential complication of the injury and its treatment.

Prophylactic anticoagulant drugs reduce the risk of DVT developing but do not eliminate it completely. If swelling of the limb occurs it may be attributed to the injuries rather than to deep vein thrombosis.

Effect of delayed diagnosis

It is desirable to detect and treat any deep vein thrombosis as soon as feasible after it starts. It is recognised that effective anticoagulant treatment given for the first four weeks after the onset of thrombosis will lead to a much better outcome than if this treatment is started after the first month. Modern anticoagulant drugs are very effective in producing reliable levels of anticoagulation: injected drugs are not usually required. In patients experiencing trauma to the lower limb, swelling attributed to the injuries may conceal the onset of the DVT – leading to greater damage to the deep veins of the leg than would be the case with timely treatment.

Resolution of a DVT

Once thrombus has formed in any deep vein, a process begins which will usually lead to restoration of blood flow in the vein. Small blood vessels grow into the blood clot which is blocking the vein and those create healing tissue within the vein. Small channels usually appear within the healing tissue and gradually enlarge to form a small channel through the previously blocked veins. Slowly they expand to fill much or all of the healing vein.

However, a further process also occurs as the healing tissue matures and that is scar formation. A channel appears within the vein, but ultrasound images show bright linear echoes within the vein which are

the end product of the healing tissue that originally filled the vein (pictured left). In addition, veins may become narrowed as contraction of scars in the vein wall progresses. Commonly the deep veins in the calf become considerably reduced in diameter following a DVT.

Consequences of a previous DVT

The narrowed and scarred veins left behind as the healing process continues in the deep veins usually carry blood reasonably well, but not as efficiently as previously.

The valves in the deep veins often become damaged and allow blood to flow in the reverse direction, towards the feet. The pumping mechanism which returns blood to the heart from the legs is based on the calf muscles, which squeeze the veins within the calf to provide the pumping mechanism. The loss of venous valves reduces the efficiency of the pumping mechanism, so the calf muscles work harder and increase in size.

Failure of the venous valves leads to higher pressures in the veins at the ankle. That pressure is transmitted to the skin and can lead to a chronic inflammatory condition known as ‘lipodermatosclerosis’ in the skin and subcutaneous tissues. Left untreated, that condition may lead to leg ulceration (pictured below).

Management of a DVT

Advice on anticoagulant treatment is provided in NICE Guideline 158, which discusses the subject in detail. Conventionally, treatment is given for 3-6 months. The aim of that is to prevent extension or recurrence of the DVT. Following that period, the risk of further DVT is fairly low if the thrombosis has been caused by injury to the leg.

The patient may continue to have swelling of the calf and lipodermatosclerosis at the ankle, but further anticoagulant treatment will have no effect on those symptoms. The residual syndrome of leg swelling, aching, skin changes, ulceration and varicose vein development is referred to as post-thrombotic syndrome (PTS). PTS may vary considerably from patient to patient and is graded according to the Villalta Scale: a clinical scoring system based on the presence of symptoms and clinical signs.

The veins and valves damaged by a previous DVT are difficult to manage and for the most part it is unfeasible to repair the damage. Some exceptions to that may occur, however. Where the large veins passing through the pelvis from the leg become blocked, it may be possible to pass a guidewire though the blocked segment and restore blood flow with the help of stents to maintain the vein open.

For the remainder of patients, the most effect method of management of PTS symptoms is the use of medical compression stockings. These may need to be worn on a lifelong basis to prevent deterioration of the skin and leg ulcer formation.

In conclusion, deep vein thrombosis may occur in the lower limbs of claimants who suffer trauma in a road traffic incident. That condition may lead to post-thrombotic symptoms long after the lower limb fractures have healed. Lifelong management of leg swelling, aching and leg ulceration may be required. Expedient treatment of a DVT if it arises following trauma will lead to the best outcome. q

SPINAL CORD INJURY IS TWICE AS PREVALENT AS PREVIOUSLY THOUGHT

[DATA RELEASED IN MAY has revealed that the number of people injured or diagnosed with a spinal cord injury (SCI) each year is approximately double that previously estimated. The number is 4,400 and not 2,500, as previously thought.

The new data analysis was conducted by Andrew Coxon, National Spinal Cord Injury Database manager at the NHS, Abigail Lock, CEO at Back Up and Shajia Shahid, clinical research network manager at Spinal Research, with the support of a raft of charities.

As a result, the estimated prevalence of spinal cord injuries in the UK has risen to 105,000.

The analysis was derived from a number of NHS data sources, including the National Spinal Cord Injury Database and the UK Rehabilitation Outcomes Collaborative

covering admissions and referrals.

While improved data collection and further analysis are necessary, a significant portion of the increase can be attributed to the broader inclusion of both traumatic and nontraumatic injuries.

Spinal cord injuries can be caused by an accident, an illness or a health condition. They affect not just mobility and sensation, but also the functioning of bladder, bowel, skin, breathing and sexual function.

These new statistics have profound implications for design and delivery of services to people living with an SCI, including acute, rehabilitation and community health services, adult care, continuing health care, wheelchair services, non-governmental agencies engaged in transport, housing and the workplace, and charities and the third sector.

Nik Hartley OBE, chief executive of the Spinal Injuries Association, said: “The revelation that there are double the number of people across the UK who are sustaining a spinal cord injury each year is stark, but no surprise to the charities that support people across the UK. People with a spinal cord injury and their families too often face stretched or inappropriate health and support services, barriers to accessing carers, transport and housing and a lack of awareness about this life-long condition.

“The NHS and wider government must dramatically increase vital specialist health care and support to the 4,400 people each year who are having to come to terms with a life of paralysis from spinal cord injury. We will not stop campaigning until that change in investment happens.” q

NICE ACCREDITS NEW THUMB ARTHRITIS GUIDELINES

[NEW GUIDELINES from the British Society of Surgery of the Hand on the management of thumb base osteoarthritis (TBOA) has been accredited by the National Institute for Health and Care Excellence.

The document, Evidence-based Management of Adults with Thumb Base Osteoarthritis, provides comprehensive insights into the optimal approaches for managing the condition. Authored by experts in the field, the document delves into evidence-based strategies, encompassing diagnosis, treatment and rehabilitation. It offers a thorough examination of current research findings, clinical guidelines and therapeutic interventions tailored to address the unique challenges posed by TBOA.

One of the authors, Soham Gangopadhyay, explained: “Thumb base osteoarthritis is a common condition and it is generally agreed that initial management should be non-surgical, followed by surgery if needed. However, the provision and components of non-surgical treatment and choice of surgery remains variable across the country.

“Treatment of hand and wrist osteoarthritis is one of the top 10 priorities established by the James Lind Alliance Priority Setting Partnership. As such, we set out to provide an overview of the best available evidence for non-surgical and surgical management of TBOA in the United Kingdom and suggest a pathway for treatment of this condition.

“We performed a systematic review of RCTs [randomised clinical trials] on management options for thumb base osteoarthritis. Management was divided into non-invasive treatment, joint injection and surgery. The results indicated that the treatment of thumb base

osteoarthritis should follow a step-wise approach, starting with nonsurgical measures with low risk of harm before progressing to more invasive and complex treatments if pain and dysfunction continues.

“The evidence from our systematic review is presented in the form of clinical recommendations for practice in a number of user-friendly formats, including a patient flow algorithm and a quick reference tool that links into various resources to guide clinicians and patients dealing with TBOA.” q

MAJOR PARTIES COMMIT TO IMPROVED OSTEOPOROSIS SUPPORT

[OVER A PERIOD of 46 weeks the Royal Osteoporosis Society (ROS) mounted a campaign, together with the Sunday Express (‘Better Bones’) and, more recently, the Daily Mail (‘War on Osteoporosis’) for the extension of fracture liaison services (FLS).

These crucial services diagnose people with osteoporosis early, after the first broken bone, and help people stay on treatment. But the clinics are missing in half of trusts in England due to a postcode lottery; and many FLS are severely under-resourced, resulting in a ‘revolving door’ for fracture patients in hospitals.

In the week running up to the dissolution of Parliament, Health Secretary Victoria Atkins promised to extend FLS across the NHS in England by 2030. In a statement to the Commons she said: “Every year in England, some 67,000 fractures are suffered by people of working age, the majority of whom are women, and many of them are entirely preventable.

“I have listened to the tireless campaigning of the Royal Osteoporosis Society and the campaigns of The Express and The Mail on Sunday [sic], so today I want to confirm that this government has the ambition to expand the use of fracture liaison services to every integrated care

board in England and achieve 100% coverage by 2030.”

The following day Labour’s Shadow Health Secretary Wes Streeting added that party’s support to the measure.

He said: “Osteoporosis is a debilitating illness that leads millions of people to suffer painful bone breaks and disability. The faster patients are diagnosed, and the earlier they can be treated, the sooner they can get back to living their lives to the full.

“Labour has listened to this important campaign, and we will make sure the NHS diagnoses and treats osteoporosis patients on time. We are matching the Westminster Government’s ambition to expand the use of fracture liaison services to every integrated care board in England by 2030.”

The news follows the Ministerial Mandate for 100% FLS coverage in Wales, which has been supported by a transformation fund.

ROS chief executive Craig Jones expressed his delight at the news: “This is the biggest policy breakthrough people with osteoporosis have ever had. At last, the tragedy of preventable fractures has been recognised by both parties of government, and a shared commitment has been made for universal services to diagnose people early.” q

STUDY COMPARES SHOULDER REPLACEMENT METHODS

[A NEW STUDY using data from the National Joint Registry (NJR) has compared two types of shoulder replacement surgeries for osteoarthritis patients.

Data from the National Joint Registry provided valuable insight into the debate surrounding two types of shoulder replacement surgeries. Published in May 2024 in the BMJ and funded by the National Institute for Health and Care Research, the new study analyses and compares outcomes after reverse total shoulder replacement (RTSR) and anatomical total shoulder replacement (TSR) for osteoarthritis patients aged 60 or older with intact rotator cuff tendons.

Traditionally, TSR has been the preferred practice for osteoarthritis patients; however, in recent times RTSR has gained popularity and the National Institute for Health and Care Excellence identified it as a key research priority.

Researchers from NDORMS at the University of Oxford set out to provide high-quality evidence to help address the uncertainty. Using patient outcome data from the registry and from hospitals, the study analysed over 12,000 patients between 2012 and 2020. It compared outcomes between RTSR and TSR for revision surgery, serious adverse events, reoperations, hospital stay duration and lifetime costs.

The study showed that, while TSR had a higher risk of revision surgery in the first three years, there was no significant difference in the longer term and both procedures were equally safe for patients. Research studies such as this one provide invaluable insights for patients and surgeons while supporting informed decision-making for patients undergoing shoulder replacement surgery, the NJR says.

More than 8,000 shoulder replacements are performed every year in the UK and those volumes are rising. The NJR’s comprehensive data

collection and analyses such as this serve as an important resource for enhancing patient outcomes and elevating patient safety across orthopaedic specialties. q

BEYOND ChatGPT: THE POWER OF MAI MOTION IN MUSCULOSKELETAL MOTION ANALYSIS

By orthopaedic consultant and expert witness Professor Paul Lee

[WHILE AI MODELS like ChatGPT have garnered attention for their text-processing capabilities, MAI Motion represents a different branch of AI: computer vision. That distinction is crucial as it highlights the versatility and breadth of AI applications. Whereas ChatGPT interprets and generates text based on language models, MAI Motion utilises AI for visualisation, transforming two-dimensional images into rich, threedimensional interactive models.

That application of AI opens up new avenues for objective and detailed analysis of physical movements, setting it apart from the language-focused functionalities of models like ChatGPT.

The MAI Motion system exemplifies the cutting-edge application of AI-driven computer vision in musculoskeletal medicine, setting new standards for accuracy, objectivity and comprehensive analysis.

That sophisticated technology is not just an advancement in medical diagnostics; it’s a revolutionary step forward, offering unparalleled insights into human movement and biomechanics that are transforming both clinical practices and medico-legal assessments.

consistency in repeated measurements, essential for monitoring progression or recovery over time.

Transformative impact in medico-legal practice

MAI Motion’s comprehensive and objective analysis is particularly transformative in medico-legal contexts.

The motion lie detector in your pocket

MAI Motion technology harnesses the power of advanced computer vision and artificial intelligence to provide a depth of analysis previously unattainable in musculoskeletal assessments.

Some key features that showcase its capabilities are:

• High-resolution data capture: MAI Motion captures 5,000 data points per second, offering a high-resolution look into movements and adjustments of the human body. It is all possible via the standard camera from your mobile phone.

• Three-dimensional motion analysis: Unlike traditional twodimensional approaches, MAI Motion transforms captured data into a three-dimensional space. That allows for an all-encompassing analysis of movement, free from the constraints and biases of camera angles and observer perspectives. By creating a 3D model of movement patterns, it provides a holistic view of the biomechanical interplay at work, offering insights into how different joints and limbs interact dynamically.

• AI-enhanced precision: At the core of MAI Motion is its robust AI algorithm, which not only collects data but also interprets it, identifying patterns that signify deviations from normal kinematics. That level of analysis supports highly-accurate diagnoses and enhances the understanding of complex musculoskeletal disorders, facilitating targeted treatment plans.

• Objective and reproducible assessments: The objectivity of MAI Motion ensures that assessments are free of human bias and subjectivity, crucial for applications in medico-legal environments where precision and reliability are paramount. Its reproducibility also ensures

• Enhanced legal documentation: The objective data provided by MAI Motion can be used to construct detailed and defensible legal documents that withstand the rigorous scrutiny of court proceedings. That can be a deciding factor in personal injury cases and compensation claims, where the extent of injury and its impact on quality of life must be precisely demonstrated.

• Dispute resolution: With its objective analysis, MAI Motion helps resolve disputes over the nature and extent of injuries by providing clear, unbiased evidence. That may expedite settlements and ensure fair adjudication in cases of litigation.

• Preventive insights: Beyond diagnostics, MAI Motion offers preventative insights by highlighting potential risk areas before they lead to injury. That predictive capability is invaluable in occupational health, sports medicine and rehabilitation, helping to tailor interventions that prevent injury and enhance physical performance.

MAI Motion technology is not merely an evolutionary step in musculoskeletal diagnostics: it is a revolutionary tool that redefines what is possible in the understanding and treatment of musculoskeletal conditions. By integrating AI-driven computer vision, MAI Motion offers a depth of analysis that is transforming both clinical outcomes and legal proceedings, ensuring that every movement and its implications are comprehensively understood and appropriately addressed.

In my opinion, as an orthopaedic surgeon and sports medicine expert, MAI Motion is the future of musculoskeletal assessment: precise, objective and informed by the most advanced technology available. Best of all, you can use it directly from your smart phone. q

BEST PRACTICE PATHWAY FOR NON-AMBULATORY

FRAGILITY FRACTURES IS NOW AVAILABLE

[ A NEW NATIONAL PATHWAY has been introduced under the GIRFT programme, outlining best practice for ensuring patients with all types of non-ambulatory fragility fracture (NAFF) receive excellent and equitable NHS care.

Many thousands of older people are admitted to hospital with a fracture every year: hip fractures alone lead to around 70,000 hospital admissions of older people in England annually, and the number is significantly higher when all anatomical sites of fracture are taken into account. While the anatomical site of injury may be different, fragility fracture patients have similar needs, such as pain relief, restoration of mobility, management of co-morbidities and the prevention of delirium.

The GIRFT Non-Ambulatory Fragility Fracture Pathway offers guidance for all stages of the patient journey – from presentation in secondary care to admission and initial care, on-going ward care and discharge and follow-up – which should be applied to all NAFF patients, regardless of the anatomical site of their injury.

Existing pathways for NAFF patients are complex, involving input from different departments and professional groups, and are often shaped by the organisational structure of a trust. That has led to marked variation within and between trusts in how this group of patients with similar needs is cared for.

The new NAFF pathway is a collaboration between 38 stakeholders with geographical and cross-specialty representation. It aims to address those operational practicalities, offering universal concepts that trusts can adopt to work towards a more equitable service, using existing resources.

Key recommendations in the pathway include nominating a trust board member to be responsible for, and to report on, equitability of care for NAFF patients, with regular oversight and governance of the pathway provided through an oversight group. It also recommends designating a single point of contact to be consulted from the point of admission, who liaises with senior management, delegates decisions and informs discharge planning. They could be an advanced clinical practitioner, advanced nurse practitioner or a doctor.

The new pathway is co-badged by the Royal College of Emergency Medicine, British Geriatrics Society, the British Orthopaedic Association, the Chartered Society of Physiotherapy, the Royal Osteoporosis Society, the Royal College of Occupational Therapists, the Royal College of Physicians’ National Hip Fracture Database and the Association of Trauma and Orthopaedic Chartered Physiotherapists.

Bob Handley, GIRFT’s clinical lead for orthopaedic trauma surgery, led the working group which developed the pathway. He said: “During my GIRFT reviews I have seen that many units have rightly put considerable effort into improving their hip fracture pathways.

“The combination of the National Hip Fracture Database, national guidelines and Best Practice Tariff has created an environment for constructive change. Now it is important that units take steps to extend these benefits to all NAFFs to ensure equitable access to care for all fragility fracture patients.

“We are confident we have identified an approach which will foster the team management required – not based on significant new investment but on equitable and efficient use of currently available resources – with a key component being the board responsibility to oversee and report on equitability.” q

EXPERTS FOR MEDIA

The following experts offer their expertise to the media

EXPERTS FOR MEDIA is a new section in Your Expert Witness for experts who wish to offer their views and the benefit of their experience to the vast range of print and broadcast media. Ever wondered how news teams find the experts they consult to explain the ramifications of breaking news stories, seemingly at the drop of a hat? Or how the producers of TV drama series ensure their stories are accurate and reflect the realities of the professions they portray?

Mr Robert Hensher FRCS FDSRCS

Consultant Oral and Maxillofacial Surgeon

Mr Hensher’s subspeciality interests include dental implantology, facial injury and temporomandibular joint replacement. He prepares over 50 reports yearly including negligence and criminal cases.

E: jackiesorrell0101@gmail.com M: 07947445414 E: roberthensher@gmail.com M: 07836540457

Mr Luke Meleagros BSc MBBS MD FRCS Consultant Surgeon

Mr Meleagros completes around 6-10 expert reports per month, the majority in medical negligence cases and a smaller number of personal injury cases. He has reported extensively on cases involving abdominal laparoscopy surgery and hernia surgery.

T: 0208 527 0977 E: L.Meleagros@btinternet.com Sec: jawdobson@gmail.com

The fact is that researchers consult registers of experts and expert periodicals just as lawyers do. In fact, Your Expert Witness is receiving an increasing number of enquiries from media researchers and public relations agencies looking to locate appropriate experts to inform their clients.

Experts for Media is therefore an ideal space to attract their attention. For prices and to book your space, contact Ian on 0161 710 3880 or via ian@dmmonline.co.uk

Mr Thomas Wood MSc MPhil CUBS

Data Science Consultant

Mr Thomas Wood is a CUBS-accredited Expert Witness, certified for civil litigation. He also offers due diligence services for acquisitions of technology companies using AI.

• Natural language processing (NLP) • Machine learning

• Data science • Artificial intelligence (AI)

T: 020 3488 5740 E: thomas@fastdatascience.com W: fastdatascience.com

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