Image © Tero Vesalainen
Anaesthesia and Physician Associate Lawsuit against the GMC
The Anaesthesia and Physician Associate Order is due to come into force in December 2024. However, there is a growing concern from the medical profession about the role of these healthcare professionals after they have completed only 2 years of training. Many members of the BMA and Medical Royal Colleges feel that Parliament was misled when the order was debated, and that the new Government must pause the legislation to allow the Health and Social Care Committee to assess their concerns about patient safety.
A campaign group called Anaesthetists United has proposed a claim for judicial review challenging the GMC’s failure to introduce the safe and lawful practise measures and its failure to regulate on a properly informed basis as unlawful. The legal case against the GMC was joined in September by two families who have suffered bereavements following care delivered by Physician Associates.
Read more: https://anaesthetistsunited.com/our-legal-arguments/
Junior Doctors accept Government Pay Deal
Junior doctors voted to accept a pay deal of around 22% over two years, the BMA announced on 17 September, stating:
“The BMA’s junior doctors committee (JDC) in England has accepted the government’s pay offer, with 66 per cent of junior doctors voting in favour of the deal.”
The average of 4% over their existing pay award for 2023-24, will be backdated to April 2023.
The statement added: “Outside the pay negotiations, the government has agreed that from September 18 ‘junior doctors’ across the UK will be known as ‘resident doctors’ to better reflect their expertise.
“This follows a motion to the BMA’s annual policy making conference in 2023 when doctors voted in favour of a name change.”
Wes Streeting, the health secretary, said he is pleased the BMA has accepted the government’s pay deal and said that the situation “should never have been allowed to get this bad”.
Read more: https://www.gov.uk/government/news/junior-doctors-accept-government-pay-deal
https://www.bma.org.uk/our-campaigns/
Yaser Jabbar Paediatric Surgery Scandal at GOSH
Mr Yaser Jabbar, paediatric orthopaedic surgeon, is at the centre of an inquiry by Great Ormond Street (GOSH), looking at the care of hundreds of children since 2017. At least one patient has had a leg amputated, others have been left in chronic pain and with deformed limbs.
Senior leaders were told as early as 2020 about concern over Jabbar’s practice, but nothing was done until 2022.
He performed operations without the full consent of patients at GOSH and privately at the Portland Hospital.
Jabbar is facing an investigation by the GMC, although he has voluntarily given up his licence to practise in the UK. He left GOSH at the end of September 2023 and was listed as working in Dubai, where he was operating on children at the Clemenceau Medical Center and for orthopaedic specialist firm Orthocure.
It seems likely that multiple claims will be brought against his employers.
Read more: https://www.bbc.co.uk/news/articles/c3035e26gl0o
Partisan Experts in Wilson v Ministry of Justice [2024] EWHC 2389 (KB)
The judgment of HHJ Melissa Clarke (sitting as a judge of the High Court) in Wilson v Ministry of Justice [2024] EWHC 2389 (KB) found that several of the multiple experts were not fulfilling their roles as independent advisers to the court.
Mr Wilson was a guest of Her Majesty when he was stabbed in the prison kitchens by another inmate. He suffered multiple life-threatening and life-changing injuries and was hospitalized for several weeks. The defendant admitted negligence in allowing a convicted murderer access to kitchen knives. At the trial on damages there were seven different disciplines of expert: spinal injury, psychiatry, pain medicine, physiotherapy, care/OT and accommodation, together with a single joint expert in urology. The claimant was awarded damages of over £5 million.
The Judge criticized Mr Naveen Kumar, Spinal Surgeon and expert for the defendant: “I found Mr Kumar to be a partisan witness who, unusually, agreed quite early on in his cross-examination with the contention that he had lost all independence and objectivity in this case. He initially agreed that part of his evidence (that he did not find Mr Wilson to have any balance or weakness issues) was wrong, and it was put to him that it showed he had a lack of objectivity and was advocating for the Defendant. Mr Kumar replied “I agree. I have said he had impaired balance previously“.
She also found wanting the evidence of the pain medicine expert for the Defendant, Dr Edwards, who “significantly altered his stance in cross-examination to reach a position much closer to that” of the Claimant’s expert. The Defendant’s physiotherapy expert, Mrs Keech, “departed from her fair and independent approach, to one which veers into a partisan approach” having seen the surveillance evidence, “cherry-picking what she mentioned and what she failed to mention in order to paint a positive and improved picture of Mr Wilson, which was not one that could fairly be drawn from the video surveillance” evidence. And finally, the Defendant’s accommodation expert, Mr Burton, emerged from cross-examination “with his credibility and independence significantly damaged”. Having initially, like Mrs Keech, approached the case independently and fairly, upon seeing the surveillance videos Mr Burton then allowed his evidence “to be corrupted”.
The Judge, unsurprisingly, preferred the evidence of the claimant’s experts in all these areas, after the experts for the defendant endured cross-examination and ultimately public humiliation.
The responsibility for any expert is to assist the court and not the party who instructs them.
Read more: https://www.bailii.org/ew/cases/EWHC/KB/2024/2389.html
September was Aortic Disease Awareness month and September 17th was World Patient Safety Day
Missed aortic disease in Emergency Departments, including dissection and ruptured abdominal aortic aneurysm, is one of the most common causes of death related to misdiagnosis (NHS Resolution report).
Aortic dissection can be a challenging diagnosis to make, and may present with collapse, chest or back pain or with neurological symptoms and signs. The Royal College of Emergency Medicine (RCEM) produced a ‘THINK AORTA’ poster campaign. The RCEM chest pain standard requires senior review before discharge of patients over 30 years of age with this presentation.
The charity Aortic Dissection Awareness states that “Our mission is to save lives by improving diagnosis of Aortic Dissection and ensuring that every family affected by this disease has access to the best available information, care and support.”
The registered charity is led by patients, for patients and was named the UK's Best Specialist Patient Support Charity in the 2023 Non-Profit Organization Awards. Membership of the charity is free to anyone affected by or interested in aortic dissection.
Success is measured by the increasing number of aortic dissection survivors and by the changes we see happening in the aortic dissection healthcare landscape, such as:
Publication of the first-ever national guidance on diagnosing acute Aortic Dissection by RCEM and the Royal College of Radiologists, working with our THINK AORTA campaign.
Agreeing a national set of national Aortic Dissection research priorities with the Department of Health, which have resulted in an additional £4 million (and counting) funding for Aortic Dissection research since 2020.
Publication of the new NHS England Acute Aortic Dissection toolkit, to help regional Aortic centres to improve their services and patient pathways in order to end the 'postcode lottery' of regional variation in care and outcomes.
A reported 68% increase in emergency Aortic surgery cases in the UK between 2014-2021, as a result of awareness initiatives such as our charity, our annual AD Awareness Day and our life-saving THINK AORTA campaign.
The charity held its annual UK patient conference at the Royal College of Surgeons, Edinburgh this September along with the sister Irish patient conference in Dublin’s Guinness Enterprise Centre.
Awareness is reaching all corners of the world with the “THINK AORTA” campaign posters being taken up by more countries, who have translated the message into many more languages including Brazil (Portuguese), Cananda (French) and many Arab speaking regions.
Chair of the Aortic Dissection Awareness Charity, Gareth Owens, said:
"The international theme and Faculty for Aortic Dissection Awareness Day UK this year demonstrates clearly how THINK AORTA has become a truly global Aortic disease awareness campaign. THINK AORTA leaders from North and South America, Europe & Asia joined us in Edinburgh, while in Africa, the THINK AORTA Egypt team held their launch event with 200 patients, relatives and clinicians the same day. The recent translation of our resources into Arabic for Egypt has extended the reach of the campaign to the whole Arab world. The life-saving THINK AORTA poster is now available in the native language of 50% of the world's population. This has all happened faster than we expected, thanks to the support of our THINK AORTA partner organizations and the worldwide medical community."
Read more: Aorticdissectionawareness.org
https://scts.org/news/307/think_aorta_campaign
https://resolution.nhs.uk/wp-content/uploads/2022/03/1-NHS-Resolution-ED-report-High-value-and-fatalities.pdf
The European Society of Cardiology (ESC) Updated and published their Guidelines for the management of peripheral arterial and aortic diseases 2024
The new guidelines were published 30 August 2024 and presented at the ESC Congress in early September.
“The 2024 ESC Guidelines for peripheral arterial and aortic diseases (PAAD) represent the first instance where recommendations for these two conditions have been merged, updating and consolidating the 2017 guidelines for peripheral arterial diseases and the 2014 guidelines for aortic diseases. The focus is primarily on atherosclerotic arterial diseases, though non-atherosclerotic genetic conditions are also considered. These guidelines provide a comprehensive framework for healthcare professionals, covering the entire PAAD patient journey — from diagnosis and risk stratification at initial presentation to long-term management post-hospitalisation. Emphasising patient-centred care, the guidelines also stress the importance of preventive strategies, lifestyle modifications, and physical activity recommendations to prevent disease progression and complications. While not exhaustive, they offer practical recommendations on diagnosis, surveillance, and treatment, with new and revised recommendations highlighted at the beginning of the document. Healthcare providers are encouraged to consider non-atherosclerotic conditions and consult specific documents as needed. The objective is to equip healthcare professionals with the best available evidence to manage patients of all ages with PAAD effectively.”
Read more: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Peripheral-Arterial-and-Aortic-Diseases
Men on Epilepsy Drug, Sodium Valproate, Advised to use Contraception
The Medicines and Healthcare products Regulatory Agency (MHRA) now say men, as well as women, under the age of 55 should not take sodium valproate, unless all other treatment options had been rejected, because of "a potential small increased risk" of neurodevelopmental disorders in their future children.
The dangers of exposure in the womb are well-known, according to the MHRA these include intellectual disorders, communication disorders, autism, ADHD, specific learning disorders, motor disorders, tic disorders and other neurodevelopmental disorders.
An estimated 20,000 children in the UK have had life-changing injuries from exposure to the drug before birth. However, there are still an estimated 65,000 boys and men under 55 taking sodium valproate.
The new guidance follows a similar warning from the European Medicines Agency, after data from Scandinavian national registries suggested 5% of children born to men taking the drug were harmed.
Read more: https://assets.publishing.service.gov.uk/media/65660310312f400013e5d508/Valproate-report-review-and-expert-advice.pdf
Lord Darzi Published his Independent Investigation of the NHS in England this September
Lord Darzi, surgeon and Labour former minister, addressed his report to the Secretary of State for Health & Social Care and his overall conclusion was that:
“The NHS is in critical condition, but its vital signs are strong”
He went on to say:
“It continues to struggle with the aftershocks of the pandemic.
Its managerial capacity and capability have been degraded by disastrous management reforms, and the trust and goodwill of many frontline staff has been lost. The service has been chronically weakened by a lack of capital investment which has lagged other similar countries by tens of billions of pounds. All of this has occurred while the demands placed upon the health service have grown as the nation’s health has deteriorated.”
His report includes a section devoted to clinical negligence and the worrying rise in claims, particularly in obstetrics.
"Complaints have nearly doubled in a little over a decade, according to data shared with the investigation by the parliamentary and health service ombudsman. As the highest level to which complaints about the NHS can be directed, they received 14,615 formal complaints in 2011-12, rising to 28,780 complaints by 2023/24.”
He clarified that:
“Nothing that I have found draws into question the principles of a health service that is taxpayer funded, free at the point of use, and based on need not ability to pay.
With the prominent exception of the United States, every advanced country has universal health coverage—and the rest of the world are striving towards it. But other health system models—those where user charges, social or private insurance play a bigger role—are more expensive. It is not a question, therefore, of whether we can afford the NHS. Rather, we cannot afford not to have the NHS, so it is imperative that we turn the situation around.
“Many of the solutions can be found in parts of the NHS today. The vast array of good practice that already exists in the health service should be the starting point for the plan to reform it. The NHS is a wonderful and precious institution. And no matter the challenges it faces, I am convinced it can return to peak performance once again.”
Read more: https://assets.publishing.service.gov.uk/media/66e1b49e3b0c9e88544a0049/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England.pdf
Civil Procedure Rule Updates from 1 October 2024 and Extension of Fixed Recoverable Costs in Low Value Clinical Negligence Claims
On 1 October 2024, the latest amendments to the Civil Procedure Rules will come into force. The full text of the Civil Procedure (Amendment No. 3) Rules and Practice Directions 2024 are in the links below.
For Expert Witnesses, the main change is the amendment to the overriding objective (Part 1), in addition there are amendments to Parts 3, 28 and 44, to promote the use of alternative dispute resolution. This amendment follows a consultation by the Civil Procedure Rule Committee to implement the Court of Appeal's Decision in Churchill v. Merthyr Tydfil CBC [2023] EWCA Civ 1416.
Dealing with a case justly and at proportionate cost will include "promoting or using alternative dispute resolution", and active case management will include ordering (in addition to the existing encouraging) the parties to use, and facilitating the use of, alternative dispute resolution.
All clinical negligence claims with a value agreed between £1,501 and £25,000 will be subject to fixed costs unless they qualify for a ‘specified exclusion’. These include claims involving: a litigant in person, stillbirth or neonatal death, and more than three medical experts.
Whilst the Lower Damages Clinical Negligence Claim FRC (LDFRC) Scheme proposes to fix Claimant legal representative costs, the position in terms of expert fees remains unclear.
It will be interesting to see how this will operate in practice, given that expert fees usually take up a significant portion of the costs in bringing a clinical negligence claim [see PD 45 – Tables of Fixed Costs (2024)]. Significantly, overvalued claims which settle within the £1,501 to £25,000 range will still be subject to the LDFRC Scheme costs, whether or not they followed the LVCD Protocol.
Read more: https://www.legislation.gov.uk/uksi/2024/839/made
https://www.justice.gov.uk/documents/171st-practice-direction-update.pdf
If you are interested in training to be an accredited civil mediator, please see the Mediation course dates on the SpecialistInfo booking site:
https://www.specialistinfo.com/mediation-course
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