Your Expert Witness No. 70

CONTENTS IN THIS ISSUE

November will see experts gathering

New online library allows access to CCRC referrals for all

ERE Pledge makes slow progress, survey finds

Research reveals scale of scepticism around access to justice

Lawyers call out Scottish Govt on human rights and legal aid

11 Report identified opportunities to prolong wells’ active life 13 Oil and gas industry forges ahead with emissions reduction

13 Floating wind developments will have dual benefits

MARITIME DISPUTES

14 New charter party for offshore turbines nears completion

15 Yacht tragedy draws attention to maritime law

15 Shipping industry condemns Red Sea attacks

ERGONOMICS & HUMAN FACTORS

16 Ergonomics body looks back on 75 years of development

16 Training course helps understand human factors

17 The role of ergonomists as expert witnesses in personal injury cases

VIEWPOINT

19 RIP Michael Cohen

FORENSIC ACCOUNTANCY

21 Uptick in money laundering cases reaching courts marks positive milestone

23 Institute offers insight into auditors’ fraud obligations

25 Accountants’ body responds to AI consultation

COMPUTER FORENSICS

27 New N Korea threat unmasked

27 AI detects abusive messages 21 times faster than humans

29 Trio guilty of enabling bank account fraud

29 Celebrating three decades of providing expertise in audio and video forensics

PROPERTY, CONSTRUCTION & ENGINEERING

31 CE marking to stay for construction products

31 RICS appoints new committee chair

33 New building control regime beds in following transition period

FIRE INVESTIGATION

34 Fire safety announcement builds on recent efforts

35 Reducing the gaps: how co-operation and co-ordination are key to fire door safety

AGRICULTURAL ISSUES & TREE CARE

36 Farmers fined for obstructing EA investigator and persistent pollution

37 Tree care: it’s just common sense

38 Don’t look back in anger; let it be

TRANSLATING & INTERPRETING

39 Lords holds inquiry into courts’ use of language services

39 Government ‘out of step’ on translations

ARTIFICIAL INTELLIGENCE

42 “Open the pod bay doors, HAL”: will AI replace human experts?

MEDICAL ISSUES

47 Medical Notes

NEWS

48 CQC publishes final part of Valdo Calocane inquiry

51 New rules for fixed recoverable costs published

51 Warning issued over defibrillators

53 New death certification system comes into force

55 Streeting ‘stunned’ as review finds significant failings at CQC

57 Can you request an inquest if you suspect medical errors?

PLASTIC, RECONSTRUCTIVE & HAND SURGERY

59 Council launches investigation into butt lifts

59 Fillers not responsible for cancer, updated statement avers

61 When hand injuries can lead to a claim

63 Leading doctor hails recognition of aesthetic medicine

CARDIOLOGY

65 Heart campaign joined by patient who endured 18-hour wait

66 Study highlights inequalities in heart valve provision

HEPATOLOGY

67 Edinburgh research offers hope to liver sufferers

DENTISTRY & MAXILLOFACIAL SURGERY

69 NI negotiators secure delay of amalgam ban

69 Dentists call on govt to take action on unmet need for care

73 Maxfax body shares conference highlights

73 GDC clarifies position on surveillance

OPHTHALMOLOGY & OPTOMETRY

75 Survey reveals inequalities in eye patients’ experiences

75 New contact lens diploma courses approved

76 Optometrists urge new government to prioritise eye healthcare

77 Protect your eyes from the ever-brighter sun

77 Getting started in medicolegal practice: my experience

HEARING LOSS

78 New research reveals extent of hearing threat of loud music

PHYSIOTHERAPY

79 Society points to physio recruitment crisis in NI

79 Physios call for prioritisation of rehab

ORTHOPAEDICS

81 Cauda equina case: trust’s radiologist exonerated

81 ‘Jewel in the crown’ registry celebrates 20 years

83 New standard defines terminology for weightbearing after surgery or injury

83 Orthopaedics must be a government priority, BOA warns

85 Bone density, osteoporosis and fracture risks

87 How can AI help diagnose arthritis early?

PAIN

89 What are the challenges of assessing prognosis and degree of disability?

THORACIC SURGERY

90 Incurable lung conditions going undiagnosed, charity finds

PSYCHIATRIC & PSYCHOLOGICAL ISSUES

91 Expert witnesses: helping delivering justice in the family courts

93 Psychiatrists’ body calls for end to out-of-area placements

93 A social psychological approach could see end to rioting

93 Suicides in Scotland rose in 2023

95 The importance of expert psychiatric and psychological evidence in legal proceedings

VASCULAR SURGERY

96 Issues in diagnosing vascular disease

OBSTETRICS & GYNAECOLOGY

98 Endometriosis study makes recommendations for improvement in care

98 RCOG paper addresses post-traumatic stress among professionals

Opening Statement

[ IT’S EVERYWHERE – artificial intelligence, or AI. While for most of us our commonest encounter with AI is the use of ChatGPT by our kids to write their essays (or cheat, as some would have it), the judicial system is beginning to embrace the speed available and – let’s face it – the ability it gives us to emulate those same kids.

One expert, however, has seen the future as being predicted by the 1968 collaboration of Clarke with Kubrick in 2001: A Space Odyssey. His description of the conversation between Dave and HAL illustrates the fears both he and a great number of people have on the subject.

• AI has been proven to have potential in the criminal investigation field, as shown by research funded by the National Police Chiefs Council. The technology proved to be up to 21 times faster at finding abusive messages in digital devices. Just the sheer amount of data the machine was able to process is mind-boggling.

• On the whole, though, most of the news on the IT front is concerned with the use of technology by criminals and – according to an alert from GCHQ – malicious actors sponsored by non-friendly states.

• Fraud is, of course, one of the commonest of IT crimes, and the commonest form of fraud is money laundering. The latest report from KPMG shows an increase in the number of money laundering cases brought before the courts. That is, ironically, a good thing. The fact that there are more cases shows an increased ability of the authorities to prosecute cases and gain convictions.

• Money is the subject of one of the sessions of the annual Bond Solon Expert Witness Conference, being held in November. The money in question is the expert witness’s fees, and the subject of the session is how expert witnesses can get paid that fee. It’s just one of a whole smorgasbord of informative lectures and debates on offer.

• One of the issues that is being addressed by both the expert witness and legal professions is that of lack of equal opportunity. In the case of expert witnesses, the Equal Representation for Expert Witnesses (ERE) campaign has carried out the second of its periodic surveys, which shows a reassuring increase in the number of people and firms signing its Pledge since the previous survey. Progress is slow, ERE concedes, but it is progress nonetheless.

• Progress has been made on a number of other fronts. A surprise announcement in the House of Commons by Building Safety Minister Rushanara Ali on 2 September – the first day of Commons business after the Summer Recess – included a measure to mandate sprinklers in new care homes.

• For a period at the end of August and early September the media was occupied with the tragedy of the sinking of the super yacht Bayesian, with the deaths of seven people on board including owner Mike Lynch. What happened next was the starting of an investigation by the Italian authorities. That leads the attention to the subject of maritime law, or Admiralty law. The code has a long history dating back to and beyond Eleanor of Aquitaine, who introduced it onto a small island off the west coast of France.

• A long way from the French Atlantic coast is the Red Sea. It is also proving to be an increasingly dangerous area of the world. A consortium of shipping organisations has called for the killing and injuries to stop. Who doesn’t echo that sentiment? q

Ian Wild

Ian Wild, Director of Business Development Your Expert Witness

NOVEMBER WILL SEE EXPERTS GATHERING

[THE UK’S LARGEST GATHERING of expert witnesses, the Bond Solon Annual Expert Witness Conference, returns to Church House, Westminster on 8 November. Last year over 700 experts attended. Past speakers have included the Lord Chief Justice, the Master of the Rolls and the President of the Law Society.

During this past year, so much of the news has involved expert witnesses. There has been the Lucy Letby trial and appeal and the massive Post Office Inquiry, as well as plenty of new case law. There's a lot to catch up on!

Attending the conference – either in person or virtually – is an invaluable opportunity to keep up to date with what is happening on the expert witness landscape, and to network with fellow experts who represent over 80 areas of expertise and organisations that provide essential services to support experts in practice. The conference counts as six CPD/CME hours.

Hear from high-profile speakers including judges, barristers and solicitors, who will discuss the latest key issues affecting the expert witness industry and provide updates on the laws that affect your work as an expert witness.

Neurologist Dr Paul Watts commented: “This is the only conference I have ever been to where I have concentrated on, attended to, and hung upon every word spoken.”

This year, the exceptional speaker line-up and topics include:

• Paul Philip, chief executive of the Solicitors Regulation Authority

• addressing Issues of Instructing Solicitors' Unethical Conduct

• Sam Townend KC, the chair of the Bar, on the working relationship

• between barristers and experts, including common issues and how

• to deal with them

• Annual legal update – covering the key changes concerning experts

• over the past 12 months

• Debate: Experts are from Mars and Solicitors from Venus. Can

• their relationship ever be harmonious? The head of the International

• Commercial Litigation Group of Clifford Chance, one of the world's

• largest law firms, and a leading expert witness will exchange their

• views.

• Specialist parallel sessions for experts in

• medico-legal, commercial, criminal or

• family law

• Detailed Assessment of Costs for Expert

• Witnesses: Chris Butler, consultant senior

• costs lawyer at Kain Knight (City) Ltd,

• deals with a subject many experts are

• interested in – money.

The full programme and details of other top speakers are available to view on the Bond Solon website at www.bondsolon.com

Those attending the conference venue at Church House can benefit from the networking opportunities that it brings. Alternatively, if your preference is for virtual attendance, Bond Solon are live-streaming the event and you will be able to view and interact with the live sessions, engage and connect with other delegates and sponsors via the conference app.

All of the speakers’ talks are being recorded and will be available to virtual and in-person delegates to watch on the conference app after the event.

Mark Solon of Bond Solon explained: “As an expert witness, you need to understand how your fees are assessed in the legal system, as this can make the difference to you being paid in full, being partially paid or getting nothing! I am delighted that Chris

Butler, senior costs lawyer at Kain Knight Ltd, will speak at the Bond Solon Expert Witness Conference. Chris will share his findings from over 35 years, having seen some excellent examples of best practice from experts and some horror stories. He will tell you how to make sure you are properly remunerated and give you lots of practical tips.”

After the conference, delegates will be able to celebrate commitment to excellence at the Cardiff University and University of Aberdeen Bond Solon Expert Witness Certificate Awards Ceremony and complementary drinks reception.

The price per person is £315 + VAT for in-person attendance or £285 + VAT virtual. CUBS/UABS Certificate holders receive a 10% discount. Email expertwitness@bondsolon.com to receive the discount code.

A corporate booking discount is available for group bookings. Contact 020 7549 2549 or email expertwitness@bondsolon.com for more information. q

NEW ONLINE LIBRARY ALLOWS ACCESS TO CCRC REFERRALS FOR ALL

[THE Criminal Cases Review Commission (CCRC), the body which investigates potential miscarriages of justice in England, Wales and Northern Ireland, has launched an online library of every case it has sent back to the courts since 1997. The CCRC Case Library allows users to search, filter and read brief summaries of each case, which focus on the main reasons the CCRC made the reference to the appellate courts.

The CCRC has so far referred almost 850 cases back to the courts. Over 820 of those cases have now been heard, with the appeal successful in more than two-thirds of them.

A spokesperson for the CCRC said: “Our new case library will help people understand more fully the range of the work carried out by our team, and the basis on which our many hundreds of referrals have been made. We hope this will assist potential applicants and support our work in finding and investigating possible miscarriages of justice.”

The case library aims to help potential applicants understand the reasons why a conviction or sentence might be granted a fresh appeal. It will also be a useful point of reference for journalists, researchers, legal professionals and those interested in miscarriages of justice.

Users can filter cases according to categories of offence, such as murder, theft or fraud, and categories of referral, including non-disclosure, police misconduct and new witness evidence.

All entries have been tagged according to the relevant category of offence and the relevant categories of referral. If, for example, a theft conviction was referred by the CCRC based on police misconduct, the case will be tagged with both ‘theft’ and ‘police misconduct’.

Some entries have been anonymised to protect individuals’ identities. Sensitive and confidential information is not included in case summaries.

The library can be accessed at ccrc.gov.uk/case-library/ q

ERE PLEDGE MAKES SLOW PROGRESS, SURVEY FINDS

[ IT IS NOW two years since Equal Representation for Expert Witnesses (ERE) launched the ERE Pledge to increase the number of women appointed as expert witnesses. The ERE was founded after a survey in 2020 revealed that more than half of respondents had not seen even one female expert witness testify in the previous three years. The pledge was initiated as a sister pledge to the Equal Representation in Arbitration (ERA) Pledge.

Writing for Bond Solon, Hannah GannagéStewart said: “ERE’s second survey to date was published at the end of June. It shows signs of progress, but co-founders and partners at consulting firm AlixPartners, Kathryn Britten and Isabel Kunsman, acknowledge that an overall ‘apparent lack of progress is not unexpected’ at this stage.

“The simple fact is that as experts are drawn from a wide range of professions, where diversity and inclusion is lacking in those disciplines so too will it lack in the pool of witnesses. In this case we are looking at gender parity, but it applies to diversity more generally.”

In their introduction to the survey, Britten and Kunsman write: “We are delighted that support for ERE continues to grow.

To date, 1,580 individuals and over 130 organisations across more than 50 countries have signed the pledge – a 30% increase from a year ago.

“In 2023, we conducted an expanded survey to provide a benchmark to monitor progress, and to help us to better understand the challenges facing female experts and identify potential solutions. Our 2024 survey has once more obtained a terrific response. We received 363 replies from legal and expert witness professionals from 23

countries, spanning a wide range of genders, ages and job roles.

“Compared to a year ago, the findings in this survey reveal a growing desire among legal professionals to effect change, notwithstanding a lack of tangible progress in the number of women taking the witness stand. The respondents reported that women were appointed or testified as the sole expert witness in just 9% of their cases in 2023, compared to 10% in 2022.

“The lack of a rise in women testifying does not surprise us at this stage. As the responses we received indicate, female expert witnesses continue to face several challenges, including unconscious bias and the tendency to appoint experts based on prior experience.

“The aim of the ERE initiative is to achieve a lasting cultural transformation, which takes time. However, this year’s survey shows signs that change is slowly starting to happen. The survey findings indicate a promising pipeline of female expert witnesses, a willingness among lawyers to consider more female experts, and a recognition from experts of the ways in which we can help to develop the pipeline.

“Expert witnesses are one of the cornerstones of a robust legal system. To bolster the public’s trust in our courts we must achieve a bigger, stronger and truly diverse pool of experts.”

In an interview with Bond Solon, Kathryn Britten said: “Many professions still lack gender diversity at the most senior levels. While diversity and inclusion initiatives within relevant organisations are starting to make a difference, it will take time for a new pipeline to develop the breadth of knowledge and experience necessary for individuals to take on expert witness roles.

RESEARCH REVEALS SCALE OF SCEPTICISM AROUND ACCESS TO JUSTICE

[ONLY ONE IN FIVE of people (21%) believes justice is accessible, the Law Society of England and Wales has warned.

Research by the Law Society and the Legal Services Board reveals that the justice system is not open to all, as one in three (38%) of people with legal issues did not receive any help. More than one in ten (13%) assumed it was too expensive, 8% did not know how to find an advisor and 5% believed it was too difficult.

There is also a lack of awareness about what legal aid is available for. Nearly three in ten (29%) did not know it was available for any issues, half (49%) said it was available just for crimerelated issues and only two in five (43%) said it was available for domestic violence.

Law Society president Nick Emmerson said: “There is alarmingly little confidence in access to justice or awareness of legal aid. Those on lower incomes, who are likely to be eligible for legal aid, are also more likely to think legal aid is unavailable.

“It is disheartening that our justice system has failed to provide support for those who cannot pay legal costs. Not only have massive cuts in legal aid left countless without access to justice, but weak public legal education has also left millions in the dark.

“We will continue to push the UK government to invest in solutions that ensure accessible justice for all, a strong legal aid system and better public legal education.” q

“Consequently, it is crucial for aspiring experts in these industries to have opportunities to attend meetings with lawyers and hearings to gain an early understanding of the expert witness role.” q

LAWYERS CALL OUT SCOTTISH GOVT ON HUMAN RIGHTS AND LEGAL AID

[ THE SCOTTISH GOVERNMENT has proposed a range of positive justice sector reforms in its 2024-25 Programme for Government, but has failed to recognise the urgent need for investment in access to justice and legal aid, according to the Law Society of Scotland.

The programme, unveiled by First Minister John Swinney in the Scottish Parliament, indicates a number of bills will be brought forward in areas which will be of particular interest to Law Society members, including adults with incapacity, criminal justice modernisation and abusive domestic behaviour reviews, crofting and leases.

Law Society of Scotland president Susan Murray said: “In terms of the government’s legislative agenda, the bills we’ve identified are those we believe will be most closely watched by our members. We will engage with MSPs on these accordingly, though we are concerned at the lack of movement on previously promised human rights legislation.

“We recognise that, while this Programme for Government reflects a difficult fiscal position for the Scottish Government, a number of the measures announced by the First Minister are positive, both for the justice sector and for the wider Scottish community. These include on-going support to reduce court backlogs and funding to better support victims and witnesses of crimes.

“However, the programme makes no mention of the urgent need to properly fund Legal Aid practitioners. Continued underinvestment in Legal Aid over the long term risks undermining improvements that have been made elsewhere within our justice system. The result will be further erosion of access to justice for the people of Scotland and will be more keenly felt by those in our communities who are most vulnerable.” q

REPORT IDENTIFIED OPPORTUNITIES TO PROLONG WELLS’ ACTIVE LIFE

[A HUGE OPPORTUNITY to access resources in a more timely, clean, and cost-effective way and support the UK’s supply chain is the highlight from the 2024 Wells Insight Report, published on 5 September. That was the view of the North Sea Transition Authority (NSTA), which published the report. It reveals that well intervention is currently able to provide hydrocarbon production at a cost of less than £12 per barrel of oil equivalent (boe), a very attractive option at today’s oil and gas prices. In addition, well intervention – defined as activities aimed at improving or maintaining the productivity of oil and gas wells during their operational life – requires fewer operational days, less construction material, minimal waste disposal and lower fuel burn than drilling a new well, and therefore produces lower emissions.

It concludes that operators should strive to increase their well intervention activity to extend the production lifespan of their wells, and to provide a stable flow of work for the UK’s world-class supply chain, whose expertise is in demand globally.

Suppliers, including rig owners, are increasingly seeking opportunities overseas due to a lack of contracting opportunities in the UK Continental Shelf (UKCS). It is vital that this capability is kept in the UK to deliver the floating wind, carbon storage and hydrogen projects which will accelerate the energy transition.

Carlo Procaccini, NSTA’s chief technical officer, said: “Well intervention work can and does produce impressive results, boosting efficiency and providing cleaner and cost-effective production. We expect that bringing together operators with the supply chain will highlight significant opportunities for everyone.”

Separately, the report reveals that total active well stock on the UKCS is now 2,546, down from 2,560 in 2022. The past year has also seen an increase in the number of shut-in wells to an all-time high of 31% of the active well stock, at 795: up from 742 in 2022.

A proportion of the shut-in well stock could be brought back online, the report says; however, without investment in infrastructure or downhole interventions, it is likely that many of these wells will be permanently decommissioned.

Where reactivation is not feasible, wells should be decommissioned in a timely and cost-effective manner. Disappointingly, the industry only achieved 70% of planned well decommissioning activities last year as operators continued to defer work. The NSTA recently opened investigations into missed deadlines as part of its approach to boosting compliance and tackling the backlog of wells awaiting plugging and abandonment. As with well interventions, well decommissioning should provide a sustainable and lucrative source of income for the supply chain. q

OIL AND GAS INDUSTRY FORGES AHEAD WITH EMISSIONS REDUCTION

[DESPITE FACING A CHALLENGING POLICY and taxation landscape, the UK oil and gas industry has still leapt ahead of its government-agreed emissions reduction targets and is on track to achieve 2030 milestones, according to Offshore Energies UK’s (OEUK) Emissions Reduction Report, due for publication in September.

FLOATING WIND DEVELOPMENTS WILL HAVE DUAL BENEFITS

[THE ANNOUNCEMENT on 3 September of 131 new green infrastructure projects offering 9.6 gigawatts (GW) of new energy was hailed as a positive step in securing the next generation of renewable energy infrastructure by Offshore Energies UK, which represents the UK’s offshore industry.

It will bring an extra 3.3GW of offshore wind energy including 400 MW of floating wind for the Green Volt project off the East coast of Scotland which is being developed by Flotation Energy and Vårgrønn.

OEUK pointed out that part of the new energy will be helping existing energy producers to operate in a more environmentallyfriendly fashion.

In a press release, OEUK said: “This project is a significant development in unlocking the potential of the government’s Innovation and Targeted Oil and Gas initiative which is designed to provide wind energy to power the oil and gas platforms which are still needed during the energy transition, and at the same time supply the UK grid.”

Nicol Stephen, chief executive of Flotation Energy, added:

“Scotland is already a global pioneer in floating wind. This funding will kickstart the next phase of Europe’s largest floating wind project 80km off the coast of Northeast Scotland.

“Green Volt is a huge £2.5bn project. It will create over 2,800 jobs during construction. Once operational, the floating offshore windfarm will supply clean power to the UK grid, while also supplying renewable electricity to nearby oil and gas platforms.” q

Analysis by OEUK shows the UK oil and gas industry has made important strides in reducing its carbon footprint, building upon an active and effective decarbonisation plan. The sector is on track to meet continuing emissions reduction targets, reflecting industry’s dedication to sustainable practices and environmental stewardship.

OEUK’s CEO David Whitehouse said: “The UK oil and gas industry has successfully reduced upstream emissions by 28% and more than halved methane emissions since 2018. This positions the UK to achieve the North Sea Transition Deal’s emissions reduction target of 25% by 2027 – four years ahead of schedule – and the 50% methane reduction target by 2030: seven years early.

“All political parties recognise that the UK needs oil and gas for decades to come, so we’re calling on them to prioritise our homegrown production over more carbon-intensive imports, to support value in our economy and the highly skilled people and firms needed to build our clean energy future.

“The expertise of the UK industry’s people, together with private sector investment and innovation, are driving these emissions reductions. The government can choose to back UK firms to continue this work with policies that keep them here in the UK and unlock further investment. In the right investment conditions, UK industry can further accelerate the homegrown energy transition as it enables our access to secure supplies of homegrown energy.”

The report will be officially launched at the OEUK Conference 2024. Those attending can get detailed insight into the UK’s oil and gas industry’s emissions reduction progress and the potential of an integrated homegrown energy sector in achieving net zero targets by 2050.

The event, at which David Whitehouse will be a speaker, takes place at P&J Live in Aberdeen on 17 September. q

NEW CHARTER PARTY FOR OFFSHORE TURBINES NEARS COMPLETION

[BIMCO’S WINDSEACON project is making steady progress in developing a time charter party for supply of a vessel for the purpose of transportation and installation of offshore wind turbine generators.

BIMCO is the representative organisation for shipping companies, describing itself as ‘the practical voice of shipping’. It claims over 2,000 members in 130 countries, covering 62% of the world's tonnage and consisting of local, global, small and large companies.

A time charter party is a contract granting the customer, or charterer, the use of a vessel for a fixed period of time, for use on numerous occasions during that time. The charterer pays for the hire of the vessel on a daily or monthly basis and is responsible for fuel and port charges. However, the ship’s owner retains responsibility for the crew and vessel maintenance.

WINDSEACON is a BIMCO initiative to create a comprehensive global standard contract for the transport and installation of wind turbines in offshore wind farms. The project aims to address the unique challenges and needs of the offshore wind industry, which is growing rapidly as a result of the global demand for more renewable sources of energy and the need for decarbonisation.

The project is led by a dedicated BIMCO subcommittee comprising industry experts, representing developers, vessel suppliers, turbine manufacturers, lawyers and P&I clubs (protection and indemnity

associations). The subcommittee is supported by a large sounding board of key market players, who will provide feedback and input throughout the drafting process.

The subcommittee has agreed on the scope and structure of the contract. The new WINDSEACON time charter party for supply of a vessel for the purpose of transportation and installation of offshore wind turbine generators will be the first of its kind. The subcommittee is currently in the process of drafting and expects to present its work for review by the Documentary Committee in October.

A BIMCO spokesperson said: “By providing a balanced and commercially viable standard contractual framework, WINDSEACON will make legal and commercial negotiations more effective and efficient, and reduce the risks and uncertainties involved in offshore wind projects. WINDSEACON will also reflect the collaborative spirit and the best practices of the industry stakeholders, and establish a solid foundation for the continuous evolution and growth of the offshore renewables sector.” q

YACHT TRAGEDY DRAWS ATTENTION TO MARITIME LAW

[ THE ON-GOING INTRIGUE over the sinking of super-yacht Bayesian raises in the public eye the full range of issues relating to seagoing adventures. The tragedy followed the sinking in May of the 80ft sports yacht Atlantis (pictured) off Florida, thankfully with no loss of life.

While there are criminal investigations on-going in Italy over the Bayesian incident, relating to actions taken or not taken during the storm that caused the sinking, the issues arising from such accidents – and the frequency of the weather that gives rise to them – leads to the need for thorough investigations and the expert opinion required to reach a conclusion.

According to leading maritime consultancy Clarkson’s: “Maritime law has existed for hundreds of years, evolving

significantly over the centuries to keep pace with the modernisation and growing commercialisation of the sector.”

Those ‘hundreds of years’ date back substantially to Eleanor of Aquitaine, wife of King Henry II of England. Having learned about the various codes of ‘admiralty law’ while on the Second Crusade with her first husband, King Louis VII of France, she established the system on the Île d’Oléron off the west coast of France. The system was introduced into England by Eleanor while acting as regent for her son Richard I during his absence.

Nowadays, Clarkson’s describes the purpose of maritime law as being “to provide clear rules for all maritime activity wherever it is taking place, setting out who is responsible for what”. q

SHIPPING INDUSTRY CONDEMNS RED SEA ATTACKS

[A COALITION OF ORGANISATIONS representing the shipping industry issued a joint statement in June calling for action following attacks on a number of ships in the Red Sea, including the fatal attack on the MV Tutor

The statement reads: “The shipping community is appalled and deeply saddened with the tragic news that yet another seafarer seems certain to have been killed in a drone boat strike on Wednesday 12 June while on board the MV Tutor in the Red Sea. We utterly condemn these assaults which directly contravene the fundamental principle of freedom of navigation.

“Our thoughts and condolences go to the family and loved ones of the seafarer who tragically lost their life. It is deplorable that innocent seafarers are being attacked while simply performing their jobs – vital jobs which keep the world warm, fed and clothed.”

The strike was the second fatal attack in which seafarers were ‘caught in the crosshairs of geopolitical conflicts’. The statement pointed to the deaths of three seafarers during an attack on the True Confidence earlier in the year.

The statement continued: “This is an unacceptable situation, and these attacks must stop now. We call for states with influence in the region to safeguard our innocent seafarers and for the swift de-escalation of the situation in the Red Sea. We have heard the condemnation and appreciate the words of support, but we urgently seek action to stop the unlawful attacks on these vital workers and this vital industry.”

The statement was issued ahead of the Day of The Seafarer on 25 June, when the signatories expressed a hope that “the world takes a moment to recognise the immense contribution that seafarers make to the global economy and the unjust circumstances they are facing in the Red Sea and across the world”. q

ERGONOMICS BODY LOOKS BACK ON 75 YEARS OF DEVELOPMENT

[ THE INTERNATIONAL ERGONOMICS ASSOCIATION describes ergonomics thus: “Ergonomics is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimise human well-being and overall system performance.”

As a science, ergonomics arose during World War II to understand the relationship between emerging military technology and its human operators. The process quickly became applied to civilian workplaces and in 1949 the Ergonomics Research Society was founded in London.

That society evolved over the years to become first the Ergonomics Society and then, in 2009, the Institute of Ergonomics and Human Factors, to ‘reflect the popular usage of both terms and to emphasise the breadth of the discipline’. In 2014 the institute was granted Chartered status and became the Chartered Institute of Ergonomics & Human Factors. This year the institute celebrates its 75th anniversary as a professional body.

The institute’s current chief operating officer Tina Worthy commented: “We're a small professional membership organisation with a track record of big achievements and we never cease to be impressed by the amazing work of our members.”

The institute encompasses a number of specialist categories of consultant, falling into six broad categories. One of those is investigation, whose consultants’ services include expert witness, incidents and accidents and human performance. They also include carrying out procedural and safety case reviews.

The institute also includes a number of sector groups, whose main aims are to promote the discipline of ergonomics and human factors within that sector, provide a space for ergonomics and human factors professionals to exchange ideas and thoughts and

bridge the gap between ergonomics and many other disciplines. The sectors concerned are automotive, aviation, defence, healthcare, nuclear, pharma and workplace. q

TRAINING COURSE HELPS UNDERSTAND HUMAN FACTORS

[ONE OF THE TRAINING COURSES offered by HSE is Human Factors in Accident and Incident Investigations. The course gives delegates knowledge and practical support for investigating human factors issues, helping them to find ways of achieving effective change within their own organisational context.

They learn from experts who have been involved in accident and incident investigations across a wide range of sectors and situations.

In the preamble to the course, HSE says: “Accident and incident investigations should consider why human failures occurred. Finding the underlying causes is key to reducing the risk of similar adverse events and lessons learned provide insights to effective improvements.”

Delegates will be provided with information that will help them to develop, consolidate or reaffirm current competence in the field of investigating human factors by exploring:

• The process of investigating human factors aspects of incidents,

• accidents and adverse events

• Knowledge and experience of investigation tools and techniques

• to capture, analyse and communicate the human factors causes

• of accidents

• Knowledge of how humans can cause failures in systems, and

• systems can lead to human failures, which lead to adverse events

• Human factors principles to learn lessons and identify effective

• interventions

• The sharing of knowledge and experience between delegates

• and course presenters.

Recently revised to reflect the latest approaches and techniques, the course covers the theory and practice of methods which support the effective investigation of human factors issues, along with essential knowledge to help to understand why things go wrong with people and systems. The course also looks at how to use lessons learned to apply effective change.

The course is run periodically at the HSE Science and Research Centre in Buxton – the latest was on 10-11 September – and can also be held face-to-face at a company’s premises. For more information visit solutions.hse.gov.uk q

THE ROLE OF ERGONOMISTS AS EXPERT WITNESSES IN PERSONAL INJURY CASES

By By Dr Ian Randle BSc MSc PhD MErgS C.ErgHF of Hu-tech Experts

[AN ERGONOMIST, also known as a human factors specialist, plays a crucial role in legal cases involving workplace injuries, product liability and safety compliance. Their expertise in understanding the interaction between humans and their work environment makes them valuable in providing objective, scientific analysis in court.

It is important when engaging an ergonomist to ensure that they are chartered or registered members of the Chartered Institute of Ergonomics and Human Factors (CIEHF). That will ensure that they are properly qualified and are bound by the professional code of conduct of the CIEHF.

The ergonomist as a liability expert

Ergonomists are often called upon in cases where there are allegations of workplace injuries due to poor ergonomic practices. They can include repetitive strain injuries, musculoskeletal disorders and accidents and injuries caused by poorly designed equipment or workspaces.

Some key ways in which ergonomists can contribute are:

• Assessment of tasks and workplace evaluation

Ergonomists are trained in structured task analysis to assess accident and injury risk. They are qualified to evaluate the work for factors such as poor posture, repetitive motions and inadequate workstation design that may contribute to the risk of injury. They can also assess the likelihood of human error and the underlying causes of accidents.

• Biomechanical analysis

By understanding the biomechanics of the human body, ergonomists can explain how certain movements or positions may lead to specific injuries. That can be particularly important in cases involving musculoskeletal disorders and is a beneficial supplement to the evidence provided by medical experts on causation.

• Recommendations for risk reduction

• or mitigation

Ergonomists are also trained to devise changes which prevent future injuries. That might include redesigning workstations, altering work practices or introducing new tools and equipment. That provides the court with important guidance when determining whether changes to the workplace are deemed to be ‘reasonably practicable’.

Ergonomist or engineer?

In cases involving musculoskeletal injury, such as manual handling or work-related upper limb disorder, the choice of liability expert can significantly influence the outcome. While engineers may be considered for their technical expertise and knowledge of machinery, ergonomists combine that with a deep understanding of biomechanics, anatomy and physiology.

That knowledge of an individual’s physical and mental capabilities is crucial when assessing foreseeable risk of injury and providing an opinion for the court based on the objective application of human science.

In conclusion, ergonomists and human factors specialists have specific skills and capabilities which set them apart from engineers, safety professionals and psychologists. The contribution of structured ergonomic and human factors analysis techniques may be crucial in cases which require an objective assessment of human capabilities and limitations when interacting with workplaces and systems to determine foreseeable risk of injury.

Those skills can be applied to cases ranging from musculoskeletal injury in industrial workplaces to fatal accidents involving humans interacting with complex systems. As workplaces continue to evolve, the role of ergonomists in litigation is likely to become even more significant. q

RIP MICHAEL COHEN

By CHRIS MAKIN chartered accountant, accredited civil mediator and accredited expert determiner

[ I RECENTLY ATTENDED the funeral of a man you have probably never heard of, but who was of enormous importance to all you litigators, whether civil and commercial, family, criminal or ADR.

After several years as a boring old chartered accountant – annual accounts, audits, tax returns, business plans (yawn) – I was asked to act as an expert in several cases, including one concerning a stuntman on a Superman film who was injured at Elstree Studios, which required me to spend a week at the RCJ and a day in the witness box. I was hooked.

Then I was asked to act in an international fraud case against the SFO, where I had to work on my report for the defence for a solid eight months; it eventually ran to 43 ringbinders and I was told I would be at the Old Bailey (actually an annex in Chancery Lane called Chichester Rents) for a trial lasting 18 months. But my report was agreed by the prosecution and I didn’t need to appear. I had had to give all my clients to other partners in that eight months, so I had literally nothing to do. I wrote my first mailshot letter on the train back from London ‘I’m a forensic accountant – gizza job’, the work flooded in and many years later it has never stopped. I realised this was getting serious, and that I needed to learn how to be a proper expert. This is when I came across The Academy of Experts. It was founded by Michael Cohen in 1987, at a time of great transition in litigation.

Many of you will not remember the bad old days, but I certainly do. Lord Woolf, Master of the Rolls, was concerned about inefficient courts, cases which lasted almost as long as Jarndyce v Jarndyce, excessive legal costs, solicitors ‘churning’ cases, experts as hired guns and much else. He published Access to Justice which became the basis of the Civil Procedure Rules, soon followed by the Family Procedure Rules and the Criminal Procedure Rules, all on similar lines where judges controlled cases. This was the late 1990s; the CPR was launched on 1 April 1999.

There was also much wrong with the expert witness ‘profession’. It is a profession now, but it wasn’t in the bad old ‘90s. The hired gun was commonplace and so many experts thought it was their duty to win, or to save, their client as much as possible. I remember an orthopaedic surgeon who lectured with a skeleton which he danced, and he said he didn’t believe that whiplash existed. He was very popular with his motor insurance clients.

This, of course, was quite wrong; those who instruct us are not our clients, since our overriding duty is to the court, irrespective of who instructs us or by whom we are to be paid.

This is where Michael Cohen came in. He was a barrister and an expert in insurance. He saw the need for experts to be educated in such matters, so he founded The Academy of Experts in 1987 – in good time for his concepts to be reflected in the CPR and all that followed.

I was not a founder member; I joined in 1990 but my membership number (531) shows that I joined when it was a very small organisation. Since then it has flourished, with about 4,000 members of virtually every profession in the UK, and with pockets of members in other jurisdictions.

The Academy is respected by other professional bodies; for example it has close working relationships with ICAEW (my profession) and RICS, to name but two. It has a judicial committee of seven senior judges, and has published a Model Expert Report, Model Terms of Appointment of Experts, Guidance for Those Who Instruct Experts and, more recently, Guidance on Remote and Virtual Hearings.

There is the regular journal TEDR (The Expert and Dispute Resolver) of which Michael was until recently the editor.

As a measure of how highly

The Academy is regarded in legal circles, one need only look at the calibre of those who have served as president: Sir Geoffrey Howe QC (Margaret Thatcher’s chancellor); Lord Savile (of the Bloody Sunday enquiry) and now Lord Neuburger.

The Academy is a centre of excellence for experts, and much of that is the result of Michael Cohen’s dedication to the cause. He has been a tireless, and very competent, lecturer on all things litigation and expert.

I had the great honour to be admitted as a fellow in 1994, one of only about 60 worldwide. Michael devised training courses and an accreditation scheme for mediators, and I was accredited as such in 1998. He developed a training course and accreditation scheme for expert determiners (a form of arbitration) and I am proud to say that I was in the first ever batch of EDs to be accredited in 2009; I am now the chief examiner in ED.

So, thanks to Michael, we now have an Academy of members offering a wide range of dispute resolution methods, both conventional litigation and ADR.

This man never stopped. For many years he had done lecture tours around the world, and only a few months ago he lectured in Dubai, Singapore, Hong Kong and Australia. So he was still full steam ahead until just a few weeks before he died – and only a few weeks before his ninetieth birthday!

Sleep well, Michael; you deserve your rest. And we members of the litigation community – even those of us who have never heard of you! – are so very grateful for all you have done for us. q

About Chris Makin

[ 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

UPTICK IN MONEY LAUNDERING CASES REACHING COURTS MARKS POSITIVE MILESTONE

[NEW FIGURES published on 28 August from KPMG UK’s midyear Fraud Barometer show that money laundering has been the most common fraud type by value in the first six months of the year. Nine cases were heard in UK Crown Courts collectively worth £128.2m. With the UK regularly cited as a hub for illicit finance, it is positive that more suspected perpetrators of this crime are appearing to be prosecuted, KPMG says.

The research, which records alleged fraud cases with a value of £100,000 and above heard in UK Crown Courts, has revealed that 122 fraud cases in total were heard in the first six months of the year. That is up from 105 cases during the same period in 2023. By contrast, fraud value was just over £305m, a 14% drop compared to the first six months of the previous year, when the total fraud value stood at £354.2m.

Commenting on the findings, Roy Waligora, partner and head of UK investigations at KPMG, said: “Money laundering continues to be a problem in the UK due to the complexity and sophistication of financial systems that can be exploited for illegal activities. It will be interesting to see if the relatively new requirement for overseas entities to be registered at Companies House will result even more of these cases reaching the courts soon.”

Government and the public bear the brunt of fraud

The public sector has been the biggest victim of fraud in terms of value in the first half of 2024. In all, 26 fraud cases related to the government were heard, with a combined value of £193.4m: an increase of 30% compared to the same period in 2023. The general public also continues to bear the brunt of fraud, with 41 cases totalling £33.2m being heard in the same period.

Roy Waligora observed: “Greater focus on fraud in the public sector may have contributed to more effective identification and prosecution of fraudulent activities against the government. This proactive approach to tackling fraud may also result in a higher number of similar cases being seen during the second half of the year. However, UK courts remain under pressure to address high volumes of fraud at a time when the UK justice system is also under pressure to tackle hard crime.

“The widely expected publication of guidance on what constitutes ‘reasonable procedures’ by government will kickstart the timeline for corporates to implement improved fraud management and may make the prosecution of fraud somewhat simpler.”

Account takeover fraud reigns supreme

When examining the most common type of fraud, account takeover fraud was the highest by volume in 2024 so far. A total of 16 cases,

with a combined value of £7.2m, have reached the UK Crown Courts in the first six months. That was followed by fraud related to counterfeit, pirated or below-stated quality goods (15 cases) and embezzlement (15 cases).

Roy Waligora added: “Methods for perpetrating account takeover fraud are becoming more sophisticated, so it is promising to see that so many of these criminals are being brought to justice. However, with UK Finance reporting 121,650 cases of account takeover fraud in the whole of 2023, it’s clear that only a tiny fraction of these criminals are brought to justice.” q

INSTITUTE OFFERS INSIGHT INTO AUDITORS’ FRAUD OBLIGATIONS

[ON 29 AUGUST the Institute of Chartered Accountants in England and Wales published its insight into auditor obligations on fraud. It followed recent regulatory action that highlighted the importance of remaining alive to the risks of fraud. Auditors must be aware of how legal requirements and auditing standards guide obligations when reporting suspicions of fraudulent activities, the ICAEW said.

The article referred to ISA 240 – the International Standard on Auditing – which states that auditors must obtain reasonable assurance that financial statements are free from material misstatements, whether caused by fraud or by error. This responsibility extends to a legal duty to report suspicions of fraud to regulators.

Substantial fines serve as a stark reminder of the severe consequences that can arise when auditors do not adequately discharge their responsibilities. Such penalties highlight the risks of failing to identify and report significant issues in a timely manner.

Auditing regulated entities

The article states: “Under the Financial Services and Markets Act 2000 (FSMA), auditors of regulated entities are required to disclose information or opinions relevant to the regulator's functions, as stated in sections 342(5) and 343(5) of the Act. This includes

any suspicions of fraud that could impact the Financial Conduct Authority’s Principles for Business and/or the Threshold Conditions for authorisation set by both the FCA and the Prudential Regulation Authority.

“In instances where an auditor reasonably believes that fraud or other serious irregularities have occurred, especially involving individuals in governance, they are legally obliged to report these suspicions to the appropriate regulator without delay. While FSMA provides the legal framework, the professional standard ISA 250B (Revised) further elaborates on the auditor's duty to report.

“According to ISA 250B, para 12, when an apparent breach of statutory or regulatory requirements comes to the auditor’s attention, including instances of suspected fraud, the auditor must obtain available evidence to assess the implications for their reporting responsibilities, determine whether there is reasonable cause to believe that the breach is of material significance to the regulator and consider whether the breach constitutes criminal conduct that should be reported to the appropriate authorities.”

Discussing situations when suspicions should be reported, the article said: “In situations when auditors encounter a suspected fraud or breach, they might typically seek evidence to understand its implications

before reporting it to the regulator. However, Article 28 of ISA 250B explains that their responsibility to report does not require a complete assessment of the breach's full impact beforehand. Instead, auditors will need to exercise professional judgement to determine whether there is reasonable cause to believe the matter is, or could be, materially significant to the regulator.

“It is worth noting that an apparent breach of statutory or regulatory requirements does not automatically trigger a statutory duty to report to a regulator. For example, as per Article 27 of ISA 250B, a minor breach that has been corrected and reported by the regulated entity and appears isolated may not warrant reporting.”

Prompt action is required

“The FSMA and ISA 250B emphasise the need for timely reporting. When suspicions of fraud arise, auditors must act quickly, as delaying a report can allow fraudulent activities to continue, potentially worsening financial damage.

“Failing to meet these obligations can have severe consequences. The substantial penalties recently imposed on audit firms underscore the seriousness of these duties and serve as a cautionary reminder to the auditing profession of the dangers of inaction.” q

ACCOUNTANTS’ BODY RESPONDS TO AI CONSULTATION

[THE Association of Chartered Certified Accountants (ACCA) has described the UK government’s proposed AI cyber code as a useful starting point for a global regulatory approach.

Responding to a UK government consultation led by the Department for Science, Innovation and Technology outlining an AI cyber security code of practice, ACCA says the government is best placed to set up overarching regulatory structures and principles, while those on the frontline of AI developments should be given the space to work to combat emerging cyber risks.

However, the pro-innovation approach of the proposed code – as set out in the government’s White Paper – needs to have safeguards and its requirements may need to be revisited. The cyber challenge in AI is dynamic, and a ‘point in time’ view can become quickly outdated.

ACCA also highlighted the risks to and impact on end users in SMEs, with a significant number of its members operating in that segment. The greater challenges faced by that group of stakeholders on cyber readiness – across both skills and budgets – are well-documented, ACCA says. The association wants end-user SMEs to be safe and protected from cyber risk, yet be empowered to choose AI, given its potential to augment business productivity.

Glenn Collins, ACCA’s head of technical and strategic engagement for the UK, said: “ACCA is pleased to see the consultation taking a principle-based approach as our current view of AI offers too many unseen scenarios. ACCA, its members and partners will be profoundly impacted by its planned use of AI, including delivering finance professionals with an optimal experience and skill set for the modern workplace.”

ACCA warned that adherence to any code carries a cost, including

indirect costs of adhering to the code and the impact through the supply chain. Effort and cost will be needed to raise awareness of the code, as well as monitoring and enforcement.

Narayanan Vaidyanathan, its head of policy development, noted: ‘We anticipate utility from such a code for those providing assurance or third-party verification of AI systems. This is an important category of stakeholders who will have a key role to play in creating a trusted AI ecosystem to supplement the regulatory and legal direction from policy makers.

“We do not anticipate this group to be subject to the requirements of the code itself, but assurance requires checks against a well-defined and ideally publicly available standard – which this code could provide. Cyber risks are a part of what the assurance of an AI system may need to check for. Therefore, those providing assurance would find such a cyber code and associated standards helpful.”

In its response ACCA also called on the government to tackle the skills gap, which needs to be filled in order to combat cyber security risks. The Apprenticeship Levy could be expanded to a ‘Growth and Skills Levy’ that is more flexible and can be used to fund shorter-term accredited training programmes that upskill and reskill workers on the cybersecurity of AI.

Companies should also be able to increase the proportion of their unspent levy funds passed on to their supply chains – ACCA suggests an increase of 25% to 40%. That could unlock millions of pounds to develop AI skills.

Ultimately, cybersecurity issues linked to AI need staff to be trained on current and emerging risks. If insufficient training is given, standards and frameworks will fail to achieve any impact. q

NEW N KOREA THREAT UNMASKED

[THE National Cyber Security Centre (NCSC) – a part of GCHQ – has issued a new advisory alongside partners in the US and the Republic of Korea which reveals how a cyber threat group known as Andariel – sponsored by the Democratic People’s Republic of Korea (DPRK) – has been compromising organisations around the world to steal sensitive and classified technical information and intellectual property data.

The cyber actors have primarily targeted defence, aerospace, nuclear and engineering entities – and organisations in the medical and energy sectors to a lesser extent – in order to obtain information such as contract specification, design drawings and project details. As part of its operations, Andariel has also launched ransomware attacks against US healthcare organisations in order to extort payments and fund further espionage activity.

The advisory shares technical details and mitigation advice to help defend against the actors who have been seen exploiting known vulnerabilities to access victims’ systems before deploying malware and other tools to maintain persistence, evade detection and exfiltrate data.

Paul Chichester, NCSC director of operations, said: “The global cyber espionage operation that we have exposed today shows the lengths that DPRK state-sponsored actors are willing to go to pursue

their military and nuclear programmes. It should remind critical infrastructure operators of the importance of protecting the sensitive information and intellectual property they hold on their systems to prevent theft and misuse.

“The NCSC, alongside our US and Korean partners, strongly encourage network defenders to follow the guidance set out in this advisory to ensure they have strong protections in place to prevent this malicious activity.”

The advisory outlines how Andariel has evolved its operations from conducting destructive attacks targeting US and South Korea organisations to conducting specialised cyber espionage and ransomware attacks. It warns that in some cases the actors have even been observed launching ransomware attacks and espionage operations on the same day and leveraging both activities against the same victim.

The advisory has been co-sealed by the NCSC, the US Federal Bureau of Investigation, the US Cyber National Mission Force, the US Cybersecurity and Infrastructure Security Agency, the US Department of Defense Cyber Crime Center, the US National Security Agency, the Republic of Korea’s National Intelligence Service and the Republic of Korea’s National Police Agency. q

AI DETECTS ABUSIVE MESSAGES 21 TIMES FASTER THAN HUMANS

[NEW DIGITAL FORENSIC RESEARCH has found that artificial intelligence models can accurately identify threatening and abusive messages considerably faster than humans, which could help significantly increase the speed of police investigations.

Virtually every crime has a digital element, and the National Police Chiefs’ Council (NPCC) estimates there is a backlog of 25,000 digital devices waiting to be examined as part of live investigations in England, Wales and Northern Ireland.

The 12-month study was conducted by digital forensic experts from the Forensic Capability Network (FCN) – the national body for forensic science funded by the NPCC – and AI experts from the University of Warwick.

By analysing synthetic or ‘dummy’ data using customised natural language processing models on secure servers, the project aimed to identify the effectiveness of AI at identifying threatening and abusive language related to violence against women and girls.

The FCN’s models were able to comb vast amounts of text-based material to quickly find words and phrases that could be relevant to a criminal investigation, even when the abuse was subtle or used slang and colloquial phrases which are more difficult to detect. In one test the model took just over one minute to identify three aggressive and emotive phrases within 456 messages: around 21 times faster than an average human investigator.

The project also successfully demonstrated that AI could help protect the privacy of victims of violence against women and girls, as it was trained to home in on relevant messages and ignore material irrelevant to the investigation.

The NPCC’s digital forensic lead, Deputy Chief Constable Jayne Meir of Northumbria Police, said: “These findings are very encouraging. Analysing huge amounts of data has become a crucial part of modern policing and the volume of data is only growing. So we must explore the most efficient and streamlined models for doing this investigative work; ones which achieve the best quality while alleviating the burden on police resources. Our police investigators and digital forensic specialists will always be the ones to make decisions, but if we can help them analyse evidence faster with technology, then we should absolutely explore that.”

The FCN’s lead scientist Simon Cullen, who led the project, said: “We’re some way off taking these models from a test environment into operational policing, but we’ve shown in theory that carefully

customised AI models can operate in the background and flag useful information that could be relevant to an investigation. Then, it’s up to a human to decide what should happen next. In terms of other use cases for this technology, we think the impact could be even more effective in tackling volume crime.” q

TRIO GUILTY OF ENABLING BANK ACCOUNT FRAUD

[ THREE MEN have pleaded guilty to running a website enabling criminals to circumvent banking anti-fraud checks. A National Crime Agency (NCA) investigation showed that www.OTP.Agency was run by Callum Picari from Hornchurch in Essex, Vijayasidhurshan Vijayanathan from Aylesbury, Bucks and Aza Siddeeque from Milton Keynes, Bucks. Criminals were charged a monthly subscription fee which helped them socially engineer bank account holders into disclosing genuine one-time passcodes or giving other personally identifiable information.

A basic package costing £30 a week allowed multi-factor authentication to be bypassed on platforms such as HSBC, Monzo and Lloyds, so that criminals could complete fraudulent online transactions. An elite plan cost £380 a week and granted access to Visa and Mastercard verification sites. The plans allowed criminals to access personal bank accounts and steal money.

NCA cyber investigators began probing the website in June 2020 and believe over 12,500 members of the public were targeted between September 2019 and March 2021, when it was taken offline after the trio were arrested. It is not known how much money the group made from the venture, but estimates show it would have been around £30,000 if users purchased the basic plan and up to £7.9 million if they had opted for the elite package.

Siddeeque promoted the website and provided technical support to criminal customers. Picari was its owner, developer and main beneficiary, and plugged the service on a Telegram group with over 2,200 members, posting a message in October 2019 which read: “First and last professional service for your OTP stealing needs. We promise you will be making profit within minutes of purchasing our service…”

He also said: "Ever wanted to grab a one-time passcode for any website? Well now you can! With OTPAgency you can grab an otp for vbv, 30+ sites and also Apple Pay. it’s only £30 a week you really don’t wanna miss out.”

The Telegram group was deleted after an article published by Krebs on Security in February 2021 prompted a panicked message exchange between Picari and Vijayanathan.

The trio were charged with conspiracy to make and supply articles for use in fraud. Picari was also charged with money laundering. They all initially attempted to deny knowingly being involved in criminality, but have each since admitted the charges, with Siddeeque being the last to plead guilty. All three will be sentenced at Snaresbrook Crown Court on 2 November.

Anna Smith, operations manager at the NCA’s National Cyber Crime Unit, said: “Picari, Vijayanathan and Siddeeque opened the door for fraudsters to access bank accounts and steal money from unsuspecting members of the public. The trio profited from these serious crimes by running www.OTP. Agency and their convictions are a warning to anyone else offering similar services: the NCA has the ability to disrupt and dismantle websites which pose a threat to people’s livelihoods.

“We would also urge anyone using online banking services to be vigilant. Criminals may pretend to be a trusted person or company when they call, email or message you. If something seems suspicious or unexpected, such as requests for personal information, contact the organisation directly to check using details published on their official website.” q

CELEBRATING THREE DECADES OF PROVIDING EXPERTISE IN AUDIO AND VIDEO FORENSICS

[THIS YEAR sees the 30th anniversary of one of the country’s leading technology forensics practices: Audio Video Forensics. Since its foundation in 1994, Audio Video Forensics has been at the forefront of forensic technology, providing unparalleled expertise and cutting-edge solutions to complex problems in myriad legal cases.

Founder and principal Iain McArthur commented: “Over the past three decades we have witnessed and embraced significant advancements in audio and video technology. We have continually evolved to stay ahead of the curve, ensuring that our clients benefit from the latest innovations and methodologies. Our commitment to excellence and precision has remained unwavering, and we are proud to have played a pivotal role in numerous high-profile cases.”

Audio Video Forensics was founded in response to a growing demand for forensic visual and audio services within law enforcement and private legal companies. Since 1994 they have developed and improved techniques to provide audio video and still image evidence for law enforcement agencies, military clients and private legal companies, as well as in health and safety cases and insurance investigations.

Iain McArthur continued: “Our work has been crucial in dealing with audio and video evidence from mobile phones, CCTV and covert sources in highly complex and high-profile prosecution and defence cases, such as the Rhys Jones murder enquiry, both trials of Levi Bellfield, numerous murder enquiries, industrial accident enquiries and road traffic accidents throughout the UK, Ireland, Europe, the Caribbean, Africa, New Zealand and the Middle East.

“Contracted by the Special Investigation Branch of the Military Police, we worked on a wide range of complex forensic audio and visual material on cases from Iraq and Afghanistan.

“We have delivered training and presentations to many police colleges, and have been a registered expert adviser on the NCA database since 1999.”

Among their many satisfied clients is Shahida Begum, principal at CS Solicitors, who provide a specialist service in defending contested allegations of sexual offences, prison mutiny, murder and terrorism within the prison estate.

She commented: “I have instructed Audio Video Forensics for over 10 years now. I would like to express my complete satisfaction with Iain's most informative and helpful service. Iain always takes the time to speak about the case and does not hesitate to provide a comprehensive review of the case. I have never been disappointed with the content of the report and the preparation time.”

Barrister Julian Nutter was equally effusive: “In early 2014 I was instructed for the defence of a young man accused of being part of a murder by joint enterprise in a launderette in the Anfield area of Liverpool. My client was acquitted in part as a direct result of your expert evidence in conducting a clear and concise analysis of the CCTV video relied upon by the prosecution. Your evidence undermined and effectively destroyed the method adopted by the prosecution expert witness and proved to the jury's satisfaction that there was a real doubt as to the presence of our lay client in that launderette.”

Iain concluded: “Stay tuned for upcoming events, webinars and conference talks as we celebrate our 30th anniversary throughout the year. Here’s to the next 30 years of innovation, integrity, and impact!” q

• For further information visit www.audiovideoforensics.com

CE MARKING TO STAY FOR CONSTRUCTION PRODUCTS

[ ONE OF THE MEASURES set out in the announcement by Building Safety Minister Rushanara Ali on 2 September was the extension of CE marking for construction products. Recognition of CE marking was due to end in June 2025 as part of the postBREXIT process.

The minister said: “We have listened to the findings from the Independent Review of the Construction Products Testing Regime. This was clear that there is currently insufficient testing and

RICS APPOINTS NEW COMMITTEE CHAIR

[THE Royal Institution of Chartered Surveyors (RICS) has appointed Victor Olowe as the chair of its new Valuation Assurance Committee (VAC).

Victor is a governance consultant, board reviewer and a former chief executive of the Council for Licensed Conveyancers, with expertise in professional regulation, consumer protection, quality assurance and board governance. He currently chairs the Quality Assurance Scheme Committee at the Institute and Faculty of Actuaries, CGMA Examination Board at CIMA/AICPA and Water UK’s Independent Sewerage and Water Adoption Panels. He also serves as vice chair of Morley College London.

The appointment of the VAC chair comes as RICS also launches its consultation response on the regulation of valuation practice and a proposed valuation compliance officer role. Once the VAC is established, they will make decisions on the next steps to progress it.

The VAC is a permanent subcommittee of the RICS Standards and Regulation Board (SRB), which will oversee the regulatory quality assurance framework for more than 16,000 RICS-registered valuers and 2,500 RICS-regulated firms internationally that offer valuation services.

The formation of VAC represents one of the main recommendations arising from the Independent Review of Real Estate Investment Valuation, which was commissioned by the RICS SRB to respond to concerns over the responsiveness of valuations to rapidly-changing market dynamics and perceived lack of valuer independence.

RICS is currently recruiting the rest of the committee and plans to have it fully operational by the end of 2024.

RICS SRB chair Nigel Clarke said: “I am pleased to confirm Victor’s appointment as the chair of the Valuation Assurance Committee, which marks a significant step in implementing the 2021 Valuation Review recommendations. Following a competitive recruitment process Victor was appointed to the role, to which he brings extensive expertise as a chair and experience working within professional regulation, standards setting and quality assurance.

“Victor is well placed to steer the new committee in overseeing the regulatory quality assurance framework for RICS-registered valuers and RICS-regulated firms undertaking valuation services.” q

certification capacity in the UK alone to provide the volume of conformity assessment that would be required were CE recognition to end. We are also clear that ending recognition of CE marking without reforming the domestic regime would create trade barriers and negatively affect the supply of products that meet recognised standards.”

“Construction products currently make up 13% of UK manufacturing and ensuring supply is vital to delivering housebuilding target, she said.

“Evidence to the Grenfell Tower Inquiry revealed the scale of concern about construction products – products which are vital to all our buildings and infrastructure – and the system that oversees them remains inadequate.”

She continued: “As part of the reforms the Government will work with UK Conformity Assessment Bodies, the UK Accreditation Service and the wider industry to strengthen the conformity assessment market. Any changes to the recognition of CE marking will be subject to a two-year transitional period.”

Reflecting the industry’s welcoming of the announcement, Nick Boulton, chief executive of the Trussed Rafter Association (TRA), said: “The announcement of the extension to the recognition of CE marking for construction products provides a clearer path forward, reducing uncertainty and allowing TRA members to operate.

“The extension also ensures that our industry has sufficient time to adapt to any future regulatory changes, with the promise of a minimum two-year transitional period. This is particularly critical for products like metal web beams which use technical approvals to support their conformity marking, and were facing a cliff edge next June.

“For now, we can confidently continue our work knowing the CE mark remains valid in the UK market.” q

NEW BUILDING CONTROL REGIME BEDS IN FOLLOWING TRANSITION PERIOD

[ IN AN UPDATE from the Building Safety Regulator (BSR) issued on 7 August, HSE shared findings from the latest building control registration data indicating a growing number of professionals joining the register, which it says reflects the industry’s commitment to upholding high standards.

The transition extension period ensured that sector professionals had sufficient opportunity to align with the new requirements at a realistic pace without disrupting or compromising their ability to provide essential services. As of 30 July there were 4,049 building professionals registered as building inspectors in England and Wales. All registered building inspectors have signed up to and are accountable under the Code of Conduct.

The figures for registration by class show there were:

Class 1 (Trainee) – 1,971

Class 2 (Registered Building Inspector) – 1,614

Class 3 (Specialist Building Inspector) – 464

Of those registered at Class 2 and Class 3, 516 are also registered at Class 4 (Building Inspector: Technical Manager).

Commenting on the latest figures, Ged Cooper, BSR Head of Building Control Professional Standards, said: “We are encouraged by this steady increase in numbers and are pleased to see a consistent level of success in Class 2 and Class 3 and it’s heartening that a high proportion are also Class 4 technical managers. We expect to see this positive progress continue.

“BSR is focused on being a fair and pragmatic regulator. Granting an extension for building inspectors to complete their competency assessments shows our commitment to a supportive regulatory environment and a level playing field in building control.

“Building control bodies must take regulatory advice from RBIs of Class 2 or Class 3 to perform their functions effectively. We’ve started investigations and inspections of these bodies and will require assurance with evidence to demonstrate that they have sufficient resources to deliver their regulatory duties and responsibility.”

Throughout the transition period, BSR listened to and acknowledged the sector’s challenges. That included enabling a limited number of professionals who had completed the competency assessment process by the 6 July deadline, but were awaiting their results, to continue to undertake the restricted activities for which they had completed the assessment process.

On the immediate future for the profession, Ged Cooper said: “As an enabling regulator BSR focuses on facilitating compliance and supporting building control professionals through clear regulatory pathways and frameworks. Building control is crucial in

the construction process and we value the role of building inspectors in supporting building control bodies.

“The profession is entering a new transformative era, with unified, consistent standards making it a positive career choice. Enhanced professional standards will lead to stronger compliance with Building Regulations. Improved practices will set high standards as the norm, not the exception.

“Looking at the landscape ahead, the quality, effectiveness and efficiency of building control activities are set to significantly improve.”

BSR believes that increased transparency and accountability within the building control sector will increase confidence and trust, reassuring the public that building work is being strongly and consistently regulated. That improved status will not only help attract new professionals into the sector, but also retain existing talent, contributing to a more robust and effective building control landscape. q

FIRE SAFETY ANNOUNCEMENT BUILDS ON RECENT EFFORTS

[ THE GOVERNMENT HAS ANNOUNCED it is bringing forward legislation to mandate sprinkler systems in new care homes. It was one of several building safety-related measures announced in the House of Commons on 2 September by Building Safety Minister Rushanara Ali MP.

The minister said: “Sprinklers enhance fire protection where residents may be reliant on others for help and assistance, especially if a building evacuation is needed. Many care home providers already include sprinklers in new designs. For those that do not yet provide for sprinklers; again, I recognise that businesses and investors seek certainty. So, care homeowners and developers will benefit from a six-month transition period until the guidance comes into effect and will then have a further six months to enable work on current development projects that are underway, or about to start, to continue.”

disabled and vulnerable residents to have a person-centred risk assessment to identify appropriate equipment and adjustments to aid their safe evacuation in the event of fire. The proposals to be brought forward are in response to the Grenfell Tower Inquiry’s Phase 1 recommendations.

Also included in the surprise announcement was the ending of the ‘outdated’ National Classes fire testing standards. That would, Ms Ali said, end a long period of dual specification in favour of the more robust European standard. The measure implements the recommendation, made in the Hackitt Report, for a clearer, transparent and effective testing regime.

A further measure relates to the safe evacuation of disabled and vulnerable residents of high-rise and ‘higher-risk’ buildings. These Personal Emergency Evacuation Plans, or PEEPs, will entitle

Rushanara Ali added: “The Government has committed funding next year to begin this important work by supporting social housing providers to deliver Residential PEEPs for their renters. Future years’ funding will be confirmed at the upcoming Spending Review.”

The statement was made on the first day of Parliamentary business after the summer recess and took many in the industry by surprise.

The Fire Industry Association was broadly supportive of the measures, stating: “One of the most notable aspects of the government’s new regulations is the mandate for sprinklers to be installed in all new care homes. This move underscores a growing recognition of the vital role that water-based suppression systems play in preventing the spread of fire and protecting some of the most vulnerable members of our society.”

It did add a caveat, however: “These updates aim to enhance fire safety, but they also raise questions about compliance and implementation, especially regarding alternative technologies like watermist systems.” q

REDUCING THE GAPS: HOW CO-OPERATION AND CO-ORDINATION ARE KEY TO FIRE DOOR SAFETY

by Karen Trigg of seamless access pioneers Allegion UK

[ FIRE DOORS ARE OFTEN the first line of defence against fire. When closed, they compartmentalise and delay the spread of fire and smoke while protecting property and providing occupants with an opportunity to escape.

In contrast, dutyholders must recognise that a building’s fire doors will not perform as intended unless essential hardware has been correctly specified, installed and maintained.

Incorrect hardware specification is a common problem associated with fire door safety. When selecting fire door hardware it’s important that any chosen door application meets the required fire ratings, performance ratings and latest legislative requirements. For example, all doors located on an escape route must have suitable exit hardware installed, which is determined by a number of factors including building size and whether it is public facing or not. In addition, it is a legal requirement for all exit devices to comply with the latest revisions of EN 1125 or EN 179 and to possess UKCA and CE markings.

Similarly, one of the most significant gaps in fire safety is the installation of fire door hardware. Fire door integrity can quickly become compromised by hardware alignment issues and improper installation methods. As a result, the door may not be able to latch or close fully from its standing position, leaving gaps large enough for fire and smoke to pass through. While there is currently no legal framework to assess the competence of installers, responsible persons are encouraged to appreciate that installation is a specialised task. During installation installers must also look to follow manufacturer’s guidelines and fitting instructions, which should be supplied with all third-party certified fire doors and hardware.

When it comes to maintenance, it’s vital to recognise that even durable door hardware can become worn and tired in high-footfall environments and may need repairing or replacing over time. A damaged or ineffective self-closing device, for example, can limit the closing action of a fire door and prevent it from fully closing into the frame – rendering it useless in the event of a fire.

As part of regular fire risk assessment duties, responsible persons should perform quarterly checks on fire doors – as well as annual checks on flat entrance doors and self-closing devices in HMOs. A competent assessor must ensure that the entire fire door is in working order, reviewing the certification, door integrity, glazing, gaps, seals, hinges and closing elements.

If a fire door isn’t operating as intended, it’s imperative to seek out professional advice and ensure maintenance is carried out both quickly and professionally.

In any circumstance, under the latest regulations responsible persons must co-operate, co-ordinate and share necessary information with others in order to comply. With that in mind, dependable fire door hardware devices will be supplied with full product information from the manufacturer – including the Declaration of Performance, third-party certification and product data sheets.

Transparent and accurate construction product information is more readily available than ever before and highlights whether a product complies with the necessary standards, helping dutyholders to ensure the most suitable fire door hardware solution is being applied in the correct way.

More than that, with it being made easier for enforcement authorities to act against non-compliance, it is necessary to become educated on key fire door safety themes, such as

specification, installation and maintenance. While fire safety practice may be complex by nature, it pays to understand the fundamentals. q

FARMERS FINED FOR OBSTRUCTING EA INVESTIGATOR AND PERSISTENT POLLUTION

[WILTSHIRE FARMER Neil Dyke has been fined after removing water sample bottles from an Environment Agency officer who was investigating a pollution incident at the farm.

Dyke, of Chipps Farm in Corsley, Warminster, appeared before Bath magistrates on 31 July, where he admitted intentionally obstructing an officer in the exercise of their duties. He was fined £289 and ordered to pay £116 victim surcharge and costs of £3,699.

In a case brought by the Environment Agency, the court heard that an officer went to the farm in January this year after pollution was reported in the Rodden Brook. The officer noticed a tractor spreading slurry in the next field and could see that the water in the brook was a dark brown/green colour, with foam on the surface, and smelled strongly: classic indicators of slurry pollution. He took photos and a water sample as well as an ammonia test, which showed a result of around 10mg/l, which was the maximum reading he could measure.

A tractor arrived and the officer explained to the driver what he was doing and twice asked the driver his name, but he refused to say.

Later, the tractor returned and the driver disputed the officer’s authorisation to take a sample. Though the officer showed his authorisation, the driver – Dyke – said he would not allow samples to be taken off site and he picked up the ones that were lying on the ground, putting them in the tractor cab. He refused to give them back, despite being asked a number of times, and drove off.

Following the hearing, a spokesperson for the Environment Agency said: “Dyke’s behaviour was totally unacceptable. The officer was carrying out his lawful duties to establish slurry pollution in the brook. We will not hesitate in pursuing anyone who tries to prevent our officers from carrying out work to protect the environment.”

Earlier in the month, a Wellington dairy farmer was given 14 weeks in prison suspended for a year, and ordered to pay £10,000 costs, after he persistently allowed slurry to run off into a stream near his farm. David Bartlett of Upcott Dairy Farm, Sampford Arundel, Wellington, appeared for sentencing before District Judge Brereton at Taunton magistrates’ court on 18 July.

He had previously pleaded guilty to three offences relating to pollution to the Westford stream, a tributary of the River Tone. He was also ordered to pay £154 victim surcharge.

In a case brought by the Environment Agency, the court heard that the farm had a long history of failing to properly contain slurry and had been warned several times in the past for causing pollution of the Westford stream.

In October 2022, officers installed remote monitoring equipment on the stream which confirmed regular pollution events were continuing to occur.

Using the data from the remote monitoring, officers went to the monitoring site in December 2022 where they found significant amounts of sewage fungus contaminating the bed of the watercourse, an indication of persistent pollution. q

TREE CARE: IT’S JUST COMMON SENSE

[

FOLLOWING AN EXTENSIVE REVIEW and revision process

the National Tree Safety Group (NTSG) has launched its revised 2nd edition of Common Sense Risk Management of Trees. The NTSG Drafting Group has worked for over three years in consultation with sector experts, refining and amending the document to provide the most up-to-date advice to landowners who are responsible for the management of trees under their control.

The National Tree Safety Group was formed in 2007 to bring together a cross-section of stakeholders with a shared interest in tree safety, to assist those who own and have responsibility for trees, including householders with gardens, rural landowners and farmers, large charities, public and private sector organisations, and local and national government.

The first edition of its guidance was published in December 2011 and has been widely accepted as a sector standard on how trees should be managed in the context of safety, and how a landowner can fulfil their duty of care to staff, visitors and the general public. This 2nd edition builds on that work.

The drafting group comprised members of numerous organisations who represent a wide cross-section of the sectors at which the guidance is aimed.

The first edition of the guidance supported a growing awareness among those dutyholders of the need to check their trees and provided guidance on a widely accepted approach to managing risks from trees, based on sector-wide consultation. More than a decade on, the NTSG has taken stock of what has changed, such as the emergence of widespread tree disease, growing public activism and advocacy around the benefits of trees – now reflected in government policy – and a number of new legal cases.

There are reasons why trees require a specific and unique approach to safety management, the NTSG points out: as natural organisms they organically change from year to year, and while tree diseases are not new, emerging pests and diseases have moved from being isolated problems to impacting a large percentage of the nation’s stock of trees.

The 2nd edition, comprising a Full Guidance Publication and a Summary document, is about an overall approach and lays out the principles behind tree risk management. Its scope is not prescriptive in dealing with tree pathology and failure. The Full Guidance Publication includes scenarios providing examples of how trees can be managed in practice in different types of ownership and use. Safety and human health are paramount.

The Full Guidance Publication and the Summary are available to purchase as hard copy through the Arboricultural Association’s online bookshop and digital copies can be downloaded from the NTSG website.

Arboricultural Association CEO John Parker said: “We’re really pleased to be strongly engaged with the National Tree Safety Group in assisting it to deliver its messages about better care for trees in the context of safety issues. It has never been more important for all those concerned with tree care to understand that the risks they pose must be balanced with all the benefits they provide.”

Ross Murray, the incoming NTSG chair and Forestry Commissioner, said: “I am indebted to all the members of the drafting group who worked so hard for so long on this 2nd edition. Their contribution has been instrumental in achieving a valuable tool for landowners who also own trees. I must especially mention Hilary Allison, Forestry Commissioner and outgoing chair of the NTSG, who has championed the NTSG generally and steered the drafting group by providing highlevel support, encouragement and advice.

“The Forestry Commission has been a supporter of the NTSG since its inception and it continues to be so. I look forward to continuing the excellent work of Hilary and previous chairs so the NTSG’s mission and guidance becomes second nature to all those whose land has trees growing on it.” q

DON’T LOOK BACK IN ANGER; LET IT BE

Mark Chester, of Cedarwood Tree Consultants, explains how a sense of perspective is essential when assessing claims involving trees

[MY WORK AS AN EXPERT WITNESS involves matters relating to trees. That can be damage to – or caused by – trees, and personal injury claims. Such matters can invoke emotions. It is important, as an expert witness, to remain calm and not become emotionally involved when working on such cases.

People can become passionate about trees. One only has to consider the emotions linked to the felling of the Gap Sycamore (pictured), the felling of trees in Sheffield by the contractor Amey and the issuing of an injunction at the midnight hour to stop works in Brighton. Trees can be a source of delight; a focal point; a common cause. They can also interrupt people’s lives, causing damage to our homes and generally causing a negative experience.

As an expert, I have been involved with a range of cases, from those where a tree, blown over in a storm, has damaged a home, to the shedding of a large branch causing personal injury. In other cases, a neighbour had cut back a boundary hedge and cut back too far, and a utility company had undertaken works which were not approved. It can be easy to become involved in the flow of emotions, especially when the client, claimant or defendant, in tears, shares their woes.

In order to do justice, I need to step back and focus on the evidence. In one high-profile case the claimant, whose neighbour had a fruit tree, faced a legal bill of £250,000 after pursuing a claim for the nuisance that the tree and its fruit had on their life. It took the judge to inform the claimant that they needed to stop for the case to conclude.

In one case where a local authority was pursuing enforcement action, it was soon apparent that the evidence presented was not as strong as the officers had originally assumed. Some 60 charges were reduced to 10 by the start of the hearing, and then to a handful. The officers had allowed their own feelings about the defendant – ‘a repeat offender’ – to cloud judgement. They were unsuccessful. A more focused case might have succeeded.

was not the claimant trying to bluff. I explained that I did not work for the defendant, but was an independent, impartial expert.

I asked whether the claimant had read their own expert’s report. They had not. They were noticeably less bullish when I left the site. My role was to inform the defendant’s insurers on the merits of the claim, to inform a settlement.

Perhaps emotion is inevitable, given the nature of each claim. Sometimes, as I discuss the merits of the claim, the client’s emotion is very evident. For one potential client, whose boundary tree had been damaged by the neighbour’s extension, and who needed to provide the judge with the names of three experts for one to be selected, the knowledge that one of those approached had agreed to be involved due to sympathy with the claimant is a concern.

Emotion is not always wrong. I recall one case where the evidence supported the claimant. They had been injured when a branch of a tree broke, causing a collision. Their view was that the tree, on land managed by a management company, had not been properly managed, and that had led to the branch failure.

I had undertaken my feasibility assessment and concluded that there was a case to answer. I met with the barrister instructed to progress the claim, and the claimant. It had been a prolonged journey for the claimant, who knew from a family connection to plants that there was a case. The defendant had strongly resisted the claim until my involvement. “Thank you for believing me. You have a case. Pursue it with due vigour.”

I was instructed to produce a detailed expert report for the barrister. The defendants settled within a week of receipt of my report.

My role as an expert is to ensure that a judge, magistrate or other presiding party is informed in making their decision. They may choose to reach another conclusion from me: that is their prerogative. In one case of which I am familiar, the expert for the claimant shared how they tried to persuade the jury of the merits of their position, but were unsuccessful. Not only did that prolong the inevitable; it also affected their evidence in cases that followed, as their impartiality was questioned.

I have on numerous occasions been invited to appraise if, when a tree has been uprooted, the damage was natural or due to the involvement of a neighbour. Sometimes the potential claimant has been reassured to know that the damage was not due to malice, but nature; but on other occasions the claimant is so emotionally involved they have difficulty in accepting that. Conveying reality is not easy, but I have concluded that it is best presented at the earliest opportunity, to avoid progressing on a journey that is not sustainable.

It surprises me sometimes how a claimant can become emotionally involved and also receive counsel that lacks objectivity. In one case, a utility company faced a claim for excessive tree felling. I had already read the report of the expert for the claimant, which wasn’t especially supportive of the claim.

I arrived on site to be greeted by the claimant, who informed me that his barrister had informed him that his case was good: “My barrister says that your lot haven’t got a chance.” Correspondence I had read indicated this

When the experts become emotionally involved, objectivity can easily be lost. Without objectivity a case may be lost or unnecessarily prologued. My duty, to court and to client, is to be impartial. As I have explained, if I believe there is a case I will support it through thick and thin: if not, the sooner the matter is resolved, the better. q

LORDS HOLDS INQUIRY INTO COURTS’ USE OF LANGUAGE SERVICES

[ THE CROSS-PARTY House of Lords Public Services Committee has launched a short inquiry into interpreting and translation services (ITS) in the courts. The inquiry seeks to understand the experience of procuring ITS in the courts, the policy recommendations for supporting service providers and the potential role of technology in enabling ITS. The committee is inviting written evidence on topics including:

• The extent to which the current ITS provided in court meets the needs of

• defendants, prosecutors, witnesses and legal professionals

• The key issues in the provision of ITS and how they impact the running

• of the courts, public trust, interpreters and translators – including whether

• there is any data on miscarriages of justice in relation to ITS

• The qualifications and experience of interpreters and translators and the

• recruitment process, including any barriers to recruitment

• Quality assurance and complaints procedure in relation to ITS

• The potential role of new technology – such as artificial intelligence,

• machine translation and the digitisation of court proceedings – in the

• future of interpreting or translation services in the courts

• The current capability and accuracy of market-leading artificial

• intelligence and machine translation tools in relation to ITS

The committee has invited written evidence to be submitted by 30 September and expects to report on its findings towards the end of the year.

Baroness Morris of Yardley, chair of the Public Services Committee, said: “It is vital that people in court, including victims of crimes, witnesses and those charged with offences, have equal access to justice, can be understood and understand what is happening in the court, regardless of

GOVERNMENT ‘OUT OF STEP’ ON TRANSLATIONS

[A JOINT STATEMENT by the Institute of Translation and Interpreting, the Chartered Institute of Linguists and the Association of Translation Companies addresses significant changes that have been made on the UK Government page on certifying a document, which includes a short section on certifying a translation. Changes have also been made to the Ministry of Justice Family Procedure Rules for PD7A.

Those changes, the statement says, do not reflect existing, long-standing UK best practice, or the format in which translated documents have been required to be presented by most UK authorities.

“As such, this changed guidance exposes both the individuals submitting certified translations, as well as the authorities receiving certified translations, to the risk of translation errors, to certified translations being rejected and to lengthy delays in processing translated documentation.”

The three leading translation bodies in the UK that are signatories to the statement point out that they have worked together to harmonise guidance around certifying translations, and to ensure uniform delivery and universal acceptance of translations certified by their members – which form the majority of certified translations submitted to UK authorities.

The changed guidance on gov.uk and from the Ministry of Justice is now out of step with the best practice advice from the UK’s leading translation bodies, they state.

“Taking into account the mixed landscape of UK Government departments, agencies and public services in early 2024, our three leading associations issued joint, publicly available best practice guidance entitled Certified Translation-Getting It Right, which the CIOL, ITI and ATC mutually endorse and recommend to all authorities in the UK.” q

what language they speak. However, there are concerning reports of people struggling to access interpreting and translation services in the courts.

“Existing issues surrounding the procurement and provision of language services for the public sector have already been highlighted in an October 2023 report by the Association of Translation Companies. That report included a conclusion that the provision of interpretation and language services was fragmented across the UK, which in turn caused complications with procurement and implementing and monitoring best practice. Other studies have also highlighted problems with recruitment and retention of translators due to poor remuneration.

“Organisations across the public sector use interpretation and translation services to help people who use public services to overcome language barriers and communicate effectively. Our inquiry will focus on how ITS is used in the courts.

“We have asked for written evidence submissions and will be holding a small number of oral evidence sessions during this short inquiry. Our aim is to effectively scrutinise the ITS policy and process, including the potential use of technology in providing these services, solutions to translator recruitment, quality assurance and impact of ITS on the courts and court users. Effective delivery of ITS in the courts is essential and we will be seeking recommendations to facilitate this.”

The Chartered Institute of Linguists has already shared its Working Together White Paper with the committee as highlighted by Baroness Morris, which sets out urgent recommendations agreed across a broad range of language stakeholders for tackling immediate challenges around procurement and provision of language services for the UK’s public sector.

CEO John Worne has also written recently on these issues in the Law Gazette, with CIOL council member Dr Diana Singureanu, who is a research fellow at the Centre for Translation Studies at the University of Surrey.

The CIOL is encouraging its members to add their own experiences and perspectives at committees.parliament.uk/call-for-evidence/3437/. q

“OPEN THE POD BAY DOORS, HAL”: WILL AI REPLACE HUMAN EXPERTS?

By Roger Emmott, managing director of Roger Emmott Associates Ltd

[ MY EXPERIENCE with expert reports and tribunals has not yet involved any use of AI. In this article I consider some of the issues and opportunities.

Court and arbitration processes value expert evidence and the associated experience and track record of experts and fact witnesses. Judges and arbitrators are conservative people: opinions and decisions on final awards are made after careful scrutiny of all facts, data, evidence and legal frameworks. So could there be a case to use AI in new ways to assist? Possibly to help the process of interpretation and analysis and presentation of a case or cases based on facts or expert evidence?

I asked ChatGPT for its opinions.

• When will AI replace expert witnesses in courts and arbitrations?

The replacement of expert witnesses by AI in courts and arbitrations is a complex issue influenced by multiple factors, including

technological advancements, legal frameworks, ethical considerations and societal acceptance

• Tell me more

Technological Advancements: AI needs to reach a level where it can accurately analyse data, draw conclusions and present findings in a comprehensible and reliable manner. Current AI can assist with data analysis and pattern recognition but is not yet capable of replicating the nuanced judgment and expertise of human experts

Legal Frameworks: Courts and arbitration panels operate within strict legal frameworks that govern the admissibility and credibility of evidence. For AI to replace human expert witnesses, there must be changes in laws and regulations to allow AI-generated testimony. This process involves rigorous validation and standardisation of AI tools

Ethical Considerations: The use of AI raises ethical issues, such as accountability, bias, and transparency. Ensuring that AI systems are fair, unbiased, and their decision-making processes are transparent is crucial for acceptance in legal settings

Societal Acceptance: Trust in AI is a significant factor. Judges, lawyers, and the general public need to have confidence in AI systems. This trust will develop over time as AI proves its reliability and accuracy in various applications

• What happens next? 5-10 years?

Assistance and augmentation: AI will increasingly assist expert witnesses by analysing large datasets, identifying patterns and providing insights that experts can use in their testimony

• 10-20 Years?

Partial replacement in routine cases: For routine and data-heavy cases, AI could take on more significant roles, providing primary analyses that human experts review and interpret. This could be in areas like forensic accounting or digital forensics

Increased trust and validation: As AI systems become more reliable and their use becomes more accepted, the legal system might start to rely more on AI-generated reports, with human experts verifying and presenting the findings

• Over 20 years?

Potential for full replacement in specific areas: In highly standardised and less subjective areas, AI could potentially replace human experts. This would likely occur in fields where the interpretation of data is straightforward and the AI systems have been extensively validated

Human oversight remains critical: Even in the long term, human oversight is likely to remain crucial for ensuring fairness, addressing ethical concerns and handling complex, nuanced cases that require human judgment

• Are human experts necessary or will AI take over?

Human expertise and judgment will continue to be essential in the legal system

But remember: HAL* responded to the question ‘Open the pod bay doors’ with ‘I’m sorry, Dave; I’m afraid I can’t do that’. AI may yet triumph. Be forewarned! 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@blockchainhub.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

[AS WE’VE SEEN earlier in this publication, AI is everywhere. In healthcare the ability of digital models to predict and detect disease is proving to be a useful tool for its human deployers.

• Predicting the risk of osteoarthritis developing is one of the golden tickets of orthopaedic medicine, and it is possible that AI can be useful towards that end. A new research project is using AI to number crunch the data to make such predictions possible when it comes to osteoarthritis of the knee, with a view to extend its use in the future for other joints.

• Most of us subscribe to the view that, while AI will provide us with a wealth of opportunities to move forward research and diagnostics, it is, thankfully, the case that decisions on the assessment of disability and the future needs of injured parties is made by humans – judges in the courts assisted by experts in their field.

One subject which is firmly rooted in subjective experience is pain. A recognised expert in pain medicine explains the process of assessing damages, given that pain is difficult to pin down. Similarly, assessing the damages in cases of osteoporotic fractures is a complex process requiring substantial expertise, as regular contributor Professor Paul Lee explains.

• The hand is perhaps the most complex series of joints that a clinician can encounter. Apart from arthritis, a major cause of damage to the hand is an accident at work. Assessing the cause of the injury is another of the fields requiring the expert’s eye.

• Hand surgery is a close ally of plastic and aesthetic surgery, which has itself been dealing with a rash of reports of unqualified practitioners offering procedures – often abroad – that can have disastrous consequences for those unwise enough to undergo them. Those consequences can include hospitalisation and even death. Those falling for the too-good-to-be-true offers in this country are not exempt: a council in the Midlands has begun an investigation into so-called Brazilian butt lifts. On a more optimistic note, the fears over a possible cancer connection with dermal fillers are apparently unfounded, although some fillers can cause lymphatic obstruction.

• The possibly cancerous results of the increase in sun exposure due to climate change are mainly seen as affecting the skin. But excess UV can also damage the eyes, so effective protection for those organs is also essential. We hear about the problems associated with some fashionable sunglasses.

• We are also being reminded again of possible damage to hearing due to exposure to loud noise. Again, the solution is adequate protection. The RNID has carried out some research with alarming results, so to speak. They offer advice on the kind of protection available.

• No matter how much we protect ourselves from harm, eventually the inevitable happens. Death can possibly be the only occasion in our time on earth that we have dealings with the legal system in all its pomp. That possibility is set to expand in coming years, with the implementation of the new system for registering deaths.

• Where there is any suspicion of wrongdoing, there will be an inquest. But what happens when a relative suspects something is amiss, but the process is being gone through? Can they request an inquest? We find out. q

CQC PUBLISHES FINAL PART OF VALDO CALOCANE INQUIRY

[ FOLLOWING THE CONVICTION of Valdo Calocane (VC)

in January for the killings of Ian Coates, Grace O’Malley-Kumar and Barnaby Webber, the Care Quality Commission (CQC) was commissioned by Rt Hon Victoria Atkins MP, former Secretary of State for Health and Social Care, to carry out a rapid review of Nottinghamshire Healthcare NHS Foundation Trust (NHFT) under Section 48 of the Health and Social Care Act 2008.

That review has been delivered in three parts. The first two parts, an assessment of patient safety and quality of care provided by the trust and an assessment of progress made at Rampton Hospital since the most recent CQC inspection, were published in March.

The final part, published on 13 August, is a rapid review of the available evidence related to the care of VC during the period he was under the care of NHFT, alongside a small number of other cases for benchmarking purposes, to determine whether the evidence indicates wider patient safety concerns or systemic issues with the provision of mental health services in Nottinghamshire.

VC was under the care of NHFT between May 2020 and September 2022. During that period it is clear that he was acutely unwell. He presented with symptoms of psychosis and appeared to have little understanding or acceptance of his condition. Issues with him taking his medication were also recorded from early on.

The review found that there appear to have been a series of errors, omissions and misjudgements in his care. Key among these were:

• Inconsistent approaches to risk assessment. Risk assessments

• minimised or omitted key details and did not make explicit the

• serious nature of the risk VC posed to himself and others based

• on previous behaviour.

• Poor care planning and engagement. VC’s family contacted

• NHFT to raise concerns on a number of occasions, but the

• information they provided was not consistently acted on.

• The decision to discharge VC back to his GP in September

• 2022. The evidence over the course of VC’s illness and contact

• with services and police indicated beyond any real doubt

• that VC would relapse into distressing symptoms and potentially

• aggressive behaviour. Discharging VC back to his GP – due

• to his lack of engagement with mental health services – did not

• adequately consider or mitigate the risks of relapse.

The review also found that, if the decision had been made to treat VC under Section 3 of the Mental Health Act 1983 on his fourth admission to hospital, further options would have been available for his care and treatment in the community.

Given VC’s known medical history at this point – a diagnosis of paranoid schizophrenia, prior indications that he was not taking his medication and evidence that he could present a risk to others when relapsing – it could have been possible to detain him under Section 3 of the Mental Health Act. That gives healthcare professionals the ability to administer depot medicine (longer-lasting medication administered via injection) against the individual’s will or to consider placing the individual on a community treatment order.

The scope of the review was limited to the period of time that VC was under the care of NHFT. However, the findings should provide additional evidence for NHS England’s more detailed scrutiny of VC’s interaction with mental health services through their forthcoming independent homicide review.

Chris Dzikiti, CQC’s interim chief inspector of healthcare, said: “This review identifies points where poor decision-making, omissions and errors of judgements contributed to a situation where a patient with very serious mental health issues did not receive the support and follow up he needed.

“While it is not possible to say that the devastating events of 13 June 2023 would not have taken place had Valdo Calocane received that support, what is clear is that the risk he presented to the public was not managed well and that opportunities to mitigate that risk were missed.

“For the individuals involved, their families and loved ones, the damage cannot be undone. However, there is action that can, and must, be taken to better support people with serious mental health issues and provide better protection for the public in the future.

“We have made clear recommendations to improve oversight and treatment of people with serious mental health issues at both a provider and a national level. Wider national action is also needed to tackle systemic issues in community mental health – including a shortage of mental health staff and lack of integration between mental health services and other healthcare, social care and support services – so that people get the right care, treatment and support when and where they need it.”

The final part of the review makes a number of recommendations, which should be viewed in conjunction with the recommendations from parts one and two. q

NEW RULES FOR FIXED RECOVERABLE COSTS PUBLISHED

[ ON 8 MAY the government published its response to a consultation on a new streamlined process for fixed recoverable costs for lower value clinical negligence claims (LDFRC) – those with a damages value of £1,501 to £25,000 – in England and Wales.

The consultation was launched in September last year and concerned

WARNING ISSUED OVER DEFIBRILLATORS

[ A SAFETY WARNING has been issued due to manufacturing concerns with a number of defibrillators used in healthcare settings. Issues have been highlighted with the HeartSine Samaritan PAD, Omron HDF-3500 automated external defibrillators (AEDs) and the Philips Heartstart intrepid monitor/defibrillator.

The HeartSine Samaritan PAD and Omron HDF-3500 are small, lightweight, portable, battery-operated AEDs designed to treat cases of cardiac arrest. The production company, Stryker, have determined that a manufacturing-related issue may impair device audio prompts. That could prevent the device from delivering instructional voice prompts during use of the device. Stryker are notifying all customers that have one of these devices within the identified range of potentially affected devices to perform the actions outlined.

In addition, Philips has become aware of a potential safety issue where the HeartStart Intrepid Monitor/Defibrillator may display intermittent ECG waveforms when the fourth limb lead is placed on the patient using either a five-lead or 10-lead ECG cable.

All HeartStart Intrepid Monitor/Defibrillators may be affected by this issue. Information has been released about the actions that should be taken by the customer or user to prevent risks for patients or users. q

disbursements such as expert reports, counsel fees and court fees and other disbursements. The main objective is to provide faster resolution, with legal costs that are proportionate to the value of compensation.

For all LDFRC scheme claims, the following items will be separately recoverable:

• Expert report fees (including expert costs associated with the report)

• and ‘after the event’ insurance premiums covering the cost of

• expert reports

• Court fees relating to an application for pre-action disclosure

• Inquest costs and disbursements to the extent that they would be in

• clinical negligence claims not subject to the LDFRC scheme

• In the limited circumstances where limitation is due to expire

• imminently, the court fee for issuing proceedings and any court

• fees incurred applying for or extending a stay of proceedings, where

• proceedings are started as a result of a limitation period that is

• about to expire

For LDFRC scheme claims involving protected parties or children, the following items will be separately recoverable:

• Counsel fees in relation to Part 8 approval hearings

• Court fees in relation to Part 8 approval hearings

For LDFRC scheme claims that do not involve protected parties or children, the following items will not be separately recoverable:

• Counsel fees incurred in the pre-action phase

• Court fees, except as set out above

The government’s response also clarifies wording around disbursements for expert fees and makes clear that rules relating to costs and disbursements in the LDFRC scheme will not apply to inquest costs and disbursements.

NHS Resolution is identifying the changes required to manage claims under the new arrangements. q

NEW DEATH CERTIFICATION SYSTEM COMES INTO FORCE

[THE DEATH CERTIFICATION SYSTEM

in England and Wales is overdue for reform: it has remained largely unchanged for over 50 years. Introducing a robust system in England and Wales whereby all deaths would be subject to either a medical examiner’s scrutiny or a coroner’s investigation has been an ambition of successive governments and ministers.

The importance of death certification reform and the introduction of medical examiners has been underlined in numerous reports and inquiries, including the Shipman Inquiry third report, the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, the Morecambe Bay Investigation report and the government response to the report of the Gosport Independent Panel.

It has long been established that, following a death, the case will either follow the path of medical certification by a medical practitioner or investigation by a coroner. That will remain the case in the new system, but with important differences.

Medical examiner scrutiny is not mandated in the non-statutory system; however, NHS England and NHS Wales Shared Services Partnership started implementing the medical examiner system on a non-statutory basis in 2019.

It has increasingly become standard practice

for medical examiners to provide independent scrutiny of deaths not taken for investigation by a coroner. Medical examiners are now scrutinising almost all deaths in acute trusts and a growing proportion of deaths in all other healthcare settings, including the community.

The new death certification reforms require an independent review to be carried out for all deaths in England and Wales, without exception. That will either be provided by independent scrutiny by a medical examiner or by investigation by a coroner. The new procedure will come into force from September.

Legislation

The underpinning primary legislation is:

• Section 21 of the Coroners and Justice Act

• 2009, which was commenced in June 2018

• Sections 19 and 20 of the Coroners and

• Justice Act 2009, which was commenced on

• 1 October 2023

• Section 169 of the Health and Care Act 2022,

• which was commenced on 1 October 2023

The primary legislation that underpins the new statutory medical examiner system is the Coroners and Justice Act 2009. Since its passage, the act has been amended (most recently by the Health and Care Act 2022) to reflect changes to the health system.

The Coroners and Justice Act 2009 allows NHS bodies in England and Wales to appoint medical examiners. It also enables the governments to make regulations in several areas, and those regulations provide the detail of how medical examiners and the reformed death certification process will operate.

Primary legislation has been commenced and several sets of regulations have been made or amended in relation to the system.

The three sets of regulations made by the Department of Health and Social Care are:

• The Medical Certificate of Cause of Death

• Regulations 2024

• The Medical Examiners (England)

• Regulations 2024

• The National Medical Examiner (Additional

• Functions) Regulations 2024

The Welsh Government has also made The Medical Examiners (Wales) Regulations 2024.

The guidance makes clear what the legal requirements will be in each area, ahead of the publication of more detailed guidance. It should be read together with the regulations to support those involved in the death management system to understand and prepare for the reforms.

The full guidance is available at www.gov.uk. q

STREETING ‘STUNNED’ AS REVIEW FINDS

SIGNIFICANT FAILINGS AT CQC

[ AN INDEPENDENT REVIEW of the Care Quality Commission (CQC) has identified significant internal failings which is hampering its ability to identify poor performance at hospitals, care homes and GP practices.

The interim report by Dr Penny Dash (right), chair of the North West London Integrated Care Board, found inspection levels were still well below where they were pre-COVID. She also found a lack of clinical expertise among inspectors, a lack of consistency in assessments and problems with CQC’s IT system.

The failings mean the regulator is currently unable to judge the quality of health and care services consistently and effectively, including those in need of urgent improvement. The report also found that social care providers are waiting too long for their registration and rating to be updated, with implications for local capacity.

Health and Social Care Secretary Wes Streeting said: “When I joined the department it was already clear that the NHS was broken and the social care system in crisis. But I have been stunned by the extent of the failings of the institution that is supposed to identify and act on failings. It’s clear to me CQC is not fit for purpose.

“We cannot wait to act on these findings, so I have ordered the publication of this interim report so action can begin immediately to improve regulation and ensure transparency for patients.

“I know this will be a worrying development for patients and families who rely on CQC assessments when making choices about their care. I want to reassure them that I am determined to grip this crisis and give people the confidence that the care they’re receiving has been assessed. This government will never turn a blind eye to failure.”

Dr Dash was asked to carry out a review of CQC in May. Over the ensuing two months she has spoken to around 200 senior managers, caregivers and clinicians working across the health and care sector, along with over 50 senior managers and national professional advisors at CQC.

Commenting on her findings so far, Dr Dash said: “The contents of my interim report underscore the urgent need for comprehensive reform within CQC. By addressing these failings together, we can enhance the regulator’s ability to inspect and rate the safety and quality of health and social care services across England.

“Our ultimate goal is to build a robust, effective regulator that can support a sustainable and high-performing NHS and social care

system which the general public deserves.”

To start to rebuild its credibility, Dr Dash has highlighted urgent actions CQC can take including overhauling the inspection and assessment system, rapidly improving operational performance and fixing faltering IT systems.

Professor Martin Green OBE, chief executive of Care England (right), said: “It is clear that Dr Dash has listened to the voices of care providers, resulting in a clear set of recommendations. This report acknowledges the severe and systemic problems that sit at the very heart of CQC and gives a specific set of steps that the regulator must take to improve performance and re-establish the sector’s long-eroded trust.

“CQC must embark on a radical improvement programme that should not only include some tangible improvements in their performance, but also needs to move away from a culture of blame. We all want proportionate and effective regulation, and the challenge now is for CQC to take action and work with organisations across the sector to deliver it.”

The Health and Social Care Secretary has announced four immediate steps the government and CQC will take to restore public confidence in the regulator and ensure patients can get an accurate picture of the quality of care available. q

CAN YOU REQUEST AN INQUEST IF YOU SUSPECT MEDICAL ERRORS?

Rachael Heyes, medical negligence solicitor at JMW Solicitors, outlines what you can do if you believe medical failures played a role in your loved one’s death, and how to request an inquest by a coroner.

[LOSING A LOVED ONE is distressing, and it is even harder if you suspect medical errors contributed to their death. Understanding your rights and taking the necessary steps is essential to ensure any potential medical negligence is thoroughly investigated.

An inquest is a legal investigation by a coroner to determine the circumstances of a person’s death. It focuses on four key facts: the identity of the deceased and the time, place and manner of their death. While the first three are often straightforward, determining how a person died can require a more in-depth investigation, involving reviews of medical records and witness statements from healthcare professionals and the deceased’s family.

An inquest is not about assigning blame; it is a fact-finding process to clarify the circumstances of the death. The coroner gathers and analyses information, providing a detailed account of the events leading to the death. That process is to ensure that deaths, particularly those that are sudden, unexplained or suspicious, are thoroughly examined, which helps maintain public trust and accountability.

Although the coroner doesn’t assign legal liability, the conclusions of an inquest can reveal systemic issues or specific failures that might have contributed to the death. Such findings can prompt further investigations or lead to recommendations for changes in procedures to prevent future deaths.

Grounds for requesting an inquest

Under the Coroners and Justice Act 2009, an inquest is required if:

• The cause of death is unknown

• The death was violent or unnatural

• The death occurred in custody or detention, including under the

• Mental Health Act.

If the cause of death is unclear a doctor may be unable to issue a death certificate, leading to a referral to the coroner, who might then order a post-mortem. Not all cases result in an inquest. If you believe your loved one’s death was unnatural, you can write to the coroner highlighting any perceived failings in care.

In cases of suspected medical negligence, potential failings might include surgical errors, misdiagnosis or failure to provide timely treatment. If you have access to medical records or if the hospital has conducted an internal investigation, those documents may be helpful to the coroner. If the coroner declines to investigate further you may consider a Judicial Review, where a court evaluates whether the coroner’s decision was fair.

Seeking legal guidance

While legal representation at an inquest is not a mandatory part of the process, it is recommended due to the potential complexities involved. Families are considered ‘interested persons’, granting them the right to participate in the proceedings and access relevant documents. Since organisations involved are often legally represented, having a solicitor specialising in medical negligence can be beneficial.

A solicitor can guide you through the inquest process, from gathering and analysing evidence to representing your interests. They can also instruct a barrister to question witnesses on your behalf, ensuring a thorough and impartial investigation.

If the coroner or jury concludes that medical failings contributed to

your loved one’s death, that might indicate substandard care and you may be able to pursue a claim for compensation. Legal experts can help you navigate that process.

The inquest process and outcomes

During the inquest, the coroner examines all evidence, including medical records and witness statements, to uncover the facts surrounding the death. If the death occurred in state custody or under the Mental Health Act, an enhanced inquest, known as an Article 2 inquest, may be held, involving broader procedural and policy issues. After reviewing the evidence, the coroner or jury will conclude how the person died. Conclusions can be short-form, such as ‘natural causes’ or ‘unlawful killing’, or they could be narrative conclusions, which are more detailed and specific to the case. In Article 2 inquests the conclusion may include terms like ‘missed opportunities’ or ‘significant failures’. If neglect contributed to the death, that may also be included in the conclusion.

Preventing future deaths

A major part of the coroner’s role is preventing future deaths by addressing systemic failings. The coroner can issue a Regulation 28 report, known as a Report to Prevent Future Deaths, highlighting concerns and recommending actions to prevent similar incidents. Organisations receiving such a report must respond within 56 days, outlining their actions to address the issues.

Next steps

After the inquest concludes, it is essential to carefully review the findings. If medical failings contributed to your loved one’s death, you may have grounds for a medical negligence claim. Successful claims can result in compensation for medical expenses, funeral costs and loss of dependency.

Understanding your rights and seeking legal advice are vital steps in ensuring that any potential medical negligence is thoroughly investigated, helping achieve closure for your family and preventing future tragedies. q

COUNCIL LAUNCHES INVESTIGATION INTO BUTT LIFTS

[ BRENTWOOD BOROUGH COUNCIL’S Environmental Health team are investigating a number of cases of hospitalisation following the non-surgical aesthetic procedure known as a Brazilian butt lift –also referred to as a BBL or Liquid BBL – in Brentwood, Essex.

The aim of the butt lift is to make patients’ buttocks bigger, with a more rounded or lifted effect. If performed incorrectly it can be fatal.

Currently the procedure is unlicensed and unregulated; therefore, the quality and competency of practitioners is unmanaged by industry regulators.

Brentwood’s Environmental Health team were concerned about the undertaking of the procedure and the aftercare provided by an individual and associated companies in the town and issued prohibition notices under the Health and Safety at Work etc Act 1974. The notices prohibit the conducting of the BBL procedure until the risks to persons undergoing that procedure have been controlled so far as is reasonably practicable.

A spokesperson for the council said: “Brentwood are working with several local authorities, national agencies and industry experts in the UK, where non-surgical aesthetic procedures are being undertaken.

“Individuals who have undergone these procedures have experienced excruciating pain, discomfort and infections, some of which have required medical interventions and hospitalisation. We urge anyone who has undergone a non-surgical aesthetic BBL procedure and is experiencing pain, discomfort and/or has signs of infection, please do seek medical assistance immediately.

“We strongly recommend that anyone considering a non-surgical aesthetic procedure undertake extensive research. If the cost of the treatment is lower than the market average, proceed with caution as the practitioner may not be using the products advertised.

“Please be aware that non-surgical aesthetic procedures still require a sterile clinical environment, therefore procedures should be performed in appropriate treatment rooms. If you have concerns or doubts about the procedure, contact us.”

Commenting on the Brentwood case, negligence solicitors Cosmetic Surgery Law said: “Although butt lift procedures are performed in the UK, the number of patients travelling to locations such as Turkey to undergo the surgery has significantly increased in recent years. It is estimated that over 12,000 butt lifts are now performed in Turkey every year.

“When any form of cosmetic surgery is carried out incorrectly, or the appropriate level of medical skill and care is not exercised, then the patient may be entitled to make a medical negligence claim against the medical practitioner, or the clinic where it was performed.”

The firm explained that it employs a team of lawyers who specialise in dealing with claims on behalf of people who have suffered as a result of negligently performed cosmetic surgery and substandard beauty treatments. q

FILLERS NOT RESPONSIBLE FOR CANCER, UPDATED STATEMENT AVERS

[ON 30 APRIL the British Association of Aesthetic Plastic Surgeons (BAAPS) issued an updated statement on dermal fillers. It follows concerns over the side effects of fillers, including possible cancer.

BAAPS president Marc Pacifico said: “There is no evidence that fillers cause cancer or its spread. The scientific evidence suggests that some fillers might impact lymphatic flow and result in lymphatic obstruction. With any cosmetic procedure its essential to go to a properly qualified and experienced practitioner who understands facial anatomy and will be fully versed on the safety profile of the dermal filler being administered.”

In September last year BAAPS reported on the findings of research in the US, unveiled during the Annual Scientific Conference of the BAAPS in London, stating: “Hyaluronic acid –the key compound in most fillers – has been found to block lymphatic channels, which help the body drain fluid and are a key part of the immune system that helps to fight disease. Research is now being planned to see if the treatment affects the risk of diseases including cancer. Fillers have also been linked to cysts, lumps, swelling and facial pain.”

Marc Pacifico said at the time: “Our surgeons have seen filler lasting longer than expected, well over a year in many cases. Many have noted that anatomical structures are certainly more tethered and scarred when fillers have previously been used and have seen an increase in intraoperative and preoperative anatomical distortion due to the overuse of fillers.”

Following the concerns the government pledged to introduce steps to regulate who can inject fillers and what they can use. Lack of progress in the area has been a source of concern to many surgeons. q

Otto Placik, CC BY-SA 3.0, via Wikimedia Commons

WHEN HAND INJURIES CAN LEAD TO A CLAIM

By Francesca Smith of Smith Medico-Legal

[THE HUMAN HAND is a remarkable feat of evolution, uniquely equipped with the ability to grip and perform fine manipulative movements such as picking up small objects – setting us apart from other animals. That complex structure of tendons, nerves and bones is a testament to the intricate workings of the human body.

However, when the hand is damaged it can be a challenge to make a prognosis. The delicate interplay of the various components means that even minor injuries can have significant consequences, requiring careful assessment and treatment.

Injuries to the hand can range from simple cuts and bruises to more severe conditions like fractures, tendon tears or nerve damage. Each type of injury requires a tailored approach, as the hand’s complex anatomy means that the impact on function can vary greatly.

Accurately diagnosing and treating hand injuries is crucial, as the hand’s role in our daily lives is so integral. From the fine motor skills needed for tasks like writing or using tools to the broader functions of gripping and manipulating objects, the hand’s versatility is unparalleled

By understanding the unique nature of the human hand and the challenges involved in its treatment, healthcare professionals can work to ensure the best possible outcomes for patients, restoring function and enabling a return to everyday activities.

What are the main causes of workplace hand injuries?

Workplace hand injuries can have a significant impact on an employee’s ability to perform their job duties. Expert evidence can provide clarity as to whether workplace negligence, practices or health and safety breaches caused injury to the claimant’s hand. Some of the most common causes of

hand injuries at work include:

Inadequate training: Employees who have not received proper training on how to safely operate machinery or handle hazardous materials are at a higher risk of sustaining hand injuries. Employers have a duty to ensure staff are competent to carry out their roles.

Defective equipment: Faulty or poorly maintained tools, machinery and equipment can malfunction and cause serious hand injuries. Employers must regularly inspect and service all workplace equipment.

Repetitive tasks: Jobs that involve repetitive hand and wrist movements, such as assembly line work, can lead to conditions like carpal tunnel syndrome over time. Employers should implement ergonomic measures to minimise repetitive strain.

Lack of personal protective equipment: Failure to provide appropriate gloves, guards and other protective equipment leaves employees vulnerable to cuts, crushes, burns and other hand-related injuries.

Workplace hazards: Unguarded moving parts, sharp objects, hot surfaces and other workplace hazards pose a constant danger to employees’ hands if not properly controlled.

To prevent hand injuries, employers must identify risks, implement safety measures and ensure staff receive comprehensive training. Vigilance and a proactive approach to hand safety is crucial in any workplace.

What types of hand injuries require plastic surgery?

Hand injuries can range from minor cuts and abrasions to severe trauma – including fractures, nerve damage and tissue loss. Plastic surgery is often necessary in cases involving:

• Deep cuts or lacerations which affect numerous layers of tissue

• Complex fractures that impact the bones, joints or tendons

• Crush injuries that cause significant tissue damage

• Amputations or partial loss of fingers or the hand

• Nerve injuries that require microsurgical repair

• Severe burns that lead to scarring and contractures

Plastic surgeons have the specialist training to restore function and appearance after those types of debilitating hand injuries. Through techniques like tendon and nerve repair, skin grafts and reconstructive procedures, they can help patients regain mobility, sensation and a normal aesthetic appearance. The provision of adequate skin cover is the first step in a complex reconstruction.

Seeking prompt plastic surgery evaluation is crucial, as timely intervention is key to the best possible outcomes for serious hand trauma. Patients should not hesitate to consult a plastic surgeon if they have sustained a complex or severe hand injury.

Understanding the consequences of hand injuries

Hand injuries can significantly impact a person’s ability to perform everyday tasks and maintain their quality of life. Simple actions like buttoning a shirt, tying shoelaces or using a computer can become incredibly challenging. That can lead to feelings of frustration, isolation and even depression.

The role of a plastic surgeon expert witness is to provide an independent and impartial medical expert opinion on the current condition and extent of the claimant’s injuries, the prognosis for recovery and the likely impact on the claimant’s future earning capacity. q

• Smith Medico-Legal are experts in hand and plastic surgery. Their experts are experienced, published, leading authorities in hand surgery, plastic and reconstructive surgery.

LEADING DOCTOR HAILS RECOGNITION OF AESTHETIC MEDICINE

[ A DOCTOR who is considered one of the East Midlands’ foremost authorities on medical aesthetics has hailed the Royal Society of Medicine’s (RSM) decision to officially recognise aesthetic medicine as a specialty as a ‘monumental step forward’ for both practitioners and patients.

Dr Dimitri Vichas, known as Dr Dimi, runs the Nottingham-based medical aesthetics specialist Eudai Clinic. He has enthusiastically welcomed the RSM’s announcement, which he believes will “legitimise medical aesthetics as a vital component of holistic healthcare”, enabling patients to access safer, more effective treatments than ever before.

Established in 1805, The RSM is one of the most prestigious medical societies in the world. The not-forprofit organisation is a key driver of professional standards and its recognition carries serious cachet.

The society’s decision to formally recognise medical aesthetics as a speciality is therefore a significant step forward to medicalising the field and pushing for legislation to make it illegal for individuals who lack medical qualifications to practise aesthetic medicine.

It is the first time the body has granted the honour to a field of practice for 35 years.

Announcing the establishment of the new Section for Aesthetic Medicine and Surgery, the RSM said: “Aesthetic medicine and surgery is a rapidly developing area with growing numbers of physicians, surgeons and dentists offering treatments.

“In response to the growth in the number of practitioners and treatments offered, as well as advances in the science underpinning the field, the Council of the Royal Society of Medicine feels the time is right to establish a new Section with a purpose of promoting evidence-based best practice to ensure optimal outcomes for patients.”

The Section will formally come into being on 1 October 2024.

Dr Dimi (pictured), who studied in Nottingham after leaving his home country of Cyprus, is one of the most highly regarded and sought-after practitioners of medical aesthetics in the East Midlands. He believes that the true significance of the RSM’s recognition of the field lies in the positive impact it will have on patient safety.

“This formal recognition elevates the standards of practice, ensuring that only qualified professionals with comprehensive training and a deep understanding of patient safety are performing these procedures,” he said.

Known popularly as plastic or cosmetic surgery, medical aesthetics, as Dr Dimi puts it, is “not merely

about enhancing appearance”.

Properly qualified professionals have been instrumental in changing perceptions of the field – another reason why he is especially delighted with the RSM’s decision.

“As a physician deeply committed to advancing the fields of lifestyle, longevity and regenerative medicine, I believe that recognising medical aesthetics as a specialty by prestigious institutions like the Royal Society of Medicine is a monumental step forward for both practitioners and patients,” said Dr Dimi.

“Medical aesthetics involves a profound understanding of the underlying physiology, the integration of complex treatments and the application of science to improve both the physical and psychological well-being of patients,” he added. He believes the official recognition will help to ‘bridge the gap’ between dermatology, plastic surgery, lifestyle and longevity medicine.

The RSM said: “The Section will be a scientific medical, surgical and dental forum with the aim of promoting best practice in the specialty based on up-to-date research to improve outcomes for patients.”

Dr Dimi explained: “For patients, this means better access to safe, effective treatments that are backed by rigorous scientific research and delivered by professionals who are held to the highest standards. It also paves the way for more innovative research and development, leading to advanced treatments that not only address external concerns but also contribute to overall health and longevity.”

Dr Dimi believes the importance of the RSM’s recognition represents a colossal leap forward for the field: one which “cannot be overstated.”

“In essence, this recognition would mark a significant evolution in how we approach aesthetic medicine, ensuring it continues to grow as a respected and integral part of modern healthcare.” q

HEART CAMPAIGN JOINED BY PATIENT WHO ENDURED 18-HOUR WAIT

[A RETIRED TEACHER who waited around 18 hours to be treated in hospital for a heart attack is among more than 40,000 people backing the British Heart Foundation’s campaign to fix what it describes as ‘the worst heart care crisis in living memory’.

In April 2022 Glynn Evans (pictured) started to get an indigestion-like pain in his chest while on holiday in Cornwall with his family. He wasn’t worried at first, but by around 8pm that evening he and his wife knew something was seriously wrong. Glynn’s wife Lyn rang 999.

Glynn, from Bourne in Lincolnshire, said: “My son-in-law was going to take me to hospital, but said the last thing he wanted was for me to keel over in the back of his car. So we waited for the ambulance. It eventually turned up the next morning.”

Glynn said that when he finally got to the Royal Cornwall Hospital in Truro, there were 24 ambulances in the queue ahead of him. He added: “I stayed in the ambulance and a doctor had to come out to me to do a blood test. He came back later and told me that it wasn’t good news – I’d had a heart attack.”

Glynn wasn’t seen in hospital until about 2pm: around 18 hours after his wife first called 999.

Delays to heart attack treatment can lead to permanent disability or even death, the BHF says. Before the pandemic the average ambulance response target for suspected heart attacks and strokes was 18 minutes, but the target was increased to 30 minutes due to pressure and long delays in ambulance services. The 30-minute target has been met just once since May 2021.

The BHF is drawing attention to the on-going and extreme waiting times for emergency, urgent and routine heart care in its latest campaign, Hearts Need More.

Glynn, who now lives with heart failure, said: “The doctor who treated me was furious that I had to wait so long. I’m not sure my heart failure would be quite as bad if it hadn’t taken so long to treat me.

“There’s nothing that anyone can do about my long wait now; but I don’t want anyone else to have to wait that long and miss out on the best available treatment. That’s why I’m supporting the BHF’s Hearts Need More campaign.”

BHF chief executive Dr Charmaine Griffiths commented: “What happened to Glynn was unacceptable, and it wasn’t just a one-off. At the BHF we get calls almost every day from people who have gone through stressful and often dangerous waits for heart tests, treatment or even emergency care.

“Long waits for heart care put lives on the line. For the first time on record we’re seeing a sustained rise in early heart and circulatory disease deaths. That means thousands more families ripped apart.”

For more than 50 years groundbreaking research and advances in medicine helped to make huge strides towards reducing deaths from heart attack and stroke. However, since 2012 there has been a significant slowdown in the rate of improvement, and since 2020 the premature death rate in England has risen year-on-year. Latest figures for 2022 show that an average of 750 people a week aged 75 or under died from cardiovascular disease in England – the highest annual total since 2008.

In over four years, since the pandemic began, the number of people in England waiting for planned heart care has almost doubled to nearly 420,000, the BHF says, and average ambulance waiting times for heart attacks and strokes have remained consistently above target. There are also concerns of a potential rise in heart problems linked to COVID-19.

As part of its Hearts Need More campaign BHF has launched an online pledge, which asks people to add their name to a call for the new government to prioritise heart and circulatory diseases. More than 40,000 people have signed so far, many of whom have either been directly affected by long waits for heart care or know someone who has been, and the BHF is hoping to reach a milestone 50,000 signatures. q

STUDY HIGHLIGHTS INEQUALITIES IN HEART VALVE PROVISION

[ A RECENT PUBLICATION co-authored by past-presidents of the British Heart Valve Society highlighted inequalities facing women, ethnic minorities and patients in areas of high deprivation in terms of access to aortic valve replacement (AVR) for aortic stenosis in England.

The study used hospital episode statistic (HES) data to identify those with aortic stenosis and subsequently aortic valve replacement between 2016 and 2019. They evaluated nearly 200,000 patients with aortic stenosis, of whom just over 17% underwent aortic valve replacement.

Another cohort of 10,000 patients was derived from a HES data-linked clinical practice datalink to identify timeliness of aortic valve replacement.

Being female, black, of south Asian ethnicity or living in the most deprived areas were associated with a lower likelihood of receiving AVR. Timeliness of AVR was also worse in those living in socially deprived neighbourhoods and in those from black and south Asian ethnicities.

It was the first UK-based study of social, ethnic and gender differences in the treatment of aortic stenosis and demonstrated clearly that the valve community and beyond need to work collaboratively to improve access to life-saving AVR through increased detection, rapid diagnostics, early referral and timely intervention, especially focusing on women, black and south Asian ethnicities and those living in the most deprived areas.

Although the ‘big data’ retrospective data analysis does not delve into the reasons that the differences were seen, it is a hypothesis-generating piece that encourages clinicians to evaluate their practice to see how the imbalance can be addressed. q

EDINBURGH RESEARCH OFFERS HOPE TO LIVER SUFFERERS

[A TYPE OF CELL responsible for repairing damaged liver tissue has been uncovered for the first time by scientists at the Institute for Regeneration and Repair at the University of Edinburgh. A study showing how the new-found cells migrate to the site of damage provides fresh insight into the way the liver heals itself.

Experts say the findings could spur the development of new therapies that harness the liver’s unique capacity to regenerate following damage.

Liver regeneration

During acute liver failure the ability to repair and regenerate is often overwhelmed, with patients requiring an emergency liver transplant to regain liver function.

Scientists from the University of Edinburgh studied human liver tissue from patients with acute liver failure for signs of cell proliferation and regeneration following the rapid loss of liver function. They found that a significant proportion of cells retained the ability to multiply. There were, however, still substantial areas of damage in the patients' livers, suggesting that processes other than cell proliferation are critical during regeneration.

Healing cells

The research team profiled the genes within every liver cell in both healthy and regenerating human liver tissue to better understand the regeneration process. They did so using a cutting-edge technique called single cell RNA sequencing. The findings uncovered a previously undetected population of wound-healing liver cells that emerge during human liver regeneration to boost its recovery.

Working with University of Glasgow scientists at the Cancer Research UK Scotland Institute, the team used special imaging techniques in mice to view the wound-healing cells in action.

During liver regeneration, so-called leader cells appear at the edge of the healthy tissue, dragging the tissue together to close the wound – similarly to how skin heals after a cut.

Preventing infection

Imaging also revealed that the population of healing liver cells appears before cell proliferation begins.

Widespread infection is a major concern following acute liver failure. Bacteria from the gut can escape into the liver when the liver is damaged. That can lead to sepsis if the liver is unable to clear the infection. The liver may prioritise the healing of wounds before cell proliferation to restore the gut-liver barrier and prevent the spread of bacteria, experts say.

Professor Neil Henderson, principal investigator at the institute’s Centre for Inflammation Research, explained: “Cutting-edge technologies have allowed us to study human liver regeneration in high definition for the first time, facilitating the identification of a cell type that is critical for liver repair. We hope that our findings will accelerate the discovery of much-needed new treatments for patients with liver disease.”

The study was funded by the Wellcome Trust and was published in the journal Nature. The research team also included scientists from the Universities of Birmingham, Cambridge and Texas, University College London and the United States Acute Liver Failure Study Group network. q

NI NEGOTIATORS SECURE DELAY OF AMALGAM BAN

[ ON 19 JULY, the European Commission agreed to the continued use of dental amalgam in Northern Ireland until 31 December 2034, or until a date agreed under the Minamata Convention on Mercury: whichever is earlier. A 10-year derogation has been secured specifically for Northern Ireland, rather than a direct ban on amalgam under EU Regulation 2024/1849.

The derogation has been met with a ‘palpable sense of relief’ by the dental profession, having been secured against all odds.

The British Dental Association (BDA) described it as a culmination of massive efforts over many months – of lobbying, media work and collaboration – ultimately securing political agreement between the UK Government and the European Commission for the protection of dental services in Northern Ireland.

“Understandably,” the BDA said in a statement, “the profession can be forgiven for questioning the level of political commitment shown to dentistry over recent years; but on the dental amalgam issue, we have witnessed the warnings issued by the dental profession being taken up in an unprecedented way by party leaders and successive Health Ministers in engagements with the Secretary of State and the UK Government who advocated on our behalf.

“Our issues prompted an Inquiry by the Stormont Windsor Framework Democratic Scrutiny Committee, and have been raised on a number of occasions at Stormont’s Health Committee; and we recognise the considerable effort expended by Department of Health officials, including by the Chief Dental Officer (CDO) in providing the evidence base ahead of this derogation being granted.

“Who would have imagined that an issue centred on Northern Ireland dentistry would become a test case for the new post-Brexit constitutional arrangements, just as Stormont was restored and at a time when the new UK Labour Government wishes to reset relations with the EU.

“As a profession, dentistry must take heart that its voice has been heard at the highest levels of government and considered a priority in the context of relations between Stormont, United

DENTISTS CALL ON GOVT TO TAKE ACTION ON UNMET NEED FOR CARE

[ THE BDA has reacted with alarm to the latest figures regarding unmet need for NHS dentistry, calling for urgency and ambition from the new government as the number in England hit an all-time high of 13 million.

Over one in four adults are now struggling to access care, the BDA pointed out: a rise from the 12 million reported last year and ‘lightyears’ from the 4 million that was the norm pre-COVID.

The BDA said: “Our analysis of the recently published GP Survey by Ipsos shows an estimated 5.6 million adults tried and failed to secure an appointment in the past two years. Nearly as many have given up trying, with 5.4 million not attempting to make appointments as they didn’t think they could secure care. The costs of care pushed 1.25 million away, and around 780,000 indicated they were on waiting lists.”

That provides ‘precious little evidence’ that dentistry has bounced back following the marginal changes rolled out by the last government, which failed to tackle the discredited NHS contract, fuelling workforce and access crises head on.

In talks with the new Health Secretary Wes Streeting on the first working day after the election results came in, BDA chair Eddie Crouch and GDPC chair Shawn Charlwood made the case for fundamental reform; and pressed for a short-term rescue package to help keep practices afloat.

The BDA statement continued: “We are cautiously optimistic now that the new government has publicly admitted the NHS is ‘broken’. We are

Kingdom and European Union levels.

“This positive outcome was secured by the collaborative efforts already mentioned, and crucially with the political will in place. Our representatives were relentless, but we were always bracing ourselves for the impact of yet more unmitigated costs being imposed upon practices from an amalgam ban at a time of such pressure within the service.”

The BDA set out a timeline for the progress made this year in securing the derogation. In January the association sounded the alarm when the European Parliament voted in favour of a total phase-out of dental amalgam from 1 January 2025; the default position being that a ban would also apply directly in Northern Ireland under the NI Protocol.

In March, it followed up in its oral evidence to Stormont’s newly formed Windsor Framework Democratic Scrutiny Committee, warning of the irreparable and long-lasting damage to the provision of dental services by moving from phase-down to the phase out of dental amalgam, at a time when Health Service (HS) dentistry is on its knees.

“Our evidence was informed by crucial feedback received from the profession which captured the significant issues already evident within HS dentistry and we continued to brief MLAs on these issues and provide briefing papers over this time.

“We recognise the significant stance the CDO took, advising the Windsor Framework Democratic Scrutiny Committee in her oral evidence that Northern Ireland wasn’t ready to implement an amalgam ban from 1 January 2025.”

The derogation provides breathing space; however, the issue has reinforced the need for urgent reform and adequate investment into dental services, the BDA said.

“It has illustrated the range of actors who each have a responsibility to make dental reform happen - an approach which we want to see carried forward, and not lose momentum. We require that same level of political leadership to get on with putting HS dentistry onto a sustainable footing for the future.” q

facing denials on the scale of the crisis, nor the role a failed contract is playing in fuelling it.

“We now need to move rapidly to rescue and reform this service. We will keep up the pressure to ensure words are followed up with action.” q

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MAXFAX BODY SHARES CONFERENCE HIGHLIGHTS

[ THE British Association of Oral and Maxillofacial Surgeons (BAOMS) has published some takeaways from its Annual Scientific Meeting, held on 6 August at the University of Oxford’s Mathematics Institute.

The theme for the conference was The Patients’ Voice, because, the BAOMS says, patients are at the heart of the work done by oral and maxillofacial surgeons. During the conference, each panel included a patient whose insights ensured participants' attention was focused on the most important people in their working lives.

The authors spoke to some of the patient participants to find out how they found the conference. One of them was Laura Marston, a head and neck cancer survivor who was on the panel to talk about what head and neck cancer patients want to know about risk.

She said: “I found it very positive that the comments from the patients I spoke to aligned with how the panel I was on are keen to hold consultations in the future, with more patient involvement; so that was wonderful.”

Former MP Lembit Opik spoke about societal judgments around his facial deformity and the surgery he had as an adult. He underestimated the effect of the change, which had profound psychological effects.

He said: “This conference is inspiring because for the first time it feels like the patient is at the centre. It’s the first conference where I’ve felt listened to with genuine empathy from the profession and if I’d have had that as a child it would have been life changing. It’s not about giving us what we want, but giving patients the space to reveal

GDC CLARIFIES POSITION ON SURVEILLANCE

[ ON 15 AUGUST the General Dental Council (GDC) published revised Covert Surveillance Guidance. The updated guidance highlights the GDC’s commitment to transparency, legality and the protection of individual privacy during both fitness to practise (FtP) and illegal practice (IP) investigations.

The guidance outlines the stringent legal and ethical framework governing covert surveillance in FtP and IP investigations, to ensure all investigative activities comply with the Human Rights Act 1998 and other relevant legislation and guidance.

Stefan Czerniawski, executive director for strategy at the GDC, explained: “Covert surveillance will be used sparingly and only as a last resort, ensuring that any investigative practices are necessary, proportionate and respectful of privacy. This guidance supports our commitment to enhancing public trust and patient safety.

"The General Dental Council is committed to protecting the public and ensuring public confidence in the dental professions.

The updated Covert Surveillance Guidance is one element of ensuring transparency, legality and the protection of individual privacy.”

In its Introduction, the document states: “It will be very rare for the GDC to use covert surveillance techniques to support fitness to practise and illegal practice investigations. On each occasion, it will require a decision that balances the seriousness of the intrusion into the privacy of the subject of the investigation against the need for/value of the activity for the investigation.

“Authorisation requires the proposed surveillance to be legal, necessary, proportionate and not arbitrary.” q

what they need and that can make all the difference in the world.”

The final keynote address of the conference was The Norman Rowe Lecture, delivered this year by Daniel Borsuk, associate professor at the University of Montreal and chief plastic surgeon at Sainte Justine University Hospital Centre, Canada.

The reviewer wrote: “It was a fitting end to a conference with a patient focus, as his presentation underlined that at the heart of every surgery is a patient’s story. Daniel spoke about how his facial reconstructive work can restore people to their true selves by bringing back their identity, confidence and appearance.

“After his training in plastic and reconstructive surgery, Daniel specialised in advanced craniofacial, microsurgical and aesthetic surgery. He has performed facial transplantation operations on several patients and outlined the tools surgeons have, and how techniques have improved over time with more emphasis on the aesthetic.”

The review quoted Professor Borsuk: “Listening to a patient’s individual needs is the most important thing we can do. Their aesthetic and functional demands and expectations are unique and the only way to understand that is through an open and transparent discussion before any form of rhinoplasty. To me this is the richest part of medicine, and I tell residents, you can do a lot more good with your voice and words than you can with your scalpel.” His address was titled after a quote from Sir William Osler who used to say: “Treat the patient, not the X-ray.” q

SURVEY REVEALS INEQUALITIES IN EYE PATIENTS’ EXPERIENCES

[THE GENERAL OPTICAL COUNCIL (GOC) has published its 2024 public perceptions research, which seeks to understand the public’s views and experiences of using eye care services. This year's results show that public satisfaction remains high overall, with 92% of respondents satisfied with the optometrist who carried out the sight test/eye examination, and 88% satisfied with their overall visit.

NEW CONTACT LENS DIPLOMA COURSES APPROVED

[THE Association of British Dispensing Opticians (ABDO) has received approval from the General Optical Council (GOC) to begin delivering the Diploma in Contact Lens Practice syllabus from September. As the awarding organisation, ABDO will be working in partnership with two education centres – ABDO College and Bradford College.

ABDO is currently the only provider that can recruit students to the GOC’s new education and training requirements for contact lens opticians.

Dean Dunning, ABDO’s deputy head of professional qualifications and education and chief contact lens examiner, said: “We are delighted that we are now able to deliver our 2024 syllabus, which is the first of its kind to follow the GOC’s requirements for approved qualifications for contact lens opticians. It has been a huge undertaking, lasting over two years, and wouldn’t have been possible without a great deal of help from educators, industry professionals, registrants, students and employers, for whom we are extremely grateful.

“We have worked very hard to ensure that we have a syllabus that meets the needs for a modern contact lens optician to practise safely and successfully, embracing the fast-paced changes happening in the contact lens industry.

“We look forward to collaborating with our training partners at ABDO College and Bradford College, along with the GOC, over the coming months to ensure a smooth transition to the new syllabus.”

Samara Morgan, GOC’s head of education and CPD development, commented: “We are delighted to note ABDO’s contact lens qualification as the first contact lens specialty to meet the updated education and training requirements. This means we have seen adaptations against all of the updated education and training requirements for optometry and dispensing optics, additional supply, supplementary prescribing, and/or independent prescribing and for contact lens opticians.

“It’s been exciting to see how optical education providers of GOCapproved qualifications are adapting their qualifications to meet the new education and training requirements. We know it’s involved a lot of hard work from providers, and we appreciate their dedication to ensure they offer courses that are fit for the future.” q

However, patients from an ethnic minority background were less satisfied than white participants (84% vs 91%) as were those with a disability – 82% compared to 89% of those without a disability.

The research shows that the most vulnerable patients experience significantly worse outcomes. Only 63% of patients with four or more ‘markers of vulnerability’ had their sight tested in the past two years, compared to 82% with none. Similarly, 77% of patients with four or more markers of vulnerability were satisfied with their overall visit compared to 94% with none.

Consumers have become more active, the research found, with 31% of respondents shopping around before selecting which optometrist’s practice to go to, significantly higher than in 2023 (21%). Of those who purchased glasses following their sight test/eye examination, the majority (78%) purchased them from the optometrist’s practice where they had their sight test/eye examination – but that was down from 85% in 2023. More consumers are turning to supermarkets, high street stores or the internet for glasses (14% compared to 5% in 2023), particularly among those aged 16-44.

Progress on people going to an optometrist’s practice for an eye problem instead of GPs and hospitals appears to have stalled, with 33% of respondents stated they would go to an optometrist, compared to 36% in 2023. However, that figure remains ahead of a GP surgery (30%). Young people aged 16-24 (14%) and ethnic minorities (14%) are more likely to turn to an eye hospital. Those in Wales (43%), Scotland (44%), and Northern Ireland (41%) are more likely than those in England (31%) to say they would go to an optometrist practice first if they had an eye problem.

Steve Brooker, director of regulatory strategy at the GOC, said: “While it’s pleasing that public satisfaction and trust levels remain high overall, it’s worrying that experience of eye care can vary considerably based on someone’s background and life circumstances. We know registrants want to give all patients the best possible care and the sector needs to work collaboratively to reduce the inequalities revealed by our survey.

“We will aim to reduce inequalities through our corporate strategy for 2025-30, which includes an objective to create fairer and more inclusive eye care services. Further, we are strengthening our standards of practice to improve care for patients in vulnerable circumstances. And we will be commissioning new research into the lived experiences of different patients to bring these survey findings to life.”

The research was carried out by DJS Research, interviewing a representative sample of 2,035 people in the UK between 17 January and 8 February 2024. q

OPTOMETRISTS URGE NEW GOVERNMENT TO PRIORITISE EYE HEALTHCARE

[ THE COLLEGE OF OPTOMETRISTS has written an open letter to new Health Secretary Wes Streeting MP, urging the Department of Health and Social Care to prioritise eye health and to establish optometrists as the first port of call for anyone with an eye care issue.

The letter outlines the college’s own Manifesto for Change in tackling the eye care crisis in England, which sets out its key priorities to:

• Enable optometrists to provide more care to patients closer to home

• Prioritise a better-connected NHS and unlocking the potential of new

• technologies

• Support the optometry workforce to develop specialised skills.

In the letter, Dr Gillian Rudduck MCOptom, the president of the College of Optometrists, wrote: “I was delighted when in January this year

Labour outlined its plans to support improved eye care services, and a commitment to cutting waiting lists across the healthcare landscape. I was particularly encouraged by plans aimed at improving eye care services, such as negotiating a deal with high street optometrists to deliver NHS outpatient appointments.

“I was further encouraged that the Labour Party Manifesto offered a commitment to allow healthcare professionals, such as opticians [optometrists] to make direct referrals to specialist services or tests, as well as expanding self-referral routes where appropriate.

“As you may know, there are over 600,000 people on NHS waiting lists to begin ophthalmology treatment in England, making it one of the largest contributors to the NHS backlog. Optometrists have an essential role to play to help cut NHS waiting times and improve patient outcomes.”

She concluded: “We look forward to working with you and your team to make this a reality, and ensure patients receive the eye care they need in the right place and at the right time.” q

PROTECT YOUR EYES FROM THE EVER-BRIGHTER SUN

[ A LEADING OPTOMETRY

CHAIN has reiterated the dangers to the eyes of over-exposure to UV light from the sun, in light of rising summer temperatures and sunshine in the UK. Experts at Optical Express have revealed their top tips to protect the eyes while enjoying sunnier spells.

According to the experts, millions of Britons risk permanent damage to their eyes by wearing low-quality, fast-fashion sunglasses that offer little or no UV defence, over higherquality alternatives that offer genuine sunlight protection.

Stephen Hannan, clinical service director at Optical Express, said:

"The sun emits differing types of UV rays, including UV-A and UV-B, which reach our skin. They have different effects on our eyes, with over-exposure causing us problems in the absence of sufficient and appropriate eye care.

“UV-A light can damage your central vision through long-term exposure as it can harm the macula, which is a very important part of the retina at the back of your eye responsible for our vision.

“UV-B light affects the two structures responsible for the transmission of images to the retina, known as the cornea (the outer window) and the lens (the inner window), which absorb most UV-B rays. As UV-B rays impact the most sensitive part of your eyes, they can be even more harmful than UV-A light.

“Unprotected and extended exposure to UV-A and UV-B rays can lead to debilitating eye problems like cataracts, macular degeneration and photo-keratitis. It is just as important to protect your eyes from UV damage as it is to protect your skin with sunscreen.

“The best way to do this is by wearing high-quality sunglasses while you're outside. Always opt for a pair of sunglasses that offer UV 400 protection, as this can eliminate 97-100% of UV rays.

“Even if you're wearing tinted glasses, not all of them offer genuine protection and can actually damage your eyes more than not wearing your sunglasses. Tinted lenses can trick the pupils into dilating, allowing more UV light to enter the eye, without offering protection.

“Ensure that your sunglasses display a CE or British Standard Mark, as this certifies them as offering a sufficient level of protection and proves that they comply with the essential requirements of European health, safety and protection legislation.

“Even if your sunglasses meet both requirements, make sure the frames fit your face well enough so that light can't easily enter your eyes from, for example, the side or above.

“Your Optical Express optometrist can help you choose a stylish pair of sunglasses that suit your style but most importantly protect your eyes from permanent issues.” q

GETTING STARTED IN MEDICOLEGAL PRACTICE: MY EXPERIENCE

By Mr Edward Ridyard, consultant ophthalmologist

[ EVER SINCE MEDICAL SCHOOL I had been interested in the idea of medicolegal work. I remember vividly an orthopaedic surgeon informing me enthusiastically how his medicolegal practice provided him with intellectual stimulation and satisfaction, as well as being a flexible option that could fit around his busy clinical practice and family life.

I really liked the idea of something that was interesting, enhanced my knowledge of my subspecialty, as well as highlighting potential pitfalls that I could avoid in my own clinical practice and highlight to others.

Having been a consultant for two years in a busy tertiary centre, I decided to get started. I had the great fortune of meeting Professor Charles Claoué at a conference during my training and we stayed in touch. Charles had set up the Eye Law Chambers (ELC), which is a group of eye specialists who provide medicolegal services in the field of ophthalmology. Charles advised me on how best to get started as a newcomer to the field.

I attended a course by Bond Solon, which provided an excellent framework in writing an expert witness report. In addition to that I attended an Inspire MediLaw course, which provided a great overview of the field.

What was interesting and appealing about Eye Law Chambers was that they offer a mentor service, where they guide you through your first few expert witness reports and ensure that all necessary practical points in preparing a report are covered. For obvious reasons a medicolegal report is a legal document and there are specific

components that need to be included in every report. That advice and guidance has been invaluable.

I also had the great fortune of being introduced to the ALLDOQ platform. This is a turnkey solution for anyone wanting to get started in medicolegal practice, offering a program that allows you to organise and prepare a report. The program is intuitive to use, and again has made the daunting task of getting started in medicolegal practice much less intimidating.

I have now had my first few instructions and was delighted to receive the Award of Excellence for Ophthalmology Services from the Federation of Forensic and Expert Witnesses.

The only other practical point to mention is that, as an expert witness, you need to have somewhere where you can physically examine patients. For most, who already have established private practices, that will not be an issue; however, it was not the case for me, so I had to arrange that prior to reviewing my first patient.

It would be great to connect with anybody thinking of getting started in this great field and to share experiences. I am more than happy to offer advice and guidance of how to get started in medicolegal practice via my contact details below. Best of luck! q

• Mr Edward Ridyard is a consultant ophthalmologist specialising in glaucoma and cataract surgery at Leeds Teaching Hospitals NHS Trust. Mr Ridyard and ELC are always happy to respond via email to initial enquiries about any potential cases. Email eyes@dbcg.co.uk or visit www.eyelawchambers.com

NEW RESEARCH REVEALS EXTENT OF HEARING THREAT OF LOUD MUSIC

[ NEW RESEARCH from the RNID has revealed that millions of music lovers may be at risk of permanent hearing damage.

The hearing loss charity polled more than 2,000 people who have attended, or plan to attend, a music event in 2024 and found that more than half (58%) of participants have experienced tinnitus or temporary hearing loss after listening to loud music. A third said they had experienced it more than once.

Worryingly, the majority of music lovers overestimate how long they can safely listen to loud music without hearing protection. More than three quarters were unaware that a concert, festival, gig or nightclub at 100 decibels could cause permanent hearing damage after as little as 15 minutes, with many wrongly believing they could listen safely without hearing protection for up to four hours.

Despite the risks, fewer than a third (32%) of people surveyed have used, or plan to use, hearing protection such as earplugs at a music event this year. Younger people, however, were more likely to use hearing protection. Nearly half (46%) of 25-34 year olds said they do use hearing protection, compared to only 22% of 45-54 year olds.

The RNID teamed up with BBC Apprentice 2024 finalist, entrepreneur and musician

Tre Lowe to raise awareness of the risks of over exposure to loud music and encourage music lovers to protect their hearing.

Tre developed tinnitus at 15 and at times the noise was so overwhelming it sounded like he was ‘standing on the edge of the M25’. He was regularly exposed to loud music, but didn’t realise the negative effect this would have on his tinnitus.

“There is a real lack of education out there about protecting your hearing and how it’s so easy to damage your ears,” he said, “I

wish I’d known that and that’s why I’m so passionate about getting the message out there.”

Franki Oliver, audiology manager at RNID, said: “It’s really concerning that so many music lovers are unaware of the life-changing damage that loud music can have on your hearing. Whether you are at a live event, or listening to music through headphones, we all need to take steps to protect our hearing to ensure we can continue enjoying music in future.

“In the UK we enjoy an amazing range of festivals, concerts and music events, and there are easy steps we can take to look after our ears. It’s great to see that younger people are more concerned about potential hearing damage, and more likely to use hearing protection like earplugs.

“Modern earplugs filter out harmful sounds without impacting the quality so you can still enjoy the music – they’re an essential piece of kit for every festival goer this summer.”

The RNID recommends taking earplugs to live events. Modern earplugs are reusable, stylish and inexpensive. Many festivals and music events also have disposable earplugs available for free.

To learn more about Tre Lowe’s experience of tinnitus visit rnid.org.uk q

SOCIETY POINTS TO PHYSIO RECRUITMENT CRISIS IN NI

[THE LATEST OFFICIAL FIGURES from the Department of Health show that there are currently 196 physiotherapy vacancies in Northern Ireland across all physiotherapy grades. That represents in excess of 15% of the entire physiotherapy workforce in the province, according to the Chartered Society of Physiotherapy (CSP): the highest number of physiotherapy vacancies ever recorded.

With more than one in seven physiotherapy posts vacant, patients with long COVID or other conditions that require rehabilitation are missing out on vital treatments. Without rehab from physiotherapists to support a full recovery, patients can become trapped in a cycle of failing health, being discharged from hospital only to become ill again, sometimes leading to a life-limiting decline.

The Chartered Society of Physiotherapy is calling on the Department of Health to increase student physiotherapy numbers and invest in physiotherapy careers as a matter of urgency in order to help reverse the rising gap in workforce supply.

Claire Ronald, CSP senior negotiating officer, said: “It is disappointing that the Department of Health has decided not to increase the number of undergraduate training places for NI this year. We currently produce approximately 60 physiotherapy graduates each year. That is nowhere near enough the number required to fill the vacancies here.

“All of the service commitments the Department of Health made in 2020/21 are still being funded non-recurrently and this continues to have a detrimental impact on the ability of trusts to recruit and retain the physiotherapy staff needed to deliver the services required.

“Should urgent action not be taken, we are extremely concerned that the current workforce situation will have a huge impact on current Department of Health initiatives to rebuild services, tackle waiting lists and further develop multidisciplinary teams in primary care. For example, the physiotherapy workforce is key to reforming orthopaedic pathways, identified as a priority in the recently published Elective Care Framework for tackling waiting times in NI, which are the longest in the UK.” q

PHYSIOS CALL FOR PRIORITISATION OF REHAB

[The Chartered Society of Physiotherapy has called for Lord Ara Darzi to focus on rehabilitation in his upcoming review of the NHS. Together with members of the Community Rehab Alliance – which the CSP convenes – the society highlighted that tackling logjams in patient flow cannot be done without making rehabilitation a key area of the review.

The Community Rehab Alliance – a group of more than 60 national charities and professional bodies – cited compelling evidence of rehab’s role in reducing ambulance queues, A&E waiting times and unnecessary lengths of hospital stays.

Though rehab could help cut emergency department attendances by a million a year, its exclusion from the most recent elective care recovery plans and surgical hubs were missed opportunities, the CSP argued.

The CSP also underscored the importance of making use of the existing workforce across sectors if the government is to achieve meaningful reform.

Sara Hazzard, CSP’s assistant director, said: “We will continue to make the point that rehab is as important as medicines and surgery because it adds life to years, not just years to life. Without access to high-quality, community-based rehabilitation, people will continue to be driven towards the most expensive parts of the health and social care system, such as A&E and secondary care.

“Fixing our broken NHS needs to address the flow of patients both in and out of hospital, and that means ensuring the right staffing and structures are in place for prevention and rehab to help people stay well or recover as fully and fast as they are able to.” q

CAUDA EQUINA CASE: TRUST’S RADIOLOGIST EXONERATED

[BARRISTERS’ CHAMBERS 2TG has reported the success of Anna Hughes in representing the defendant NHS trust in the case of Spellman v Portsmouth Hospitals University NHS Trust [2024] EWHC 2011 (KB). Anna was instructed by Dominic Samson of DAC Beachcroft LLP.

The clinical negligence claim arose out of the reporting of an MRI scan to assess for cauda equina compression when the claimant attended the defendant’s hospital on 6 June 2017. The claimant alleged that there was a negligent failure to report cauda equina compression, and that the failure to do so meant she missed the opportunity to undergo urgent surgery to treat her condition.

The defendant maintained that the scan did not show compression of the cauda equina and that, in any event, it had been reported in a reasonable manner.

Anna Hughes wrote: “Mr Justice Sweeting agreed that the legal test that was to be

applied in this ‘pure diagnosis’ case was that set out by the Court of Appeal in Penny v East Kent Health Authority [2000] Lloyd’s Rep Med 41, and confirmed by the High Court in Brady v Southend University Hospital NHS Foundation Trust [2020] EWHC 158 (QB): namely that the court first had to determine what, as a matter of fact, was there to be seen on the imaging, and then apply the Bolam test in order to determine whether, notwithstanding what was in fact present, the scan had been reported in line with a reasonable and logical body of radiology opinion.

“It was held that, as a matter of fact, the MRI scan did not show an acute cauda equina compression, so that it could not be said that there had been an unreasonable failure to report the same. In reaching this conclusion, Mr Justice Sweeting noted that the claimant’s radiology expert had ‘made a number of errors in his interpretation of the

scan including identifying pathology at the wrong level’. The Judge indicated that this ‘did not inspire confidence’ in the opinion of the claimant’s expert and, as a result, he accepted the evidence of the defendant’s radiology expert on all points of dispute.”

Accordingly, the claim was dismissed.

Commenting on the case, expert witness agency Expert Court Reports said: “In the case of Spellman v Portsmouth Hospitals University NHS Trust outlined above, several experts were consulted. The court relied heavily on the testimony of expert radiologists and spinal surgeons who provided differing opinions on whether the MRI scan indicated CES and whether the interpretation was negligent.

“Ultimately, the court sided with the defence, reasoning that the radiologist had not breached their duty of care, as the MRI scan did not show acute cauda equina compression.” q

‘JEWEL IN THE CROWN’ REGISTRY CELEBRATES 20 YEARS

[THE NATIONAL JOINT REGISTRY (NJR) recently held an early evening reception to celebrate over 20 years of the work of the registry, providing an opportunity to focus on its impact as a recognised global exemplar of an implantable medical devices registry. The event

showcased the value of its work and the collaborative approach it has with its diverse range of stakeholders.

Speakers focused on the importance of data collection and analysis for the use of medical implant devices to ensure patient safety and also on the NJR’s support of orthopaedic research to constantly improve patient outcomes.

Professor Sir Stephen Powis was the guest keynote speaker in the programme of talks during the evening. He described the NJR as the ‘jewel in the crown of patient safety initiatives’: a clear endorsement of the importance NHS England attaches to the contribution the NJR makes to patient safety and a nod to its exemplar status in the development of the new surgical device and implant registry, which will facilitate the national reporting of activity relating to any surgical device or implant across both the NHS and independent health care sector.

Guests had been invited to be fully representative of the NJR’s wide range of stakeholders and included patient organisations, orthopaedic surgeons and clinicians, data analysis statisticians and researchers, joint implant manufacturers, commissioners and regulators, as well as those from NHS England. q

Professor Sir Stephen Powis, national medical director, NHS England (left) with NJR chair Professor Sir Paul Curran.

NEW STANDARD DEFINES TERMINOLOGY FOR WEIGHTBEARING AFTER SURGERY OR INJURY

[ A NEW British Orthopaedic Association Standard (BOASt) on mobilisation and weightbearing after orthopaedic surgery or musculoskeletal injury has been published.

All clinical stakeholders and patient representatives participated in a consensus exercise to establish recommendations for weightbearing terminology and instructions after orthopaedic surgery or musculoskeletal injury. The aim is to provide an agreed lexicon with precise definitions that can be used by all care providers involved in a patient’s rehabilitation pathway.

It applies to all patients with orthopaedic conditions affecting the pelvis and upper and lower limbs.

The standards for practice include that all patients should have a clearly documented rehabilitation plan detailing instructions for weightbearing as an integral part of their mobilisation status. Patient instructions should be provided in a format that is tailored to their individual needs.

A weightbearing status should be attributed to each affected

ORTHOPAEDICS MUST BE A GOVERNMENT PRIORITY, BOA WARNS

[IN ITS RESPONSE to the King’s Speech on the opening of Parliament on 17 July, the British Orthopaedic Association (BOA) welcomed the commitment to reduce waiting lists, but added a caveat regarding trauma and orthopaedic provision.

The BOA stated: “The government must recognise that to make any significant impact on the waiting lists it must ensure that trauma and orthopaedic services – the largest of the specialties – are made a priority by the NHS and are not ‘switched-off’ at the first signs of pressure on the system.

“These procedures are not ‘elective’: they are ‘planned essential care’ which people cannot live their lives without. Unacceptable long waits and cancellation of appointments have a devastating impact on a patients’ health, wellbeing, independence and their ability to contribute to economic activity – an overriding government priority repeatedly highlighted by both the Secretary of State for Health and Social Care and the Prime Minister.”

The BOA had previously published figures quoting Office for National Statistics data suggesting that 2.8 million people aged 16-64 years were economically inactive because of long-term sickness in October to December 2023. One in five of those who have not returned to the workplace following the pandemic said they were currently on an NHS waiting list for medical treatment. Furthermore, DWP statistics state that one in five of those economically inactive say they have arthritis, osteoporosis or another form of MSK condition.

Various commentators, including the private medical insurance industry, have highlighted the direct correlation between long waiting lists for people with arthritis and their ability to work, which is having a detrimental impact on growing the economy.

Commenting further on the King’s Speech, the BOA said: “Any initiatives taken to tackle the waiting lists must look at creative ways to increase productivity, not simply expect surgical teams to work longer weeks, spend less time with patients or reduce training and assessment activities.

“Government should also look to meet the repeated requests by NHS England for resources to increase the core bed base, secure universal access to fracture liaison services as soon as possible (the commitment of 2030 is by no means ambitious) and ensure fitfor-purpose adult social care services to support people before and following their surgery. The absence of any recognition in the Royal Address of the need to address social care is disappointing.” q

limb. The specific terms to be used to define weightbearing status are non-weightbearing, limited-weightbearing and unrestrictedweightbearing. Terms such as touch, partial, proportional, permissive or progressive weightbearing should no longer be used.

All instructions for non- and limited-weightbearing require the following detail to be documented:

• Clinical justification – including the rationale for prevention

• or limitation of weightbearing by the clinician making the

• recommendation

• Quantification – limitations should include accurate descriptions

• of functional restrictions (eg no stairs, no sports) or distance

• restrictions (eg indoor only, bed to chair): limitations should not

• be quantified by percentage of body weight, kilograms of force

• or similar descriptors

• Duration – including planned phases of care progressing

• through any weightbearing statuses outlined above

Any requirement for walking aids or additional specific rehabilitation protocols (eg braces) should be recorded alongside the weightbearing and mobilisation instructions.

Inpatients should have a weightbearing status review at intervals no longer than 72 hours, any patient whose weightbearing status directly affects their ability to be discharged from hospital should have it reviewed within 24 hours and all weightbearing prescriptions should be reviewed at each point of follow up.

The document was produced by the BOA Clinical Standards Committee, including representation from the BOA Executive Group, Trauma Committee and Orthopaedic Committee on 1 August 2024. It will be reviewed in August 2028 in compliance with the BOA BOASt review process.

Ther document can be accessed at www.boa.ac.uk q

BONE DENSITY, OSTEOPOROSIS AND FRACTURE RISKS:

UNVEILING THE HIDDEN DANGERS OF PERSONAL INJURY AND NEGLIGENCE CLAIMS

By Professor Paul Lee, consultant in orthopaedics and expert witness

[OSTEOPOROSIS, a condition characterised by low bone density and increased fracture risk, is a silent epidemic affecting millions worldwide. As an expert in trauma and orthopaedics, I often encounter the severe consequences of osteoporosis, which can lead to significant personal injury and complex medical negligence cases. In this article I explore the intersection of osteoporosis and fracture risks, and the implications for personal injury and medical negligence claims, aiming to provide insights for legal professionals navigating these multifaceted issues.

Understanding osteoporosis and fracture risks

Osteoporosis occurs when bones lose density and become more fragile, increasing the risk of fractures even from minor falls or stress. The most common sites for osteoporotic fractures are the hip, spine and wrist. These fractures can lead to prolonged disability, significant healthcare costs and a reduced quality of life.

Key risk factors for osteoporosis include ageing, hormonal changes (especially in premenopausal and postmenopausal women), family history, low body weight and certain medications or medical conditions such as thyroid dysfunction. Diagnosing osteoporosis traditionally involves bone mineral density (BMD) testing using dual-energy X-ray absorptiometry (DXA), which provides a T-score indicating the degree of bone loss.

Advancements in bone density measurement

While DXA has been the standard for BMD testing for many years, advancements in technology have introduced new methods – such as radiofrequency echographic multi spectrometry (REMS). REMS offers a more accurate and comprehensive assessment of bone health by providing a detailed analysis of bone quality and density. This advanced technology can detect subtle changes in bone structure that DXA may miss, making it a valuable tool in both diagnosis and on-going management of osteoporosis.

Fracture risks and hormonal influences

Hormonal changes, particularly in premenopausal and postmenopausal women, play a significant role in bone health. Oestrogen deficiency after menopause accelerates bone loss, increasing the risk of osteoporosis and fractures. Hormone replacement therapy can mitigate those effects, but it must be carefully managed due to associated risks such as cardiovascular disease and certain cancers.

Thyroid function also affects bone density. Both hyperthyroidism and hypothyroidism can lead to bone loss, making regular monitoring and appropriate management of thyroid conditions essential in preventing osteoporosis.

The personal injury perspective

When handling personal injury claims involving osteoporotic fractures, it is crucial to determine whether the injury resulted from a pre-existing condition or an external event. The factors that should be considered are:

• Cause of the fracture: establishing whether the fracture was due to an accident or occurred spontaneously due to severe osteoporosis.

• Extent of osteoporosis: assessing the client’s BMD scores and medical history to understand the severity of their condition.

• Impact on quality of life: documenting the extent of disability, pain and suffering resulting from the fracture.

In those cases the challenge often lies in differentiating between fractures caused by negligence, such as a slip and fall due to unsafe conditions, and those primarily due to the client’s osteoporosis. Comprehensive medical records and expert testimonies are vital in establishing causation and securing appropriate compensation.

Evaluating osteoporosis treatments

Medications such as bisphosphonates, which include organic acids, are commonly prescribed for osteoporosis. These drugs work by slowing bone loss and improving bone density, thereby reducing the risk of fractures. However, they are not without complications; for instance, long-term use of bisphosphonates has been associated with atypical femoral fractures and osteonecrosis of the jaw.

That raises critical questions:

• Effectiveness of treatment: are the prescribed osteoporosis medications doing their job effectively?

• Risk of complications: how do the risks of atypical fractures and other side effects weigh against the benefits of those treatments?

• Alternative approaches: should patients also receive exercise prescriptions to improve bone density and overall musculoskeletal health?

Exercise, particularly weight-bearing and muscle-strengthening activities, has been shown to benefit bone health significantly. Failure to recommend or prescribe an appropriate exercise regimen could be seen as a gap in the standard of care for osteoporosis patients. That omission might lead to questions of personal injury or medical negligence, depending on the specific circumstances.

In conclusion, osteoporosis and related fracture risks present unique challenges in personal injury and medical negligence claims. Legal professionals must navigate the intricate details of medical history, diagnostic processes and treatment standards to advocate effectively for their clients. By leveraging expert opinions and thoroughly understanding the medical context, solicitors can ensure that justice is served, whether they are seeking compensation for personal injury or holding healthcare providers accountable for negligence. q

HOW CAN AI HELP DIAGNOSE ARTHRITIS EARLY?

[ VERSUS ARTHRITIS AND ORTHOPAEDIC RESEARCH UK

have partnered to support the training of healthcare professionals in the use of artificial intelligence in orthopaedics.

They have awarded a two-year fellowship to Simone Castagno from the University of Cambridge, to develop a new approach to osteoarthritis. He wants to use AI to find patterns in a wide range of data from people living with osteoarthritis.

He will use the patterns to develop a groundbreaking tool, which can predict osteoarthritis in the knee. It will also help us better understand how the condition may progress.

To do that, he’ll look at data such as clinical information, scans, biochemical tests – which measure substances like proteins and sugars in the blood – genetic information and physical activity using data from wearable devices like smartwatches. In the future, he hopes to develop the tool and look at patients who have osteoarthritis in other joints.

Ultimately, the tool will help healthcare professionals and patients make more informed decisions about their care.

“I am passionate about enhancing the quality of life for those affected by osteoarthritis and I hope that my work will extend to broader musculoskeletal and chronic degenerative conditions, paving the way for more personalised healthcare solutions,” said Dr Castagno.

Why does this research matter?

As part of Versus Arthritis’s research strategy, they want to spot the signs of osteoarthritis early, before it becomes severe – and they believe artificial intelligence can help. Spotting osteoarthritis early will offer a precious window of opportunity. It will allow healthcare professionals to suggest timely treatments and lifestyle changes, which could reduce the impact of someone’s condition.

Everyone is different and what treatment works for one person might not suit another, so the researchers also want to explore how treatments can be tailored to certain groups. On top of that, the researchers are also analysing data from wearable devices such as smartwatches, to look at exercise patterns. That will shed light on how exercise or weight may influence osteoarthritis. In time that will help healthcare teams provide tailored advice on helpful activities for people living with osteoarthritis.

“Measuring the prevalence of musculoskeletal conditions is challenging for many reasons,” said Caroline Aylott, head of research delivery at Versus Arthritis. “We need better measures in place to make sure people with musculoskeletal conditions like arthritis get an earlier diagnosis, that a more personalised approach to treatment is embraced by healthcare systems and that targeted research into musculoskeletal conditions is adequately funded so we have better treatments and drugs to support people in the future.”

Dr Arash Angadji, chief executive of Orthopaedic Research UK, added: “It is widely recognised that the use of AI, especially when harnessing the vast amount of available patient data, can play an important role in improving clinical performance and patient outcomes.” q

WHAT ARE THE CHALLENGES OF ASSESSING PROGNOSIS AND DEGREE OF DISABILITY?

By Dr Ivan Ramos-Galvez, consultant in pain medicine

[ONCE CAUSATION has been established in a medical negligence or personal injury case, the amount of compensation awarded to the claimant is dependent upon the injuries suffered and the long-term effects of those injuries on daily life.

In an ideal world all claims would be settled when an injury has fully resolved and any lasting functional impairment can be more accurately assessed. In reality, however, settlement is often reached before recovery is complete. In those cases, predicting the patient’s prognosis and likely degree of disability, if any, become crucial. The claimant should be fairly compensated for any injuries suffered, but the defendant should not be required to pay out an unnecessarily high amount. Unfortunately, predicting the ultimate outcome and degree of disability the patient is likely to suffer is extremely challenging.

For most injuries there is a typical expected recovery time, after which symptoms should be fully resolved in the majority of people. However, as this is based on average recovery times, it will not be accurate for everyone. The severity of the original injury often predicts the outcome: more serious injuries are usually associated with longer recovery times and higher rates and degrees of residual disability.

However, even with relatively mild injuries such as whiplash, around 15-20% of patients will develop a chronic pain condition that may limit their participation in daily activities. In addition, the treatment received and individual responses to it, which are often genetically determined, will both influence the healing process. Other factors that can affect the prognosis include age, gender, family and social support, pre-existing comorbidities, psychiatric symptoms and the patient’s willingness to engage in treatment plans and rehabilitation programmes.

Another issue that can impact the assessment of likely prognosis is the tendency for symptoms associated with some conditions to fluctuate over time. That is particularly true of some chronic pain conditions, where sufferers describe ‘good’ and ‘bad’ days. Predicting how frequently these flare-ups will occur, and exactly how they will impact on the patient’s life, is extremely difficult and makes determining the appropriate amount of compensation more challenging.

One crucial aspect of evaluating injury outcome is distinguishing between impairment and disability. An impairment is any deviation or loss of any body function or structure, while disability is characterised by a limitation or reduction in an individual’s ability to participate in their normal daily activities due to disease or injury. It is important to understand that these two states are not necessarily directly dependent on each other. For example, a person who loses an arm would be considered to have a significant impairment but would not be considered severely disabled if they were still able to participate in the majority of their daily tasks. Conversely, an impairment that appears minor can be extremely disabling if it significantly interferes with normal activities. That may be the case for someone with an arthritic joint that restricts their ability to work, and thus confers an economic burden as well as a physical one.

For some patients, the promise of financial gain may provide sufficient motivation to exaggerate or falsify their symptoms in order to receive a worse prognosis or establish a higher level of disability, and thus receive more compensation. Involvement in litigation or a compensation claim is known to influence the reporting of symptoms, with patients typically describing more symptoms over a longer time period.

The phenomena of exaggeration, compensation neurosis and malingering are often grouped together under the banner of compensation syndromes, although the precise motivation that drives each of them is different. Exaggeration normally results from a desire to be believed, while malingering is a deliberate attempt to deceive. Compensation syndromes may occur after an injury or disease if the patient believes there is a reasonable prospect of financial compensation; but identifying the minority

of patients who display this behaviour is difficult and rarely possible simply from a medical examination, although suspicion may be raised if the symptoms reported bear little relation to the injury sustained.

Often, surveillance is needed to record the patient undertaking an activity they have previously claimed to be unable to do.

A typical patient evaluation should ideally include a physical and psychological examination, an assessment of the likely causation of the symptoms and a credibility assessment. This last aspect is not designed to serve as a judgment about the character of the patient, but rather to determine the consistency of the allegations and give a more accurate portrayal of the patient’s condition. In reality, functioning and disability are context-dependent and can vary according to geographical, social, economic and cultural factors. q

• Dr Ramos-Galvez is a highly experienced expert witness and consultant in pain medicine at the Royal Berkshire Hospital. He accepts instructions for both defendant and claimant in personal injury and clinical negligence cases. His expertise with regard to pain is widespread, including CRPS, fibromyalgia, spinal pain, chronic and chronic widespread pain, chronic pain syndromes, neuropathic pain, pelvic mesh pain, phantom limb pain and post mastectomy pain syndrome.

To find out more visit www.medicolegal-partners.com/ramos-galvez and contact info@medicolegal-partners.com to discuss a case.

INCURABLE LUNG CONDITIONS GOING UNDIAGNOSED, CHARITY FINDS

[ THOUSANDS OF PEOPLE could be living undiagnosed with incurable lung conditions despite seeking medical help for coughs and chest infections, according to new analysis from Asthma + Lung UK.

The charity’s survey of 12,000 people with lung conditions in the UK found that over half of respondents were treated for their immediate chest symptoms, but didn’t have the underlying cause investigated at the time. Coughs and chest infections that keep on coming back can be early warning signs of a lung condition such as asthma and chronic obstructive pulmonary disease (COPD). The survey also found one in five of all respondents had to wait over a year for an accurate diagnosis of a chronic lung condition.

Asthma + Lung UK says the root of the problem is that simple tests for diagnosing lung conditions aren’t widely available to healthcare professionals, forcing them to take a ‘sticking plaster' approach of treating chest symptoms, but not the cause.

Combined with pressures in primary care, that means the early tell tale signs of a lung condition are too often missed, leaving people with breathing difficulties without an accurate diagnosis, or receiving treatment for conditions they don’t have.

Currently, 1.7 million people are living with COPD in the UK, and around 600,000 are living undiagnosed. Previous analysis commissioned by Asthma + Lung UK shows that as many as 750,000 people in England are misdiagnosed with asthma, costing an estimated £132m every year.

Data also shows that, after a referral to see a specialist, two in five people are not starting treatment within the recommended timeframe of 18 weeks, and over 6,000 are waiting more than a year.

Early detection in primary care is crucial for treating and managing lung conditions such COPD, which includes emphysema, or protecting people from potentially life-threatening asthma attacks. It can also lead to a reduction in hospital admissions and improvement in quality of life and healthy life expectancy.

Despite lung conditions being the UKs third biggest killer, there are currently no national targets to limit the amount of time someone should wait for a diagnosis when presenting with symptoms of a lung condition, which is why Asthma + Lung UK is urging the government to establish targets.

Sarah Sleet, CEO at Asthma + Lung UK, commented: “People who are struggling to breathe face agonising waits for an accurate diagnosis. They’re being misdiagnosed, or diagnosed too late, or are not put on the right treatment. As a result, the pressures on the NHS grow and grow with more emergency admissions and hospital stays. We need lung conditions to be treated as seriously as cancer and heart disease.

“A sticking plaster approach of treating symptoms, not the underlying cause, means too many people with lung conditions go undiagnosed for far too long. The new government’s commitment to rebalancing spending between primary care and secondary care is very welcome. We are calling for funding for GP practices to provide rapid testing for everyone experiencing signs of a lung condition.

“We also need national targets for diagnosis and specialist treatment to drive faster diagnosis and provide quicker access to the right course of treatment so people with lung conditions can slow down the progression of their illness and better manage their symptoms.” q

EXPERT WITNESSES: HELPING DELIVERING JUSTICE IN THE FAMILY COURTS

By Lisa Crowther,

Quality Assurance Manager at Carter Brown

[IN THE REALM OF FAMILY LAW, the involvement of expert witnesses is often pivotal in delivering justice. In the family court the instruction of an expert must meet the requirement for necessity set out in Part 25 of the Family Procedure Rules 2010.

While the family court continues to strive to resolve at least 81% of new public law cases within 26 weeks, new initiatives such as the Suspected Inflicted Head Injury Service (SIHIS) also seek to make the instruction of experts within proceedings a more efficient process –which raises the question of the expert’s role in the legal process.

The complexities inherent in disputes surrounding separation, arrangements for children and allegations of abuse require specialised knowledge that transcends the capabilities of the average person. Expert witnesses, with their specialised knowledge, play a crucial role in clarifying issues, providing impartial opinions and assisting the court in making informed decisions.

The expert’s ‘gold’

Expert witnesses bring a depth of understanding to areas that demand technical expertise. In family matters a child psychologist may be called upon to assess a child's emotional well-being, attachment and the psychological impact of potentially living with the arrangements made. Similarly, in considering a parent’s mental health, a psychiatrist can assist by offering a medical diagnosis, and then signpost to the most appropriate forms of treatment or intervention. An expert’s ability to translate complex information into understandable terms aids the court in comprehending nuances that would otherwise be obscured.

Impartiality and objectivity

The role of an expert witness is not to advocate for one party over another, but to provide an unbiased perspective grounded in their professional expertise. That objectivity is fundamental to the judicial process. The Family Procedure Rules 2010, particularly Part 25, emphasise the duty of experts to the court, underscoring that their paramount duty is to help the court on matters within their expertise. Their testimony must be evidence-based and built on a sound methodology, free from partiality, with a strong focus on assisting decision-making.

The testimony of expert witnesses can significantly influence the outcome of family law cases. For instance, in cases involving allegations of domestic abuse an expert in domestic violence can provide insights into the behavioural patterns of the abuser, the psychological impact on the victim and the broader social context of the abuse. That testimony can be crucial in shaping the court’s understanding and next steps.

Ethical considerations and professional conduct

Expert witnesses must adhere to stringent ethical standards and professional conduct. They are expected to maintain confidentiality, avoid conflicts of interest and ensure their testimony is based on accurate and complete information. Their reports and testimonies must be clear, concise and comprehensible, devoid of technical jargon that could confuse rather than clarify. Experts should seek to remain in good standing with both their regulatory and professional bodies, which will differ depending on the expert’s discipline.

The role of expert witnesses in family law is indispensable. Their specialised knowledge, objective analysis and ability to clarify complex issues underpin the delivery of justice. For family lawyers in the UK, effectively leveraging the expertise of those professionals can be the

key to achieving fair and informed judicial outcomes for children and families. As such, the careful selection and collaboration with expert witnesses should be viewed as a critical component of legal strategy in family law cases. q

PSYCHIATRISTS’ BODY CALLS FOR END TO OUT-OF-AREA PLACEMENTS

[ THE Royal College of Psychiatrists has responded to a BBC report revealing a 25% increase in the number of adults with mental illness being sent out of their local area for treatment.

In the article the college’s president Dr Lade Smith CBE explained that the out-of-area placements could slow the recovery of patients with complex mental health needs. NHS data shows that 5,500 adults were affected by the practice in the year to March 2024, a quarter more than in the previous year.

Professor Subodh Dave, Dean of the Royal College of Psychiatrists, issued the college’s response to the article.

“It is unacceptable that thousands of people with severe mental illness are being forced

to travel hundreds of miles away from their loved ones for essential care,” he said. “This harmful practice should have been stopped years ago, and it is concerning to see it is becoming significantly more common.

“People experiencing depression, eating disorders, schizophrenia and other severe mental illnesses are likely to be extremely distressed and vulnerable. The love and support of their family and friends plays a vital role in aiding their recovery. Being isolated puts their health at risk, leading to a longer stay in hospital.

“Mental health teams want to provide people with high-quality, continuous care, both in hospital and in the community during the return to daily life. This increases the

A SOCIAL PSYCHOLOGICAL APPROACH

COULD SEE END TO RIOTING

[ A SOCIAL PSYCHOLOGICAL PERSPECTIVE could play a pivotal role in ending the riots seen recently across England, according to experts at the British Psychological Society (BPS).

Professor John Drury, a member of the BPS’s Social Psychology section, suggests that addressing the ‘empowerment processes’ of the groups behind the violent attacks could help bring an end to the rioting.

Speaking about crowd behaviour and protests, Professor Drury said: “There are some basic psychological processes that can be applied to why crowds turn violent.”

He identified three such processes: shared social identity, shared values and relations with other groups.

“When part of a crowd, people may well see others as part of their group and feel a greater sense of belonging. The more people that share the same group identity, the more cohesion there is. Then, in turn, the more support people will feel for enacting the group’s identity.

“But what is the shared identity in the case of these crowds? In this case the term ‘patriot’ has become used. But what does it mean to be a ‘patriot’? Does it mean violent xenophobia for example? To enact this identity would mean enacting racist violence. If there are enough of them there who share these values in relation to the numbers of police, this makes them feel powerful enough to act in a way they wouldn’t normally do in everyday life when they are alone.

“Often at a crowd event there’s another group present: in this case the police. Does the crowd believe they are being treated fairly? Or does police action create a sense of common fate and strengthen any unity or any grievance within the crowd and empower certain groups within the crowd as a whole?”

Speaking about the role of meta-perceptions: beliefs about others’ beliefs, Professor Drury said: ”Just a few days before the violent rioting in Southport there was a large demonstration in London of ‘far-right people’. We know from research that a large demonstration makes people feel that they aren’t alone and that many others feel the same way. Those people getting involved in the violent attacks of the last few days may have felt empowered because they feel opinion is on their side.”

Professor Drury suggests a social psychological approach that could help bring an end to the racist riots: “First, potential participants need to understand that there is not the wider public support they think there is for their views, that the opposite is the case.

“Second, prevent them mobilising and marching: to limit that capacity-building. Third, prevent their actions – including smaller acts of hate – from having a tangible impact. Prevent them from turning their subjective identity into objective reality, by negating and cancelling out their effects.

“Finally, as it is particular identities that are empowered or disempowered, assert and support collective identities antagonistic to theirs.” q

likelihood of people successfully resuming education or work and reduces their risk of relapse. If patients are sent out of their area, the team treating them will not be familiar with their personal needs and may not be able to co-ordinate with their local services to help facilitate their long-term recovery.

“The government has an important opportunity to put an end to this outrageous practice once and for all. This will not only benefit people’s health but also ease pressure on the NHS.” q

SUICIDES IN SCOTLAND ROSE IN 2023

[PROBABLE DEATHS BY SUICIDE in Scotland increased in 2023, with those from the poorest communities two-anda-half times as likely to die by suicide, official data shows.

Figures published by the National Records of Scotland show there were 792 deaths recorded as probable suicides last year, an increase of 30 from 2022. Male suicides increased by 34 to 590, while female suicides decreased by four to 202. The rate of death by suicide in men is estimated to be more than three times as high as the female rate. It also shows the average age of death for suicides had increased overall from 41.9 in the year 2000 to 46.6 in 2023.

Moreover, the rate for those from remote small towns was estimated to be 20.5 deaths per 100,000 of the population, compared to 13.2 from large urban areas. While 2023 data for the rest of the UK has not yet been released, based on statistics from the previous year Scotland had the highest rate of death by suicide of all four nations with 14 deaths per 100,000 people, followed by Wales with 12.4, Northern Ireland with 12.3 and England with 10.5.

Dr Murray Smith, suicide prevention lead, Royal College of Psychiatrists in Scotland, said: “Every death by suicide is devastating for all those affected. The increased rate in probable deaths in some of our most deprived areas illustrates the on-going health inequalities experienced by many Scots.

“Efforts in suicide prevention and a focus on ensuring those in suicidal crisis can access prompt and appropriate help – wherever they are – remain vitally important.” q

THE IMPORTANCE OF EXPERT PSYCHIATRIC AND PSYCHOLOGICAL EVIDENCE IN LEGAL PROCEEDINGS

By Zofia Ludwig , director of Expert in Mind, with contributions

her expert witness panel

[ PSYCHIATRIC EVIDENCE plays a crucial role in certain legal proceedings, serving as a vital component in understanding the psychological aspects that may underlie certain behaviours or conditions. By evaluating an individual's mental state, courts can make more informed decisions that take into account the full spectrum of human experience, beyond just physical evidence.

Psychiatric evidence in family law proceedings

In family law, psychiatric evidence can be instrumental in determining the best outcomes for children, parents and other family members involved. Family courts often deal with highly sensitive and emotionally charged issues and understanding the mental health of those involved is essential. For instance, in cases of domestic violence psychiatric evidence can shed light on the mental state of both the perpetrator and the victim.

It can reveal patterns of behaviour, underlying mental health conditions and potential risks to family members. That evidence can be critical in deciding protective measures and custody arrangements, and even in understanding the motivations behind certain actions.

Psychiatric evaluations can help identify if a parent's behaviour, which may seem problematic, is actually a symptom of a treatable mental health condition. By recognising that, the court can recommend interventions or treatment plans that could lead to positive outcomes for both the parent and child, rather than resorting to punitive measures that might not address the root cause of the behaviour.

Personal injury claims and medical negligence claims

While physical injuries are usually visible and can be objectively measured, psychological injuries are often invisible and subjective, requiring expert evaluation to be properly understood.

An index event, such as a car accident, workplace injury, medical negligence or traumatic event, can lead to significant psychological consequences, including post-traumatic stress disorder (PTSD), depression, anxiety or agoraphobia.

These conditions can be as debilitating as physical injuries, if not more so – affecting an individual's ability to work, maintain relationships and enjoy life. They can arise from the trauma of the incident itself, the stress of dealing with a prolonged recovery or the emotional toll of living with the consequences of an accident, incident or medical error.

Psychiatric evidence helps establish the extent and severity of psychological injuries, without which the full impact of the injury may not be recognised – leading to inadequate compensation that fails to cover the cost of on-going mental health treatment, lost wages due to inability to work and other related damages.

Moreover, psychiatric evidence can demonstrate the long-term effects of psychological injuries, which might not be immediately apparent. While physical injuries may heal over time, psychological injuries can persist, worsen or lead to additional mental health issues if left untreated. Long-term psychiatric evaluations can provide insight into future needs in terms of treatment and support.

Additionally, psychiatric evidence can be used to understand the patient's mental state before the negligence or incident occurred. That is important in determining whether the psychological harm was entirely due to the negligence or injury, or if pre-existing conditions were exacerbated by the event.

from members of

Why psychiatric evidence makes a difference

Psychiatric evidence provides a comprehensive view of the impact of an event or condition on an individual. It acknowledges that mental health is as important as physical health and that psychological injuries can be just as debilitating as physical ones.

In legal proceedings, recognising and considering psychiatric evidence ensures that justice is served in a more holistic manner. It allows the court to take into account the full scope of an individual's suffering and needs, leading to fairer outcomes. That is particularly important in cases where the psychological impact may not be immediately visible, or where it may have long-term consequences that require on-going support.

By considering psychiatric evidence alongside physical evidence, courts can make more informed decisions that better reflect the realities of the individuals involved. That approach leads to more equitable outcomes, whether in family law, personal injury claims, clinical negligence cases or indeed any other type of legal case.

In summary, psychiatric evidence is indispensable in legal proceedings because it provides a deeper understanding of the human condition and the ways in which mental health intersects with legal issues. It ensures that psychological injuries and/or conditions are recognised, validated and appropriately considered, leading to fairer and more just outcomes for all parties involved. q

• To discuss further the role of an expert, understand their various areas of expertise and how they can assist with a case, contact enquiries@expertinmind.co.uk

ISSUES IN DIAGNOSING VASCULAR DISEASE

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 HAVE PROVIDED ADVICE in many cases where diagnostic problems in vascular disease have led to litigation. In some cases it led to an extended period of limb pain, but in others disastrous outcomes have occurred, including loss of both lower limbs and even death of the patient. A collection of factors appear to result in cases of delayed or misdiagnosis.

Vascular diseases particularly affect the lower limb, wherein symptoms arising from blocked arteries or veins may be confused with those arising from other conditions. Patients frequently present to A&E departments where the medical staff have limited clinical experience and may fail to recognise a collection of symptoms that could indicate both vascular conditions and musculoskeletal disorders. The subsequent clinical evaluation is cursory and misses important clinical signs, such as the absence of peripheral pulses. Delayed diagnosis leads to an adverse outcome for the patient, who becomes the claimant.

Problems

examination of the chest, electrocardiogram and chest X-ray are often done but show normal findings. That may offer reassurance to an inexperienced clinician and the diagnosis is missed. NG158 advises immediate therapeutic anticoagulation and CT angiography where symptoms suggest a pulmonary embolism. Failure to arrange those tests and treatment may provide evidence of substandard care.

Problems with diagnosis of limb ischaemia

Acute limb ischaemia, where a major artery supplying the legs becomes blocked, is not usually difficult to diagnose on the basis of clinical signs. The patient reports excruciating pain in the affected limb, which is cold, white and has no pulse. Emergency vascular referral and intervention is required to rescue the situation and any delay in management can lead to severe ischaemic damage to the limb, necessitating amputation.

with the diagnosis of venous thrombosis

In the UK, about 50,000 cases of deep vein thrombosis (DVT) develop every year. It leads to blocked veins in the leg, which cause pain and swelling of the limb. About one third of those patients suffer embolisation of clot from the leg to the lungs, which leads to symptomatic pulmonary embolism in about 10%. The symptoms are pain in the chest, shortness of breath, fainting episodes and collapse. The methods of clinical evaluation include assessment of limb swelling and palpation for the presence of calf tenderness. A fundamental problem in venous thrombosis of the deep veins is that clinical examination is very inaccurate in detecting thrombosis. Therefore, a DVT or pulmonary embolism (PE) cannot be excluded by clinical examination. As a result of that, the National Institute for Health and Care Excellence (NICE) have published NICE Guideline 158 (NG158), which offers a detailed description of how investigation of suspected DVT or PE should proceed. Where this advice has been disregarded in clinical practice, leading to an adverse outcome, the claimant may have grounds for a liability case.

A simple blood test (d-dimer) can rapidly exclude the presence of venous thrombosis and is available both in general practice and in hospital. Where there is stronger evidence of venous thrombosis, NG158 recommends that urgent imaging methods are used to detect deep vein thrombosis in the legs or blood clot in the pulmonary arteries in the lungs. Failure to request such investigations may comprise substandard care.

In general, the investigations for deep vein thrombosis (ultrasound imaging of the veins) and pulmonary embolism (CT pulmonary angiography) are very accurate, although not infallible. One area which may lead to misdiagnosis is that NG158 recommends scanning of the femoral and popliteal veins (in the thigh and at the knee) but not the calf veins: so a patient may be reassured that no clot is present, whereas a calf vein thrombosis has been missed. NG158 therefore recommends re-scanning of the calf one week following the initial scan. This is recommended when the first scan failed to show a DVT but symptoms still persist. Failure to arrange that further scan could provide the claimant with evidence of substandard care in the event of an adverse outcome. In cases where pulmonary embolism is suspected, clinical

I have come across cases in which the diagnosis was confused by the presence of neurological symptoms in the lower limbs. The blood supply to the nerves in the legs comes from the abdominal aorta and its major branches, the iliac arteries in the pelvis. Sudden occlusion of one or more of those arteries may result in paralysis of one or both lower limbs, in addition to acute lower limb ischaemia. The pain of limb ischaemia may not be felt due to the loss of nerve function. However, loss of pulses in the lower limbs is a substantial clue to the actual cause of the problem.

I have advised in a number of cases where limb paralysis was the presenting clinical feature and the lower limb circulation was not evaluated as part of the initial clinical assessment. Eventually it was observed that the circulation to the lower limbs was impaired and that pulses were absent, but delay in diagnosis led to an adverse outcome. In one case a young patient underwent bilateral aboveknee amputations following a 24-hour delay in diagnosis of acute limb ischaemia. Amputations were probably avoidable had the diagnosis been established more rapidly and treatment provided. It led to a robust case in causation.

Cases which appear to offer more difficulty for clinicians are those of ‘critical limb ischaemia’ or ‘chronic limb-threatening ischaemia’. That usually arises in patients with more longstanding arterial disease, in whom occlusion of a major artery reduces blood flow to the limb leading to diminished blood flow to the foot but not to a cold white leg. The limb can often be rescued avoiding major amputation in 80-90% of cases with expedient management by vascular surgery.

National standards are for treatment to be completed within 14 days of referral to hospital. This leads to the least likelihood of limb amputation. If limb ischaemia is allowed to persist, ulceration of the toes and foot progresses steadily until the limb is irretrievably damaged and a major amputation is required.

The appearance of the limb can be confusing and the diagnosis may not be clear on cursory examination. Patients report pain in the foot or leg, which is worse at night and leads them to hang their painful leg from the bed. Initially, gangrene of the toes may not be present but the foot is bright red in appearance, sometimes known as ‘sunset foot’. The foot is very short of blood flow as all blood vessels dilate leading to the red appearance. Evaluation of the peripheral

Fatal outcome from pulmonary embolism: thrombus removed from the pulmonary artery in the lung at post-mortem examination

pulses is helpful since that severity of ischaemia is accompanied by absent pulses. Sometimes the ankle pulses may be difficult to evaluate clinically and Doppler ultrasound assessment of the pulses should be done. That is available in general practice, podiatry and in hospital practice.

Misdiagnosis of this condition is frequent. The redness of the foot may lead to an incorrect diagnosis of gout being made. I have also come across ‘Raynaud’s syndrome’ written in the records where critical limb ischaemia was present. Where ischaemic pain is present in the calf, I have advised in cases where it has been attributed to ‘muscle strain’.

Delayed diagnosis commonly leads to the development of gangrene and loss of toes, the forefoot or a major limb amputation. In general, vascular surgeons consider that avoidance of major limb amputation is a successful outcome. Some claimants consider that loss of toes was the result of substandard care; however, the need for toe amputations cannot always be prevented because thrombus or fragments of atheroma into the toe arteries leading to loss of blood flow in the toe is largely irreversible. Defendants are likely to assert that loss of the toe could not have been prevented. It may be difficult to state a credible case in which toe amputation would have been avoided.

In both acute limb ischaemia and chronic limb threatening ischaemia, expediency of management is important and delays in providing the correct treatment may furnish the claimant with a liability case.

In conclusion, venous thrombosis and limb ischaemia are common conditions involving the peripheral circulation, mainly of the lower limbs. Very effective treatments are available for those conditions.

The symptoms and clinical signs are well-described in undergraduate text books in medical practice. Failure to recognise and manage those conditions expediently may lead to disastrous outcomes, including avoidable amputations and death. Claimants may be able to form robust cases for liability and causation in instances where basic medical practice is of an inadequate standard. q

ENDOMETRIOSIS STUDY MAKES RECOMMENDATIONS FOR

[THE National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has published a study Endometriosis: A Long and Painful Road

Endometriosis occurs when tissue similar to the lining of the uterus is found in places outside the uterus. Those deposits can bleed in response to hormones, causing pain and scarring in the pelvis.

In its introduction the document states: “A delay in diagnosis is a significant issue as it can lead to prolonged suffering, ill health and risks to fertility. Delays occur due to a perception that pelvic pain and heavy vaginal bleeding can be normal, and because healthcare professionals do not always consider the presenting symptoms to be endometriosis –

there may be many symptoms, not just cyclical pain and heavy bleeding.”

NCEPOD reviewed the pathway and quality of care provided to patients aged 18 years and older with a diagnosis of endometriosis during a sampling period of 1 February 2018 to 31 July 2020. That was undertaken with wide multidisciplinary input, reviewing the care of patients with endometriosis who underwent a surgical laparoscopy during the study period.

Recommendations include: “Endometriosis is often treated as multiple episodes of acute care, instead of on a continuum like other chronic conditions, such as diabetes or inflammatory bowel disease. This

RCOG PAPER ADDRESSES POST-TRAUMATIC STRESS AMONG PROFESSIONALS

[TWO-THIRDS of obstetricians and gynaecologists have encountered a traumatic work-related event during their career, which can trigger post-traumatic stress symptoms (PTSS) and if unaddressed can decline into PTSD.

In recognition of that significant issue for health professionals, and the critical link to protecting and enhancing the care of women and families, the Royal College of Obstetricians and Gynaecologists (RCOG) commissioned a Good Practice Paper on Prevention and Treatment of Work-Related Post-Traumatic Stress Symptoms in the Maternity and Gynaecology Workforce

Health professionals affected by PTSS may experience flashbacks, intrusive thoughts, feeling ‘on edge’ and under threat, as well as anger or guilt. The impacts can also lead to exhaustion and lower job satisfaction, with an alarming 12% of obstetrics and gynaecology doctors leaving the profession in the UK within three years of completing training, the highest level of any medical specialty.

Mrs Geeta Kumar, RCOG vice president for clinical quality, said: “The RCOG commissioned this Good Practice Paper to provide a comprehensive framework to prevent, and provide early intervention for, work-related PTSS. This will not only benefit healthcare professionals in our specialty but, crucially, enhance the safety and experience of women, too.”

Researchers and clinicians from the University of Liverpool, University of Nottingham and the University of the West of England led the development of the publication.

Co-author of the paper, Professor Pauline Slade of the University of Liverpool, said: “It is clear that the reported levels of PTSD are highly detrimental for individual health professionals, for patient care and more broadly at specialty and organisational level. We urge NHS trusts, health boards and policy makers to consider this Good Practice Paper and embed it within staff welfare practices. We must change the culture of healthcare settings in order to see positive change.” q

IMPROVEMENT IN CARE

approach needs to change to enable appropriate pathways of care, holistic and medical management, discharge planning and follow-up.”

In particular: “Signs and symptoms of endometriosis need to be recognised and not just seen as troublesome periods.”

Responding to the publication, Dr Geeta Kumar, vice president for clinical quality at the Royal College of Obstetricians and Gynaecologists (RCOG), said: “This insightful ‘deep dive’ into how women and people with endometriosis are cared for by the NHS found room for improvement in around half of the patient cases studied. Clear recommendations are provided for NHS organisations, Royal Colleges and individual teams to support through audit and quality improvement initiatives.

EXPERTS FOR MEDIA

The following experts offer their expertise to the media

“The overarching message is to implement holistic, joined-up multidisciplinary care with appropriate referral pathways accessible for both primary and secondary care, including discharge planning and follow-up. Women reported better care experiences when referred to specialist centres and the key role of specialist endometriosis nurses also shines through.

“Surgical theatre capacity is identified in the report as a factor in the delayed initiation of appropriate management and diagnosis. The RCOG is continuing to call for gynaecological theatre capacity to be prioritised by hospitals to tackle the significant gynaecology waiting lists, recognising this has been deprioritised and underfunded for too long.” q

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?

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 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

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