Your Expert Witness Issue No. 26

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contents IN THIS ISSUE 7

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Opening Statement

HOW TO CHOOSE THE CORRECT EXPERT 9 Appointing the right expert 11 Has Jackson LJ changed the role of the expert forever?

13 New fee structure alienates experts 13 Electronic transmission of data – help or hindrance?

14 New standards for family court experts 15 Clinical negligence experts – improving practice and safety FINANCE & FRAUD 17 Hard Prest to pierce the corporate veil 18 Bringing forensic accounting and IT together 19 Forged signatures still command the courts' attention 20 MoJ calls in police over prison contract GAS & CARBON MONOXIDE POISENING 21 Gas poisening tragedy strikes on an all-too-regular basis 22 A combination of factors can give rise to gas poisening 23 Latest prosecution shows continuing flouting of gas laws 23 Parliament to resume CO metering debate

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BUILDING & PROPERTY 24 Architects caught up in defects case 24 An expert in all he surveys 25 Landlords’ association reaches out to all – including non-members EMPLOYMENT LAW 26 Employment tribunal fees subject to Judicial Review 26 Returning mums face discrimination, research finds 27 Wellbeing – the future of safety MOTORING OFFENCES 29 The speed camera never lies...only the unqualified, untrained personnel!

THE LAW IN SCOTLAND 31 Tribunals consultation due to end 31 Doctors welcome tobacco packaging commitment

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TREES & FORESTRY 32 Tree health – time for a different approach ANIMAL & VETERINARY ISSUES 33 Dog bite hospitalisations down 34 Have you picked an expert or just a practising clinician?

CULTURAL ISSUES 36 Favouritism can be detested or desired – culture matters TRANSLATION & INTERPRETING 37 Poznan conference calls for papers 37 Court contract woes hit translation company profits

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MEDICAL ISSUES 39 Medical Notes

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ORTHOPAEDICS 41 Old cases – missing notes UROLOGY 42 Spinal injuries urology – what is that all about?

INSTRUCTING A PHYSIOTHERAPIST 43 Physiotherapists and whiplash related disorders 44 Physiotherapy expertise forms the basis of nationwide service 45 Why aren't physiotherapists used as musculoskeletal experts?

PSYCHOLOGY & PLASTIC SURGERY 46 Learning to communicate is key to avoiding litigation 47 Surgeons’ cosmetic guidelines stress the import of psychological issues PLASTIC SURGERY 48 Senior surgeon uses plastic techniques for lump removal 49 Sun, sea and sepsis – plastic surgery abroad shows high level of complications 49 Apprentice winner comes under fire from clinicians

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SPEECH & LANGUAGE ISSUES 50 Speech therapists join in a conversation about professionalism 51 Special needs require specialist assessments 52 Liaising with other therapists can be key 53 Association can help ‘Find a Therapist’ for speech and language needs 54 Child friendly justice – is it possible?

CANCER 55 Innovative cancer treatment to be offered in UK DENTAL ISSUES 56 Dentists respond to Mid Staffs report 57 Would-be dentist prosecuted and fined 57 Irish dentists aim for corporate status

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CARDIOLOGY 58 Leeds case overshadows need for reform

EXPERT CLASSIFIED 59 Expert Witness classified listings 63 Medico-legal classified listings

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Opening Statement ‹ WITH THE EFFECTS OF economies in the legal system being increasingly felt – both in terms of

cuts in legal aid and the squeezing of budgets for law suits – and the new CPR requiring more and more precise matching of experts to the issues under consideration, there is ever more pressure to ensure lawyers choose the correct experts to report on their cases.

So, attention turns to the actual qualifications and expertise of the individuals involved. In an informative piece in this issue of Your Expert Witness, Daphne Wassermann of Cadogans takes us through the process of choosing and instructing an expert, with a run-down of what they might expect from you as well as what you can expect from them.

The impending increase in the practice of ‘hot-tubbing’, following a pilot programme in Manchester, will take some of the adversarial nature out of the evidence, but it will also expose experts to the risk of having evidence openly contradicted by their peers. Furthermore, fee cuts, in particular the London ‘weighting’, have seen some of the most esteemed experts leaving the ring.

In one area, however, a diminution in the use of experts has been both long-term and broadly welcomed. That is in the family courts, where protracted and sometimes irrelevant wrangling by entrenched sides – each producing report after report – was long seen as detrimental to the well-being of the children the courts are meant to protect. New standards introduced this year add to the streamlining process.

• All-in-all it’s not been a great year for the Ministry of Justice. Following on from the criticism levelled at it from various quarters regarding the contract for translation services, it found itself in the position of having to call in the police to investigate the carrying out of the contract for prisoner transfers. An audit seemed to reveal that ‘some staff recorded prisoners as having been delivered ready for court when in fact they were not’. Did nobody at the court notice?

The contractor which had been providing tagging services refused to take part in an audit and is being investigated. The new contract for the tags has been awarded to new companies. One of them is Capita, who took over from the firm providing the translation service – a contract it has described as ‘onerous’.

• Nobody probably needs reminding that the property market has been through a turbulent time, one of the results of which has been an increased readiness to take to the judicial process to minimise exposure to loss. That applies to developers and owners alike. One casualty was the firm of architects who issued certificates of compliance for a block of flats when they were in fact the subject of a number of defects.

The architects found themselves in the firing line when the owners sued for compensation.

Owners of rental properties need to be on their guard as well. Maintaining their homes properly can be a matter of life or death as well as a financial item. That is particularly true when it comes to the presence of carbon monoxide gas. And it isn’t just gas appliances that emit the stuff – any fossil fuel is a potential hazard.

• Changes to legislation have also been a feature in the employment sphere.

The main battle is over the introduction of a fee to take a case to court or to an employment tribunal. There is to be a judicial review on the issue later in the year.

There has also been a rise in the number of claims of discrimination on the return to work following maternity leave. A quarter of women surveyed by an employment law specialist reported suffering such discrimination. q

Ian Wild

Ian Wild, Director of Business Development Your Expert Witness

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Appointing the right expert

by DAPHNE WASSERMANN, Technical Director, Cadogans

‹ THE WISE MAN BUILT his house on a rock. The rain came down,

the floods came, and the winds blew and beat on that house – and it didn't fall, for it was founded on the rock. The foolish man built his house on the sand. The rain came down, the floods came, and the winds blew and beat on that house – and it fell, and great was its fall.

For rain, floods and wind read cross-examination. Poor expert evidence can completely undermine your case. Is your case built on rocks or sand?

The right expert can help you to find out about your foundations and build a strong house.

Finding an expert Our research suggests that people who regularly appoint experts generally go for the experts they already know. If no one suitable is on their list they will ‘phone a friend’. After that come searches on the internet or through directories.

If an expert is new to you, what are your criteria for selecting them?

Most people require expertise in a particular field together with experience of report writing and court-room experience. Expert witness training and general technical expertise come low down the list.

Do you ask for a copy of a previous (anonymised) report? Do you check for any published court records where the expert has appeared? Do you seek references from people who have used this expert in the past?

In our experience this is rarely done.

Initial information – honesty is the best policy In the early stages it is sometimes difficult to know the issues involved and therefore match the problem to the right expert.

The first thing that an expert will do is look at the material provided to her. If she does not have the requisite expertise she should tell you immediately and advise you what kind of expertise you need. She may have a colleague whom she can recommend.

If the material provided is biased or incomplete, the expert will get a false impression. It is therefore important to provide complete and balanced information. On the basis of this, a good expert will let you know if she has doubts about the validity of your case or if there are gaps in the argument that need to be filled. It is better to find out your weaknesses or those of the evidence at the start rather than in the courtroom.

An object lesson in this happened to me many years ago. The matter related to a woman hit by a stone that she claimed was thrown up by a mulcher working on an embankment across the road from her car park.

I was informed that the mulcher was 150m away. On this basis, with information on the speed of the blades etc., I calculated that the stone could not have reached the woman. In court (a Scottish one) I was shown a photograph of the mulcher just across the road from the car park. I was asked whether the stone could have hit her if the mulcher was there.

Answer ‘yes’. End of my evidence.

Further investigations It is at this point that the question of fees usually arises. Bearing in mind sand and rocks, cheapest is not always best. If the price is low, ask yourself why. You get what you pay for.

Nevertheless, you will want to know what to expect. The expert should be able to give you an idea of what can be done for a particular fee, based on the information that you have provided.

Your expert is also likely to identify any additional information that is needed or to recommend site visits, test-work or research. The reason for doing this work and the possible findings should be highlighted to you, along with the probable costs. Remember, you don’t want the other side to surprise you with bad news. Better to find it out yourself and take avoiding action.

Horses for courses Many disputes revolve around a single issue which can be dealt with

by a single expert. In many cases these will be independent individuals. In some cases they will be employed by a company of forensic investigators.

The more complex disputes may require experts in different disciplines. They may have to study large volumes of material. In the same way that the legal team will have more senior and more junior members, it may be useful for the expert team to have the same mix of skills and experience. This is where a broad-based forensic consultancy can come into its own. The wealth of experience of the appointed expert can be backed up by a team of assistants to provide a cost-effective solution.

In the same way, experts in different disciplines, but used to working with each other within one company, can be more effective than a disparate group of individuals.

What are you paying for?

Sometimes a matter may seem fairly clear cut. In most cases, further investigation reveals other possibilities which must be examined, explored, analysed or tested. An incomplete investigation may leave you open to surprises later on – those sandy foundations again.

Additionally, the best investigation in the world will fall down if no-one can understand it. The ability to communicate complex technical information in clear English for a non-specialist to understand is essential. This applies to both written and oral evidence.

What can go wrong?

A recent object lesson is the Trebor Bassett ‘popcorn fire’ case. Four experts, representing all parties, were criticised for not meeting deadlines, falling out with each other to the extent that they were unwilling to meet and providing biased testimony.

Most instructions that I have received recently have included details of the expert’s duties. I would hope that your initial contact with your expert should have reassured you of her independence. The first report will indicate competence and ability to meet deadlines.

The final crunch With good evidence from both sides it is likely that you will be in a position to settle the matter before a hearing. If this doesn’t happen, your expert will appear in court or other hearing and at that point you lose control.

This is where it is essential that the expert has seen and considered all the factual evidence and all competing probabilities. It is then up to the expert to use her skill and avoid being led to a place that neither you nor she wants her to be.

With most civil matters settling before a hearing, even a full-time expert will have relatively little experience in court. This can be supplemented by training in court-room skills. So it is worth asking your expert about their training as well as their experience.

Conclusion I hope that I have given you an idea of what a good expert can provide for you. It is worth paying for to ensure that the storms of cross-examination don’t bring down your house.

• Daphne Wassermann is a technical director with Cadogans and has been working in forensic engineering for nearly 25 years. Cadogans accepts instructions relating to engineering and health and safety matters, large and small, from within the United Kingdom and abroad. For details of Cadogans’ full range of services and specialist expertise please contact them by telephone, email or fax or visit their website www.cadogans.com. www.yourexpertwitness.co.uk

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Has Jackson LJ changed the role of the expert forever? ‹ ONE OF THE MAIN consequences of the Jackson reforms in

terms of expert witness instruction has been an emphasis on both the extent and quality of expert evidence.

Both are addressed by the holding of a case management conference.

According to a blog by forensic accountants Bellamy LLP: “One such saving is the early determination of the scope of expert evidence and the identification of the precise issues which an expert will address. The parties will also have to provide estimates of the costs of such evidence.

“Furthermore, in cases where the court has given no detailed directions about expert evidence, the judge has the power to impose costs sanctions for prolix or irrelevant evidence, a situation which may be much more likely in future.”

Those changes are having far-reaching effects on the way litigators appoint experts, and on the way experts themselves are presenting their credentials.

In part as a response to the Jackson reforms the RICS has established its own accreditation scheme for experts in the built environment sector.

The RICS Expert Witness Accreditation Service (EWAS) is open to all property professionals. It is intended to raise quality and standards in a sector that has not previously been subject to professional regulation.

Dr John Fletcher, Director of Alternative Dispute Resolution for RICS, said: “In the current climate, where the role and quality of experts is under increasing scrutiny, a qualification that signals high standards of expertise and professionalism in this area of practice is not just worthwhile, but has become crucial.

“The introduction of EWAS will send a positive signal to the market about the quality and standards of RICS accredited expert witnesses. Our aim is to give confidence to the public, markets and clients of member firms and the legal profession alike that RICS accredited experts are professional, follow an approved process and participate in an appropriate compliance regime.”

Another major transformation in the way expert evidence is presented which has resulted from Jackson is the introduction of Australian-style ‘hot-tubbing’. That is an informal term for the process whereby experts give their evidence concurrently in a kind of conference chaired by the judge.

The 2013 amendments to the Civil Procedure Rules state: “At

any stage in the proceedings the court may direct that some or all of the experts from like disciplines shall give their evidence concurrently.”

Describing the process, the document states: “The judge may initiate the discussion by asking the experts, in turn, for their views. Once an expert has expressed a view the judge may ask questions about it. At one or more appropriate stages when questioning a particular expert, the judge may invite the other expert to comment or to ask his own questions of the first expert.”

A trial of the process was carried out in the Manchester Technology and Mercantile Court from 2011 to 2012, which resulted in the inclusion of the process in the amended CPR. Hot-tubbing is more likely to be useful and cost-effective where the experts agree on a broad range of the issues involved but disagree on a small number of salient points.

The procedure takes the adversarial role out of the process; the choice of expert will probably reflect that change. q

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New fee structure alienates experts ‹ MUCH OF THE controversy over

LASPO has been concerned with curtailments to legal aid for many litigants.

The reforms severely limit the entitlement to legal aid in many cases and virtually abolish it for medical negligence claims.

The effect of the reforms on expert witness services has mainly revolved around cuts to the rates they can be paid under legal aid, and in particular the abolition of the London rate differentials in many cases.

The Legal Aid Agency (LAA) has published updated guidance on the remuneration for expert witnesses, which consolidates a number of separate guidance documents into one single reference document.

The new guidance coincides with the new maximum expert rates introduced by the Civil Legal Aid (Remuneration) Regulations 2013 and the Criminal Legal Aid (Remuneration) Regulations 2013.

It also clarifies when providers should apply for prior authority, including benchmarks of ‘unusual’ hours below which

prior authority should not be sought, and outlines specific arrangements for certain types of expert, including risk assessment experts, drug and alcohol testing and DNA testing.

An area where legal aid is still available in medical negligence cases is that of cerebral palsy.

On that issue the guidance states: “Following discussions with representatives of clinical negligence providers, the MoJ is satisfied that the limited numbers of neurologists, neuroradiologists and neonatologists available to provide the specialised and unusual evidence that is often necessary in cerebral palsy cases indicates that the exceptionality test in Paragraph 2 of Schedule 5 to the 2013 Regulations is likely to be satisfied in many of these cases.”

Litigators have found that the reduction in fees has led in many cases to a reduction in the number of experts available to carry out instruction, as many have withdrawn from providing expert witness services. R

Electronic transmission of data – help or hindrance?

By TUDOR THOMAS BDS FRCS

‹ ELECTRONIC TRANSMISSION OF DATA is now an established

part of modern life, but has this led to greater efficiency? At the present time, in my opinion, it is not more efficient as far as the medical expert is concerned.

Firstly, viewing several hundred pages of medical records on the screen is not easy and cross referencing requires more care than in the assessment of paper records.

Secondly, pages in the electronic data are not all scanned into the system in the same alignment and this means constantly having to rotate pages on the screen, a time consuming and irritating process.

X-rays are provided on CDs – as sometimes are medical records – and most require a password in order to gain access. In a recent audit in my practice approximately 40% of CDs were sent without the password information being provided.

There also appear to be several different systems involved in the electronic processes. On several occasions recently I have received a disc from a GP surgery containing medical records with each page having to be opened separately. When several hundred pages require to be reviewed, this is just not practicable.

Therefore electronic transmission, now that it is a standard process, should be made more efficient. This is needed to make the system less liable to error. There is always a danger when there is irritation and frustration in assessing data, that something important will be missed.

Currently assessment of records is part of the fee paid to the expert and it is felt that cases which have a small volume of records and

cases with a large volume of records ‘cancel each other out’. That is not always the case and the assessment of electronic data often results in more time needing to be spent on assessing that data.

Unless the providers of the data make that process more efficient, there must come a time when an extra charge will need to be levied for assessing copies of records which have been provided electronically, but in a less than efficient manner. R

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New standards for family court experts ‹ THE AREA WHICH HAS probably seen the biggest shake-up in the use of experts has been in the family courts. In May the Ministry of Justice announced it was to implement national standards aimed at raising the quality of experts there. The ministry said this is in order to “…get rid of time-consuming evidence which adds little value in helping judges reach a decision”.

According to the MoJ, the standards will mean evidence provided in a family court can only be given by qualified, experienced and recognised professionals. The ministry launched a consultation which closed on 18 July, the results of which are expected in the near future.

In a statement at the time, the MoJ said: “For far too long there has been an increasing trend in England and Wales for expert witnesses to provide unnecessary and costly evidence – in the form of further written statements, clarifications and additional court appearances.

“Under the new plans experts who are well-qualified and experienced will continue to provide their valuable service in advising the family courts – but the so-called experts who provide evidence which is simply not up to scratch will be driven out.”

Justice Minister Lord McNally said: “Poor quality expert evidence can lead to unacceptable delays for children and their families. By putting standards in place we will ensure only the highest calibre of evidence is permitted in family proceedings.”

The consultation was jointly led by the Family Justice Council and follows the independent Family Justice Review by David Norgrove, which identified weaknesses in the quality of evidence being put forward by experts at family proceedings involving children.

Dr Heather Payne, chair of the Family Justice Council’s Experts

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Working Group, which drafted the standards, commented: “The standards are designed to improve the quality, supply and use of expertise to improve outcomes for children in the family courts. They are intended to help experts and the courts alike, to ensure that they are delivering the relevant and high-quality opinions based on the best possible evidence which the family courts need to help them make decisions.

“They also seek to provide the courts and lawyers with clear guidance on how to ensure that expert evidence is sought from an expert of the appropriate discipline, with appropriate professional qualifications. The standards are a first step to promoting the more effective and intelligent use of expert evidence.”

However, even before the introduction of the standards, the findings of the Family Justice Review were making their way de facto into the justice system. On 6 June, Cafcass – the Children and Family Court Advisory and Support Service – published research indicating that the instruction of expert witnesses in cases involving care applications in family courts was already decreasing. Experts were instructed in 70% of the cases in a study sample, compared to 92% of cases in a similar study carried out in 2009.

While the study found that fewer experts were instructed in the sample cases than had been found in previous research, a survey of Cafcass Children’s Guardians found they felt that those who were instructed were beneficial to cases, rating 88% of expert witnesses as ‘overall beneficial’.

Cafcass chief executive Anthony Douglas said: “Cafcass’s research yet again shows that the family justice system is responding to the Government-approved recommendations made by the Family Justice Review, even before legislation has been put in place. At a time when scarce resources must be directed to the right areas, we agree with the Family Justice Board that the use of expert witnesses should be limited to cases in which they are absolutely necessary, in accordance with the latest Practice Direction from the president and emerging case law.” q

Clinical negligence expert witnesses improving practice and patient safety

By JO HUNT F. Inst. LEX and DR ROBBIE DEDI, MB ChB MRCP, Directors of Clinical Negligence Expert Ltd

‹ ARE YOU A CURRENT practising NHS consultant, senior

nurse or therapist who has always considered expert witness work to be something to avoid and something for your colleagues nearing retirement? Have you ever thought to consider the positive impact such work can have on your personal practice, that of your colleagues and in respect of patient safety? Can involving yourself in litigation, really bring about something over and above endless hours of report writing, researching relevant publications, court attendances, losing the respect of your colleagues and the risk of being struck off the GMC register?

The NHS has in recent years received an unprecedented increase in claims for medical/clinical negligence. The debate surrounding the reason for this is outwith the scope of this editorial but the fact itself cannot be disputed. Should you happen to be reading this article then you will be well enough informed to know that all claims for clinical negligence, ranging from a cancelled appointment and a couple of days increased pain to a catastrophic brain injury, will have required the expert opinion of at least one medical professional.

You may not however, be well enough informed to know that the demand for that expert opinion is far exceeding the current supply.

There is again a debate to be had on the reason for this but such a debate would undoubtedly include reference to the ever increasing sub-specialism of all aspects of healthcare professionals and the out of date perception that expert witness work is something to consider when one nears retirement age.

The effect of demand outweighing supply is perhaps best demonstrated by considering the effect on yourself, should you find yourself involved in litigation. How would you wish your practice to be judged? Would a consultant uro-gynaecologist be happy to accept the opinion of a consultant obstetrician and gynaecologist on his/her ability to perform a TVT procedure? Would the anaesthetist called to assess a patient with post-operative pain following knee replacement, and whom is subsequently diagnosed with arterial damage, be happy to accept the opinion of a vascular surgeon on the standard of that assessment? Would the paediatric surgeon, who is alleged to have delayed returning a patient to theatre, be happy to accept the expert opinion of a general paediatrician on his/ her difficult decision making process?

Such opinion is being provided and is being relied upon, both by claimant and defendant lawyers. There are of course many reasons for this, not least the lawyer who does not understand the nature of the claim he/she is managing, but the absence of appropriately specialised expert witnesses is the largest hurdle for even the most experienced clinical negligence lawyer. In summary, current practicising NHS professionals are in great demand in the legal profession.

Should you now be slightly persuaded that this may be something for you, then perhaps considering the positive impact on your individual practice and on patient safety may also be of interest.

Clinical Negligence Expert Ltd’s database of experts consists mainly of current practising NHS professionals. Feedback from our database of experts has a common theme – not only do they find the work interesting but they learn from nearly every case they provide an opinion on.

We all know that it is difficult to learn by the mistakes of others, but when reviewing first hand the effect of a clinical error or

misjudgement, taking steps to ensure that the same clinical error or misjudgement is not mirrored in your every day practice becomes second nature. In addition, positive practice perhaps unrelated to the subject matter of the claim can be taken from a case and replicated in your personal practice and organisation. Many of our experts already undertake clinical or specialty lead roles within their employing organisation. The clinical errors and misjudgements identified through their review of a clinical negligence claim can – and have – been shared, anonymously of course, through risk management or clinical governance structures.

In summary, clinical claims are increasing and leaving a shortfall of specialists to provide an independent opinion on these cases. They are often thought provoking and may provide a means of learning from mistakes to reduce risk in your own practice and beyond.

Should this article have provoked sufficient thought for you to consider embarking upon becoming a clinical negligence expert witness, please do not hesitate to contact us. We would be pleased to provide advice and guidance, on an individual or group training basis, on what is to be expected and how you may become an ‘expert expert’. q

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Hard Prest to pierce the corporate veil

by TOM ASLIN, Partner, Kingston Smith LLP

‹ RATHER THAN BEING AN unusual

fashion choice, the corporate veil is an important concept in the legal status of UK companies, and one which was recently tested in the Supreme Court in the case of Prest v Petrodel.

The concept of the corporate veil Under UK company law, companies are treated as separate legal entities and as such can be considered to be legal, but non-natural, persons. It is this concept which enables a corporate entity to own assets and contract with its suppliers, customers and employees.

Crucially, this also means that a company is considered to be a separate legal entity to its shareholders, and indeed this is why companies can be considered to be ‘limited’, as a shareholder’s exposure is limited to the amount they have invested in their shares in the company. Thus any claim against a company cannot (usually) be extended beyond the assets vested within that company, thus protecting a shareholder from losses over and above the amount he or she has invested.

It is this separation of identity between a company and its shareholders which is sometimes described as the corporate veil.

To pierce, or lift, the corporate veil is to ‘look behind’ the corporate structure and to connect the assets and liabilities of a company with its shareholders

Prest v Petrodel The case of Prest v Petrodel concerned assets held in companies, including Petrodel Resources Limited, owned by Michael Prest. The central issue was the status of these assets, and whether or not they could be used to partly satisfy a $17.5m award made to Mr Prest’s former wife, Mrs Yasmin Prest, in the context of their divorce proceedings.

In the first instance, the High Court found that the assets of the Petrodel companies were available to Mr Prest, given that he effectively owned and controlled these companies, and ordered that seven UK properties held by the Petrodel companies should be transferred to Mrs Prest. However, this decision was

appealed by the Petrodel companies, mainly on the basis that the High Court could not simply overturn long established principles relating to company law, namely the piercing of the corporate veil. The Court of Appeal upheld this appeal, and in its judgement held that the corporate veil could only be lifted in very specific circumstances, where either there had been deliberate abuse of a corporate entity, or where assets could be shown to be held on trust on behalf of a party to the proceedings by the company (or companies) in question.

Mrs Prest appealed this decision, and her appeal was allowed by the Supreme Court, which agreed with the Court of Appeal’s assessment of the circumstances when the corporate veil could be lifted, but held that Mr Prest had not deliberately structured his companies so as to frustrate Mrs Prest’s claim. Therefore the Supreme Court was not persuaded to pierce the corporate veil in this case; instead Mrs Prest succeeded in the appeal because the Court considered that the Petrodel companies held the assets on trust for Mr Prest, as a result of the way in which these assets had been vested to the companies.

In short, whilst Mrs Prest succeeded in her action against the Petrodel companies, the Supreme Court has reinforced the status of the corporate veil as a mechanism to separate the personality of a company from that of its owner.

Business valuations and investigations As forensic accountants, Prest v Petrodel is an important case for us in its reinforcement of the concept of the corporate veil. We are often instructed, in a variety of cases including shareholder disputes, compulsory purchase claims and matrimonial cases, to place a value on privately owned companies. Such exercises are often complex, and require a degree of judgement rather than simple ‘number-crunching’, as a result of the uncertainties over a company’s expected future earnings and the different levels of risk the market places on companies operating in different sectors.

To attempt to value companies in circumstances where the corporate structures involved need to be wholly or partially unravelled would add a further level of complexity, and in some cases would make the exercise – and certainly the result – highly convoluted. Having said this, there are situations where one needs to look through the structure of the company to arrive at a realistic valuation of the business at its core. For example, in a recent shareholder dispute in which we acted for the minority shareholder, it became apparent through our work that the majority shareholder had restructured the company so as to depress the profits of the business by around £500,000 pa, and had also disguised significant levels of drawings from the business as repayment of debt rather than remuneration. In such situations, it is important to consider the relationship between the company and its shareholders, even though such situations do not necessarily merit the lifting of the corporate veil.

In conclusion, Prest v Petrodel is an important judgement because of its clarification of the circumstances in which the corporate veil can be lifted, and also in preserving the distinction between a company and its shareholders. Indeed, in his lead judgement, Lord Sumption of the Supreme Court recognised that the separate identity of a company can be described as a fiction, but noted that this fiction was ‘the whole foundation of English company and insolvency law’. q www.yourexpertwitness.co.uk

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Bringing forensic accounting and IT together Tony Sykes explains how IT Group has formed a strategic alliance with Dow Schofield Watts to address a gap in the services offered by others.

‚ FROM THE HIGH PROFILE cybercrime work that we do to the less

publicised IP and copyright instructions, expert instructions in IT seek to establish opinion on causation or liability. In most cases this is the first stage of a process and, having established causation and/or liability, the next stage is to determine quantum. Quantum inevitably requires forensic accountancy skills and these two stages of the process can and do exist separately.

Similarly, in an investigation scenario not necessarily directly related to an IT dispute, the first stage of the process is to capture and process electronic data, followed by a review of the documents by forensic accounting experts to identify key documents for disclosure.

Often, in both of these situations, the two stages of the process can be disconnected. However, bringing together the IT and accountancy skills saves both time and money and delivers a seamless and efficient service to clients.

IT Group and the Dow Schofield Watts forensic team have over 100 years of combined experience across a broad spectrum of forensic IT and accountancy work. q • Tony Sykes, senior partner in IT Group, is a chartered IT professional and a chartered electrical engineer. He has twenty years experience as an IT and electrical engineering consultant and is an experienced expert witness. IT Group provides a broad range of consultancy services including Insurance assessment, forensic IT/telecoms/electrical systems examination, e-disclosure and expert services. Visit www.itgroup-uk.com and www.dswcf.com.

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Forged signatures still command the courts’ attention

‹ IN THE 21ST CENTURY the news media are filled with stories

of online fraud, identity theft and corporate embezzlement. They are the stuff that high-profile trials are made of, featuring millions of pounds, multinational corporations and cross-border internet traffic.

On a more mundane and everyday level, however, the old fashioned activities of the fraudster forging signatures to con people or companies out of thousands of pounds continues unabated.

A cursory run through news stories from this year yields three notable cases where forged signatures were used to obtain money.

As recently as June two cases came to court at opposite ends of England. At Newcastle Crown Court a woman was given a suspended sentence for obtaining a £20,000 loan against the former matrimonial home by forging her estranged husband’s signature. It was four years before her husband found out.

In Kent, a man used the same ploy to extend a mortgage to pay off credit card debts. That deception only came to light six years later when the wife began divorce proceedings.

Back in February a much more sophisticated scam came to light.

A mother repeatedly forged her doctor's signature to make multiple insurance claims for a cancelled family holiday to Lanzarote.

The woman admitted submitting claims totalling £11,070 to seven insurers after calling-off her family’s trip when her daughter became ill. The 28-year-old from Staffordshire failed to declare on any of the claim forms that she had more than one insurance policy covering the holiday and faked her doctor’s signature on six of the forms.

That scheme was thwarted when one of the insurance companies alerted the Insurance Fraud Investigators Group (IFIG). When the

other attempted frauds came to light the case was referred to the Insurance Fraud Enforcement Department (IFED), part of the City of London Police, for investigation.

DC Julian Brown, of IFED, said: “The woman used her daughter’s illness and a cancelled family holiday as a means to try and con thousands of pounds from insurers. This may have seemed like a foolproof plan at the time but now, with a criminal record against her name, she may think it was one of the worst decisions she has ever made.”

In many cases of signature fraud the person whose signature is being used needs to prove that they did not sign the document in question. In that case the evidence of a handwriting expert can be invaluable. q

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MoJ calls in police over prison contract ‹ ON 28 AUGUST THE Ministry of Justice

(MoJ) announced that, together with the directors of contractor Serco, it has asked the police to investigate alleged fraudulent behaviour by members of Serco’s staff in the management of their Prisoner Escorting and Custodial Services (PECS) contract.

The PECS contract covers a range of services, including transporting prisoners between court and prison. Serco are responsible for delivering this in London and East Anglia.

The statement said: “An apparent disparity between Serco’s records of contract performance and the actual situation on the ground had been subject to investigation by the MoJ for some months. Evidence of potentially fraudulent behaviour has now emerged as part of the detailed audit work announced by the Secretary of State for Justice in the House of Commons in July. It has shown some staff recording prisoners as having been delivered ready for court when in fact they were not – a key performance measure for the contract.”

It went on to say that the MoJ has informed Serco that it is putting the contract under administrative supervision with immediate

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effect. Serco have agreed to repay all past profits made on the PECS contract and to forgo any future profits. It has also confirmed to the MoJ that no member of the board had knowledge of the practice. If any evidence of corporate as opposed to individual wrongdoing emerges, the statement says, MoJ will terminate the contract.

Secretary of State for Justice Chris Grayling said: “It’s become very clear there has been a culture within parts of Serco that has been

totally unacceptable, and actions which need to be investigated by the police.

“We have not seen evidence of systemic malpractice up to board level, but we have been clear with the company – unless it undertakes a rapid process of major change, and becomes completely open with Government about the work it is doing for us, then it will not win public contracts in future.

“The taxpayer must know that their money is being properly used.” q

Gas poisoning tragedy strikes on an all-too-regular basis ‹ EVERY SUMMER, IT SEEMS, the news headlines are made by

a tragedy involving poisoning by carbon monoxide gas. The headlines are made when it involves young people on holiday – as recently as August a teenage surfer was killed while she slept in her tent.

That followed the poisoning of a mother and daughter in a boat on Lake Windermere, a year after the deadly gas seeped into a tent in Shropshire from a barbecue in the porch and killed another sleeping teenager.

These horrific cases illustrate the need for vigilance when dealing with any kind of combustion equipment – what they do not illustrate is the scale of the problem in everyday life. The gas safety charity CO Gas Safety (www.co-gassafety.co.uk) highlights the fact that it is impossible to quantify with certainty the number of deaths and injuries from carbon monoxide (CO) because there is no automatic test when there is an unexplained death and even people with symptoms have difficulty obtaining tests.

However, best estimates suggest there are around 40 deaths per year from CO poisoning and up to 3,000 admissions to A&E departments following poisoning incidents. Fortunately, there appears to be a downward trend in cases.

Writing in 2011 in the newsletter of the charity Straight Statistics, science journalist Nigel Hawkes said: “The figures are based entirely on press reports. Such sources aren’t to be despised, but it says something for the dearth of reliable information about carbon monoxide deaths that they should be the sole source. While deaths that are reported are likely to be accurate, as they generally originate from coroners’ inquests, there may be others that are not reported at all.”

However, the great majority of CO poisoning incidents are not due to accidents with barbecues or portable generators. They are caused by the gradual build-up of CO due to the inadequate maintenance of fossilfuel heating systems.

That, too, is significant. There is a widespread view that CO poisoning is caused purely by gas appliances. That is probably due in part to the fact that the HSE only reflects figures for gas poisoning (including LPG).

Indeed, the search term carbon monoxide throws up no hits on the HSE website – the subject is covered under the heading ‘gas’.

However, as an article elsewhere in this feature shows, the effects are just as serious where solid fuel is concerned. CO Gas Safety assembles statistics regarding all kinds of fuel, drawn from coroners’ reports and press articles. Their figures for casualties differ markedly, therefore, from the HSE’s.

No matter what the cause, however, the determination of the causes of a CO poisoning event and apportioning responsibility are the work of an expert. Again, while the HSE may prosecute inadequate (or even illegal) gas installation work, cases involving other fuels require their own expertise. The following pages aim to give an illustration of where that expertise may lie. q

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A combination of factors can give rise to gas poisoning ‹ An illustration of the kinds of issues that can arise in cases

involving carbon monoxide (CO) is contained in a case study from Bralsford Brown and Associates. The case arose from problems the tenant of a house in Yorkshire was having with the solid fuel heating system, powered by a boiler in the cellar of the house, and the subsequent presentation of a number of family members at the accident and emergency department of the local hospital with CO poisoning.

Master plumber and expert witness Russell Bralsford was instructed by solicitors for the tenant to prepare a report on the operation of the boiler and heating system, paying special attention to the possibility that the boiler may have been emitting excess CO. Following the incident and hospital attendance, a specialist had visited the property to inspect the boiler. The specialist issued a warning label and certificate instructing the tenant not to use the boiler, stating that the flues were blocked. On a further visit the next day the same specialist reported that the structural integrity of the flue was in doubt and that flue gases could be leaking into the flues alongside, which were for disused fireplaces in the house. These flues are known as mid-feathers.

The landlord commissioned two further inspection reports following a repair that the tenant felt was unsatisfactory. One of these reports listed numerous faults, including smoke ‘spillage’ during a smoke test.

Russell Bralsford takes up the story: “I carried out a visual inspection of the boiler and cellar area and noted that a section of flue pipe which appeared to be new had been fitted to the boiler and connected to the base of the chimney. The first section of the flue was constructed of a steel pipe and coated with a vitreous enamel. This section of flue pipe section had a 135o bend with a removable access panel in order to sweep the flue with rods and brushes. The piece of pipe used to connect the vitreous flue section to the chimney was constructed of

a flexible stainless steel liner most commonly used with a flue emanating from gas appliances.”

In addition to the wrong type of flue being used (the boiler manufacturers stipulate a castiron or vitreous enamelled steel flue pipe), Mr Bralsford noted that the ventilation area in the cellar fell short of the specification, with the ventilation bricks also being used as a conduit for cables.

During a smoke test the seals around the boiler were seen to be leaking. When he carried out a test for CO he recorded a Master plumber and expert reading of nearly twice the safe witness Russell Bralsford level.

Although no smoke was seen to come from the mid-feathers during a smoke test, that was possibly due to the fact it had been a windy day, according to Mr Bralsford. Significantly, the weather can have an effect on CO levels.

“When circumstances allow (on a less windy day), fumes could easily rise from the cellar area and penetrate throughout the house by way of natural circulation of warm air,” wrote Mr Bralsford. “If, say, a bedroom window was open, for instance, the whole house would then act similar to a large chimney where fumes from the cellar could be pulled up through the house to the opened window.”

He concluded: “On the balance of probabilities it is most likely that this boiler has caused exposure to the tenants of the property to abnormal levels of carbon monoxide.” R

Ventilation bricks were also being used as a conduit for cables

During a smoke test the seals around the boiler were seen to be leaking

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Latest prosecution shows continuing flouting of gas laws ‹ IN THE LATEST PROSECUTION by the HSE for unsafe gas work,

a builder from Wiltshire has been fined for illegal and dangerous work which could have led to a young family – including two young children – being killed by poisonous carbon monoxide fumes.

Phillip Whittaker was prosecuted by the Health and Safety Executive (HSE) at Yeovil Magistrates on 22 August after an investigation into work on a house in Somerset revealed he was not a member of the Gas Safe Register and therefore not legally qualified to carry out gas work.

He was contracted by the householders to build an extension to a house in Frome in April 2012. The court heard the plans involved moving the existing boiler on an external wall to a new external wall and rerouting the associated gas pipework to a repositioned gas meter.

After the gas meter had been moved Whittaker re-routed the pipework, which he connected to the boiler in its existing position. He then built the extension over the boiler and flue, which was now on an internal wall.

As a result, poisonous fumes from the combustion process involved in operating the boiler were vented into the property instead of outside for around six weeks, until the family was alerted to the danger by a friend. A Gas Safe registered engineer was called and rectified the situation.

Whittaker pleaded guilty to four breaches of the Gas Safety (Installation and Use) Regulations 1998. He was fined a total of £3,000 and ordered to pay costs of £3,000.

Speaking after the hearing, HSE inspector Mehtaab Hamid, said: “Mr Whittaker’s dangerous work could have caused the family serious health issues and ultimately could have led to their deaths.

“He was not competent to carry out gas work and, was not a member of the Gas Safe Register.

“He installed gas pipework using unsafe practices and, by building the extension over the boiler and flue, made it almost impossible for the products of the combustion process to escape into the atmosphere, creating an immediate danger within the property.

“Although no serious injury occurred, the family have been left distressed by their experience.” q

Parliament to resume CO metering debate ‹ WHEN PARLIAMENT RETURNS from its summer recess it will

continue debating the Energy Bill which, although its primary focus is on energy supply and cost, has had inserted into it an amendment regarding testing for carbon monoxide.

The amendment was tabled by Barry Sheerman MP of the All Party Parliamentary Carbon Monoxide Group and will require installers of smart meters to carry CO meters to test for the presence of the gas.

Mr Sheerman said: “Carbon monoxide poisoning is a deadly but preventable threat. Far from dragging its heels, Government must lead the way in ensuring that UK homes are safe from the threat of this silent killer.

“I hope the House will recognise what a great opportunity smart metering provides for ensuring home safety and that this amendment will spark a wider debate about CO safety in the home.”

A further amendment regarding the installation of CO meters in homes, tabled in the Lords by Baroness Finlay of Llandaff, was withdrawn after the government offered to examine the issue.

Tabling the amendment, Baroness Finlay said: “The most authoritative estimates suggest that carbon monoxide poisoning is much more prevalent than previously thought. The majority of those who have discovered that they have been poisoned have never attended A&E and are thus excluded from official figures.

Indeed, the overwhelming majority of people poisoned by fossil fuel combustion are completely unaware that they are being or have been poisoned.” q

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Architects caught up in defects case ‹ A BUILDING DEFECTS case earlier

this year illustrated the pitfalls involved even for those who have no direct contact with the building’s owners.

A block of flats in Peterborough was found to have numerous defects after the developer had sold half of the units on long leases and retained the others for rent.

When the defects were discovered a claim was brought by a number of residents against the developer, who was the freeholder, and the property agent, who had

been retained by the freeholder to carry out inspections.

Unusually, the architect was included in the claim. The architect had issued certificates of compliance. He had relied on the developer to confirm that certain elements of the work had been completed satisfactorily.

According to Hewetts Solicitors of Reading: “Historically, courts have been less willing to see a contractual link between the architects issuing architect’s

certificates and the possible end-users if the end-user is not the actual person directly in contract with the person issuing the certificate.

“However, this judgment has said these certificates are contracts in their own right and there was due consideration given by the purchasers by paying the purchase price to the developer.”

The case means that architects have to be more attentive to the circumstances when issuing certificates of compliance. q

An expert in all he surveys ‹ ONE AREA THAT GIVES rise to much dispute – and which

frequently ends in the court – is that of building and property. Whether it is a boundary dispute between neighbours or a case being brought for defective building work, a report from an independent surveying expert will often be sought.

Three from numerous cases taken on by York-based Keith James Chartered Building Surveyor illustrate the nature of these disputes.

In the first, the practice principal Keith Laverick (pictured) was engaged to compile an independent expert report on the deficiencies of building work in dispute and near completion and was also asked to evaluate the cost of remedial repairs. The work was a large extension in Leeds and Keith advised the home owner. Keith and the builder's own expert narrowed the issues and agreed settlement.

The second concerned inadequate building work on a house in York itself. Keith’s report is to be used as part of a case being brought by York Trading Standards.

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Another recent case involved a dilapidations claim, where Keith was appointed as joint expert by the landlord and tenant. Says Keith: “I inspected the building, which had been used as a nursery school in Yorkshire on a 10-year lease, and prepared a report for the court. Both the landlord and tenant trusted my independent judgement and wanted my services. Both parties agreed to be bound by my opinion.”

Although based in Yorkshire, Keith is finding his expertise is increasingly in demand in London, where he is keen to expand his activities. He is also keen to become accredited to the RICS Expert Witness Accreditation Service (EWAS). q

Landlords’ association reaches out to all – including non-members ‹ WITH OVER 50 Acts of Parliament and

more than 70 sets of regulations governing the private-rented sector, it is important that private landlords are aware of their obligations and their responsibilities toward tenants.

Research carried out for the National Landlords Association (NLA) has shown that half of the landlords surveyed find it difficult to keep up with the latest legislative changes. Despite that, 76% say they seek out new forms of information and advice available to them.

To ensure they can rely on professional advice the NLA has made its best practice tenancy agreements and other essential forms freely available online to every landlord in the UK. Previously, only NLA members could access the NLA’s best practice agreements but now the NLA is offering its approved online documents, including tenancy agreements, referencing letters and Section notices, to all the country’s landlords.

Along with the forms, the NLA also provides information and guidance through its regular

branch meetings held throughout the UK. Local representatives chair meetings that are open to all landlords who are welcome to attend and discuss any issues affecting them in their local area.

The meeting agendas include guest speakers and industry experts on a range of current housing topics.

Carolyn Uphill, chairman of the NLA

said: “The NLA is here to help and support landlords who need advice. This is why we have made our essential information readily available to all landlords.

“We work with 39,000 landlords, 21,500 of whom are full members who have the additional benefit of a wide range of advice and services from the expert telephone advice line and 24 hour online library.” q

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Employment tribunal fees subject to Judicial Review ‹ THE CHANGES TO employment

tribunals introduced on 29 July – whereby those seeking redress at a tribunal will be required to pay a fee of up to £1,200 – will be subject to a Judicial Review hearing in October. The review was granted to the trade union UNISON in the week prior to the fees system being introduced.

Following the announcement that the Royal Courts of Justice had granted the review, despite a prior rejection in writing of an application, the union’s General Secretary Dave Prentis (pictured) said: “The timing could not be more critical, but today we are one step closer to justice for workers.

“The introduction of punitive fees for taking a claim to an employment tribunal would give the green light to unscrupulous employers to ride roughshod over already basic workers’ rights.

“The Government should not put a price on justice. It is disappointing that, in the interim, fees will still be paid but we will be making a strong case for a Judicial Review in October because we believe that these fees are unfair and should be dropped.”

The union argued that, in accordance with EU law, national courts must not make it virtually impossible, or excessively difficult, to exercise individual rights conferred by European Community law. In addition, as fees are not payable at all in most claims brought to the First-Tier Tribunal – a similar tribunal at the equivalent level in the judicial hierarchy to the Employment Tribunal – it is a breach of the principle of equivalence to require significant fees to be paid to vindicate EU rights where no fees are required to vindicate similar rights derived from domestic law.

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According to employment law specialists at Carlisle firm Bendles: “Until this verdict is delivered, however, fees will still need to be paid for all cases lodged, but will be refunded if the practice is ruled unlawful.”

The new charges had been broadly condemned, not least because it was

claimed the savings to the public purse would be outweighed by extra social costs.

Further, although the number of claims may fall – some believe by up to 25% – because claimants would have to pay upfront, they may pursue their claims more vigorously. q

Returning mums face discrimination, research finds ‹ ONE IN FOUR MUMS who have returned to work believe they have been subjected to

discrimination, either before or after the birth of their child, according to research commissioned by employment law specialists, Slater and Gordon.

Researchers found that 51% of the 2,000 women surveyed considered that their employers’ and colleagues’ attitude towards them changed when they fell pregnant, while two thirds said things had been 'difficult' for them since they returned from maternity leave.

Being overlooked for promotion and being forced to watch more junior employees progress faster up the career ladder were common complaints, while many women said they felt that their views weren’t considered as important as those of staff without children and that they often felt ‘left out’.

Worryingly, nearly half of working mums felt having children halted their career progression, while a third described rising up the career ladder as a mum as ‘impossible’.

Kiran Daurka, a lawyer at Slater and Gordon said: “Despite the equality legislation in place, attitudes and working practices continue to block women in achieving their career aspirations in the UK. This report shows that there are still negative perceptions of women with children and this kind of attitude is short-sighted and bad for business.

“Anecdotally, we hear of mothers complaining about being put on a ‘mummy track’ when back at work, and this research illustrates that this is a real experience for many women.

“I find it quite dispiriting to hear that more than a fifth of mums feel that they need to prove themselves to their bosses following their return from having babies.” q

Wellbeing the future of safety

By Martin Barnard, Director of Health and Safety, Capita Symonds

‹ SAFETY OFFICER BAITING IS, of

course, a much loved and well practiced pastime, particularly for those of a cynical disposition who have never taken the subject of health and safety seriously. Some of it is well deserved and is a timely reminder that now may be the time to leave the – sometimes stigmatised – subject behind and look to the future with a fresh approach.

Indeed, a recent example of a well-baited trap caused me to reflect on the thrust of the question asked: “Isn’t health and safety a tarnished product which needs to be called something else?” The question was qualified by several references to activities not being permitted anymore because of ‘health and safety’ – the dreaded term increasingly overheard in conversations, the tone of which is invariably negative.

Much is being done by many which is excellent, and is undoubtedly reducing serious accidents, reducing incidents of illhealth and improving the wellbeing of people generally. Maybe now is the time to change the vocabulary and give the whole subject the impetus and encouragement it deserves.

Therein lies the answer. Now is the time to move away from the potentially divisive concepts of ‘health’ and ‘safety’ and combine them into the common goal of ‘wellbeing’.

Wellbeing means ‘a good condition of existence’ or ‘the state of being comfortable, healthy and happy’. It is the ideal springboard to breathe new life into a subject which, if you forgive the pun, has for many died a long, slow, lingering death.

No doubt the cynics will search out reasons why ‘wellbeing’ is wrong. However, such a term embraces all that is good within the

many organisations and individuals who want the future to be better than the past.

Some are already on their way by looking more closely at how they put people to work, be it their own employees or those of contractors, e.g. they communicate, monitor and assess the standards they expect. Taboo subjects such as drugs and alcohol being proactively addressed with help for the individuals, rather than the instant dismissal for failing a test which has traditionally been the threat.

Removal of the health/safety split allows a more open approach and encourages new ideas and thinking, focussed through Centres of Excellence. More and more of the leading organisations are creating such centres to channel their efforts in a way which creates joined up thinking and which invariably adds value to the overall aims and ethos of the business – i.e. excellence.

Training Academies, whilst not a new concept, are being used to integrate and align the knowledge of Project Teams – so that what is done for the main contractor is now being extended to sub-contractors and even the client/designer side. In that way, the leading organisations get what they want and know they need – an educated Project Team with a common interest and objective, the wellbeing of each other.

By far and away, the most obvious impact is seen amongst senior people in a business. Most have traditionally ‘managed health and safety’ by following procedures and ticking the boxes. There is a growing recognition of the need to lead rather than manage. Converting to ‘wellbeing’ will allow those who are natural leaders (and those

willing to gain leadership skills) to thrive.

Caring for others is instinctive to those who really are leaders and they need to be given a new stage to perform on. One that is untarnished by what many see as an irreversible cynicism and distrust.

This year’s Capita Safety Lecture is the ideal opportunity to learn from an organisation which has learned hard lessons in the past, but has high aspirations for the future. Excellence, academies and leadership are common words for organisations such as Network Rail and those who share their ambitions. In my view, ‘wellbeing’ is the future of safety. What about you? q • For all enquiries please speak to Michelle Tindale on 01342 333550.

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The speed camera never lies... only the unqualified, untrained camera safety unit personnel! ‹ A SPEEDING OFFENCE HAD allegedly been committed: a speed

camera captured a vehicle – a BMW X5 – travelling at a speed that was calculated as 36mph in a 30mph zone.

The photographic evidence was of very poor quality, however computer enhancement of the images allowed measurement of the distance between the two points on the photographs to be determined.

The calculated distance in a straight line between the two points – which is only a best guess estimate of velocity when the camera is at an angle of 30 degrees to the horizontal – was determined. The distance between the two points at an interval of 0.5 seconds was, at worst, 0.6 cm on the photographs, which at one second was 1.2 cm.

When scaled up, that equated to a distance of 12 metres travelled in one second. That equates to a speed of 26.8mph. The BMW X5’s cruise control, the result of German engineering, had been digitally set to 25mph.

From the photographic evidence used to predict the speed of the vehicle, the distance between the lines was determined to be inaccurate. As the distance away from the camera increases, so the distance between the lines should reduce sequentially. However, as can be seen from the first photograph, the distance between lines was:

The distance between the second and third lines should be 0.7cm, not 0.6cm. That is not satisfactory – although it could be acceptable if the distance is sequential on both photographs, which it is. However, on analysis of the second photograph, the distance between the lines is:

Clearly, the final value between the eight and ninth lines should be 0.1 cm.

Most importantly, the distance between the white lines on the road, which was measured using a certified one metre steel ruler and corroborated with a steel tape, should be exact and equal. The actual distances between the white lines varied from 1.88m to 2.09m.

Such discrepant and inaccurate values invalidate the whole of the photographic evidence and also the calibration of the Gatso camera, because they are the focal points of all the calculations. They also explain the difference between the X5’s 25mph reading and the calculated reading of 26.8mph.

The camera had been calibrated on the 20 September 2012: five months previously. The technology manager failed to measure the distance between the white lines on the road. The white lines are prepared using a machine, which does not take account of the bumps in the road and has been proven here to be ‘hit and miss’ and therefore inaccurate and discrepant. The inaccurate and discrepant calibrations fall woefully short of the legal requirement for calibration.

Two recent cases in the High Court quashed similar alleged offences: R (Seroka) v Redhill Magistrates’ Court, (2012), HCJAC. The decision was quashed due to poor quality of photographic evidence and due to variation in the distance between the white lines on the road markings.

Cox v Procurator Fiscal, Aberdeen (2011), HCJAC 14. The decision was quashed due to variation in the distance between the white lines on the road markings.

In this index case, the ‘decision maker’ – a civilian unqualified and untrained in such matters – acting on behalf of the Central Ticket Office

By DR M R GRAHAM, MBChB, PhD, FRSM, MICR, MFSSoc

manager, the officer in charge of the Safety Camera Unit, made a decision, after two requests not to intervene, to let this case go to the Magistrates Court.

The author and driver of the vehicle frequently provides evidence for the Divisional, Crown and High Courts as a forensic expert in both civil and criminal cases. The evidence presented to the unqualified decision maker should have demonstrated, using simple maths and physics, that in the interests of justice and to save tax-payers money, it would have been sensible to re-measure and re-mark the road, calibrate the camera more frequently and relinquish this case.

On this occasion that was a step too far – the reason being that the Safety Camera Unit would have lost revenue. R

KD/0623051020490312 Your reference: KSCU/M 1020490312 305 062 Re: Notice number 09.02.2013: Alleged speeding Offence on X5) Vehicle: CA51MHF (BMW North Road at Junction Location of speed camera: iff.

Card d, Roa ege Coll with Time: 18:17 Speed Limit: 30 mph Alleged speed: 36 mph

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Tribunals consultation due to end ‹ THE CONSULTATION ON proposals to

merge the Scottish Tribunals Service (STS) with the Scottish Court Service (SCS) is due to close on 19 September.

Launched on 17 June, the consultation is also asking for views on how best to preserve the unique character of both tribunals and courts in a joint organisation.

The joint administration would be independent of ministers and would provide support for both courts and tribunals, led by a corporate body chaired by the Lord President of the Court of Session. This would support the long-term independence of tribunals by putting their administration on the same footing as courts. It follows the introduction

of the Tribunals (Scotland) Bill to the Scottish Parliament in May. Community Safety and Legal Affairs Minister Roseanna Cunningham said: “Tribunals are an integral part of Scotland’s legal landscape, but have been established in an ad-hoc way over many years. That’s why we have developed a phased programme to strengthen our tribunals system, making it simpler and more user friendly, while retaining and protecting the independence and benefits of the current specialised tribunals.

“We have much to be proud of, and I want to build on this by setting up a structure that puts users first and treats them fairly, timeously and with respect – no matter the

nature of their dispute.”

In May a Bill was introduced in the Scottish Parliament to set up a two-tier structure for devolved tribunals and a new office, the President of Scottish Tribunals, to protect the expertise of each jurisdiction and ensure business runs efficiently.

The next step in the reform, said Ms Cunningham, is to consider putting the administrative support of devolved tribunals on the same footing as courts, under the leadership of the Lord President. q

Doctors welcome tobacco packaging commitment ‹ THE SCOTTISH GOVERNMENT’S commitment to consult on

standardised packaging for cigarettes has been welcomed by the BMA in Scotland. The measure was included in a Programme for Government, published on 3 September.

The document says: “The Scottish government is determined to take forward this important public health measure and will consult on the issue in the coming months, with the intention of introducing legislation in 2014/15.”

BMA Scottish council deputy chair Charles Saunders, a public health consultant in Fife, commented: “As doctors we see first-hand the devastating effects of tobacco addiction. Therefore we support moves to reduce the number of people taking up this deadly habit. Packaging is a key marketing tool for the tobacco industry and can influence young people to start smoking so it is vital that this final source of advertising is removed.

“Scotland has already led the way on some of the most significant public health policy in the UK and I am therefore pleased that our ministers have shown the confidence to continue their strong track record on innovative tobacco control policies.”

Ministers in Scotland have also reiterated their intention to introduce minimum pricing for alcohol despite legal challenges. q

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Tree health:

Time for a different approach

By MARK CHESTER of Cedarwood Tree Care

‹ TREES HAVE BEEN in the

headlines over the past decade or so, for the wrong reason: health threats. After the devastation to elms in the 1970s from Dutch Elm Disease, we have since had Phytophthora cactorum and Phytophthora citricola causing Bleeding Canker which attacks horse chestnut, their relative Phytophthora ramorum threatening larch, oak being threatened by Sudden Oak Dieback and now the current threat to ash from Chalara fraxinea. Millions of larch have been felled in recent years in the UK in an attempt to contain the disease, whilst in the US diseases attacking trees such as the maple have devastated the landscape in many urban settings, as felling is used to control the spread.

In the mid ‘noughties’, working as a tree officer in the midlands, I was authorising the felling of scores of horse chestnut, all with the tell-tale signs of rusty resin spreading over peeling, dying bark. I was asked at the time whether the horse chestnut had a future, and felt pessimistic.

Now, however, new ideas, supported by research, are bringing fresh hope.

The Phytophthora family of aggressive diseases can be contained. Whilst the widely planted horse chestnut (Aesculus hippocastanum) succumbs to attacks all too readily, its cousin the Indian chestnut (Aesculus Indica) with distinct red-pink flower heads, is considerably more tolerant. It is also, arguably, a more attractive tree.

Dutch Elm Disease was devastating, mainly because elms grow from cuttings or suckers (clonal propagation) and so a population of the trees can be genetically identical. With no genetic variation, they are more vulnerable to attack. The ash, however, is propagated from seed (sexual reproduction).

This introduces variation in to a population. Whilst we are in the early days, researchers may have already identified resistant strains. The process will be protracted because a tree may display resistance earlier in its life, only to succumb to the disease in later years. Many an established elm has grown untroubled until reaching a size where the Elm Bark Beetle, which carries the spores causing the disease, becomes aware of its existence and descends for a feed. The researchers urge caution – we may not know for certain that the new generation is resistant for thirty to fifty years or more.

Part of the reason for the rapid spread of Chalara fraxinea has been the importing of infected young plant material. Funding for forestry grants has increasingly been issued later in the financial year, once other priorities are agreed, with monies being released in February and March, too late for UK nurseries to meet the resulting orders. The result has been stock being imported from the continent and planted directly in to the field in this country, complete with fungal spores. A change in approach is needed, and is pending.

A new British Standard BS8545 has recently been published in draft form for consultation. It covers all aspects of the production of new trees, from the nursery through to independence within the landscape. One recommendation is that imported trees spend at least one growing season on the nursery, a type of quarantine, before being released to the client for planting. This measure, together with regular inspections, will ensure that any tree pests and diseases which have become attached en route soon become evident and the host treated or destroyed.

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The ash is under threat from ‘Chalara fraxinea’ As the climate changes, attention is once again turning to the potential of trees growing abroad. Plant hunters are exploring the globe in search of species which will be more suited to the new climate than some of our current residents. Researchers have, for example, found that conditions in parts of China are very similar to here in the UK, and trials are underway to see how well some species brought over adapt.

Meanwhile, in the UK, work is underway to see whether trees in the nursery, subject to water stress, can be better prepared for the harsh conditions they will face once planted in the landscape.

Trees can also be assisted in their battle to resist the pests and diseases which threaten them. Healthy trees are generally better equipped to resist pest attacks, and so providing more optimal conditions, such as good, weed-free soil, nutrients, mulch and irrigation, can strengthen them for the battle ahead. The tendency towards single species plantations and landscapes can leave a local population more at risk should problems arise. A simple measure, such as planting a wider range of species, provides diversity, making it harder for pests and diseases to become established and minimising the impact on the landscape if trees of a particular species succumb. Some landscape schemes contain fewer than ten different species of trees and shrubs.

Introducing more diversity also makes it harder for pests to get established, with fewer hosts available. q

Dog bite hospitalisations down ‹ FIGURES PUBLISHED ON 3 September by the Health and Social Care Information Centre (HSCIC) show a slight fall in the number of hospital admissions due to dog bites or ‘strikes’ in the 12 months to May this year compared to last year: 6,334 against 6,454.

The highest number were in the north west with 1,099. However, when the rates per 100,000 of the population are considered, admissions were highest in the north east (21.6) and Yorkshire and the Humber (17.5)

and lowest in London (7.4) and the south east coast (5.1).

Dog bites were most common in young children, with one in six admissions being for a child aged nine years or below.

The figures are from a special topic on bites, strikes and stings due to certain animals and insects, presented as part of the monthly provisional Hospital Episode Statistics publication. The figures show admissions data broken down by patient demographics, region and type of injury.

The report covers hospital admissions for bites, strikes and stings from other mammals, non-venomous arthropods, hornets, wasps and bees in addition to dog bites or strikes. q

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Have you picked an expert or just a practising clinician?

By PAUL ROGER of Veterinary Consultancy Services

‹ THIS ARTICLE EXPLORES SOME of the areas in which

veterinary expertise can be useful (and often essential) to the just resolution of dispute or criminal proceedings. This range of veterinary clinical expertise can be used to offer technical support to legal issues in both criminal and civil proceedings.

There are strict guidelines on how expert witness evidence should be presented to courts – for the benefit of the court and its understanding of the issues before it. As these issues are well covered elsewhere, they will not be considered in depth here, but the wider consideration of expertise and of the areas in which veterinary input is desirable (and probably essential in most cases) will be highlighted.

All veterinary surgeons are bound by a code of ethics outlined by the Royal College of Veterinary Surgeons (RCVS). This has

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developed over the years from a booklet on the etiquette of relationships to become a code of professional conduct of a similar status to that given to medical practitioners. It incorporates real ethical frameworks to aid individuals in the analysis of their duties and obligations to society.

This is a fundamental benchmark. It demonstrates the need for codes of conduct applicable across all professions and implies that certain practices should be carried out.

These actions include: • Continuing professional development across the spectrum of work • Reflective practice • Provision of an auditable evidence base for experience and expertise • Appropriate membership of institutions promoting the speciality • Active participation in the development of the specialist area.

There is a considerable difference in analysis provided if the application of standard operating procedures is compared across the spectrum of services and expertise – and this awareness is critical in the understanding of what constitutes expertise. Many clinical practitioners have been awarded the recognition of the court as experts. However, this is a relative term as often it reflects the expertise of the individual on the ground rather than any professional with recognised qualifications or a recognised and reviewed evidence base for the speciality concerned.

There is a need to recognise that those who offer initial clinical assessment are not unbiased in conflating their retrieved evidence into expert opinion. This is an area which we believe the justice system needs to address urgently, but it is also an area where cost containment and current approaches to the principles of justice are in conflict. In the end, society allows the level of justice it can afford and which it regards as acceptable.

So how does any agency identify areas of veterinary expertise and their practitioners? There is a published list of recognised specialists, prepared and maintained by the RCVS, which constitutes a recognised list of veterinarians with peer reviewed qualifications who submit to a 5 year review process and provide a current evidence base for their inclusion. There is also a European

Board of Veterinary Specialisation which awards Diploma and European Recognised Specialist status in a number of specialities which have a continual review process and a properly constituted format for the syllabus and level of understanding needed for each speciality and the examination process involved. The maximum number of current specialities in which the veterinary surgeon can be active is two – but only in one can they be recognised as a European specialist.

These two bodies represent a useful starting point but the specific focus of expertise may be very narrow and suited more to a particular academic refinement (again with an evidence base) although the recognised specialist may be able to guide selection.

The supply of appropriate experts is a crucial service and is where Veterinary Consultancy Services (VCS), with its extensive expertise and global contacts, can rapidly and confidently source the expertise you require whilst providing a secondary level of peer review. This service allows the range of professional expertise to be properly recognised and helps to direct the proper selection process.

Recent cases in which our directors have taken part include work in both civil and criminal legislation as well as alternative dispute resolution. They include reviews of sewage disposal and disease threats, environmental impacts of agricultural developments, national and European research fora as well as pharmaceutical trials and a number of training and CPD events varying from ethical aspects of animal welfare through to practical clinical work.

There is an increasing need for a multi-disciplinary approach to the problems we face in dealing with animals – whether we are looking at global issues of sustainability or food supply or, at a local level, considering planning and environmental impacts.

However, the expertise that our profession can bring is an essential part of reaching sensible and practical solutions whilst maintaining an oversight on disease control, biosecurity, sustainability, food security and safety as well as the amenity value of our rural areas and the companion animal in all its forms.

It is unsurprising that the expertise to deal with these issues does not reside in a single person and this is the reason for the establishment of VCS and the variety of our directors’ interests.

Changing and challenging times are ahead for all of us and this is particularly true for the smaller professions who continue to supply excellence across a wide spectrum of advisory needs. This short introduction to the variety and validated selection of sourced advice is a signpost to the way of providing for the different requirements in each case. We are happy to discuss your needs and strive to deliver strategic veterinary expertise. q • Paul Roger is a RCVS recognised specialist in sheep health and production.

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Favouritism can be detested or desired:

culture matters

By DR BASHIR QURESHI FRCGP, FRCPCH, FFSRH-RCOG, AFOM-RCP, Hon. FRSPH, Hon. MAPHA-USA

‹ SOME MEMBERS OF PARLIAMENT and local councillors in

Britain are accused of doing favours for their friends and relatives. These could be in any number of areas – planning permissions, housing, jobs, recruitment or honours – and they are punished under the rule of ‘conflict of interest’.

The media highlights this as corruption. The accused feel that they are innocent and are lost for words, while others blame them as guilty.

However, this is an innocent cultural phenomenon. If you look objectively, it is clear that those who do not do any favours are the English. Those who do favours are from Asian or other ethnic minority backgrounds.

Why? The English are brought up in a ‘nuclear (self supporting) family system’ where everyone is self dependant financially and looks after themselves. Social services and benefits are available for the needy or unemployed citizens and voting attitude is not dependent on favours from their representatives. These are Western customs.

Asians and other ethnic minorities are brought up in an ‘extended (mutual support) family system’ where everyone is dependant on other relatives financially and they look after each other. No social security benefits are available and people only vote for that candidate who can

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help them in every way possible, when elected. There is no such thing as a free lunch. These are Eastern customs.

I believe that such cases occur worldwide and may lead to litigation. If the above customs are considered objectively, it could help in mitigation and fair play in delivering justice. In the long run it pays to understand the cultural, religious and ethnic background of every fellow citizen. A glass of water can be described as half full or half empty – take your pick. q • Dr Qureshi is a medical doctor, author, journalist and court expert witness based in London. He is an expert witness in cultural, religious and ethnic issues in litigation and can provide expert services throughout the United Kingdom. Email: drbashirqureshi@hotmail.com.

Poznan conference calls for papers ‹ SUBMISSIONS ARE BEING INVITED for the ninth

conference on Legal Translation, Court Interpreting and Comparative Legilinguistics (Legal Linguistics) at the Adam Mickiewicz University in Poznan, Poland.

The aim of the conference is “…to provide a forum for discussion in those scientific fields where linguistic and legal interests converge, and to facilitate integration between linguists, computer scientists and lawyers from all around the world.”

The conference will take place from 4-6 July next year.

Papers are being invited on a wide variety of topics under a number of general headings, including: • Forensic linguistics in general • Legal translation and court interpreting • Legal languages and legal discourse • History of law and legal systems • Laws on languages Past highlights have included papers on the linguist as detective (tracing the senders of poison pen and threatening letters), linguistic features of forgeries and mistranslations in a legal context. q • Further information is available from the Laboratory of Legilinguistics at the university’s Institute of Linguistics. www.lingualegis.amu.edu.pl.

Court contract woes hit translation ‹ company profits A FALL IN PROFITS at Capita Translation and Interpreting has been blamed on the takeover of the courts interpretation contract, according to the company’s directors’ report for 2012. The report called the £15m contract ‘onerous’, but a spokesperson claimed the company never expected to make a profit in the first year.

She said: “Capita Translation and Interpreting has invested significantly in the Ministry of Justice contract to enable it to deliver the high standard of service which the MoJ and the court system expect. We therefore never expected to make a profit in the first year of the contract.”

According to a report in the Oldham Chronicle, where the company is based, the company lost £15m despite a large increase in turnover. The report also lists a number of instances where the company failed to provide interpreters.

Madeleine Lee (pictured), director of the Professional Interpreters’ Alliance – the umbrella group of organisations that oppose the contract – said the loss reflects poor management. “The entire premise of the bid was too low and undeliverable,” she told the Law Society Gazette. The alliance’s website continues to list instances of ‘no-shows’. q

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MEDICAL NOTES ‹ THE FOLLOWING PAGES CONTAIN information and news stories on what has become the

fastest-growing field of expert advice and evidence – the medical profession.

The reasons are not difficult to ascertain. With the growth in technical expertise in the treatment of an ever-larger range of conditions has come a narrowing of the specialisms, to such an extent that expert opinion is needed for virtually all cases. Added to that is the increasing willingness among the general population to resort to the courts, where previously a ‘well, it’s just one of those things’ attitude was more prevalent.

What is less certain is whether the changes in legal aid for medical negligence cases – in other words, its withdrawal in most cases – will impact upon the numbers and eminence of medical expert witnesses. We shall have to wait and see.

It seems, however, that a growing number of cases involving medical issues are concerned with medical professionals who are no better than they should be. Following on from the PIP breast implants scandal and Sir Bruce Keogh’s inquiry into the issue, both the Royal College of Surgeons and the BAAPS have been at pains to issue their own guidelines and views as to what should and should not be done on the plastic surgery front. The ‘shoulds’ include a thorough psychological assessment of the patient before the knife or needle is wielded – unsurprisingly applauded by the British Psychological Society – while the ‘shouldn’ts’ include advertising of the products and procedures with special offers attached to them – or advertising them at all, if the BAAPS has its way.

What nearly everyone was up in arms about was the sight of the winner of The Apprentice, a junior doctor, setting up a High Street chain of facial filler clinics.

The fall-out from the Mid-Staffs scandal continues, with a number of disciplines producing responses to the Francis Report. They include dentists and speech and language therapists, among others.

Some of the people appearing before the court aren’t even real medics at all. The case of the Wirral man who pretended to be a dentist is just the tip of the iceberg of would-be practitioners.

Some cases involve genuinely unfortunate human errors in administration, such as failing to ascertain proper consent or even losing notes as they pass between clinicians. The advent of the fully digitised patient record system should have made that a thing of the past, but the system that had been under development was scrapped as unsuitable at a cost, it was revealed recently, of around £10bn.

There has been some good news in the health and medical sphere, however. Two hospitals in the UK – The Christie in Manchester and University College London Hospital – are to build units to offer the advanced proton beam therapy for treatment of cancer. Hitherto, patients have had to travel to the US for treatment. The new form of radiotherapy targets cancers more precisely, causing fewer side- and after-effects than traditional treatments, which can cause long-lasting problems of their own.

Meanwhile, in Leeds the locals are celebrating the re-instatement of their controversial congenital heart defect surgery programme. Not everyone is happy that the reforms to provision of the treatment have been effectively mothballed. The streamlining of services into fewer specialist units was urged by most experts. q

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Old cases – missing notes

by IAN W FORSTER Consultant Orthopaedic Surgeon

‹ IT IS NOT UNCOMMON for treating

doctors seeing patients late in their treatment to say “if only you had been referred earlier” or “if they’d treated you properly initially then…”

Although the statute of limitation is three years, this is from the time of knowing that negligence may have occurred, possibly some years after the initial treatment.

Many years ago I treated an adult with polio in one leg. He said in the clinic one day that he was thinking of suing the local council because near his original home there was an open sewer which he thought may have been the cause of his polio. Whilst this may have been true, he was outside the limitation period and more importantly his original home had been demolished and redeveloped years previously.

Recently I advised the defence on a claimant who sustained a very nasty femoral fracture following a motorcycle accident. This was severely comminuted and associated with an open pelvic fracture on the same side.

The case was complicated because the claimant had already made a successful claim for personal injuries.

The injury was in 1979 when modern surgical techniques were just evolving. It was so severe that the claimant needed 20 units of blood. As was usual in those days the wound in the pelvis was cleaned and stitched.

The surgeon who treated him was the one who introduced the new surgical techniques to the area – he declared the fracture inoperable and put the claimant on traction. He was on traction for three months and then transferred to a hospital nearer his home.

The pelvic wound remained unhealed probably for a period of around five months.

However, this is purely the claimant’s recollection as there were no definitive notes.

In 1979/80 this would rule out surgical treatment because of the risk of infection.

There are no notes or X-rays from this initial treatment phase. The only information was from the original treating surgeon (who gave advice as a witness to fact) to the new hospital’s treating surgeon. This described the

wound and said the fracture was in a good position. This statement is not clear, as in 1979 a good position would be very different from that today. It is likely that the position obtained would be unacceptable today with modern techniques and expectations. The knee was said to be very stiff.

The new consultant (who has since died) decided the fracture was sufficiently healed as not to need further traction and he put the claimant in a hip spica POP. This plaster covers the whole pelvis and the whole fractured leg. It is extremely restrictive and uncomfortable and obviously holds the leg and pelvis in one position for some considerable time. He was in the hip spica for six months.

When he came out of plaster he had a stiff knee, a short leg and deformity in his femur.

There are notes throughout this period but they are brief and not helpful – there is no description of the X-rays. The first X-ray available in this case was in 1993.

Over the subsequent years he had a hip replacement, a knee replacement and realignment osteotomy of the femur. His leg remained very short.

During the osteotomy phase the surgeon treating him said that if he had been treated properly at the beginning he wouldn’t have had all problems he had suffered.

The main problem with this case was that there were no X-rays before 1993. This showed a healed but very comminuted fracture with deformity.

The claimant, in his letter of claim, said that his pain increased when he went into plaster and he thought his deformity increased.The claimant’s expert, looking at the referral letter and the statement, opined that the hip spica was inappropriate because of the increased risk of stiffness and inability to control the fracture. He gave the opinion that it would have been relatively easy to fix the fracture surgically at that stage, an opinion with which the treating consultant strenuously disagreed.

Both the treating consultant and myself thought it more likely that the die was cast after three months traction. We thought that the position of the fracture at three months would make it extremely difficult to treat surgically in 1979/80, particularly with the available implants.

The initial treatment in traction was not in dispute.

The dispute was

over the state of the fracture at three months and whether the wound would preclude surgery anyway.

The actual state of the fracture was undeterminable. The claimant’s expert relied on the referral letter saying the fracture was in good position and he assumed that this meant it was out to length and aligned. Both the treating consultant and I thought this unlikely and took the ‘good position’ to be the best that could be achieved but not out to length or perfectly aligned.

In this case there was a difference of opinion based on the expected result of traction and a statement made by the claimant.

Clearly there was no way this could be resolved by the experts. Another problem was that the functional outcome from this fracture would be little different either way because of the stiffness. The claimant discontinued the claim one week before trial.

The experts were all of an age who used these treatments at the time of the injury. It can be difficult getting experts with sufficient relevant expertise together – though we all had our original textbooks to help us! q www.yourexpertwitness.co.uk

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Spinal injuries urology

what is that all about?

By MR SIMON FULFORD MBBS FRCS(Eng) FRCS(urol) Consultant Urologist

‹ THE TWELVE SPINAL CORD injury units in the UK provide

rehabilitation and lifelong follow up for patients with spinal cord injuries.

These units are staffed by multi disciplinary teams including rehabilitation physicians, spinal surgeons, nurses, physiotherapists, occupational therapists, social workers and (to the surprise of many) urologists. So what is the role of the urologist in the spinal injury multi disciplinary team and why are they required?

Historically, patients with spinal cord injury usually died within a few months of urinary infection and renal failure. This was as a direct result of bladder dysfunction caused by the loss of neurological control of the pelvic organs. This situation was only improved once the importance of appropriate bladder management was recognised by pioneers such as Dr Ludwig Guttmann in Stoke Mandeville during the 1940’s.

Normal bladder function is such a routine everyday matter that we rarely give it a second thought. The bladder has two complementary functions – the storage of urine and the complete evacuation of the stored urine. During bladder filling it is important that the bladder wall relaxes to keep the pressure low. During voiding the bladder wall muscle contracts and the urethral sphincter relaxes in a co-ordinated manner to achieve complete evacuation at safe pressures.

Both functions require complex neurological control involving reflex centres within the sacral portion of the spinal cord, ascending and descending neural tracts within the rest of the spinal cord and further reflex centres within the brainstem and areas of the cerebral cortex.

Thus bladder function can be (and is) affected by any injury (or disease) to the entire length of the spinal cord.

The exact effects of a spinal cord injury on the bladder depend on the level of the injury and what residual spinal cord function remains.

In general terms higher spinal cord injuries result in a ‘reflex’ bladder and lower ones in an ‘areflexic’ bladder.

In a reflex bladder, filling results in uncontrolled bladder wall contraction. This is, however, not co-ordinated with sphincter relaxation and so can result in prolonged high pressures and incomplete emptying. The high pressures may result in renal damage and the incomplete emptying in urinary infection.

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An areflexic bladder does not contract in response to filling and as the sphincters are also unable to contract ‘overflow’ incontinence will occur once capacity is reached. Emptying is incomplete however and bladder relaxation may be poor resulting again in renal damage and urinary infection.

The primary role of the spinal injury urologist is to help patients manage their bladder dysfunction and prevent renal damage and urinary infection. It is also vital to recognise the huge impact of spinal cord injury on the quality of life and independence. Indeed, most patients with spinal cord injury will state that their bladder, bowel and sexual dysfunctions have a greater impact on them than any mobility issues. Therefore it is important for the spinal injury urologist to achieve a safe bladder whilst maximising independence and enhancing quality of life.

We are very fortunate nowadays to be able to offer spinal cord injury patients a wide range of options on how to manage their bladders. The role of a spinal injury urologist is to assess each patient, advise which options may be available to them, prescribe the required medication and/ or conduct the required surgery and, most importantly, to maintain careful surveillance for renal damage and urinary infection.

In addition to bladder dysfunction, spinal cord injury patients also suffer with bowel and sexual dysfunction. These functions are controlled by parts of the spinal cord and will therefore be similarly affected to the bladder and will, of course, have a huge impact on the patient’s quality of life. Spinal injury urologists will therefore often offer assessment and treatment for these problems alongside other members of the multidisciplinary team.

So the spinal injury urologist is central to providing safe and effective care to patients with spinal cord injury, primarily with respect to bladder function in order to prevent renal damage and urinary infection but also to maximise quality of life with respect to bladder, bowel and sexual dysfunction.

Due to the rarity of spinal cord injury a general urologist will not be exposed to such patients frequently and will not develop the necessary knowledge or skills to manage them optimally. Nor will they be able to offer expert evidence to help such patients achieve the maximum compensation that is often vital to securing their future well being. q

Physiotherapists and whiplash associated disorders

by ROSEMARY QUINN of Rose White Services Ltd

‹ IN RECENT YEARS, PEOPLE diagnosed with whiplash injuries –

incurred predominantly as a result of road traffic accidents (RTA) – seem to have become the subject of ridicule and derision. Is anyone taking them seriously any more?

A simple bump between two vehicles can cause a poorly understood condition which may have multiple ramifications for the victim. Initially, there may seem to be few signs and symptoms – adding to the suspicion of fraudulent claims. However, there are many people who do not expend time and energy making a claim at all, and there are a percentage of people still in pain after the 3-year claim window (The literature quotes vary from between 15 and 40%).

Engineers have carried out many studies of the forces and mechanics involved in RTA’s and the calculated risk of injury. Even where the risk is low, it still exists. From the passenger’s perspective, he would rather not be the 1 person in 10 who is injured in a low velocity impact accident.

Structures in the body that may be affected by the whiplash mechanism include the joints, ligaments and discs of the whole spine (not just the neck), muscles, muscle control, nerve roots, nerve activation, cranial nerve and arterial function as well as the brain – psychological and emotional issues.

The commonly used Quebec classification of injury describes five categories, is very simplistic in its approach and based primarily on signs and symptoms.

The usefulness of the Quebec classification has been rightly questioned. A new classification system with seven categories has been proposed by Michele Sterling of Queensland University. Her chart (pictured) identifies measurable disturbances in motor, sensory and psychological dysfunction. She uses validated tests to classify whiplash associated disorders for management purposes.

Management of the injury, including rehabilitation, is predominantly the domain of the clinical physiotherapist. Lawyers would do well to seek out a suitably qualified physiotherapist expert to provide a robust detailed report for the claimant. With specific training in identifying and classifying whiplash associated disorders, the expert will be able to catalogue the motor, sensory, psychological and neurological impairment. He will establish how this is affecting the claimant and the requirements for recovery. R • Please contact Rosemary Quinn on rq@rosewhiteservices.com to find out more.

REFERENCES Michele Sterling, A proposed new classification system for whiplash associated disorders—implications for assessment and management, Manual Therapy, Volume 9, Issue 2, May 2004, Pages 60-70, ISSN 1356-689X, http://dx.doi org/10.1016/j.math.2004.01.006. (http://www.sciencedirect.com/science/article/pii/S1356689X04000025)

0.

I. II.

III. IV.

No neck complaint or physical signs Neck complaint of pain, stiffness or tenderness with no physical signs Neck complaint and musculoskeletal signs: • IIa Point tenderness and normal range of movement • IIb Point tenderness and limited range of movement Neck complaint and neurological sign(s) Neck complaint and fracture / dislocation

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Physiotherapy clinical expertise forms the basis of nationwide expert reporting service ‹ ONE OF THE LONGEST established practices in the field of medico-

legal reporting is The White House Medico-Legal Services. Based in Sheffield, it is operated by partners Anna Wilkinson and Jason Howard, who lead a team of highly-qualified and experienced physiotherapists, occupational therapists and nurses.

They act as cost consultants and expert witness and reports can be prepared for: • Neurological conditions: brain injury, spinal cord injury, cerebral palsy • and neuropathies • Orthopaedic conditions: back injuries, whiplash, amputations, fractures, • tripping and slipping and trauma • Nursing and care costs • Rehabilitation costs: occupational therapy, physiotherapy, hydrotherapy, equipment and innovative technologies • Clinical negligence: therapeutic treatment and nursing care They work on a nationwide basis, with regular instructions from Claimant and Defendant Solicitors and the NHS Litigation Authority. Their experts regularly undertake lecturing programmes for other professionals and present the latest evidence-based research at injury specific conferences.

The practice also operates a lecture programme for solicitors to demonstrate the type of reports and cases where they can assist as well as seminars on rehabilitation matters.

Reports are prepared to a given timescale, solely from information supplied by the solicitor, and can be in the form of a file or encrypted disc.

Assessment and examination of the client can be in clinic or at home, with a report based on the clinical evidence and medical notes. q

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Why aren’t physiotherapists used as musculoskeletal experts in fast track cases?

PAUL ERRINGTON, legal director and KEVIN REESE, clinical director at Errington Reese Medico-Legal Services provide the answers to some FAQs

‹ THIS VERY QUESTION HAS puzzled physiotherapists for

many years. We believe to answer this we must put ourselves in the position of commissioning solicitors and insurance companies to try and understand the reluctance to use these clinicians for this purpose.

Question: Are physiotherapists of sufficient quality as people to undertake expert reporting?

Answer: Physiotherapists tend to come from the more academically gifted A level students. Most 18 year olds would have to attain at least 2 A’s and a B at A level with a biological science being a pre-requisite. Many physiotherapists choose physiotherapy over medicine and due to weight of numbers it is often harder to get into physiotherapy than medical school at university.

Question: Are physiotherapists allowed to do fast track expert reporting?

Answer: Yes. A select number already offer opinion in the more onerous cases of negligence and breach of duty, where an in depth knowledge of court format and procedure are an essential. In the 1977 Health Circular physiotherapists were deemed ‘autonomous practitioners’ and are and can be first contact clinicians for the treatment of musculoskeletal cases. Therefore an understanding of signs and symptoms inside and outside this discipline is required to safely practice.

Question: Do physiotherapists have the specialist knowledge to diagnose and prognose?

Answer: Absolutely and we go one step further – we treat.

We ourselves have over 47 years combined experience within physiotherapy and 36 as specialists in musculoskeletal medicine.

We have worked in sport, privately and in many side disciplines within the NHS including post operative rehabilitation, first contact

GP and consultant clinicians in orthopaedic wards, rheumatology and many more.

This wealth of knowledge is not untypical within physiotherapy. It must be remembered that the vast majority of GPs and orthopaedic surgeons do not offer treatment for fast track cases and pass this duty over to the physiotherapist. Indeed, many will admit they refer to physiotherapists when they do not know what to do with these cases.

As a consequence the knowledge of physiotherapists in this field outstrips their medical counterparts.

Question: Do physiotherapists need guidance from GPs and consultants when treating their patients?

Answer: No. All private physiotherapy clinics offer a diagnostic treatment service for those who can simply walk in off the street. Also many NHS institutions are using physiotherapists as first contact clinicians. This eases the burden on GPs who are likely to refer on to physiotherapists regardless and cuts down on the countless unnecessary assessments undertaken by consultants when surgery clearly isn’t indicated. An experienced physiotherapist can be trusted to perform this screening function.

Question: Why aren’t physiotherapists used in fast track cases more frequently?

Answer: A tough one. If physiotherapists can offer a better and cheaper service than their general practitioner colleagues it is a mystery. The answer probably is due to a prevailing ignorance of the quality of physiotherapy practice in the UK and the monopoly of medicine in these extremely lucrative cases.

Question: Why is the issue of physiotherapists performing fast track reporting of interest now?

Answer: Jackson! Remember the clinician who performs the treatment is most likely to be the expert. q

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Learning to communicate is key to avoiding litigation ‹ NORTH EAST-BASED Mr Paul Baguley has been qualified as a

surgeon for more than 30 years and as an aesthetic plastic surgeon for around half of that time. For the past 10 years he has been producing an increasing number of medico-legal reports in personal injury cases and in that time has seen many changes, leading to a need to constantly update his knowledge.

“As the laws change concerning litigation and personal injury claims it often causes me to reflect on my own practice,” he told Your Expert Witness. “The number of courses I have attended and the continuing education that I put myself through to keep pace with personal injury, clinical negligence and litigation claims is becoming quite a large part of my practice.”

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The question arises: does that make him a safer or better doctor?

“I would have to say it doesn’t make me a safer or better doctor, as I hope that I already practice safely and as well as I can. What it does is make me more aware of the possible causes of litigation. In my experience a lot of the causes of litigation are poor explanation to the patient, as well as poor documentation.”

So is the extensive on-going development worthwhile?

“I think any situation that makes you a better practitioner is good, not just for yourself but for society as a whole. Hence I will continue to attend courses and I will continue to learn from clinical negligence personal injury cases. Hopefully, that will help provide a better service to the litigators as well as improving my own personal practice.” q

Surgeons’ cosmetic guidelines stress the import of psychological issues ‹ PSYCHOLOGICAL ASSESSMENT IS at the heart of cosmetic

surgery guidelines published in January by the Royal College of Surgeons (RCS), according to a report in The Psychologist, the journal of the British Psychological Society (BPS).

According to the RCS, the guidelines state that, as standard practice, practitioners should discuss relevant psychological issues (including any psychiatric history) with the patient to establish the nature of their body image concerns and their reasons for seeking treatment. They should not at any point imply that treatment will improve a patient’s psychological wellbeing.

The BPS article refers to specific conditions mentioned in the guidelines. “The guidelines draw particular attention to patients with a history of psychiatric problems, especially eating disorders, body dysmorphic disorder or personality disorders. Concerns about cosmetic gynaecological surgery are also addressed,” the article states.

It also points out that contributors to the professional standards document were chartered psychologist Dr Andy Clarke, a consultant clinical psychologist in plastic and reconstructive surgery at the Royal Free Hospital, and chartered psychologist Professor Nichola Rumsey, research director of the Centre for Appearance Research, University of the West of England.

Aimed at all doctors, dentists and nurses involved in cosmetic practice, the document – Professional Standards for Cosmetic Practice – focuses on the behaviour and competencies medical professionals should be expected to demonstrate when providing cosmetic procedures.

Professor Norman Williams, president of the Royal College of Surgeons, said: “While the colleges and professional organisations involved in cosmetic practice are neither regulators nor legislators, the profession has a responsibility to provide standards to which we would expect our members to work. We have serious concerns that not all those who offer cosmetic procedures are adequately qualified, or that patients are getting accurate information prior to treatment.”

The British Association of Aesthetic Plastic Surgeons also welcomed the guidelines. Its president Rajiv Grover said: “At the BAAPS we welcome the Royal College of Surgeons’ appreciation of the urgent need for stricter controls in the cosmetic sector. This report is a step in the right direction and its content will have fed into the call for evidence of Sir Bruce Keogh’s review.” However, the BAAPS would like requirements to go further with regard to patient consultations.

Mr Grover explained: “At the heart of a proper patient consultation lies fully informed consent. Conveying the elements of medical and psychological assessment, treatment options, providing a realistic idea of likely outcome and possible risks is essential. For consent to really qualify as ‘informed consent’, however, the BAAPS would go a stage further than this report and unambiguously specify that the consultations must only ever be with the surgeon who will actually carry out the procedure.”

He continued: “The protection of the public at large is nothing more than the duty of the medical profession: to adhere to the Hippocratic Oath which states ‘first do no harm’. The marketing and advertising of cosmetic procedures is neither educating nor informing, but an exercise squarely aimed at achieving sales. This clearly puts economics ahead of patient care. Although the RCS report suggests tighter control of marketing in this area, with a ban on such strategies as time-limited offers, again at the BAAPS we feel there is a need to go even further. The only way to fully protect the public is to have an outright ban on advertising, as seen in some European countries and which is also applicable to prescription medicines.” R

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Senior Surgeon uses plastic techniques for lump removal ‹ TECHNIQUES USED IN aesthetic plastic surgery are often also

employed to correct painful or at least uncomfortable conditions in other areas, sometimes as a result of the after effects of cancer or other severe illnesses.

For instance, in an as-yet unscreened episode of the popular TV programme Embarrassing Bodies, plastic surgeon Mr Ash Mosahebi employed a technique known as VASER ultrasound liposuction to remove a large lump from the spine of a teenage girl.

An experienced consultant plastic surgeon, Mr Mosahebi – known as ‘Ash’ – is an Honorary Senior Lecturer at Royal Free Hampstead NHS Trust Hospital and University College London Medical School, where he is an active member of the Centre of Nanotechnology and Regenerative Medicine.

His work involves accreditation as a skin cancer multidisciplinary and he has recognised expertise in sentinel node biopsy in melanoma, as well as treatment of other skin cancers.

His research has included work on nerve regeneration jointly with Prof Alexander Seifalian of the UCL, lymphatic regeneration, breast filler and regeneration and the development of carbon nanotube for treatment of cancer.

In addition to breast aesthetic surgery, Ash has had training in all aspects of facial aesthetic surgery as well as body contouring, liposuction and laser work.

Ash has given many TV interviews, including discussing facelifts with Dr Hilary Jones on ITV’s Lorraine, and is the author of numerous publications. q

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Sun, sea and sepsis

plastic surgery abroad shows high level of complications ‹ A SURVEY BY THE British Association of Aesthetic Plastic Surgeons

(BAAPS), published on 21 July, has revealed that problems following socalled plastic surgery ‘holidays’ are continuing to increase, with 60% of its members recording a rise of at least 25-35% over the past five years in the number of patients seeking help for problems following cosmetic surgery performed abroad.

The revelation comes in the wake of a study by researchers at Leeds University. The study revealed that, although most people were happy with

Apprentice winner comes under fire from clinicians ‹ PLASTIC SURGEONS JOINED dermatologists in July

to condemn the facility of Dr Leah Totton, winner of the BBC’s Apprentice programme, to set up and run a chain of outlets offering injectable facial treatments. The British Association of Plastic Reconstructive and Aesthetic Surgeons and British Association of Dermatologists led a chorus of disapproval that included the main plastic and aesthetic surgery associations as well as a host of highprofile clinicians.

The Review of Regulation on Cosmetic Interventions, which was led by Sir Bruce Keogh and issued its report earlier this year, highlighted problems within the non-surgical cosmetic sector and called for urgent development of an accredited training framework

by Health Education England. The specialist professional groups continue to urge rapid Parliamentary approval in order to take the recommendations forward and ensure that proficient implementation and improved patient care is in place.

Mr Graeme Perks, president of the British Association of Plastic Reconstructive and Aesthetic Surgeons added: “At a time when all professionals are collaborating with Sir Bruce Keogh to improve cosmetic surgery practice and protect the vulnerable, it is a concern that a very junior doctor can make claims to be an authority in this field and provide the direction and clinical judgement that only comes with experience.” q

the results, there was a staggering 16.5% complication rate, with nearly one tenth of patients needing assistance from the NHS when arriving home.

In spite of Government recommendations for aggressive marketing in the sector be toned down, adverts for ‘summer holidays’ and ‘city break’ discount deals combined with surgery – even offering free flights for multiple operations, according to BAAPS – continue to proliferate.

The BAAPS members survey found that between 25-45% of patients with problems were under the age of 30 – a group particularly vulnerable to financial inducements. The most cited reasons for the complications were lack of aftercare and procedures being outdated or poorly performed.

Consultant plastic surgeon and BAAPS president Rajiv Grover said: “Despite the recent study from Leeds University claiming that most patients who elect to travel abroad for cut-price surgery are ‘happy’ with the results, the complication rates do not correlate with the frequency or severity of issues reputable surgeons record here in the UK. “At best, patients are forced to assume the cost of additional treatment after returning home from ‘makeover holidays’ as there is usually no aftercare provided, and at worst it is the British taxpayer via the NHS who assumes the cost of righting any wrongs as serious complications can develop weeks, or even months after the procedure.”

A study undertaken in the UK and published in the Aesthetic Surgery Journal established that 90% of cosmetic surgery tourism websites do not publish any information whatsoever about possible risks or complications. q

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Speech therapists join in a conversation about professionalism

‹ IN COMMON WITH MANY specialisms within the NHS, the Royal

College of Speech and Language Therapists (RCSLT) has formulated a response to the Francis Report on the scandal at Mid Staffordshire. The RCSLT has pledged to empower its members with the confidence to react to unprofessional behaviour.

Bryony Simpson, chair of the RCSLT, said: “Allied health professionals, like other health staff, are also patients and the relatives of patients. We share the deep concern regarding what occurred in Mid Staffordshire, for which there can be no excuses. Our worry is that other staff felt unable to report the unprofessional behaviour that occurred. This is especially alarming when considering vulnerable clients who are not able to communicate their

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concerns about the poor quality of care they receive.

“The RCSLT’s role is to provide leadership and support to our members, enabling them to make the right decisions. We have been communicating through webinars, seminars, journal articles and Twitter to get our members talking, raising questions and sharing experiences.”

Kamini Gadhok, CEO of the RCSLT, said: “Since news broke of what occurred we have worked hard and proactively to raise the profile of professionalism and leadership. We aim for a culture of professionalism, quality and care permeating all that we do. There is though no room for complacency. Unacceptable standards of care must be rooted out, and we will play our part.”

The RCSLT has joined a working group set up by Karen Middleton, chief health professions officer at the Department of Health, to focus on the topic among allied health professionals. Group members include representatives from the allied health professional bodies, the Council of Deans, frontline clinical staff and patients.

It follows on from an initiative last year when the RCSLT highlighted the issue of professionalism to its members via the Big Conversation, which was also launched by Karen Middleton to encourage health professionals to talk to each other about professionalism.

Kamini Gadhok continued: “The RCSLT is pleased that Karen Middleton has seized the initiative and is taking forward this sensitive issue in a constructive way, working with the Allied Health Professions Federation. As the effects of financial cuts take hold there is no reason why professionalism should suffer as a result. It must be ingrained in the everyday life of health professionals and peer-led discussion is the best way to ensure it remains under the spotlight. We urge our members to join the conversation today.” R

Special needs require specialist assessments ‹ A COMMON AREA OF medico-legal work involving speech and

language therapists concerns the special educational needs and disability tribunal, which is a first-tier tribunal known as SEND. These are cases where a child's education is affected by a communication problem and extra specialist assistance is being sought. In those cases there is a need for very specific recommendations quantifying the amount of on-going therapy considered necessary.

Appeals to SEND can be invoked in cases where parents are unhappy with their child’s statement of special needs, issued by the local authority. According to speech and language therapy expert Rebecca Matthews, not only is a formal assessment of a child’s speech and language skills essential, equally necessary is an informal assessment.

Match Solicitors of London are specialists in educational cases.

They explained that the process is initiated when either the parents or the school make a request to the local authority for a statutory assessment pursuant to the Education Act 1996 as amended. The local authority must respond within six weeks indicating whether they agree to make an assessment. They must compile expert reports in the following 10 weeks and issue a Proposed Statement of Special Educational Needs.

According to Match Solicitors: “Parents then have 15 school days to respond to the Proposed Statement. The local authority must finalise the statement within eight weeks from receipt of the parental comments.

“If the local authority decides not to issue a statement or to issue a Note in Lieu of a Statement, parents may appeal to SEND within two months of receipt of the decision. If the local authority refuses to carry out a statutory assessment, the parents can appeal to SEND. Parents can also appeal to SEND if they are not satisfied with parts of the statement.”

The present government is committed to overhauling the provision of special education and issued a Green Paper in 2011, followed by draft proposals in 2012. An update to the progress being made was published on 20 August.

At the same time the DfES announced the creation of more than 500 scholarships for teachers and special educational needs (SEN) support staff.

Charlie Taylor, chief executive of the National College for Teaching Leadership, said: “A teaching profession that values continuing professional development is crucial to raising standards in our schools. These scholarships – alongside our wider educational reforms – will help deliver our objective of raising the status of teachers.” q

Everyone has a right to be heard ‹ JANET O’KEEFE QUALIFIED AS a speech and language

therapist in 1985. Her specialisms include children with hearing impairment, autism and adults recovering from trauma. Janet passionately believes that everyone has a right to be heard.

She is an effective tribunal witness, with considerable success of giving oral and written evidence. Declining education budgets and growing demand for additional support makes it harder for parents to achieve the resources they need for children with special educational needs. Janet is a trusted champion and powerful ally to this cause.

A member of the Expert Witness Institute, Janet is an experienced and confident expert witness. She understands the complex emotional, as well as physical, effect of trauma on communication skills. This makes her court presentation both compelling and convincing. q

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Liaising with other therapists can be key

By MARTIN SAMUEL of Speech Language Therapy Ltd

‹ SOME PATIENTS SEEN BY speech and language therapists

often have very complex needs, in addition to having multiple medical conditions or impairments that can affect their communication and swallowing. It is very important therefore that speech and language therapists liaise with other professionals as appropriate. The range of professionals that we work with is determined by several factors – the patient’s needs, the design of the service, the patient pathway and, equally importantly, the patient’s wishes. All patients now have to consent to be seen by and/or referred to other specialties. In most cases this is achieved easily, but for some patients seen by speech and language therapists this is not always straightforward. In these circumstances therapists are able to use their specialist skills and knowledge to ensure informed consent is provided where possible.

Multidisciplinary working is possible across all stages of the patient pathway. For adults with acquired and/or degenerative conditions this could mean in hospital when acutely unwell, in a specialist rehabilitation unit or, when working, in the community – and this is where Speech Language Therapy Limited operates.

In the community we work with a range of other therapists (physiotherapists, occupational therapists, dieticians) where we are frequently involved in joint sessions, working on joint goals but addressing a variety of different impairments affecting functional performance. There is also close working with neuropsychologists and rehabilitation assistants who are often involved in helping to carry out therapy programmes that require greater intensity of treatment.

From a patient’s point of view, sometimes it is not always clear why two particular therapists are working together when the areas seem so different. For example, eating, drinking and swallowing sessions are often carried out by an occupational therapist (looking at upper limb function) and a speech and language therapist (looking at swallow function). However, as long as the patient has clear goals they are able to participate in the treatment programme and improve.

Patients respond well to therapists working together for several reasons. Firstly, they the benefit from being treated by a team, so communication about relevant issues that arise in therapy is often better. Secondly, they do not need to repeat information to several different professionals more than once. Thirdly, by having effective team treatment and goal planning the patient is able to progress in

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multiple areas at once by working on only one or two goals at a time.

As patients improve in treatment, the multidisciplinary team is able to be flexible and adapt if certain areas need more attention than others.

Effective team working is not just limited to members of the therapy or rehabilitation team. Speech and language therapists will also liaise with GPs, consultants, social workers, carers, families and third sector organisations to ensure that the treatment the patient receives is delivered effectively, timely and safely. There is considerable evidence that where multidisciplinary working is embedded amongst professionals, the patient receives more effective treatment. This results in improved goal planning, better patient outcomes and healthier patient experience measures.

With speech and language therapists’ skills and emphasis on communication, they are integral members of the team and often play a vital role in ensuring effective liaison across teams as well as with patients and their families and friends. They also have the skills to be able to modify and adapt language so that the patient – and other relevant people – are able to understand what is being communicated.

This is especially important in patients with moderate difficulties understanding others or in getting their message across. q

Association can help Find a Therapist for speech and language needs ‹ THE ASSOCIATION OF Speech and

Language Therapists in Independent Practice (ASLTIP) provides information and a contact point for members of the public and professionals searching for an independent expert speech and language therapist.

ASLTIP holds a register of its members and provides a searchable database of speech and language therapists who are available to members of the public. The ASLTIP website features an easy to use search function allowing you to find a member for expert witness related work.

The ‘Find A Therapist’ tool not only allows you to search through the database of approximately 1,000 UK based therapists, but to filter your search to identify therapists located in your region and to isolate therapists with relevant clinical experience or areas of speciality. Find A Therapist particularly highlights SLTs who list medico-legal work as a specialism in which they accept referrals. This can then be combined with an age group or type of disability.

Speech and language therapists work with clients across the lifespan covering a wide range of areas of communication and swallowing disorders. The ASLTIP membership has therapists working with adults and children

with speech, language and swallowing/feeding related difficulties. This includes working with children and adults with a broad spectrum of clinical needs following brain injury, facial trauma, stammer, cancer or stroke. It also includes clients with developmental speech, language, social and pragmatic difficulties as well as adults with neurodegenerative diseases and professionals with voice related difficulties.

ASLTIP members who work as expert witnesses may have experience and training in providing evidence for civil, criminal and family courts as well as educational tribunals. These therapists can conduct full assessments including expert forensic analysis of claimants’ speech, language and communication or swallowing function.

ASLTIP therapists who work in this area are also able to supply both acute and longerterm assessments following accidents, clinical negligence, traumatic brain injuries, facial injuries and other injuries/situations.

They may also be able to provide ongoing therapeutic input. Speech and language therapists assess communication and swallowing problems and then give treatment to enable people to communicate to the best of their ability, as well as advice on safe swallowing. Speech

therapists work with the client's family where necessary and may also give advice to schools and medical personnel.

Independent speech and language therapists will offer an initial consultation, which will usually include an assessment (formal or informal) and a report setting out the findings and potential costs where requested. The purpose of this consultation is to ascertain the need for speech therapy and to gather information which will form a base-line for therapy.

If speech therapy is required, the therapist will offer a series of speech and language therapy sessions which are specifically designed to meet the needs of the individual, commonly working within multidisciplinary teams. All ASLTIP members are Health and Care Professions Council registered and members of the Royal College of Speech and Language Therapists.

Members agree to abide by the guidelines and standards of the Association.

• To locate a speech therapist in your region, use the ASLTIP on-line database at helpwithtalking.com.

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Child friendly justice – is it possible?

By MARY JONES of Triangle

‹ CHILDREN’S EVIDENCE IS NEEDED

by the criminal and family courts if they are to be kept safe, but many concerns have been raised about the impact of legal processes on children and young people.

This year has seen extensive and uniformly critical media coverage of a series of trials involving child witnesses – The Times ‘Abuse trial that shamed the British legal system’, The Daily Mail ‘Child abuse victims tormented in court’.

Does it have to be like this? Triangle has been working with young victims, witnesses and defendants to try and do things differently.

Children and young people are central in the way Triangle works – being involved in staff recruitment, training and assessment, the design of buildings and resources and the development of ways of working.

We know that very young children and children with a range of complex needs can provide reliable evidence when properly interviewed and questioned. Yet practice is very erratic across the UK, both at investigation stage and at court. Children who are at risk or are in complicated situations need confident adults to communicate carefully with them

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about the things that matter. In Triangle’s view, this requires strong multidisciplinary teams with a shared value base, skilled at communicating with children and young people with a wide range of needs.

Triangle aims to set the standard in the UK and beyond for careful and effective communication with children and young people, ensuring their needs are properly understood.

Triangle has developed a range of ‘extra special measures’ that enable children’s best evidence, including interview approaches that are childcentred but evidentially robust, communication resources and a unique, child-friendly interview space located within a large play and art room that can also provide a remote livelink to court.

Triangle’s court reports have been welcomed as ‘radically child-focussed’, providing clear and accurate information and analysis in accessible formats.

Our vision is to reposition children and young people in society as competent communicators and active agents in their own lives. q • For more information call 01273 305888 or vist www.triangle.org.uk.

Innovative cancer treatment to be offered in UK ‹ NEW, CUTTING-EDGE radiotherapy treatment will be available in

the UK from 2018, the Government has announced. On 1 August Public Health Minister Anna Soubry announced £250m of funding to build two new facilities to provide proton beam therapy.

Proton beam therapy is a particularly important form of cancer treatment as it targets tumours more precisely with less damage to surrounding tissues. The therapy can improve the quality of life following cancer treatment and reduce side effects, especially for children.

Currently, the NHS sends children and adults needing the treatment to the United States. From 2018 it will be offered to up to 1,500 cancer patients at the Christie NHS Foundation Trust in Manchester and University College London Hospitals NHS Foundation Trust.

It is widely recognised that prompt access to the latest treatments can directly affect outcomes in cancer treatment. Unacceptably long waiting times have in the past given rise to claims.

Announcing the funding, Anna Soubry said: “We want the NHS to have the best cancer treatments available in the world. By investing in proton beam therapy facilities, we will be able to treat more patients in the UK and reduce the stress placed on families who have had to travel to the United States to receive this innovative treatment.

“This is a huge milestone for the NHS – not only will proton beam therapy help save more lives, it will also ensure that patients experience fewer side-effects and have a better quality of life.”

Public Health Minister, Anna Soubry, wants the NHS to have the best cancer treatments available in the world

National clinical director for specialised services at NHS England, James Palmer, added: “Today’s announcement is very welcome news and will enable us to move ahead with fully equipping the new facilities in Manchester and London. This is a key milestone in being able to offer this important treatment in the UK.” q

Two new facilities providing proton beam therapy will be built

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Dentists respond to Mid Staffs report

‹ THE FALL OUT FROM the Francis Report into the failings at Mid

Staffordshire NHS Trust is being felt across the whole spectrum of the medical profession, including dentistry. The first recommendation of the report was that all those involved in the provision or regulation of healthcare services must set out how they intend to respond to the report’s findings and recommendations. On 8 August the General Dental Council (GDC) met and issued an action plan in response to that recommendation.

The plan sets out 21 actions grouped under six themes: • Delivering high standards of care and always putting patients first • Promoting openness, transparency and candour • Ensuring that the regulation and oversight of education and training protects patients • Developing a proactive approach to detecting and preventing harm to patients

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• Improving the use of data and information sharing between regulators to protect patients and the public • Hearing the patient voice in the work of the GDC. The plan sets out the GDC’s intention to create an online patient engagement panel to ensure that patients’ views are heard by the GDC and are able to effectively influence the regulation of dentistry.

The GDC also committed to seek to influence the Law Commission’s review of professional regulation, with the intention of ensuring that there are no legal restrictions on the GDC investigating any allegations of impaired fitness to practise.

The action plan will be reviewed and updated to take account of external developments, such as the government’s response to the Francis Report, the Berwick Review of patient safety and the Keogh Report into acute hospital trusts, as well as the Clwyd-Hart Review of complaints in the NHS. R

Irish dentists aim for corporate status ‹ THE DENTISTS ACT 1984 states: “A body corporate commits

an offence if it carries on the business of dentistry at a time when a majority of its directors are not persons who are either registered dentists or registered dental care professionals.”

That means in effect that a dental practice can be a limited company in the UK, provided the majority of its directors are not non-dental professionals. There is some debate as to whether the wording should have been slanted to imply the majority SHOULD be dental professionals, rather than that the majority should not be nonprofessionals.

In Ireland dental practices are not permitted to be corporate bodies and a campaign is underway to change that situation. Dental services in the Republic are regulated by the 1985 Dentists Act which states that, with certain exceptions concerning auxiliary dental work: “It shall not be lawful for any body corporate to engage in the practice of dentistry.”

The campaign to allow incorporation of dental practices in Ireland

Would-be dentist prosecuted and fined ‹ A MAN HAS BEEN prosecuted on The Wirral for unlawfully

practising dentistry. On 9 July, Andrew Thom appeared at Wirral Magistrates’ Court and pleaded guilty to unlawfully practising dentistry contrary to Sections 38(1) and 38(2) of the Dentist’s Act 1984. On behalf of Confidential Laboratories Limited Thom also pleaded guilty to unlawfully carrying on the business of dentistry contrary to Sections 43(1) and 43(3) of the Dentist’s Act 1984.

By law all dentists, dental nurses, dental technicians, clinical dental technicians, dental hygienists, dental therapists and orthodontic therapists must be registered with the General Dental Council (GDC) to work in the UK. This is to ensure only appropriately qualified and skilled dental professionals are part of the dental team looking after patients.

However, between 2 August 2011 and on or around 11 June this year Confident Laboratories Ltd unlawfully carried on the business of dentistry at a time when a majority of its directors were not and are not persons who are either registered dentists or registered dental care professionals.

Thom was fined £100 for each offence, ordered to pay a £20 victim surcharge and £500 towards GDC costs. q

is being spearheaded by the Irish Competition Authority (CA), which oversees the implementation of the competition provisions of the EU. In its submission to the country’s health authority on changes to the legislation, the CA identified the inability of dentists to form corporate bodies as a factor in non-take up of dental services in Ireland.

The submission read: “Corporate dental bodies are likely to be successful in attracting patients who did not previously attend a dentist, as has occurred in the UK, thereby expanding the size of the market and contributing to the better oral health of the population.”

In addition, corporate bodies are able to keep costs down by taking advantage of economies of scale and increased purchasing power. q

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Leeds case overshadows need for reform ‹ THE CONTROVERSY OVER the

proposed discontinuation of children’s heart surgery at Leeds General Infirmary and the subsequent reversal of the decision has overshadowed the more general debate on the future of such treatment – a debate that has been going on for 12 years.

On the day that Health Secretary Jeremy Hunt (pictured) announced that the reforms were to be suspended because they were “based on a flawed analysis of the impact of incomplete proposals”, experts at a leading children’s heart charity warned that children’s lives are being put at risk because of what it described as ‘monumental delays’ in implementing the reforms.

The Children’s Heart Federation (CHF) urged NHS England to ‘be brave’ and implement the new standards of care resulting from the Safe and Sustainable Review completed a year ago – the review that was criticised by Mr Hunt.

CHF warn that the effect of Mr Hunt’s decision will further delay the implementation of these changes and add to the immense strain that the life-saving service is currently experiencing, arguing larger teams of surgeons are needed to ensure children can have complex life-saving surgery 24/7.

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Anne Keatley-Clarke, chief executive of CHF, said: “For the past 12 years, ever since the Bristol baby tragedy, we’ve been campaigning to ensure that another crisis in the care of vulnerable children can never be allowed to happen.

“As this review was clinician-led and the recommendations were agreed by their professional bodies and many parent groups, it has been really disappointing to see the implementation of the necessary improvements delayed. We want all children, wherever they live in England, to have access to an excellent service.

“NHS England is a new body tasked to modernise the health service to secure the best possible health outcomes. We ask them to remember that this is a national service so they should take account of, but not give undue weight to local opinion in order to provide an equitable and excellent service for every heart child wherever they live in England.

“We urge NHS England to be brave and implement the standards proposed in the Safe and Sustainable programme to put an end to the preventable risk to children’s lives who undergo heart surgery.” q

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