Issuu

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CONTENTS 7

IN THIS ISSUE

Opening Statement

NEWS Electronic monitoring system is not working as intended 9 11 High Court judge to keynote Bond Solon’s Expert Witness Conference 11 High stakes for access to justice as Scottish Government confirms legal aid reforms 12 Chief Inspector calls for assessments in police custody FORENSIC ACCOUNTANCY 13 Consumers warned to beware of risky mini-bonds and loan notes 15 Money laundering and financial crime: the expert’s role is crucial in litigation 17 Warning as investors lose hundreds of thousands of pounds to ‘Ponzi-style’ crypto scheme 17 Millions forfeited by company linked to suspected money laundering VIEWPOINT 19 The tribulations of a business valuer ORGANISED CRIME 21 Gang crime, drugs and expert evidence PROPERTY AND CONSTRUCTION 23 Building stronger property claims 25 Japanese knotweed: why the plant is back in the news 25 CIOB publishes free Building Regulations and Building Safety Act advice 27 Crackdown on baseless legal claims to get Britain building 27 Building company and director fined after botched extension put lives at risk

FIRE INVESTIGATION 29 A fire door framework: why every component counts OIL & GAS 31 Where engineering meets commercial expertise GEOTECHNICAL ENGINEERING 33 Grounds for dispute TREES AND THE LAW 34 The truth, the whole truth and nothing but the truth? Or what they want it to be? AVIATION 35 When specialist knowledge takes flight in the courtroom TRANSLATING & INTERPRETING 37 The report was right. The translation wasn’t. LIPREADING 38 Industrial espionage and the overlooked value of lipreading expertise

FORENSIC DOCUMENT EXAMINATION 39 Forensic document analysis: a question of authenticity

A to Z WEBSITE GUIDE 45 Expert Witness A to Z website guide 94 Medico-legal A to Z website guide EXPERTS FOR MEDIA 130 Our regular section for experts wishing to offer their expertise to the vast range of print and broadcast media EXPERT CLASSIFIED 40 Expert Witness classified listings 122 Medico-legal classified listings

Your Expert Witness Suite 2, 61 Lower Hillgate, Stockport SK1 3AW Advertising: 0161 710 3880 Editorial: 0161 710 3881 Subscriptions: 0161 710 2240 E-mail: ian@dmmonline.co.uk Copyright Your Expert Witness. All rights reserved. No part of this publication may be copied, reproduced or transmitted in any form without prior permission of Your Expert Witness. Views expressed in this magazine are not necessarily those of the publisher. Printed in the UK by The Magazine Printing Company Plc www.magprint.co.uk

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3YWJ

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MEDICAL ISSUES 47 Medical Notes NEWS 49 Health risk blind spot: UK public booking treatments without knowing if they’re regulated 51 NHS Resolution delivers record early resolution of claims as new strategy shows impact 53 MHRA advises quarantine of medical devices without appropriate conformity markings 53 Surgeons respond to Welsh Government announcement on funding to cut waiting list 55 ‘Lofty’ clinical negligence experts leave judge unable to rely on their evidence 57 GMC publishes fitness to practise data for doctors 58 Family courts must do more to hear children’s voices, study says 61 Delayed bowel cancer diagnosis leads to six-figure settlement 63 More than 2,500 doctors asked for MDU’s help with coroners' inquests in 2025 63 CQC finds improvements needed in urgent and emergency services at Cumberland Infirmary 65 Patients with motor neurone disease set for fast-tracked care 67 Cancer patients rate NHS care highly 67 Progress on longest NHS waits stalls 68 HSSIB research demonstrates need for advice and guidance inclusion in physician job planning, says RCP GENERAL PRACTICE 69 Virtual consultations and GP clinical negligence OBSTETRICS & GYNAECOLOGY 71 Midwives in Wales say unsafe staffing levels affect the quality of care 71 Gynaecology waits worsen for third month as demand rises, RCOG warns VAGINAL MESH LITIGATION 73 Vaginal mesh litigation: urinary, pelvic and surgical complications

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PHARMACOLOGY Choosing the right medicines expert: does the expertise 96 match the question? DELAYED DIAGNOSIS 99 Delayed diagnosis and treatment: a medico-legal perspective ORTHOPAEDICS Increased risk identified with certain modular neck hip 101 replacements 103 Five orthopaedic medicolegal issues every personal injury lawyer should have on their radar CAUDA EQUINA SYNDROME 105 The anatomy of a cauda equina claim HAND SURGERY 107 Getting to grips with hand and wrist injuries

UROLOGY 75 The critical role of urological expert evidence

SKIN CAMOUFLAGE 108 Skin camouflage and tattoo expertise: assessing the impact of visible difference

RADIOLOGY 77 The evidence behind the image

PHYSIOTHERAPY 109 Assessing injury: the physiotherapist’s role

PAEDIATRIC ANAESTHESIA 78 Paediatric anaesthesia: expert evidence in child healthcare claims

CARDIOLOGY 111 BCS comments on the Government’s cardiovascular framework 111 Funding boost for new Scottish research network

DENTISTRY & MAXILLOFACIAL SURGERY 79 One in ten NHS dental practices have stopped providing NHS care since 2017, analysis finds

PODIATRY 113 Putting your best foot forward in litigation

FACIAL TRAUMA 83 Facial trauma complications and the medicolegal implications

BURN INJURY 115 The complexities of burn injury claims

OBESITY 84 Diabetes and obesity: who is to blame?

VASCULAR SURGERY Diabetic foot disease – is amputation avoidable? 116

COGNITIVE IMPAIRMENT 85 Mental capacity, cognitive and psychometric testing: understanding the differences

OPHTHALMOLOGY & OPTOMETRY 119 AMD audit results highlight the increasing pressure on services 121 GOC publishes updated hearings and indicative sanctions guidance

BRAIN INJURY 86 The critical role of rehabilitation medicine expertise in medico-legal practice 89 Brain injury litigation: from rugby pitch to court PSYCHIATRIC & PSYCHOLOGICAL ISSUES 91 Mental health and substance use disorders pose complex questions

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Opening Statement [

WELCOME TO THE LATEST ISSUE of Your Expert Witness, bringing together specialist knowledge, expert insight and the professional expertise that can help solicitors navigate the complexities of litigation. From financial crime and money laundering to disputes involving Japanese knotweed, the need for clear, reliable and well-supported expert evidence remains central to legal proceedings. Whether examining financial transactions, assessing the impact of invasive plant growth or investigating the technical causes of construction disputes, the right expert can provide the specialist knowledge needed to understand the evidence and support a case. • Money laundering and financial crime continue to present challenges across the legal and business landscape. Transactions may involve complex financial arrangements, multiple jurisdictions and attempts to conceal the origins of funds. For solicitors dealing with allegations of financial misconduct, expert knowledge can help explain financial records, identify potentially significant transactions and provide an informed assessment of the issues. • Japanese knotweed is also back in the news, with the plant continuing to attract attention in property disputes and claims concerning damage, liability and valuation. Once established, its presence can raise questions about the condition of a property, the extent of any damage and the appropriate remedial measures. Expert assessment is often required to distinguish between the presence of the plant and the actual impact it has had on a property. With the potential for disputes to involve surveyors, property owners and neighbouring landowners, specialist evidence can be crucial in establishing the facts. • Geotechnical engineering provides another important area of expertise, particularly where ground conditions, foundations and subsurface risks become central to litigation. Understanding soil behaviour, ground stability and the interaction between structures and the ground beneath them can be essential when investigating defects, delays or failures. A suitably qualified geotechnical expert can help establish the technical causes of a dispute and explain complex engineering evidence in a way that assists the court. • Communication and documentary evidence are equally important in the legal process. Lipreading experts can provide specialist insight where spoken communication needs to be assessed, including cases involving hearing impairment, disputed conversations or the accuracy of recorded evidence. Their expertise may help clarify what was said, what could reasonably have been heard and the implications for a particular case. •Forensic document examination, meanwhile, offers a valuable means of investigating the authenticity and history of documents. Questions surrounding signatures, handwriting, alterations or the origin of a document can have significant implications in civil and criminal proceedings. Expert examination can help identify relevant features and provide an independent assessment of disputed material. • Across these diverse fields, the role of the expert witness remains consistent: to bring specialist knowledge, independence and clarity to complex evidence. We hope this issue provides useful insight into the expertise available to the legal sector and demonstrates the contribution that properly instructed experts can make to the pursuit of informed and fair outcomes. q

Ian Wild

Ian Wild, Director of Business Development Your Expert Witness

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ELECTRONIC MONITORING SYSTEM IS NOT WORKING AS INTENDED, CREATING PUBLIC PROTECTION RISKS [UNCERTAINTY OVER how many people are not being monitored,

combined with wider inefficiencies in the Ministry of Justice’s electronic monitoring service, is wasting resources and increasing public protection risks. The National Audit Office (NAO) says this raises concerns about plans to expand a system that has grown quickly but is not yet working effectively. Electronic monitoring, or ‘tagging’, uses technology to remotely monitor a person’s location and compliance with court requirements. In September 2025, the MoJ announced plans to significantly expand electronic monitoring as part of the Sentencing Act 2026, which aims to ease prison pressures by managing more offenders in the community. But poor early performance from one of its external contractors, Serco, meant that between August 2024 and July 2025, individuals were not tagged on time and officials were not notified of potential breaches in a timely manner. During this period, the backlog of visits to fit, check or remove tags increased significantly to a peak of 7,000 visits in October 2024 – before returning to fewer than 400 in November 2024. HM Prison and Probation Service (HMPPS) has worked with Serco to improve performance and reduce backlogs in fitting tags. But supplier performance improvements alone are not sufficient to ensure the wider system is working as intended. The number of unmonitored individuals is also a concern: as of March 2026, HMPPS was reviewing around 8,900 cases – 24% of those required to be tagged – to determine the number of unmonitored cases. Police and probation officers often lack information or capacity to respond quickly to breaches. Inefficiencies in the system and a lack of prioritisation add to this challenge, with high volumes of alerts and breach notifications generating significant work with limited value. For example, where outcomes are recorded, nearly half result in ‘no further action’. On visits, the NAO observed that both serious and minor breaches were often treated in the same way. There is also no shared understanding of what a more responsive electronic monitoring system should look like or how it should be measured. For example, Serco’s contract does not require it to provide officials with details of an individual’s breach until 29 to 53 hours after it occurs. The wider system is inefficient, with many errors in tagging orders and a low success rate for tagging people, causing delays in getting individuals tagged. In February 2026, although Serco met its 95% timeliness target for tag-fitting visits, it was only successful in fitting tags on 62% of the individuals it visited within its two attempts. In September 2025, the MoJ estimated that up to 22,000 additional people will need to be tagged per year from 2027. To deliver this increase, HMPPS is aiming to stabilise the service, build the foundations to scale up activity and transform the programme, including through adopting new technology and data. The government has allocated up to £175m to fund the expansion over the 2026-2029 spending review period, which includes developing a series of pilots. For example, it plans to strengthen management of domestic abuse offenders through tags that can monitor their proximity to their victim. However, key elements of the system are not yet working effectively – for example, significant understaffing persists, including an estimated shortfall of around 2,200 probation staff as of March 2026. There have been concerns about whether the system can scale up safely. The report from the independent public spending watchdog concludes that further expansion of the electronic monitoring system will not be efficient or effective unless the MoJ and HMPPS work with partners to address weaknesses in governance, data quality and system-wide inefficiencies to support a more reliable and responsive service. Gareth Davies, head of the NAO, said: “Electronic monitoring

is central to managing pressures on prisons, but it is not working effectively, creating risks to public protection. Improvements are required to ensure that those who should be monitored are monitored and that breaches are responded to effectively. “The MoJ and HMPPS should address the inefficiencies and risks identified in our report before expanding electronic monitoring.” q

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HIGH COURT JUDGE TO KEYNOTE BOND SOLON’S EXPERT WITNESS CONFERENCE ON AI IN EXPERT EVIDENCE [THE USE OF artificial intelligence (AI) in expert witness evidence

is one of the most pressing questions facing the profession and the theme of this year’s keynote address at Bond Solon’s Expert Witness Conference. The Hon. Mrs Justice Joanna Smith KC DBE, a senior High Court judge, will deliver the keynote address at the London conference on Friday 6 November. Mrs Justice Smith is Deputy Chair of the Civil Justice Council’s Working Group, which is examining whether new rules are needed to govern the use of AI by legal representatives in preparing court documents. Her keynote comes as new figures reveal the scale of concern among expert witnesses about AI’s role in their work. In the Bond Solon and Law Society Gazette Expert Witness Survey 2025, 89% of respondents agreed that specific guidance is required for the use of AI by expert witnesses in the UK. Mrs Justice Smith's talk will give delegates a clear and authoritative understanding of the rules governing the proper use of AI when acting as an expert witness. Mark Solon, conference chair and founder of Bond Solon, said: “AI is moving faster than the guidance around it, and experts need clarity, not confusion. Mrs Justice Smith’s insight will help delegates navigate this with confidence.

HIGH STAKES FOR ACCESS TO JUSTICE AS SCOTTISH GOVERNMENT CONFIRMS LEGAL AID REFORMS

“Professor Peter McBurney from King’s College London, Professor Katie Atkinson from the University of Liverpool and Thomas Wood, an expert in computer science, will also be discussing the implications of artificial intelligence. The potential for miscarriages of justice is high if expert witnesses misuse artificial intelligence or use it in a way that compromises their evidence.” The conference is the UK’s largest gathering of expert witnesses. It takes place at Church House in Westminster and is also available virtually; over 750 experts attended last year and 500 experts have already booked for this years’ event. The agenda also features Emma Price, a barrister at 5 Essex Chambers, who was Counsel to the Post Office Horizon IT Inquiry. She will set out the lessons for experts revealed by the inquiry’s findings, ahead of its final report due later this year. Caroline Thompson, Special Counsel at Withers, will examine expert liability since Jones v Kaney [2011] UKSC 13 and share practical guidance on avoiding, and responding to, complaints and claims. Delegates, who represent over 80 areas of expertise, can also attend specialist parallel sessions covering family, criminal, commercial and medico-legal work. The day closes with the Cardiff University and University of Aberdeen Bond Solon Expert Witness Certificate Awards Ceremony and a drinks reception. The results of the Bond Solon Law Society Expert Witness Survey 2026 will be published on the day of the conference. q • Further information on the Expert Witness Conference can be found at www.bondsolon.com/courses/bond-solon-expert-witness-conference/.

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THE LAW SOCIETY OF SCOTLAND says the future of access to justice will be determined by new legislation the Scottish Government has pledged to deliver within 12 months. First Minister John Swinney has used his first Programme for Government since the May election to pledge that a Legal Aid (Scotland) Bill will be delivered in his Year One Legislative Programme. The announcement follows the launch in July of consultation for reform, underpinned by core principles that legal aid should continue to be broadly available, demand-led, delivered by publicly funded private solicitors and targeted towards those least able to pay. Law Society of Scotland President Serena Sutherland said: “The Scottish Government has acknowledged Scotland’s legal aid crisis by committing to this Bill in the first year of the new Parliament. This is an enormously significant moment for our justice sector. “Having a Legal Aid (Scotland) Bill among the first items in the Government’s legislative programme is an important step but it is only one step towards restoring legal aid and access to justice in Scotland. “The stakes here are high given how many vulnerable people are being failed by the current system. We will be working tirelessly to ensure this new Bill restores access to justice and that legal aid work is a viable career path within the solicitor profession. “The Law Society of Scotland will continue to engage with the Scottish Government, with legal aid solicitors across the country and with the wider justice sector to ensure these reforms are a success.” q

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CHIEF INSPECTOR CALLS FOR ASSESSMENTS IN POLICE CUSTODY TO PREVENT SERIOUSLY MENTALLY ILL PEOPLE ENDING UP IN PRISON [SERIOUSLY MENTALLY ILL PEOPLE

are being sent to prison when they require urgent psychiatric assessment and treatment, creating unacceptable risks for the individuals concerned, staff and other prisoners, according to the Chief Inspector of Prisons, Charlie Taylor. His warning follows concerns raised by inspectors at HMP Birmingham (pictured), where men with acute and untreated mental illness, including psychosis, were arriving from court without having received a mental health assessment in police or court custody. While this practice is not typical elsewhere in England and Wales, inspectors found it had become an established pattern in the West Midlands. Police custody staff in the region were no longer requesting completion of a Mental Health Act assessment for detainees with clear signs of mental illness, before sending them to court. On average, nine prisoners a month were arriving at Birmingham without this assessment, that would normally determine whether they should be diverted for appropriate mental health care. The consequences were severe. Inspectors found cases of men exhibiting

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disinhibited behaviour, including walking naked around wings and smearing faeces, causing significant distress to other prisoners and staff. Limited space on health care wings meant that some of the most seriously unwell men had to be managed on ordinary prison wings while awaiting specialist care. Charlie Taylor said: “What my inspectors found at Birmingham was particularly concerning. Men with severe and acute mental illness were being sent to prison when they should first have been assessed to determine the most appropriate setting for their care.

“These were often extremely vulnerable individuals whose conditions could deteriorate further in jail. At the same time, their behaviour was having a profound impact on the staff and prisoners around them. “Prison officers are not mental health professionals. They work incredibly hard to care for some very unwell people, but prisons are simply not designed or equipped to provide the level of psychiatric treatment that many of these individuals need.” HM Inspectorate of Prisons has repeatedly highlighted the difficulties faced by prisons caring for people with serious mental illness. Once identified as requiring transfer to a secure mental health hospital, many prisoners continue to experience excessive delays before a bed becomes available. At Birmingham, inspectors found that 31 prisoners had been assessed as requiring transfer since the prison was last inspected in October 2025. The longest wait in recent months had been 311 days. Similar delays have been identified elsewhere in the prison estate, with some prisoners waiting many months, and in some cases years, for appropriate treatment. q

CONSUMERS WARNED TO BEWARE OF RISKY MINI-BONDS AND LOAN NOTES [ THE FCA is warning consumers about the risks of investing

in loan notes and mini-bonds issued by unregulated companies, after continuing to see people lose money in these high-risk investments. The recent failure of Woodville Consultants Ltd, a litigation funder that raised capital from retail investors through unregulated loan notes, shows the potential risk to investors. A loan note or mini-bond usually involves lending money to a company for a set period in return for interest. If that company fails, consumers could lose every penny. The FCA permanently banned the marketing of speculative illiquid securities, including mini-bonds and loan notes, to retail investors from 1 January 2021. But consumers may still come across adverts for loan notes and mini-bonds in everyday places, including social media, online adverts or websites, promoting high fixed returns. The adverts can look simple and safe, but warning signs include pressure to act quickly, unclear explanations of how money could be lost, or claims that an investment is ‘asset-backed’ without clear evidence of what stands behind it. Examples of the practices the FCA sees include: • Unregulated introducer firms passing consumers on to unregulated companies offering high-risk investments often taking a large fee, or commission, so reducing their initial investment. • Consumers encouraged to certify themselves as experienced or wealthy investors to enable investments to be promoted to them.

• Firms promoting high-risk investments without the permission they need. • Unclear fees or hidden conflicts, where those selling the investment may benefit from consumers investing. • Scammers seeking to add ‘halo’ associations to infer legitimacy; whether that be listing on overseas exchanges or highlighting an FCA regulated firm being involved in the wider administration. • Using trust structures or other arrangements to try to stay outside FCA rules. Lucy Castledine, director of consumer investments at the FCA, said: “Big, fixed returns are a warning sign, not a guarantee. Loan notes, mini-bonds and other speculative illiquid securities are highrisk investments and are not suitable for most people. “Ordinary retail investors should only invest through regulated firms because if they invest through an unauthorised firm, they may have little or no protection if things go wrong. We are working hard to prevent harm, but consumers should still stop and check before investing.” The FCA encourages anyone involved in distributing or funding high-risk investments to report anything suspicious. This includes regulated firms, banks, payment firms, lawyers, accountants and auditors who may be involved in getting these investments to consumers. The FCA has issued more than 1,200 warnings so far this year, told firms to stop unlawful promotions and referred cases to other law enforcement agencies where further action may be needed. q

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MONEY LAUNDERING AND FINANCIAL CRIME: THE EXPERT’S ROLE IS CRUCIAL IN LITIGATION [MONEY LAUNDERING and

financial crime present increasingly complex challenges for businesses, financial institutions and professional advisers. Allegations of inadequate anti-money laundering controls, fraudulent transactions, regulatory breaches or failures in compliance can lead to substantial litigation, financial loss and reputational damage. Where such matters reach the courts, specialist financial crime expertise can be instrumental in helping the court understand the evidence and assess the standards and practices in question. A financial crime expert witness brings specialist knowledge of financial crime, anti-money laundering procedures, regulatory requirements and financial controls. Their purpose is not to argue the case of the party instructing them, but to provide an independent and impartial opinion on matters falling within their expertise. In an anti-money laundering (AML) dispute, the issues can extend considerably beyond whether suspicious transactions took place. The court may need to consider whether appropriate customer due diligence was undertaken, how risk was assessed, whether enhanced due diligence was warranted and whether transactions should have prompted further investigation. The effectiveness of transaction monitoring systems, internal reporting procedures and escalation processes may also require detailed examination. An expert can review the relevant policies and procedures alongside the practical application of those controls. This distinction can be important. A business may have comprehensive AML policies on paper, but the question may be whether those procedures were properly understood, implemented and monitored by the individuals responsible for compliance. Financial crime experts may also be instructed in cases involving alleged fraud. They can examine financial records, payment trails, accounting information and other documentary evidence to assist in establishing how transactions were undertaken and whether particular activity should have raised concerns. In complex cases involving numerous companies or individuals, specialist analysis can help identify relationships and patterns that may not otherwise be immediately apparent. Regulatory litigation raises a further set of considerations. Financial institutions and other regulated organisations are expected to maintain appropriate systems and controls and to manage the risks associated with their activities. An expert may be asked to consider whether the procedures in place were reasonable in the circumstances and whether they reflected accepted professional and regulatory practice at the relevant time. The timing of the expert's instruction can also be important. Early involvement may enable the legal team to identify the principal financial and compliance issues before proceedings become unnecessarily complicated. An expert can help assess extensive documentation, identify areas requiring further investigation and explain technical evidence to the court. The preparation of an expert report requires particular care. Opinions should be based upon the available evidence, with a clear distinction between fact and professional judgement. Relevant assumptions should be identified, methodology explained and any limitations acknowledged. An expert must remain independent, including where

the evidence does not support the position of the party who has instructed them. Expert evidence may subsequently be tested through questions from the opposing legal team or, where necessary, during cross-examination at trial. The ability to explain complex financial and regulatory matters clearly, without unnecessary technical language, is therefore an important part of the expert's role. For solicitors dealing with fraud, money laundering or financial services disputes, a suitably experienced expert witness can provide a valuable independent perspective. By bringing together practical financial crime experience, knowledge of compliance frameworks and an understanding of evidential requirements, the expert can assist the court in navigating complex transactions and determining whether the conduct and controls under scrutiny met the standards reasonably expected at the time. As financial crime becomes increasingly sophisticated, independent expert evidence can play a vital role in ensuring that allegations concerning fraud, AML and regulatory compliance are examined rigorously, objectively and on the basis of sound professional expertise. q

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WARNING AS INVESTORS LOSE HUNDREDS OF THOUSANDS OF POUNDS TO ‘PONZI-STYLE’ CRYPTO SCHEME [WOULD-BE CRYPTO INVESTORS are being warned to check

firms are registered after customers lost hundreds of thousands of pounds to a ‘Ponzi-style’ scheme. Key Coin Assets Ltd told investors it could guarantee returns of 40% to 100%, with one online post claiming ‘0 Fees, 0 Risks’. However, the Insolvency Service acted swiftly to have the company shut down when it found no evidence that any trading actually took place. Nine investors who complained to Action Fraud paid more than £300,000 to the company between them, investigations revealed. Key Coin Assets Ltd was wound up at the High Court in London on 11 August. Now, the Insolvency Service and FCA are warning others to be cautious of similar offers. Anyone thinking of investing in crypto should check the FCA’s Firm Checker to see if the firm is registered, which means it has been through some FCA checks, and see its list of unauthorised firms to avoid. Consumers should be wary of guaranteed high returns and think twice if a firm asks them to avoid normal payment references or pushes them to recruit others.

MILLIONS FORFEITED BY COMPANY LINKED TO SUSPECTED MONEY LAUNDERING [AN AGRICULTURAL COMPANY has agreed to forfeit more

than $5.2m (£3.84m) following a National Crime Agency (NCA) civil recovery investigation into suspected money laundering and sanctions evasion. ENEX Premium Trading Limited, owned by Azerbaijan national, Nadir Valiyev and registered to St Kitts and Nevis, had transferred significant funds into recently-opened accounts held by ENEX between July and September 2024. In opening the UK accounts, Nadir Valiyev stated that the source of funds was from his personal wealth and retained earnings from previous trading structures. ENEX describes itself as an independent agricultural trading and logistical company dedicated to the handling, transportation and financing of grains, oilseeds and oilseed meals. However, reports in 2024 alleged Nadir Valiyev’s companies had been involved in the shipment of stolen Ukrainian grain and, as a result, in November 2024, the NCA obtained an Account Freezing Order over the funds in ENEX’s account. The NCA started an investigation into the source of the funds and identified a network of suspected front companies and bank accounts which were being used to facilitate transactions through UK Electronic Money Institutions to be converted into cryptocurrency. The funds frozen in the UK were traced to bank accounts in China held by ENEX which had turned over tens of millions of pounds from suspected front companies during the period July to September 2024. The NCA suspects that the forfeited funds represent the proceeds of money laundering. Valiyev has denied engaging in criminal activity but agreed to forfeit the funds. The settlement agreement does not amount to an admission of unlawful conduct on the part of either ENEX or Valiyev, and does not amount to evidence of criminal conduct. The head of the NCA’s Combatting Kleptocracy Cell said: “NCA officers worked diligently to track the source of these funds, uncovering evidence that payments made into ENEX’s accounts had been made by US sanctioned companies. The NCA will continue to use all powers at our disposal to identify, pursue and recover cash used in crime.” q

Mark George, Chief Investigator at the Insolvency Service, said: “Key Coin Assets Ltd promised guaranteed returns but delivered nothing. Their behaviour displayed all the hallmarks of a Ponzi-style scheme. “Investors were told their money was being invested in crypto, but our investigation found no evidence of any genuine trading at all. Instead, funds were simply moved into the director’s personal account, often within hours of arriving. “We would urge anyone considering a similar offer to check whether a firm is registered before handing over their money, and to be deeply sceptical of anyone promising guaranteed returns with no risk.” Insolvency Service investigations found that money paid in by new investors appeared to have been used by Key Coin Assets Ltd to pay off earlier ones. Bank records showed funds were moved quickly into the personal account of the company’s director, often on the same day they arrived, and then became difficult to trace. The company also posted fake customer testimonials online without permission, and told investors to avoid using words like ‘crypto’ or ‘investment’ when making bank payments, in a bid to escape scrutiny. Accounting records were not handed over to the Insolvency Service when requested. The company repeatedly changed its official address, including to a flat whose occupants said they had never heard of it. Filings at Companies House also claimed assets of up to £42m, far higher than its actual banking activity suggested. The Official Receiver has been appointed as liquidator of Key Coin Assets Ltd. q

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THE TRIBULATIONS OF A BUSINESS VALUER By Chris Makin chartered accountant, accredited civil mediator and accredited expert determiner

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WHY is everyone getting divorced? An exaggeration, I know, but there’s certainly a lot of it about. And do I know it? As a human being, I have only pleasurable memories of marriage. I married Gillian, a farmer’s daughter, in 1969 and we had 52 years of happy companionship until she died four years ago. She was wonderful. And how I miss her! It is very sad that others don’t share such happy experiences and find it necessary to bring their marriage to an end. Of course, as a forensic accountant I feel entirely differently, because divorce is very good for business – too good, in fact. As you will see from my website – www.chrismakin.co.uk – I offer a wide range of services. As a mediator I have handled everything from expensive Italian sports cars which burst into flames, to collisions on the high seas. As an expert determiner (a form of arbitration) I have handled disputes over purchase and sale of companies, dilapidation claims in department stores and the amount of rent payable to a farmer for a wind turbine. And as an expert witness I have had the whole range of civil cases such as contractual failings, diversion of trade and unfair prejudice; as well as crime cases from international fraud and Ponzi schemes down to proceeds of crime. Forensic accountants have to be versatile! Yet what do I get these days? Endless requests for me to value the family company for divorce, so that the parties can achieve a clean break. Typically, the husband wants to keep the family business so the wife takes the house and they square things off from savings and pensions. It’s easy to establish the value of the house, if only on Zoopla, but what is the business worth? That’s my job, along with advising on tax liabilities if shares are to change hands and whether there is any spare cash which could be taken from the business to facilitate a clean break. And there is a lot of valuation work about. I seem to be getting several requests a week – I have twelve cases waiting for me to write the expert report as we speak, and in recent weeks I have turned down six such cases because I simply can’t promise to write the report in a reasonable time. Once the expert report is written – and that can be a major undertaking, where I have to know the business in some detail – and when I have answered any Questions of the Expert (to be raised within 28 days of service of my report, the questions to be raised only once and only for the purposes of clarification) my involvement is usually ended. I did have to give oral evidence at a hearing in Carlisle some weeks ago, but it was an exceptional business. And yet, you never know. I am currently being sued for professional negligence for a valuation report I prepared more than six years ago. It was a most unusual case: five separate companies owned in various proportions by husband and wife, properties and assets in some companies used by other companies in their trade, and so on. But what made it particularly difficult were two things: husband and wife’s property valuers who couldn’t agree the values; and a husband who was particularly difficult at giving me the evidence I needed. In fact, my report was delivered to the court many months late, and I had to include a chapter saying that this was due to the husband’s delays. Perhaps this is why he chose to sue me. Who knows? But the outcome was that a claim form was issued to me, one day before the six-year limitation expired! And I have to say that the claim is rubbish. The main issue is that I failed to advise on the legal and the tax

consequences of a settlement devised by counsel for both parties and agreed by the judge, some months after my retainer had ended. In fact, I knew nothing of the settlement until I saw the particulars of claim just a couple of months ago. Apparently what happened is that the two barristers got together and agreed which assets should be taken over by which spouse, and the judge agreed. It turns out they got it wrong – for example, they decided that certain properties should be passed from one party to the other, although that property was not owned by the giving party but by one of the companies. And so on. So, without my knowledge, three learned lawyers agreed a restructuring, and it was my fault that it was legally ineffective (why should a chartered accountant have given legal advice?) and inefficient taxwise (I was never asked) that the husband (allegedly) received in assets far less than his wife. And all that happened many months after I had been on the case. I am insured at Lloyds of London, with cover well in excess of the amount being demanded and with no excess. And I am being defended by Clyde & Co who are doing an excellent job. This case will not cost me a penny whichever way it goes. But it’s a nuisance, and a blow to my professional pride even though I know that the whole affair is a nonsense. This is only the second claim I have ever received. The first was forty years ago, and it went nowhere. So I have a completely clean record. But I could well do without it. Moaning over. Back to the numerous family businesses I need to value for divorce. And oh for a nice clean fatal accident or fraud case! q

About Chris Makin [

CHRIS MAKIN was one of the first 30 or so chartered accountants to become an Accredited Forensic Accountant and Expert Witness – see www.icaew.com/about-icaew/find-a-chartered-accountant/find-anaccredited-forensic-expert. He is also an accredited civil and commercial mediator and an accredited expert determiner. Over the last 30 years he has given expert evidence at least 100 times and worked on a vast range of cases. For CV, war stories and much more go to the website at www.chrismakin.co.uk – now with videos! q

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GANG CRIME, DRUGS AND EXPERT EVIDENCE [

ORGANISED CRIME presents some of the most complex challenges faced by law enforcement agencies and the criminal courts. Gang-related offending, drug supply, trafficking and and other forms of serious criminal activity can involve extensive evidence, sophisticated networks and relationships that are difficult to understand without specialist knowledge. In appropriate cases, an expert in organised crime can provide the court with independent expertise to assist in interpreting evidence and understanding the wider context of alleged criminal activity. The role of such an expert is distinct from that of a police officer or investigator. An expert witness must provide objective and impartial opinion evidence within their area of expertise, rather than advocate for either the prosecution or defence. Their specialist knowledge may derive from substantial professional experience of organised crime, intelligence analysis, drug markets or gang structures. Gang-related cases can involve terminology, behaviour and relationships that may not be readily understood by those outside the environment. An expert may assist the court in understanding the structure and characteristics of a particular gang or criminal network, the meaning of terminology and the significance of communications or observed behaviour. Care is required, however, to distinguish genuine expert interpretation from speculation about an individual's intentions or involvement. Drug-related prosecutions are another area in which specialist expertise may be required. Experts can assist with the identification and characteristics of controlled substances, drug terminology, methods of preparation and distribution, and the way illicit drugs are commonly packaged and supplied. Depending upon their particular expertise, they may also provide evidence concerning the likely significance of quantities, packaging, purity and associated paraphernalia.

The valuation of drugs can be particularly important where the quantity involved is substantial or where the prosecution case concerns alleged supply rather than possession. An appropriately qualified expert may be instructed to consider the potential value of drugs at different stages of the distribution chain, taking account of factors such as quantity, purity and geographical markets. Such evidence can help the court understand the financial scale of alleged drug activity, although valuation should always be based upon reliable evidence and an appropriate methodology. Organised crime investigations frequently involve large volumes of digital and documentary evidence. Telephone messages, social media communications, financial records, surveillance material and other intelligence may reveal patterns of contact or activity. An expert may assist in explaining recognised criminal terminology, methods of communication and aspects of organised criminal activity, while leaving questions of fact and ultimate guilt to the court. Experts may be instructed in cases involving drug trafficking and the movement of controlled substances. Their evidence can address established methods of concealment, transportation, distribution and supply, as well as the operational characteristics of organised

drug networks. Where relevant, this may assist the court in understanding whether particular evidence is consistent with recognised patterns of organised criminal activity. The preparation of expert evidence requires particular discipline. The expert should identify the evidence relied upon, explain the basis for their opinion and distinguish clearly between established facts and professional interpretation. Experience alone does not make an opinion reliable; conclusions should be supported by appropriate evidence, recognised methodology and relevant expertise. For solicitors dealing with serious criminal proceedings, instructing an appropriate expert witness early can be valuable. A suitably experienced expert may assist in assessing complex evidence, identifying areas requiring further investigation, explaining specialist terminology and addressing issues such as drug identification, distribution practices and valuation. Ultimately, the organised crime expert witness provides the court with specialist knowledge that may otherwise be unavailable. By presenting that knowledge independently, clearly and objectively, the expert can help ensure that complex allegations concerning gangs, drugs and organised criminal activity are properly understood and evaluated on the evidence. q

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BUILDING STRONGER PROPERTY CLAIMS [PROPERTY DISPUTES can become

complicated very quickly. What begins as a disagreement between two parties can develop into a detailed examination of what happened, why it happened and what the financial consequences may be. In many cases, the court must make sense of technical evidence that sits outside the normal scope of legal expertise. This is where the independent knowledge of a chartered surveyor can make a significant difference, helping to establish the facts and provide a clear professional assessment of the issues at the heart of the dispute. For solicitors handling property and construction litigation, the right expert can bring clarity to matters that may otherwise be difficult for the court to assess. A chartered surveyor can examine the physical evidence alongside plans, title documents, contracts, photographs and other records, translating often highly technical issues into clear and independent expert evidence. Boundary disputes provide a good example. Establishing where one property ends and another begins can be far more complicated than simply examining a modern plan. Historic boundaries may have changed over time, physical features may no longer correspond with the documentary evidence and the parties may have very different interpretations of their respective ownership. An experienced surveyor can assess the available evidence and provide an informed opinion on the position of the boundary and the issues that have given rise to the dispute. The same principle applies to disputes concerning rights of way, easements and access to land. Questions about how a right has historically been exercised, whether it has been interfered with or the extent of the rights enjoyed by a particular property can require detailed consideration of both the physical characteristics of the land and the documentary evidence. An independent surveyor's assessment can help establish the practical realities underlying the legal arguments. In construction and property litigation, disputes can also arise because a building has not performed as expected. Defects such as damp, water ingress, subsidence or defective workmanship may lead to allegations against contractors, developers, architects or other professionals. Establishing what went wrong is only part of the process. It may also be necessary to determine why the defect occurred, whether it could reasonably have been avoided, what remedial work is required and how much that work is likely to cost. This is where expert evidence can become particularly important. Rather than simply identifying a defect, an experienced chartered surveyor can consider the underlying cause and the relationship between the defect, the original work and any subsequent loss. Their evidence can therefore assist not only with questions of liability but also with the financial consequences of the problem. Valuation can introduce another important dimension. A dispute may depend upon the value of a property before and after an alleged defect, the effect of development restrictions or the financial impact of a breach. In such cases, specialist valuation evidence can provide the court with an objective assessment based upon appropriate market evidence and professional methodology. The role of the surveyor may extend further where a construction project has suffered delay or disruption. Major projects can generate substantial volumes of documentation, including contracts, site records and payment information. Where the parties disagree about the cause and consequences of delay, forensic analysis may be required to establish what happened and when. An expert with appropriate construction and surveying experience can examine the evidence and provide an independent opinion on responsibility and the resulting financial impact.

Quantification can ultimately be just as significant as liability. Once a court has established that a party is responsible for a breach or defect, considerable disagreement may remain over the cost of putting matters right or the extent of any loss in value. Expert evidence can help distinguish between reasonable remedial expenditure and unnecessary or disproportionate costs, providing a sound basis upon which the financial aspects of a claim can be assessed. Throughout this process, the independence of the expert remains fundamental. A chartered surveyor instructed as an expert witness has a duty to provide objective evidence within their area of expertise rather than simply support the case of the party who has instructed them. Their credibility can therefore be critical, particularly where the evidence is contested by an opposing expert. For solicitors, choosing an expert with the appropriate combination of professional qualifications, technical knowledge and relevant litigation experience can make a significant difference. The most effective expert evidence does more than confirm a client's position; it identifies the important issues, tests the available evidence and explains complex matters in a way that can be readily understood by the court. As property and construction disputes become increasingly technical and financially significant, chartered surveyor experts have an important role to play in helping to establish the facts and assess the consequences. Their independent insight can strengthen the evidential foundation of a claim, assist in narrowing areas of disagreement and ultimately help the parties move towards a fair and properly informed resolution. q

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JAPANESE KNOTWEED: WHY THE PLANT IS BACK IN THE NEWS [JAPANESE KNOTWEED has once again been attracting significant

attention in the UK, with new research highlighting the invasive plant’s potential financial impact on homeowners and the wider property market. Recent reporting suggests that as many as 7% of UK homes could be affected, either directly or through proximity to infestations, with claims that affected properties may suffer a reduction in value. Japanese knotweed is not simply a gardening nuisance: its extensive underground rhizome system makes it difficult to control and, where unmanaged, it can spread across boundaries. This can result in disputes between neighbours and, in some circumstances, nuisance claims where the plant interferes with the use or enjoyment of neighbouring land. Its presence can also complicate property transactions. Although the historic perception that any Japanese knotweed automatically makes a property unmortgageable has been significantly moderated, lenders may still require further information where an infestation is identified. Depending on the circumstances, a specialist survey, management plan and appropriate insurance-backed guarantee may be required before a mortgage is approved.

CIOB PUBLISHES FREE BUILDING REGULATIONS AND BUILDING SAFETY ACT ADVICE [A NEW GUIDE to help construction clients better understand their

responsibilities under Building Regulations and the Building Safety Act has been published by the Chartered Institute of Building (CIOB). The free guide is aimed at anyone commissioning building work on behalf of a business, public body, charity or other non-domestic organisation. It clearly sets out a client’s legal duties under the Building Safety Act 2022, as well as helping identify which projects are and are not subject to Building Regulations. The guide also includes a checklist clients are recommended to follow in advance of each project, which covers checking the competence of experts, confirming processes for managing compliance and checking if their project is categorised as a highrisk building. Ayo Allu, Chair of CIOB’s Client Steering Group, said: “As a client your role is no longer simply to commission construction work. You should help ensure it is properly planned, managed and delivered in compliance with the Building Regulations, keeping in mind the decisions you make before and during the project influence safety, quality and compliance. “You are not expected to be a technical expert. However, you are expected to make informed decisions, appoint competent people, provide necessary information to your contractor and estate manager, maintain records and remain engaged throughout the project. “It is not uncommon for projects to be derailed when clients are unaware of the level of involvement they need to have and only realise when it’s too late. By empowering clients to make good decisions from the outset and fulfil their legal obligations, their relationships with their contractors are likely to be easier and their projects more successful.” q

This reflects a more sophisticated understanding of the risks. Updated professional guidance has moved away from the previously much-publicised seven-metre rule toward an assessment based on the actual circumstances, including the extent of the infestation, its proximity to structures and the potential impact on amenity and property use. Research and professional guidance have also challenged the assumption that Japanese knotweed routinely causes serious structural damage to buildings. For surveyors and insurers, the distinction between perceived risk and demonstrable risk is therefore important. A suspected infestation should be properly identified rather than assumed, and its extent and likely consequences assessed by an appropriately qualified specialist. Legal issues can arise where a property owner knows of an infestation but fails to take reasonable steps to prevent its spread, particularly where neighbouring land becomes affected. There can also be significant implications where information about known knotweed is not properly disclosed during a property transaction. The continuing media coverage demonstrates that Japanese knotweed remains a significant property, environmental and legal issue. Expert evidence can be particularly valuable where the existence, origin, extent or impact of an infestation is disputed, or where the consequences for property value, mortgageability or neighbouring land need to be assessed objectively. q

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CRACKDOWN ON BASELESS LEGAL CLAIMS TO GET BRITAIN BUILDING [THOUSANDS OF NEW HOMES and major infrastructure

projects could be unblocked under plans being considered to reduce delays from legal challenges. In July the Government launched a consultation on extending judicial review reforms beyond Nationally Significant Infrastructure Projects (NSIPs) to major housing, transport and energy developments – such as solar projects, road building or affordable homes. While judicial review remains a vital safeguard, the consultation explored targeted reforms – including limiting repeated unsuccessful attempts to bring claims and introducing clearer court timetables – to prevent weak and meritless challenges from holding up nationally important projects, while protecting access to justice and the rule of law.

Minister for Courts and Legal Services, Sarah Sackman KC MP, said: “Britain needs more homes, better transport links and new infrastructure. Legal challenges which lack merit should not be allowed to hold back the developments that create jobs, drive growth and strengthen communities. “Judicial review will remain a vital safeguard, but it cannot be a vehicle for delay. We want to protect access to justice while getting nationally important projects built faster.” The proposals build on reforms already introduced through the Planning and Infrastructure Act 2025 and changes to court rules, which streamlined judicial review for NSIPs, helping to reduce delays, deter weak and meritless claims and ensure cases are resolved more quickly. q

BUILDING COMPANY AND DIRECTOR FINED AFTER BOTCHED EXTENSION PUT LIVES AT RISK [A YORKSHIRE-BASED building company and its director have

been sentenced after botched building work on a home extension compromised gas safety and put the lives of a homeowner and her two children at risk. Adam’s Building Construction Ltd had been hired by the homeowner to build an extension at the rear of her property in Bradford. Construction began in January 2024, but the extension was built over the top of the existing gas service pipework, without repositioning the flue serving the property’s gas boiler. This exposed the family to the risk of gas leaks, fire, explosion and carbon monoxide poisoning. An investigation by the Health and Safety Executive (HSE) found that on 22 May 2024 a Building Control Inspector from the City of Bradford Metropolitan Council attended the property and discovered that the boiler flue was terminating inside the extension. He contacted Northern Gas Networks, who found the gas installation to be immediately dangerous, with the boiler still in operation and the flue discharging into the extension. The gas supply had to be cut off, leaving the residents without gas for several weeks and costing them around £4,000 to put right. The investigation also found that Adam’s Building Construction Ltd had been warned several times by local authority Building Control Inspectors during the works that the gas pipework and flue needed to be properly relocated. The company’s sole director, Mohammed Adam Azhar, was unable to show HSE inspectors that his company had prepared construction phase plans for any of its building work, which was carried out exclusively for domestic clients. This led HSE to serve an Improvement Notice requiring the company to put in place a system for producing written construction phase plans for projects where it was the principal contractor. The company subsequently failed to comply with that notice, an offence under Section 33(1)(g) of the Health and Safety at Work etc. Act 1974. Mr Azhar also personally failed to provide relevant information to the investigation when required to do so by the HSE Lead Inspector, an offence under Section 33(1)(e) of the Act. The court heard that neither the company nor Mr Azhar continue to work in the construction trade. Adam’s Building Construction Ltd, of Leeds Road, Bradford, pleaded guilty to breaching Section 3(1) and Section 33(1)(g) of the Act. On 7 August 2026 at Leeds Magistrates Court, the company was fined a total of £10,000 and ordered to pay costs of £4,263. Mohammed Adam Azhar, of Intake Road, Bradford, pleaded guilty to breaching Section 37(1) and Section 33(1)(e) of the Act. He was fined a total of £1,000 and ordered to pay a victim surcharge of £400. HSE Inspector David Beaton said: “This was a tragic accident waiting to happen. The failure on the part of the company and its director to properly plan this building work, and to make suitable arrangements for relocating the gas pipework and appliances, could have easily had fatal

consequences for the family living in the property. “Those failures were compounded by the further failures to comply with an HSE Improvement Notice and to provide relevant information to assist our investigation. “Everyone in control of domestic building work must ensure that a suitable and sufficient construction phase plan is in place before building work commences, so that no-one faces the kind of risks this family were exposed to.” This prosecution was brought by HSE Enforcement Lawyer Arfaq Nabi and supported by Paralegal Officer Henrietta Ruthven. q

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A FIRE DOOR FRAMEWORK: WHY EVERY COMPONENT COUNTS Iain Banks of Allegion UK provides a detailed guide on the functional hardware behind fire doors, exploring how each component plays a vital role in protecting people, property and compliance.

[PASSIVE FIRE PROTECTION and fire door hardware are

intrinsically linked. Fire doors are tested as a complete assembly of certified hardware components, with performance relying on the coordination of each individual ironmongery product. Hinges, door closers, locks, latches, handles, seals and signage all have a role to play – and their ability to work in tandem is what often determines whether a fire door can perform as intended. This crucial partnership is designed to contain fire and smoke when it matters most. However, even a seemingly minor fault – whether a loose hinge, damaged seal or an incorrectly adjusted door closer – can compromise the performance of an entire fire door assembly. If one element fails, the safety of a building and its occupants is put at risk. With this in mind, careful attention must be given to the specification, installation and ongoing maintenance of fire door hardware.

Door furniture

An appropriate handle is fundamental to the safe operation of a fire door. Where decorative hardware may suit an aesthetically driven application, fire doors are functional, and as such, door furniture should prioritise durability, practicality and ease of operation. Door furniture must always remain securely fixed, with handles operating smoothly and returning freely to a horizontal position after use. Loose, damaged or missing handles can prevent the latch from engaging correctly, compromising the door’s ability to provide effective compartmentalisation.

Hinges

Fire door hinges perform one of the most demanding roles within the assembly by facilitating the necessary pivot action that provides movement to the door. To support the height and weight of a standard fire door, most timber assemblies require the installation of at least three certified hinges, with each positioned on the vertical edge of the door leaf and frame. For larger, heavier doors standing over 2.2 metres tall, a fourth hinge may be necessary. In order to withstand frequent opening and closing cycles, accurate installation and regular maintenance is essential. Each hinge must be present with all fixings secured using the correct screws supplied or specified by the manufacturer. When damaged hinges are identified, they must be replaced with likefor-like certified products, with CE, UKCA or BS EN 1935 marks present and installed in accordance with the manufacturer’s instructions.

Door closers

Door closers also play a central role in the movement of fire doors and are often regarded as one of most critical life-saving devices in passive fire protection. Typically fixed to the top face of the door leaf, concealed inside a mortised pocket or built into the floor beneath the door pivot point, door closers provide the controlled closing action that ensures a fire door has reliably closed after every use. Controlled opening speeds also help to minimise a fire door’s misuse by reducing impact damage. Such is their importance to fire door safety, closers are required on all flat entrance doors and fire doors located on escape routes. Should a fire door fail to close and engage with the latch successfully, it may be that the closer has been incorrectly installed or damaged and, therefore, needs correcting or replacing.

Locks, latches and cylinders

Where door closers are responsible for returning the door to its closed position, locks and latches make sure it remains securely closed. This is critical in a fire situation, where certified fire doors can

keep fire and smoke at bay for 30 or 60 minutes – when rated FD30 or FD60 respectively. Both locks and latches should always be fire tested as part of the complete door assembly. In fact, removing latches or replacing them with products that have not been tested can invalidate certification and compromise fire door integrity.

Hold-open and exit devices

Hold-open and exit devices are specialised hardware components that provide safe, single-action egress on fire doors. An electromagnetic hold-open device can legally hold open fire doors, allowing for a greater flow of movement in high traffic areas, whilst being primed to automatically release the door when its connected fire alarm system is activated. These devices should be tested to BS EN 1155. It’s also important to recognise that using wedges or other improvised methods to hold open a fire door is unlawful and dangerous. Should an electromagnetic hold-open device not release the door when a fire alarm is activated, a problem may have occurred, such as the door straining against its self-closing device upon operation. Panic and emergency exit devices are designed to provide safe and rapid escape with minimum effort. As such, devices must be securely fitted and functioning correctly at all times to ensure reliable operation at any given moment. Poor maintenance and unsuitable hardware replacements are common issues and can affect the mechanical operation of a system, and therefore the door. Emergency exit devices and panic exit devices must comply with BS EN 179 and BS EN 1125 respectively, together with appropriate UKCA and CE marking.

Intumescent and smoke seals

Intumescent seals are concealed around the frame or door leaf and whilst going largely unnoticed during the operation of a door, they spring into immediate, critical action during a fire. When exposed to the high temperatures of fire, intumescent seals will expand significantly. In doing so, they close the gap between the door leaf and frame, creating an effective barrier against smoke and fire. Smoke seals provide additional protection by restricting the passage of smoke before temperatures become high enough for intumescent seals to activate. The inhaling of smoke is one of greatest risks to life in the event of a fire and so, over time, seals should be regularly inspected for damage.

Fire door signage

Fire door signage is often the final piece of the compliance puzzle. ‘Fire Door Keep Shut’, ‘Automatic Fire Door Keep Clear’ and ‘Fire Exit Keep Clear’ signs are mandatory on all fire doors in the UK as per the Regulatory Reform (Fire Safety) Order 2005. They provide clear instructions to a building’s occupants and visitors and must remain present, legible, undamaged and appropriate for the door’s function. Each of these hardware components performs its own specific function and no single ironmongery product can compensate for the failure of another. In truth, the true strength of a fire door lies in how each piece of hardware works together and, for that reason, fire door hardware should never be viewed in isolation. Only when every component is recognised for its role, and subsequently specified, installed and maintained correctly, can a fire door assembly perform as intended. When the hardware is right, lives are better protected, damage is limited and compliance is achieved. q www.yourexpertwitness.co.uk

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WHERE ENGINEERING MEETS COMMERCIAL EXPERTISE [THE ENERGY SECTOR is characterised by technically demanding projects, complex contractual arrangements and substantial financial investment. From oil and gas exploration and production to processing facilities, pipelines, power generation and energy infrastructure, disputes can arise at virtually every stage of a project’s life. When they do, the court or tribunal may need to consider evidence that extends across engineering, commercial practice, market conditions and financial loss. This is where specialist energy expert witnesses can play a significant role. Their practical industry experience enables them to examine complex issues and present independent opinions that can assist the court or tribunal. Energy disputes frequently require more than one area of expertise, particularly where an engineering failure, contractual event or operational problem has resulted in substantial financial consequences.

Technical expertise in complex projects

Engineering disputes within the energy sector can concern the design, construction, commissioning, operation and maintenance of major facilities. Examples include processing plants, refineries, storage facilities, offshore installations, power stations and other specialist infrastructure. A mechanical, chemical or petroleum engineering expert may be instructed to investigate the technical circumstances giving rise to a dispute. This can involve reviewing design documentation, specifications, inspection records and maintenance histories. The expert may be asked to determine whether equipment or infrastructure performed as expected, identify the cause of a failure or assess whether work complied with appropriate engineering standards. Root-cause analysis can be particularly important following equipment failure, leakage, corrosion, structural damage or operational incidents. Establishing what happened is only part of the process. The expert may also need to consider whether the event was foreseeable, whether appropriate preventative measures were available and whether different engineering or operational decisions could have avoided the resulting consequences.

Petroleum and subsurface expertise

Oil and gas disputes can introduce an additional level of complexity because important assets and activities may be located beneath the surface. Questions may concern production licences, drilling operations, seismic information, pipelines or the development potential of particular fields. Expert evidence may be required to assess technical assumptions, production expectations, field development plans or the consequences of decisions affecting petroleum operations. Such evidence can become particularly important in disputes involving production-sharing agreements, joint ventures, licences or alleged failures to meet development commitments. The expert’s understanding of the industry can also help distinguish between technical uncertainty and evidence of inadequate performance. This can be critical where parties have adopted different assumptions about geological conditions, production rates, operating costs or future development.

Energy markets, contracts and valuation

Not every energy dispute is principally an engineering matter. The commercial aspects of energy projects can be equally significant. Oil, gas and electricity markets are subject to changing prices, supply arrangements, transportation costs and other market influences. Contractual disputes may therefore require specialist evidence concerning established industry practice, pricing mechanisms, trading arrangements or the financial consequences of a particular event.

Where a dispute involves loss or damages, an expert may be instructed to assess quantum. This can involve reconstructing the position that would have existed had the alleged breach, failure or interruption not occurred and comparing it with the actual outcome. In energy disputes, this may require detailed analysis of production, sales, market prices, operating costs and contractual obligations. The assessment of loss can be particularly challenging where the dispute involves long-term projects, fluctuating commodity prices or lost production. Independent expert analysis can provide the court or tribunal with a reasoned assessment of the financial consequences rather than relying upon broad estimates.

International disputes and arbitration

Energy projects frequently cross national boundaries, making international arbitration an important forum for resolving disputes. Expert witnesses may therefore find themselves preparing reports for international tribunals, participating in expert meetings and providing oral evidence under cross-examination. Energy disputes have been heard under a range of institutional and international arbitration procedures, often involving projects and parties from several jurisdictions. The ability to explain highly technical material clearly and withstand detailed questioning is consequently an important part of an expert's role. Independence remains fundamental, regardless of whether the appointment is made by a claimant, respondent, court or tribunal.

A multidisciplinary approach

The most complex energy disputes may require several disciplines working alongside one another. Engineering evidence may establish why a plant failed; operational expertise may consider how it was managed; petroleum expertise may address the effect on production; and commercial or quantum expertise may then assess the resulting financial loss. This multidisciplinary approach reflects the interconnected nature of modern energy projects. Technical decisions can have significant contractual and financial consequences, while commercial decisions can influence engineering and operational outcomes. For solicitors handling energy litigation or arbitration, early identification of the appropriate expert disciplines can therefore be invaluable. Whether the dispute concerns energy infrastructure, plant failure, petroleum operations, supply arrangements or damages, experienced independent experts can provide the specialist evidence necessary to turn complex technical and commercial information into a coherent assessment for the court. q www.yourexpertwitness.co.uk

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GROUNDS FOR DISPUTE [GROUND CONDITIONS fundamentally influence the design,

construction and long-term performance of buildings, infrastructure and energy projects. When unforeseen geological conditions, ground movement, contamination or subsurface risks lead to delay, additional costs or damage, disputes can quickly become technically complex. In such circumstances, specialist civil and geotechnical engineering expertise can provide the court with an independent assessment of the underlying causes and the responsibilities of those involved. Ground-related disputes may arise from a wide range of circumstances, including inadequate site investigation, unexpected soil or rock conditions, groundwater, settlement, subsidence, slope instability, foundation failure and earthworks deficiencies. Questions may also arise concerning whether the ground investigation undertaken before construction was sufficient, whether identified risks were properly understood and whether the design adequately allowed for the conditions encountered. A civil or geotechnical engineering expert can examine the available site investigation reports, geological information, construction records and monitoring data. By bringing these sources together, the expert can help establish what ground conditions were reasonably foreseeable and whether the works were designed and constructed appropriately in light of the information available at the time. Land stability is another significant area of dispute. Development on slopes, former industrial sites, reclaimed land or areas affected by historical extraction can present particular challenges. Landslides, retaining wall failures and ground movement can result in damage to structures and adjoining land. Expert evidence may be required to determine the mechanism of failure, assess whether appropriate precautions were taken and consider what remedial measures may be necessary. Environmental risk can further complicate ground-related claims. Contaminated land and the presence of hazardous substances can affect development costs, construction methods and the suitability of land for its intended use. Experts may be required to consider the extent and significance of contamination, the interaction between environmental and geotechnical conditions and whether appropriate investigation and remediation were undertaken. Petroleum and energy projects can generate particularly specialised subsurface disputes. Exploration and extraction may depend upon an accurate understanding of complex geological formations and underground conditions. Disputes may concern drilling conditions, ground movement, reservoir-related issues, underground storage or the performance of infrastructure affected by geological conditions. Such claims can involve substantial technical evidence and significant financial consequences. An expert may be instructed to assess whether the original geological and engineering assumptions were reasonable, whether subsequent conditions were genuinely unforeseen and whether design or construction decisions contributed to the resulting loss or damage. Infrastructure projects present similar challenges. Roads, railways, pipelines, utilities, reservoirs and other major civil engineering works can be particularly sensitive to ground conditions. Failures or defects may have consequences extending well beyond the immediate structure, including service disruption, additional construction costs and lengthy delays. The role of the expert is not simply to identify a defect. It is to assist the court in understanding why the problem occurred and whether it was reasonably foreseeable or preventable. This may involve considering the actions of designers, contractors, developers, site investigation specialists and other parties, while distinguishing between technical evidence and matters that fall within the court's determination. Early instruction can be valuable, particularly where the dispute involves extensive technical documentation or where site conditions

may change over time. A suitably experienced civil or geotechnical engineering expert can help identify the principal technical issues, advise on further investigation, assess competing engineering opinions and provide clear, independent evidence. In litigation, specialist expertise in ground conditions and subsurface engineering can therefore be crucial. Whether the dispute concerns unstable land, unexpected ground conditions, environmental contamination or major infrastructure failure, independent expert evidence can help establish causation, responsibility and the appropriate engineering response. q

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THE TRUTH, THE WHOLE TRUTH AND NOTHING BUT THE TRUTH? OR WHAT THEY WANT IT TO BE? By Mark Chester, of Cedarwood Tree Consultants

[

PART OF THE CHALLENGE of being an expert witness is to appraise the merits of evidence presented to me by different parties. Each case has a narrative. Sometimes, as I read the material supplied to me, I recognise that something doesn’t make sense. Finding the truth may require some detective work. One of the common defences when a tree causes damage, due to being uprooted or a branch breaking, is that inclement weather, typically a storm, was the cause. Historic weather data is now available on a postcode basis so this can be proven by some research. Several claims I have been instructed to investigate where the defendant has cited windy conditions have thus been disproved.

Tree surveyors who are not qualified

In one case, where a tree in a hedgerow collided with a lorry, extensive damage was caused. It happened shortly after a tree safety assessment. The defendant suggested that the lorry had driven into the tree. When a dashboard camera showed the tree falling from the hedgerow, the defendant tried to argue the movement was natural and there was no decay. The case was interesting because the tree specialist employed to do the survey had no training in this skill, and photographs taken on site showed the remains of the tree with a heavy ivy infestation and decay present. The ‘surveyor’ may have had a defence in that the decay might not have been visible when the survey took place. However, they did not identify decay when it was now evidence – and by adjusting their statement, the credibility of the defence was compromised. This has been a repeated theme in cases I have investigated. In another case, the ‘survey’ was little more than a walk around the site with the grounds maintenance contractor and the gardener. There were no records, no evidence that a tree condition survey had been undertaken. In another case, a claimant who proposed extensive regrading of a site, in order to plant new trees, cited their landscape specialist as the expert. It was soon evident that the specialist was skilled in hard landscaping work and not plants.

Exaggerating a claim

How often do claimants exaggerate a claim, or the extent to which the damage was caused by a tree? As the truth is unveiled, the

credibility of the claim is thus compromised. The garden shed damaged by a tree and needing to be replaced with a new one; the reality is that the original shed was old and decayed. The claimant insisting on large trees to be planted to replace those damaged by a neighbour; it would not be possible to install the large trees as they need a crane to be lifted into place which is not practical. I have been instructed to comment on personal injury claims where an arborist has been injured at work and the employer has stated they did all they could reasonably have done – but notable gaps emerge in their account. It is notable how quickly a party will settle when faced with a different, evidence-based narrative. It does sometimes require some detective work, but if I am prepared to do this, the truth will usually prevail. One of the sad aspects of these investigations is that a witness will sometimes present an incomplete account of events, trying to justify and defend their own actions, when they were possibly not at fault. It can affect credibility. An honest account is usually best, as it enables conclusions to be reached more swiftly. In several cases I have worked on, it has been clear that the testimony presented could not have happened and evidence was being concealed. Finally, it is when a party is trying to resist my investigation that I begin to suspect they are attempting to hide the truth. This has happened on several occasions, with delays to site visits and presenting an incomplete narrative. One party informed me that some trees on a site had been pruned before a branch broke and caused an accident. It was only later on, as the insurance company reviewed the case, that the fact of the tree pruning happening after the incident became apparent. A scenario that had been defendable was now much less clear-cut.

It didn’t make sense; it does now

As I read the evidence presented to me, I work to explore what happened. There are occasions when what is presented to me doesn’t make sense. Usually, a witness has provided an incomplete account of events and clarification will suffice. Sometimes, they have told the truth, but not the whole truth and not without adding to it. I love the moment when I can identify what actually happened. q

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WHEN SPECIALIST KNOWLEDGE TAKES FLIGHT IN THE COURTROOM [AVIATION DISPUTES can be exceptionally complex. Behind

every flight is a highly regulated network of people, procedures, equipment and organisations, meaning that establishing what happened when something goes wrong can require specialist knowledge extending well beyond the documents contained within a case file. For solicitors, insurers and other legal professionals involved in aviation litigation, instructing an experienced aviation expert witness can provide an essential bridge between technical industry practice and the legal questions that need answering. Aviation expert witnesses may be instructed to provide independent opinions across a broad spectrum of aviation operations, drawing upon many years of practical industry experience. With a working knowledge of the aviation sector, an appropriately experienced expert can bring an understanding of how aircraft operations, ground services, safety procedures and commercial considerations interact in real-world environments. One important area is aircraft operations. An expert may be asked to examine whether established operating procedures were followed, whether decisions made by flight or operational personnel were reasonable in the circumstances, and whether failures in communication, planning or supervision contributed to an incident. This can involve reviewing operational records, procedures, training documentation and other evidence to establish the sequence of events. Ground handling represents another significant area of expertise. Aircraft spend substantial periods on the ground, where numerous activities take place simultaneously. Baggage handling, aircraft loading, passenger boarding, refuelling, marshalling, towing and the movement of ground-support equipment can all create potential risks. Where an aircraft, passenger, employee or third party suffers injury or damage, specialist evidence may be required to establish whether appropriate procedures were followed and whether responsibilities were properly allocated. Aviation experts may also be instructed in cases concerning aviation safety. Safety management is fundamental to the industry and investigations can require a detailed understanding of risk assessment, operating procedures, reporting systems, training, supervision and regulatory compliance. An expert can assess whether an organisation's practices were consistent with accepted industry standards and whether an identified failure could reasonably have contributed to an accident or loss. There is also an important role for aviation expertise in insurancerelated cases. Aviation insurance disputes can involve complex questions concerning operational circumstances, compliance with

procedures, responsibility for an incident and the condition or use of an aircraft. An independent expert can help lawyers and insurers understand the technical and operational evidence before them. The value of an expert is not simply technical knowledge. Practical industry experience can provide insight into how aviation operations actually function, including the pressures, responsibilities and interactions between different personnel and organisations. This can be particularly important where several parties may have contributed to an incident or where contractual responsibilities overlap. For legal professionals, instructing the right aviation expert at an early stage can help identify the key technical issues, establish what evidence is required and determine where liability may ultimately rest. The expert’s role is to provide an impartial opinion, explaining complex aviation matters in terms that the court can understand. Whether a case concerns aircraft operations, ground handling, safety, insurance or an aviation-related accident, specialist expertise can make a substantial difference. q

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INDUSTRIAL ESPIONAGE AND THE OVERLOOKED VALUE [INDUSTRIAL ESPIONAGE is often associated with sophisticated

cyberattacks, stolen documents or covert surveillance. Yet sensitive information can also be obtained through something considerably less technical: watching people talk. In an increasingly competitive business environment, confidential conversations may take place in offices, conferences or other public and semi-public locations. Where individuals can be observed but not necessarily heard, professional lipreading expertise can potentially assist in identifying what was communicated and, importantly, whether sensitive information may have been exposed. For organisations concerned about protecting commercially sensitive information, forensic lipreading can form part of a wider approach to security and information management. It can also become particularly valuable after an alleged breach, when video footage exists but the accompanying audio is absent, unclear or incomplete. A specialist lipreader can examine video footage frame by frame, analysing visible mouth movements and associated facial and physical cues to determine what may have been said. This is a highly skilled discipline requiring considerable experience, as speech cannot simply be read from lip movements as though words were being transcribed from a page. Many sounds produce similar visual movements, while some sounds are barely visible at all. Context is therefore important. Where footage is available, the expert may consider the sequence of the conversation, the individuals involved, their apparent responses and any available audio or documentary

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evidence. The objective is not to fill gaps with assumption, but to provide a careful and appropriately qualified interpretation of what the visual evidence may demonstrate.

Protecting confidential information

The potential applications are considerable. Companies handling sensitive intellectual property, product development information, commercial negotiations, financial information or strategic plans may have concerns about conversations being observed in locations where unauthorised individuals could have a clear view. The possibility of covertly recording conversations visually also means organisations should consider the physical environment in which confidential discussions take place. Glass-walled meeting rooms, offices overlooking public areas and televised or streamed events can potentially create opportunities for information to be observed without the participants being aware of it. Lipreading expertise can therefore contribute to investigations into alleged information leaks. Where CCTV, security footage, photographs or other video recordings exist, a forensic examination may help establish whether a conversation visible on the recording contained potentially significant information.

The role of the expert

For solicitors, the value of a forensic lipreading expert extends beyond simply attempting to determine what was said. An expert may be instructed to assess available footage objectively, explain the

OF LIPREADING EXPERTISE FORENSIC DOCUMENT ANALYSIS: A QUESTION OF AUTHENTICITY methodology used and identify the limitations of the evidence. This can be particularly important in litigation. Courts require evidence to be presented fairly and transparently, and an expert must distinguish between what can reasonably be established and what remains uncertain. Poor-quality footage, obstructed faces, unusual camera angles, distance from the subjects or rapid speech may all affect the reliability of an interpretation. An expert report can set out the material examined, the relevant visual evidence, the interpretation reached and the degree of confidence that can reasonably be placed upon it. Where appropriate, the expert may also explain why certain words or passages cannot be reliably determined.

Prevention and investigation

Although forensic lipreading may be valuable after an alleged incident, its potential role in prevention should not be overlooked. Awareness that confidential conversations can potentially be reconstructed from visual recordings may encourage organisations to review their security procedures and the environments in which sensitive discussions occur. Industrial espionage prevention is ultimately about protecting information at every stage. Cybersecurity, physical security and staff awareness remain fundamental, but organisations should also consider the possibility of information being obtained simply by observing a conversation. Where visual evidence exists following an alleged disclosure, a suitably qualified forensic lipreading expert can provide an important additional layer of investigation. By applying specialist knowledge while clearly recognising the limitations of visual speech analysis, the expert can help establish what the evidence does – and does not – show, potentially turning an otherwise silent recording into valuable evidence. q

[FORENSIC DOCUMENT ANALYSIS is the scientific examination of

documents to establish whether they are genuine, altered or fraudulent. Documents can be crucial in legal disputes, criminal investigations and commercial transactions, meaning questions over authenticity can have significant consequences. A document may appear genuine to the untrained eye, yet detailed examination can reveal alterations, erased information, substituted pages, simulated signatures or other evidence of manipulation. Independent forensic examination can provide objective evidence to help establish whether a document can be relied upon. Forensic document examination may be required whenever the authenticity of a document is disputed. Common examples include wills, contracts, financial documents, anonymous letters and identity documents. In litigation, expert evidence can help determine whether a questioned document or signature is genuine and whether alterations have been made. A forensic document examiner can use a variety of specialist techniques depending on the nature of the investigation. These may include handwriting and signature comparison, examination of printing processes, ink analysis, paper examination and assessment of alterations. Specialist lighting and magnification can reveal features that are not readily visible, while other techniques may identify erased or overwritten material, differences between inks or evidence that pages have been substituted. The examiner may also investigate whether text or signatures have been traced, simulated or otherwise reproduced. Disputed signatures are a common reason for instructing a forensic document examiner. A person may deny signing a contract or will, argue that a signature has been copied from another document or question when or how it was added. Comparison with genuine examples can reveal significant similarities and differences, helping the expert form an evidence-based opinion regarding authorship and authenticity. Forensic document evidence can be valuable in civil litigation, probate disputes, commercial disagreements and fraud investigations. An expert report should explain the examination undertaken, the evidence identified and the reasoning behind the conclusions reached. The importance of professional document examination lies in its ability to look beyond appearances. Where the authenticity of a document is fundamental to a dispute, specialist forensic analysis can provide the independent evidence needed to establish what happened and whether the document can safely be relied upon. q

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ACCOUNTANCY

AGRICULTURAL & HORTICULTURAL CONSULTANTS

ARTS & ANTIQUES SURVEYORS

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BUILDING, PROPERTY & CONSTRUCTION

COLLISION INVESTIGATION & RECONSTRUCTION

COMPLIANCE CONSULTANTS

COMPUTER & MOBILE FORENSICS

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CRIMINOLOGY

ENGINEERS

DIGITAL TECHNOLOGY

ENERGY CONSULTANTS ERGONOMICS

FINANCIAL SERVICES

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FIRE SAFETY

GARDEN CONSULTANTS

INSURANCE

FORENSIC DOCUMENTS

MARINE DISPUTES

FORENSIC SERVICES

MECHANICAL & PROCESS ENGINEERING

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POLICE CUSTODY

TRANSLATING & INTERPRETING TREE CONSULTANTS

WOOD & TIMBER

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Your Expert Witness A to Z guide of Expert Witness websites NON-MEDICAL SECTION Andrew F Acquier BA FRICS

Dr Daniel Jones MA, MEWI Cert

www.andrewacquier.co.uk

www.advancedinvasives.com

Chartered Art & Antiques Surveyor Expert witness reports and representation at court for matters involving: • Divorce settlements • Insurance valuation disputes • Arts litigation • Contentious Probate • Associate member of Resolution for many years

Foremost international Japanese Knotweed, Himalayan Balsam and Giant Hogweed expert. • Residential, Commercial, Industrial • Construction & Engineering • Infrastructure & Transportation • Independent Audit

Clarke Gammon

Mr Chris Makin

Chartered Surveyors with experience in All Aspects of Property • Residential property values • Asset valuations • Land values and more

• Chartered Accountant • Accredited Civil Mediator • Accredited Expert Determiner

www.clarkegammon.co.uk

www.chrismakin.co.uk

Crowe Expert Witness Services

Andrew Smith FPC III CeMAP

www.crowe.co.uk

www.paxen.co.uk

Forensic and Tax Resolutions Specialists Audit / Tax / Advisory / Consulting Smart decisions. Lasting value.

Financial Conduct Authority Compliance & Risk Consultant Cases relating to FCA compliance in consumer credit and mortgage lending. • Mediation • Arbitration • Adjudication • Expert Determination

DRC Forensics Limited

Simon Quinton Smith BSc FRICS MI Hort

DRC Forensics Limited offers the complete range of forensic accounting & litigation support: • Fraud • Money laundering • Partnership disputes • Loss of profit • Professional negligence

Expert Witness to the Garden Centre & Horticultural Industry • Rent Reviews • Valuation • Compensation • Lease Renewals • Acquisitions

FHDI - Kathryn Thorndycraft-Pope

Colin Todd – Fire Safety Expert

www.drcforensics.co.uk

Examining documents & handwriting • to determine authenticity • to expose forgery • to reveal aspects of origin. Forensic Equipment: ESDA, VSC and Mi-Scope.

www.forensichandwriting.co.uk

www.quintonedwards.co.uk

• Fire safety management • Fire risk assessment • Means of escape • Fire protection of buildings • Fire engineering • Application of fire safety legislation • Fire detection and alarm systems

www.cstodd.co.uk

Mr Roger Flaxman ACII MAE

Chartered Insurance Practitioner with more than two decade’s experience serving as an expert witness in matters of insurance practice, broker’s duty of care, insurance market procedure and as an advocate in the resolution of disputed insurance claims.

www.flaxmanpartners.co.uk

Forensic Collision Investigation & Reconstruction Ltd Specialists in the analysis of road traffic collisions • Collision Reconstruction • Expert Witness • Vehicle Examinations

www.FCIR.co.uk Formedecon Ltd Forensic & Investigative Services to the Legal Profession • All Aspects of Forensic Work Undertaken • LAA and Privately Funded • Free Estimates

WOODEXPERTS

Specialist Timber Consultancy and Training since 1991 • Site visits & investigations • Structural surveys • Desktop analysis & review of documents • Specialist reports • Species identification

www.woodexperts.com

www.Formedecon.com

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MEDICAL NOTES ............................... [ THE IMPORTANCE of early resolution in clinical negligence claims continues to attract attention, with NHS Resolution reporting record levels of claims being resolved without the need for court proceedings. While early resolution can reduce the costs and distress associated with prolonged disputes, ensuring that the evidence is properly investigated and patients receive appropriate compensation remains essential. This focus on evidence and accountability leads naturally to the wider responsibilities of healthcare professionals, including those working within the family courts.

• The need for family courts to do more to ensure that children’s voices are heard is an important issue. The views and experiences of children can be central to decisions affecting their lives, and specialist professionals can help the court understand their circumstances. Effective communication is equally important when considering professional standards and the GMC’s latest fitness to practise data provides insight into concerns raised about doctors and the processes involved in investigating them. Such information contributes to the wider discussion around accountability and patient safety. • These issues are particularly relevant at a time when healthcare services continue to face significant pressures. Gynaecology waiting times and rising demand for services raise concerns about access to care, while delays in diagnosis, referral and treatment can have serious consequences. Establishing whether appropriate care was provided, and whether earlier intervention might have changed the outcome, is a question that often requires specialist medical evidence. • The complexity of diagnosis and treatment is also reflected in cases relating to urology, where expert witnesses can play a critical role in assessing conditions, treatment decisions and alleged clinical negligence. Pharmacology provides another important area of expertise, particularly where medication, dosage and adverse effects can be central to a claim. Across these specialties, careful examination of the clinical records is essential when determining whether the appropriate standard of care was met. • From diagnosis and treatment, we turn to the wider role of the physiotherapist. Their expertise extends beyond rehabilitation to mobility, function, pain and the impact of injury or illness on everyday life. This is particularly significant in cases involving diabetic foot disease, where early assessment and coordinated care may be central to questions surrounding amputation. Determining whether an amputation could have been avoided requires detailed consideration of the individual circumstances and available medical evidence. • These varied subjects demonstrate the breadth of expertise required across the medico-legal field. From resolving claims and understanding children’s experiences to examining clinical decisions and long-term outcomes, specialist knowledge remains vital in helping solicitors and the courts understand complex evidence. We hope this issue provides useful insight into the professionals whose expertise can make a meaningful contribution to the legal process. q

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HEALTH RISK BLIND SPOT: UK PUBLIC BOOKING TREATMENTS WITHOUT KNOWING IF THEY’RE REGULATED [ NEW RESEARCH commissioned by the Professional

Standards Authority (PSA) reveals consumers spend almost as long researching a hotel stay as they do a private baby scan clinic, with one in four not considering safety checks when booking appointments. More than half of those surveyed say they would do more research before booking a health service if they thought there was a risk involved, but the findings reveal a dangerous blind spot – most don’t realise that some roles may not be regulated – meaning anyone can legally offer private baby scans, therapy and cosmetic treatments like fillers and Botox. The research exposes a summer safety gap at the very moment demand for some of these services peaks – from pre-wedding aesthetics to reassurance ultrasound scans. The findings were released in August as the PSA launched its Look Before You Book campaign, encouraging consumers to check their practitioner is on a government-backed register before accessing health and wellbeing services and to look for the PSA Quality Mark. The key findings included: • The regulation myth: three-quarters of those surveyed (75%) believe therapists and private ultrasound providers are legally regulated, and nearly half (46%) believe the same of aesthetic practitioners offering non-surgical cosmetic treatments like Botox and fillers. In reality, none of these roles are regulated in the UK. • Safety resources go unused: only one in six people (16.5%) have used a ‘verified’ source, such as a government-backed register, before booking non-surgical aesthetic treatments, therapy or a private ultrasound • The summer scarcity trap: the findings revealed that research tends to be less thorough when under pressure with 28% saying they do less research when appointments are scarce, 25% when under time pressure before an event and 24% when looking for a last-minute slot – all these were red flags in the run up to the wedding, holiday and party season. • Sold by social media: more than a third (36%) of people seeking Botox, fillers or other non-surgical cosmetic treatments say they are influenced by five-star reviews, and almost one in three (29%) rely on before-and-after photos or testimonials on social media. • Young people at greater risk: 18-24-year-olds are both the least likely age group to check a practitioner's qualifications before booking (32%) and among the most likely to assume services are regulated. More than eight in 10 (83%) believe counsellors are legally regulated and over half (53%) think the same of aesthetic practitioners, compared with just 64% and 26% of over-55s respectively.

Cheshire, underwent a non-surgical cosmetic procedure after being attracted by a significantly lower price than competitors. After finding a clinic through Instagram offering tear trough fillers for £150, compared with quotes of around £495 elsewhere, Joanne booked the treatment based largely on pricing and before-and-after images she had seen on social media. But the experience quickly turned into a nightmare. “When she finally gave me the mirror, my first thought was ‘oh my goodness, I've just been mutilated. I just need to get out of here’” Joanne recalls. “I felt pure dread and thought ‘I’ve been botched. I’ve ruined my face’. “I wished I’d done some more homework and checked the qualifications of the practitioner and their history. I felt really vulnerable because I was on her territory.” Joanne says she felt unable to leave the house for two weeks. “I got my husband to do the school run. I didn’t socialise. It affected my confidence at work, and my girls didn’t understand what had happened. It could have been a lot worse. I’d had something done that could be dissolved, but I spent a fortune getting it corrected. “It cost me over £700. I had to go into my savings to pay for it. I want people to ask more questions: when you’re going to a nonsurgical aesthetician and they’re putting you straight in the chair and you’re out within 10 minutes – it should be a red flag.” PSA Chair, Caroline Corby, said: “Protecting our health is really important. Worryingly, this research reveals a clear health risk blind spot. It shows that more than half of consumers would do more research if they believed there was a health risk, yet only a small minority – as low as one in six people – use a verified source, such as a government-backed register, before booking. “And these findings add to growing evidence that gaps in the regulation of health and wellbeing services can put consumers at risk, particularly those seeking cosmetic procedures. “We’re saying take one simple extra step before making an appointment: look for the PSA Quality Mark to check whether your practitioner belongs to a government-backed register. The Quality Mark shows you that someone is checking that practitioner, and that someone else is making sure those checks are the right ones. “By taking a few moments to look for the Quality Mark, consumers and patients can make more informed choices about their health, wellbeing and safety.” q • For more information about the campaign, and how to check whether a practitioner belongs to an Accredited Register, visit www.professionalstandards.org.uk/look-mark-general.

The regulation reality

In the UK, anyone can legally buy an ultrasound machine and call themselves a sonographer without formal qualifications. Anyone can call themselves a counsellor or psychotherapist regardless of how much training and experience they have. Likewise, non-surgical cosmetic procedures such as dermal fillers and Botox are completely unregulated in parts of the UK, meaning unqualified people can legally administer them and perform other aesthetic treatments. Alongside the research, a Cheshire mum whose botched fillers left her housebound and paying over £700 for corrective procedures has given a stark warning, saying: “Do your homework and check the PSA register before you book.” Joanne, a 48-year-old finance director and mother of two from www.yourexpertwitness.co.uk

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NHS RESOLUTION DELIVERS RECORD EARLY RESOLUTION OF CLAIMS AS NEW STRATEGY SHOWS IMPACT [

NHS RESOLUTION’S Annual Report and Accounts for 2025/26 shows that a record 84% of clinical negligence claims were resolved without the need for formal legal proceedings, demonstrating the impact of its ‘Resolution Through Collaboration’ strategy in its first year. The strategy focuses on delivering fairer resolution, using data to drive learning and strengthening NHS Resolution’s contribution to improving patient safety – particularly in maternity and neonatal care. In line with this approach, NHS Resolution has continued to prioritise early, collaborative resolution of claims, enabling thousands of patients and families to receive answers and compensation more quickly and without the need for court proceedings. By working collaboratively with the NHS, patients and their representatives, NHS Resolution is reducing the emotional and financial burden of litigation while sharing learning to help prevent future harm. The report also highlights that NHS Resolution received 15,236 new clinical negligence claims and reported incidents in 2025/26, an increase on the previous year. This reflects a combination of increased NHS activity and the time lag between incidents occurring and claims being brought. Despite growing volume and complexity, NHS Resolution continues to deliver consistently across its core services. The report notes that most business plan objectives were achieved, alongside the majority of key performance indicators. There has also been significant external scrutiny of clinical negligence costs during the year. NHS Resolution worked closely with the National Audit Office and the Public Accounts Committee and welcomes their findings, which recognised the organisation’s work to resolve claims more quickly and reduce both the financial and emotional costs associated with litigation. NHS Resolution continues to play a unique role in supporting patient safety across the healthcare system, using its data and insight to identify risks and support improvement. During the year, it facilitated over 1,000 engagements with NHS organisations and partners, helping translate learning from claims into changes in clinical practice. According to NHS Resolution: “Improving maternity and neonatal safety remains a central priority and we recognise that avoidable errors in maternity and neonatal services still occur and that incidents have devastating consequences for the child, mother and wider family, as well as the NHS staff involved. “In 2025/26 we published the evaluation of the Maternity Incentive Scheme. It will be followed by the evaluation of the Early Notification Scheme in 2026/27. These evaluations provide vital insight and we have used – and will use – their findings to help us to reform and evolve the schemes.” The organisation also continued a major programme of operational transformation through the rollout of its new case management system, CaseHub. While this has created short-term operational challenges, NHS Resolution has maintained a focus on minimising impact for patients and ensuring compensation payments were made

without delay. The system will support faster, more effective claims resolution and improved data in the longer term. Helen Vernon, CEO of NHS Resolution, said: “We recognise the ongoing challenges across the system and we will continue to work closely with government and partners to address these issues, while remaining focused on resolving claims fairly, sharing learning and supporting safer care across the NHS.” q • NHS Resolution’s Annual report and accounts for 2025/26 is now available on the NHS Resolution website at resolution.nhs.uk/about/ corporate-reports-and-publications/.

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MHRA ADVISES QUARANTINE OF MEDICAL DEVICES WITHOUT APPROPRIATE CONFORMITY MARKINGS [ THE Medicines and Healthcare products Regulatory Agency (MHRA) is advising healthcare professionals to stop using and supplying certain medical devices that have been supplied on to the UK market without the appropriate conformity markings required under the UK Medical Devices Regulations 2002 and under the EU Medical Devices Regulation (EU) 2017/745. The affected devices include products used in clinical settings for blood collection and infusion, surgical and biopsy procedures, wound management and skin preparation. The devices do not have the appropriate conformity markings and supporting certification required for legal supply on the UK market. The MHRA has not identified any specific defect, performance issue, quality issue or safety signal with the products. However, because the devices have not undergone the appropriate conformity assessment for supply in the UK, there is not enough reassurance that they meet UK regulatory requirements or the expected standards for quality, safety and sterility. The affected products are: • VAKU-8 Blood Collection / Infusion / Scalp Vein Set: Hindustan Syringes & Medical Devices Ltd • Bipson’s Gauze Swab Sterile: Bipson Surgical Private Ltd • Technocut Scalpel: Niraj Industries Ltd • Romsons Alco Swabs: Romsons Group Private Ltd • Medi Grip Adhesive Bandage (Antiseptic): Precision Coatings (P) Ltd • Bone Marrow Biopsy Needle: Meditech Devices Pvt. Ltd (pictured). Individuals and organisations should check whether they have any of the affected devices in use or available for supply. If they do, they should immediately stop using and supplying them, quarantine any remaining stock and use compliant alternatives. Organisations should notify the MHRA immediately if they think they have received, supplied or distributed any affected devices, and provide details of any onward distribution where known. They should retain the affected devices pending further advice from the MHRA. Distributors have been advised to cease further supply of the affected devices and notify the MHRA if they have received, supplied or distributed any of the products. They should also assist with traceability activities where requested. Healthcare professionals have been advised to report any suspected or actual adverse incidents involving these devices through the appropriate reporting arrangements for their region. q

SURGEONS RESPOND TO WELSH GOVERNMENT ANNOUNCEMENT ON FUNDING TO CUT WAITING LIST [ COMMENTING ON the Welsh Government announcement on

funding to cut the NHS Wales waiting list and end two-year waits for treatment, Professor Jon Barry, Director in Wales at the Royal College of Surgeons of England, said: “There have been welcome signs of progress in tackling waiting lists during the first three months of this Welsh Government term, including the creation of an expert group to develop plans for expanding surgical hubs by the end of the year. “Increasing capacity for the operations where patients are waiting longest, alongside improvements to referrals and follow-up care, should help more patients get treatment sooner. “Behind every waiting list figure is a patient whose life is on hold. Delivering these ambitions will depend on continued support for the NHS workforce, whose dedication is central to reducing waits and improving patient care.” q www.yourexpertwitness.co.uk

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‘LOFTY’ CLINICAL NEGLIGENCE EXPERTS LEAVE JUDGE UNABLE TO RELY ON THEIR EVIDENCE A recent clinical negligence case illustrates numerous ways in which an expert witness can thoroughly lose the confidence of a judge, despite already being known to him as a reliable and professional expert. In Liam Dickinson v Newcastle upon Tyne Hospitals NHS Foundation Trust [2026], despite describing one of the experts as an ‘undoubtedly eminent and experienced expert’, the judge, Charles Bagot KC, was unable to see past the expert’s handling of certain aspects of the evidence and his own errors. This case shows that even experts of sound reputation and extensive experience cannot expect to escape criticism after a poor performance. Judges will respond only to the evidence in front of them and if it lacks credibility their judgment will reflect that no matter the standing of the expert. Here, Bond Solon, summarise the case and its key findings.

[THE KEY ISSUE in this case was whether the defendant’s self-

confessed failure to administer intravenous thiamine (Pabrinex) had caused the claimant to develop Wernicke’s Encephalopathy (WE), leading to Functional Neurological Disorder (FND) and Functional Cognitive Disorder (FCD). Despite admitting negligence in not administering Pabrinex to the patient, whose alcoholism indicated it was required, the defendant argued that the claimant had never developed WE and that the FND and FCD were either already present or developed independently to the index incident.

What were the main concerns with the expert evidence?

The defence relied heavily on questioning the findings of the clinical staff who had diagnosed WE. The judge felt that the defendant’s experts had pre-determined that WE had not been present and went on to interpret the evidence in that light. Moreover, he pointed to factual errors in their reports. One such error was to mistakenly recall that the claimant ‘did not know who he was’, when in fact the evidence from his wife, Mrs Dickinson, had been that he did not know who ‘she’ was and did not know ‘where’ he was. The judge considered this was an important factual error that the expert ‘latched onto’ and skewed their subsequent reasoning. The judge was also concerned by the same expert’s ease at dismissing the contemporaneous evidence of various treating clinicians, including consultants, that diagnosed WE. He said the defendant expert showed ‘an excess of confidence in their ability retrospectively to second-guess the contemporaneous notes’. In other words, they implied they knew better than all the doctors dealing with the patient at the time, with the judge saying the expert had given ‘an impression of loftiness’ when contradicting medical evidence.

“I have no idea what that is.” The judge said he found it curious that his response was not to apologise for the error or recognise it as such, but to express his lack of understanding of it. The judge pointed out that the defendant’s expert ‘had been uncharacteristically less careful than my previous experience of him, in the preparation and presentation of his evidence in this case’, emphasising that precision in previous court appearances would not override later carelessness in another. Somewhat witheringly, the judge went onto say that their reaction to errors and omissions ‘gave me pause for thought about the cogency of their overall opinions’.

What was the outcome of the case?

The judge found that on the balance of probabilities the claimant did develop WE because of the required drug not being administered sooner. His finding was ultimately based on the evidence and the confidence he had in the claimant experts’ analysis. He said: “In my judgment, there is a clear thread of cause and effect to be followed through the records in this period backed by the claimant’s experts’ opinions.” q • Bond Solon provides training covering all the core skills and knowledge expert witnesses require to fulfil their role compliantly and effectively, including their Clinical Negligence Essentials Part 1 and Part 2 courses, which are designed and delivered by a leading clinical negligence lawyer for expert witnesses working or wishing to start work in this field. They also offer university certified training programmes that are widely regarded as the industry gold standard by instructing parties.

How should an expert respond when made aware of errors in their work?

The judge also commented on the difference between the ways in which the defendant and claimant experts responded to being made aware of errors in their work. He said: “It was not that surprising that all of the experts had made one or two errors.” He also highlighted where the experts on both sides had ‘overlooked or failed to mention entries which the other party thought significant’. One of the claimant’s experts accepted he had not noted a GP entry for 1 June 2016. However, when it turned out one of the defendant’s experts had also not recorded it, the judge described their attitude to their errors as ‘less satisfactory’. In one instance the judge said one of the defendant’s experts had been asked to clarify what the phrase ‘foredge waste’ meant. While it was clearly an error, the expert did not apologise for it, he simply said: www.yourexpertwitness.co.uk

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GMC PUBLISHES FITNESS TO PRACTISE DATA FOR DOCTORS [THE GENERAL MEDICAL COUNCIL (GMC) has published data

tracking fitness to practise concerns, and their outcomes, for doctors during 2025. The GMC publishes these statistics every year, but this year’s report has been redesigned to give patients, doctors and others more information about how concerns are assessed, progressed and concluded. During the year, 13,465 concerns were assessed as part of the regulator’s triage process, the initial stage which determines if a concern meets the threshold for action. That was a 25% increase on 2024, when 10,769 concerns were triaged. In 2025 there were 410,566 registered doctors. In 2025, most cases (12,146 of the 13,465), were closed as they did not meet the legal threshold for a full investigation. This is based on criteria including whether the concern relates to a doctor’s fitness to practise, its seriousness and potential risk to patients or public confidence, and whether the GMC is the correct organisation to address the issue. Cases that meet the threshold for regulatory action move to a formal investigation, after which GMC case examiners decide what action, if any, is required. In 2025, case examiners considered 679 cases. Of those, 184 were referred to an independent tribunal, 110 doctors were given warnings, 60 agreed ‘undertakings’ – restrictions on their practice – and 16 were given advice by the regulator. The remaining 309 cases were closed with no further action, often because issues had already been addressed and there was no ongoing risk. Tribunals, which make independent decisions and are run by the Medical Practitioners Tribunal Service, hear evidence from the GMC, the doctor and any witnesses before deciding if a doctor’s practice is impaired. In 2025 there were 160 tribunals. Of those, 124 resulted in a finding of impairment against the doctor. As a result, 48 were struck off – the sanction used for the most serious cases where a doctor’s behaviour, performance or health means they cannot safely remain on the medical register. 68 doctors who had a finding of impairment were suspended and seven had conditions placed on their licence to practise. In one case no further action was taken. 34 doctors were found not to be impaired, although 11 were still given a warning. More than 90% of the cases brought to a tribunal during the year involved either misconduct, such as dishonesty or sexual misconduct, criminal convictions, or both. GMC Chief Executive Charlie Massey said: “Patients place a high degree of trust in those involved in their care, and the vast majority of doctors are dedicated to providing good and safe care. It is only in a small proportion of cases, where serious concerns arise, that action is required. In 2025, this accounted for just 3% of all registered doctors.    ”But we know that every concern we receive involves real people – patients, families, doctors and colleagues – and that raising or responding to a concern can be difficult. We are committed to handling every case with compassion, clarity and fairness. “In recent years we have also strengthened our outreach work, expanding the number of GMC liaison advisors who work across every region of the UK’s four countries. They work closely with Responsible Officers, discussing local processes and expectations, as well as our fitness to practise thresholds.” This year’s report sets out the decision points used throughout the fitness to practise process, from initial triage through to investigation and tribunal. It also provides information about the support that is available to patients, witnesses and professionals involved in an investigation. The changes intend to support a more informed conversation about patient care and the role of professional regulation.

Charlie Massey explained: ”Dealing with concerns about fitness to practise is complex, and data alone cannot tell the full story. By communicating clearly about how concerns are handled, we can help make sure people feel able to speak up and engage with our processes, so the system can operate effectively in the interests of patient care and public confidence.” q

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FAMILY COURTS MUST DO MORE TO HEAR CHILDREN’S VOICES, STUDY SAYS [CHILDREN INVOLVED in private family law proceedings in England

can experience serious harm to their mental and physical health because their voices are too often ignored or dismissed, according to new research led by the University of Manchester in partnership with SHERA Research Group members and The Survivor Family Network. The study argues that children are frequently treated as passive participants in family court proceedings, with their accounts of abuse, distress and fear often minimised or interpreted through adult assumptions rather than being given meaningful weight in decisions that affect their lives. Researchers analysed the experiences of 77 children involved in private family law cases, based on interviews with 45 mothers. Using the concept of ‘childism’ – prejudice and discrimination that devalues children’s perspectives and how to challenge these prejudices – they found evidence of systemic failures that can leave children feeling unheard and exposed to further harm. The study found children experienced a wide range of psychological, emotional and physical impacts during family law proceedings. These included anxiety, depression, trauma responses, suicidal thoughts, eating disorders, social withdrawal, disrupted schooling, developmental regression and other health problems. Researchers found many children who expressed fear or reluctance to have contact with an abusive parent were viewed as unreliable or as having been influenced by their mother. Meanwhile, children who appeared outwardly compliant were often assumed to be safe, even though silence may itself have reflected fear or trauma. The research also found some children became ‘aged’ by the court process, taking on inappropriate caring responsibilities or feeling

responsible for the consequences of court decisions, with some facing threats that their mothers would go to prison if they did not comply.

Children’s voices often overlooked

The study identified examples of what researchers describe as ‘institutional silencing’, where children’s wishes were reportedly summarised in some cases without professionals speaking to them directly, or where children’s views carried little influence over final court decisions. The researchers argue that children’s rights under the United Nations Convention on the Rights of the Child are not consistently reflected in current family court practice and that children’s participation is often more symbolic than meaningful. The study also raises concerns that coercive control can continue after parental separation through the misuse of technology. Some participants described abusive fathers allegedly using access to children’s medical information to monitor or intimidate them, which the authors describe as a form of technology-facilitated abuse that requires recognition by both legal and healthcare professionals. Despite the challenges identified, the research also found examples of good practice. Trauma-informed counselling, play therapy and healthcare professionals who prioritised children’s privacy and wellbeing were all reported to help children recover, build resilience and regain confidence. The researchers say these examples demonstrate that child-led approaches can improve both children’s wellbeing and their ability to participate meaningfully in decisions affecting them. “Our findings suggest that children are often the least powerful people in proceedings that determine the course of their lives,” said Dr Elizabeth Dalgarno from The University of Manchester. “Too often, their experiences of abuse, fear and trauma are filtered through adult assumptions rather than being heard on their own terms. “Children should not simply be the subject of family court decisions – they should be recognised as rights holders whose voices shape those decisions. “While I welcome the child-focused courts that the government has introduced, the family justice system has an opportunity to move from seeing children as passive recipients of adult decisions to recognising them as active participants. If children’s voices are consistently heard, respected and acted upon, family courts will better protect their safety, wellbeing and long-term health.”

Recommendations

The researchers are calling for major reforms to private family law proceedings, including: • Ensuring children’s voices are routinely and meaningfully heard throughout family court proceedings. • Embedding the principles of the UN Convention on the Rights of the Child more fully into domestic law. • Reforming family court practice so children’s views genuinely influence decisions affecting them. • Providing specialist training for judges, legal professionals and safeguarding practitioners on children’s rights, trauma, coercive control and child sexual abuse. • Introducing stronger safeguards against technology-facilitated abuse, including the misuse of children's medical information. • Expanding access to child-centred, trauma-informed interventions such as play therapy and specialist counselling. The authors concluded that meaningful reform will require not only legislative change but also a cultural shift across the family justice system towards recognising children as equal rights holders whose lived experiences should guide judicial decision-making. q

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DELAYED BOWEL CANCER DIAGNOSIS LEADS TO SIX-FIGURE SETTLEMENT [

A HOSPITAL TRUST has admitted an 11-month delay in diagnosing a patient’s bowel cancer after failing to arrange essential follow-up investigations, resulting in a six-figure out-of-court settlement. The 61-year-old man had initially attended the A&E department at Doncaster Royal Infirmary after experiencing lower abdominal pain on his left side and becoming concerned about a lump that had developed in his abdomen. Investigations identified diverticular disease accompanied by ongoing inflammation. However, the results were not considered conclusive enough to exclude the possibility of cancer. A plan was therefore made for further investigation, including a colonoscopy approximately three months later. However, the follow-up did not take place. According to the legal claim, notes that should have been passed to the referring consultant were instead placed within the patient’s general medical records. As a result, the planned follow-up was not arranged and the patient was not contacted. Approximately 11 months later, when he attended York Hospital after experiencing further abdominal pain and losing around a stone in weight, he was diagnosed with colon cancer. Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust admitted that the delay in diagnosis had allowed the cancer to progress.The Trust also admitted that the delay resulted in the patient requiring surgical procedures that could otherwise have been avoided, including the fitting of a colostomy bag. The colostomy was subsequently reversed. Following chemotherapy, the patient was diagnosed with peripheral neuropathy, a form of nerve damage that can affect the hands, feet and arms. The legal claim alleged that the neuropathy resulted from the use of the chemotherapy drug Oxaliplatin as part of dual-agent treatment that became necessary because the cancer had progressed during the period of delayed diagnosis. The Trust did not accept responsibility for the neuropathy. Its position was that the patient would have required the same chemotherapy treatment even if his cancer had been diagnosed and treated earlier. The man said that over the 11 months period, between first being seen in Doncaster Royal Infirmary and attending at York A&E, he had believed his pains were caused by diverticular disease. Although he underwent successful chemotherapy and eventually had the colostomy bag removed, he said it had a significant impact on his quality of life. He had to give up work as a contractor and was no longer able to enjoy hobbies including golf, fishing and cycling. “This has had a devastating effect on me and my family. My life has turned upside down,” he said. “At the time of my cancer diagnosis I was working as a self-employed contractor. I was unable to return to this work because I developed peripheral neuropathy which made it impossible to perform the fine motor movements required. “I first noticed problems with my hands and feet about halfway through the chemotherapy. It started off with pins and needles down the length of the fingers of my left hand and in the tips of my fingers in my right hand. I found that I could not withstand the cold and that I had to wear gloves, a scarf and a hat most of the time. “I discussed these symptoms with the doctors who were treating me, and I was informed that was neuropathy and was a side-effect of the chemotherapy medication that I was taking. “Because of the nerve damage to my feet, I have difficulty walking and need to use a stick whenever I leave the house. I also suffer with cramps in my hands, legs and feet. “I need help from my wife and family with simple things like doing up my buttons, zips or tying my shoelaces. I also randomly drop things because of the nerve damage to my hands.”

Solicitor Abigail Frudd of Hudgell Solicitors, who represented the man in the legal case, said: “This was an inexcusable error. Tests had been inconclusive with regards to being able to rule out cancer and it was decided that the best course of action was to book the patient in for more tests in three months’ time. That didn’t happen simply because the notes were not passed onto a consultant and they were effectively filed. “My client, who had been told he had diverticular disease, believed that to be the cause of increasing pain over the coming months, when in fact his cancer was progressing. Thankfully, he did take it upon himself to go to a hospital when he continued suffering from pain, as had he not, the cancer would have continued to develop. “Sadly, we see this all too often in our work. Patients, who try to look at the positives and see no news as good news, find out they have cancer which could and should have been caught earlier, at appointments which hospitals have failed to ensure happen. “Our advice to patients is never to assume that no news is good news. If you’ve had tests and not had results, or not had a communication over a follow-up appointment or tests you expected to have, chase them up.” A spokesperson for Doncaster and Bassetlaw Teaching Hospitals said: “We regret that further tests recommended for this patient in 2016 were not arranged. Following a Serious Incident investigation, changes were made to strengthen follow-up processes, which have developed significantly since then, including through greater use of electronic records. “We are truly sorry for the impact this had on the patient and his family.” q

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MORE THAN 2,500 DOCTORS ASKED FOR MDU’S HELP WITH CORONERS' INQUESTS IN 2025 [GROWING NUMBERS of doctors are seeking medicolegal support

from the Medical Defence Union (MDU) with coroners’ inquests. New MDU data reveals that the number of requests for help more than doubled over the last decade, rising from 1,126 in 2015 to 2,537 in 2025, with a sharp rise since 2018. GPs accounted for over 60% of requests for support in 2025, while most other cases came from doctors working in hospitals. Despite an overall decrease in the number of deaths reported to coroners last year, latest government figures show that the proportion of deaths resulting in an inquest increased from 21% in 2024 to 24% in 2025. The most common conclusions were misadventure, suicide and drug- and alcohol-related deaths. Dr Udvitha Nandasoma at the MDU explained what might be driving more GPs to seek support: “We’re seeing that even in straightforward inquests, GPs are often called upon to give evidence about a patient’s medical history, for example about their mental health or the prescribing of medication. Additionally, the families of patients often have questions for the GP about the medical care provided, for example in cases of death by suicide.

CQC FINDS IMPROVEMENTS NEEDED IN URGENT AND EMERGENCY SERVICES AT CUMBERLAND INFIRMARY

“More complex inquests can involve multiple parties, often with legal representatives, including NHS Trusts, individual healthcare providers and bereaved families – navigating this as an individual GP can be daunting and time consuming, so getting professional support is vital. We have also seen an increase in GP practices being designated as interested persons, leading them to request legal representation at the inquest.” On the importance of seeking early support, Dr Nandasoma added: “We know inquests can place a significant emotional and professional burden on doctors who are already working under considerable pressure. Many find it hugely stressful to give evidence about their clinical decisions in front of a patient’s family and to be subjected to public criticism if the case is reported in the media. “We encourage members facing a coroners’ case to seek our advice as soon as possible. We can help them navigate the process from writing reports to preparing for attendance in court. Ensuring they have the best possible medicolegal advice from the outset can reduce stress and minimise the risk of complications further down the line.” Reflecting on her involvement with a coroner's inquest, an MDU member said: “This was my first experience preparing statements and dealing with a coroner’s inquest. I cannot thank the MDU team enough – they were incredibly kind, understanding and helpful in alleviating my anxieties and preparing me for the day. I now feel more confident as a doctor in facing such situations, knowing that the MDU is backing me.” q

[THE Care Quality Commission (CQC) has again rated urgent

and emergency services at Cumberland Infirmary, run by North Cumbria Integrated Care NHS Foundation Trust, as ‘requires improvement’. Following an inspection in February and March, a warning notice was issued to the trust due to significant concerns about the safe care and treatment of people using the service. The notice required the trust to focus on making immediate improvements in this area. Roger James, CQC director of operations in the north-east, said: “We saw concerns identified at the last inspection still hadn’t been resolved which continued to place people at risk. For example, the system used to direct people to appropriate services once they’d arrived in A&E was ineffective, meaning there were more people waiting than staff had the capacity to manage. “People reported concerns over delays and lengthy waits, and staff weren’t monitoring people properly, including those at risk of deterioration or people with mental health needs. Additionally, people often remained on chairs and trolleys for prolonged periods due to a lack of beds and treatment areas. “Additionally, there weren’t enough cubicles to accommodate demand with several people being cared for in temporary escalation spaces. These environments didn’t always have call bells and didn’t support people’s privacy and dignity. Nurses were unable to maintain continuous observation of these areas meaning they wouldn’t be able to respond quickly if someone’s condition deteriorated. “Despite these challenges, we also saw examples of effective multidisciplinary working within the department. For example, physiotherapists worked hard to ensure people returned home safely with appropriate equipment and community support, reducing the need for re-admission. “We have told leaders where we expect to see other rapid and continued improvements and will continue to monitor the service closely to keep people safe during this time.” q www.yourexpertwitness.co.uk

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PATIENTS WITH MOTOR NEURONE DISEASE SET FOR FAST-TRACKED CARE [PATIENTS WITH motor neurone disease (MND) will get faster

access to care and support, according to the Secretary of State for Health and Social Care, Yvette Cooper, during a visit to the Rob Burrow Centre for Motor Neurone Disease in Leeds in August. The announcement came as the government launched action to tackle delays and fragmentation in support for people living with MND and is part of the first phase of fixing the social care system and pursuing Andy Burnham’s ambition to introduce a national care service. MND patients and families often face lengthy waits and have to navigate a complex system spanning health, social care and housing services at a time when every day matters. The Rob Burrow Centre brings specialist MND services together under one roof, providing co-ordinated care, treatment and support in a single location, making accessing services easier for people living with MND and their families. Learning from this, the new fast-track care pathway aims to draw on these principles of a more joined-up, person-centred approach and help deliver care and support more consistently and much more quickly across the country, lessening the need for families to navigate multiple services and reducing stress and delays to care. Visiting the centre named in Rob’s honour, the Secretary of State paid tribute to the extraordinary legacy left by Rob and his family. It stands as a testament to their determination to improve care, treatment and support for people living with MND, bringing together specialist expertise and helping patients and families access the coordinated care they need. Yvette Cooper said: “This is Rob Burrow’s legacy. It’s a tribute to Rob, to his family, to Kevin Sinfield, and it’s also a huge inspiration to see their vision brought to life about putting patients and families at the heart of MND care. “What we’ve got to do now is make sure the principles that apply here about supporting families and patients are applied throughout the National Health Service and also in our social care system too.” Development of the new fast-track pathway will involve working closely with the MND Association, people living with MND and carers and partners across health, social care and housing. Building on examples of best practice such as the Rob Burrow Centre for Motor Neurone Disease, the pathway will support more proactive care, improve co-ordination between services, and make it easier for patients and families to access the support they need as quickly as possible. The announcement builds on the government’s wider programme of social care reform and is part of immediate action being taken to deliver improvements now while working with people, families and the care sector to shape a national care service for the future. As part of that reform to social care, the Prime Minister brought forward Baroness Casey’s independent commission into adult social care by a full year, recognising the urgent need to improve care for people and families who depend on support services. While the commission will play a central role in shaping longterm reform, the government is already taking practical action to improve care alongside this new MND pathway, including introducing workforce reforms, strengthening safeguarding arrangements and appointing a dementia tsar. In March 2026, Baroness Casey highlighted the need for urgent action to ensure people with MND receive faster access to care and support. In response, the government has already written to local authorities setting out immediate steps they can take to improve services for people living with the condition. These include: • Fast-tracking access to care and support

• Ensuring health and social care services work together to assess and meet people’s needs • Planning ahead as people’s conditions progress • Speeding up Disabled Facilities Grant processes • Waiving the Disabled Facilities Grant means test for people with MND These changes mark the important first steps in delivering the government’s vision for a national care service that works around people and families, rather than asking them to fit around services. Through close engagement with people living with MND, their loved ones, specialist organisations and frontline professionals, the government will look to tackle variation in access to support and ensure patients receive the right care, in the right place, at the right time. Alongside improving care and support, the government remains committed to supporting research into better treatments and, ultimately, a cure for MND. Craige Richardson, Deputy Chief Executive at Leeds Teaching Hospital, said: “We were delighted to welcome the Secretary of State to the Rob Burrow Centre for Motor Neurone Disease here at Leeds Teaching Hospitals. It is really encouraging to see motor neurone disease firmly on the government’s agenda and to have the Secretary of State’s support for the pioneering model of care we are developing here in Leeds. “Six months since opening, our holistic support sessions, research programme and outreach family work are already starting to take shape. We are confident that, as awareness for the centre and its offering continues to grow, it will establish itself as a nationally recognised model for integrated MND care, which combines outstanding clinical care, family support and research and innovation under one roof, while continuing Rob Burrow’s legacy of hope and compassion for the wider MND community.” Tanya Curry, Chief Executive of the MND Association, said: “It’s heartening to hear the Secretary of State today reiterating the government’s commitment, made in light of the Casey Commission’s recommendations, to fast-tracking access to care and support for people with motor neurone disease. “We hear time and time again of people with MND forced to battle a system that is slow, disjointed and too complex to move quickly enough to support people with a rapidly progressing disease. “This must change – Ms Cooper’s statement today suggests she agrees and that there is willingness at the highest levels of government to transform the experience for people with MND. We must now see that willingness turned into action, with real solutions implemented nationally and locally, in health and social care.” q

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CANCER PATIENTS RATE NHS CARE HIGHLY [TENS OF THOUSANDS of cancer patients have rated the care

they received from the NHS as nearly 9 out of 10, as NHS teams see and treat record numbers of people for the disease. The latest patient experience figures come as NHS cancer checks have reached nearly 3.4 million in a year – more than doubling in the last decade. The number of patients receiving cancer treatment has also reached a record high, with the NHS starting 700,000 treatments in the year to May – almost 2,000 every day on average. More than 64,000 people responded to the 2025 National Cancer Patient Experience Survey, giving their overall care an average score of 8.92 out of 10 – maintaining the high standards of care seen last year. Patients gave some of the highest scores to the advice, information and support provided by their cancer teams. More than 9 in 10 patients (91.4%) said they had a main point of contact within their care team, while 95.6% of those who received advice from that person found it helpful. More than 9 in 10 said they received all the information they needed before a diagnostic test, while 94.6% said they were always given enough privacy when receiving their results.

The main areas of improvement for patients over the past year related to communication or sharing information, with more patients receiving clear information about what to do after leaving hospital, rising from 87.3% to 88.4%, and more saying someone close to them could speak to their hospital team, up from 70.8% to 72.1%. Professor Peter Johnson, NHS National Clinical Director for Cancer, said: “NHS teams are seeing and treating record numbers of patients for cancer, so it is hugely encouraging that patients continue to rate their care nearly 9 out of 10. “Being diagnosed with cancer is incredibly difficult, and these results are testament to staff who make sure patients receive clear information, have their privacy respected and know there is someone they can turn to. “We always want to go further for patients, and we know there is more we can do to ensure every patient receives the same high-quality experience. Our National Cancer Plan will see every patient receiving personalised support before, during and after treatment.” The National Cancer Patient Experience Survey has run annually since 2010 and helps NHS organisations identify good practice and areas where care can be improved. q

PROGRESS ON LONGEST NHS WAITS STALLS [THE NUMBER of cases waiting more than a year for planned

NHS treatment in England has risen by more than 11,000 since March 2026, reversing months of progress in reducing year-long waits, according to analysis by the Royal College of Surgeons of England. Between March and June 2026, the total number of cases where patients were waiting more than 52 weeks for planned NHS treatment in England increased by 11.98%, from 94,404 to 105,711. This means there were more than 11,307 additional cases where patients were waiting over a year for treatment. The increase follows ten consecutive months of falling 52-week waits, suggesting that progress in reducing the year-long waits has stalled. This trend was seen across every region of England and may reflect growing demand and additional pressure on NHS services during the early summer period. At the same time, 65.8% of patients were waiting no longer than 18 weeks for treatment in June 2026, against the government's target of 92% by March 2029. The latest figures come as the Health and Social Care Secretary has highlighted the importance of improving the NHS's resilience to heatwaves and other seasonal pressures. Surgeons say that ensuring hospitals have modern, fit-for-purpose facilities and sufficient capacity will be critical to maintaining elective activity and preventing future disruption to patient care. The figures also come shortly after the government announced more than 350 additional resident doctor training posts in England as part of plans to expand postgraduate medical training capacity. Commenting on the figures, Mr Tim Lane, President of the Royal College of Surgeons of England, said: “While progress in reducing overall waiting times is encouraging, the NHS must not leave behind patients who have already spent more than a year waiting for treatment. “NHS staff have worked incredibly hard to bring waiting times down, often under immense pressure, and they deserve enormous credit for the progress that has been made. But today’s figures show that sustained improvement cannot be taken for granted. “Behind every one of these figures is a person whose life is on hold. Patients can be left living with pain, reduced mobility and worsening health, affecting their ability to work, care for their families and live independently. “The additional training posts announced this week by the

government are a positive step. However, significant bottlenecks remain in surgical training, and we must ensure that expanding training places leads to more surgeons entering the workforce, so the NHS has the staff it needs to reduce waiting times and meet future demand.” q

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HSSIB RESEARCH DEMONSTRATES NEED FOR ADVICE AND GUIDANCE INCLUSION IN PHYSICIAN JOB PLANNING, SAYS RCP [ THE Royal College of Physicians

(RCP) has responded to the results of an investigation that explores risks to patient safety where electronic patient record systems, introduced to support referrals for patient care, have contributed to harm from missed or delayed care. The Health Services Safety Investigations Body (HSSIB) has published an interim report examining patient safety concerns linked to Advice and Guidance (A&G) services in the NHS in England. NHS A&G services allow clinicians in general practice to seek specialist advice from secondary care, either before or instead of making a hospital referral. The HSSIB has recommended that NHS England and the Department of Health and Social Care (DHSC) undertakes a rapid evaluation of A&G processes. The RCP has previously expressed concerns over the implementation of the A&G pathway. An RCP survey in June 2026 found that almost half (47%) of physicians delivering A&G have no dedicated time for it written into their job plan, with many reporting that they complete this work in the evenings and on weekends. The RCP’s survey also found that 89% of physicians have received no formal training on delivering A&G. The HSSIB recommends that patient safety be improved by addressing gaps in knowledge and skill across the medical workforce for A&G tasks. The RCP supports this call, which is critical to supporting consistent and effective delivery of A&G across the country.

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With plans for A&G to be incorporated into the electronical referral system (e-RS), the RCP said it is imperative to improve some of the technical barriers that inhibit communication between general practitioners and specialists. The RCP’s survey also identified concerns about the appropriateness of some requests. 70% said they sometimes (42%) or often (28%) receive requests they believe are inappropriate for the A&G route, including some that require urgent clinical intervention. Dr Hilary Williams, RCP clinical vice president, said: “Today’s report echoes concerns that we have been hearing from our members as Advice and Guidance referrals continue to increase. This month we have seen the highest number of referrals on record. “More people are living with multiple health conditions, and it is increasingly difficult for physicians to provide accurate, detailed advice, often with an incomplete picture from the referral, and without appropriate time allocated for the volume of complex requests they receive. “It is vital, for both patients and staff that people in need of care don’t experience a cycle of referrals and A&G requests without receiving the timely, coordinated care and clear outcomes they need. ”We welcome the safety recommendations put forward to review how A&G is used, as we hear the impact of inappropriate and inconsistent use on patient care. For the single point of access to be successful, we urge NHS England and DHSC to also address the need for A&G to be appropriately factored into job planning.” q

VIRTUAL CONSULTATIONS AND GP CLINICAL NEGLIGENCE [THE WAY PATIENTS access primary

care has changed significantly in recent years, with telephone and video consultations becoming an established part of general practice. While virtual consultations can offer convenience and improve access, they can also raise important questions when a patient’s condition is subsequently found to have been missed, misdiagnosed or inadequately managed. In such cases, the expertise of a GP can be particularly valuable in helping the court understand whether the care provided was reasonable in the circumstances. For a patient who consults a GP remotely, the experience can be very different from a traditional face-to-face appointment. The GP may have no opportunity to examine the patient, observe physical signs directly or carry out basic clinical assessments. Instead, the consultation may depend heavily upon the patient’s description of their symptoms, the questions asked by the clinician and the interpretation of information available from previous records. These limitations do not necessarily mean that virtual consultations represent an inadequate standard of care. Remote consultations can be entirely appropriate for some presentations, particularly where a physical examination is unlikely to add significantly to the assessment. The important question in litigation is often whether the decision to manage the patient remotely was reasonable given the symptoms, history and information available at the time. This can become particularly significant where a patient later receives a diagnosis of a serious condition. If a delay in diagnosis occurs, it may be necessary to establish whether the GP should have recognised warning signs, arranged a face-to-face assessment, requested investigations or referred the patient to a specialist. A GP expert witness can examine the consultation record and consider the clinical decisions in their proper context. This may involve reviewing telephone or video consultation notes, the patient's previous medical history, referral letters, test results and the eventual diagnosis. Importantly, the assessment should be based on the information that was available to the treating clinician at the time rather than relying upon hindsight. The quality of documentation can also become an important issue. Remote consultations may depend upon careful recording of the patient's symptoms, relevant questions and follow-up arrangements.

Where the medical records are limited, an expert may need to consider what can reasonably be established from the available evidence and whether the documentation itself raises concerns. Safety-netting is another area that may come under scrutiny. Patients consulting remotely may need clear advice about symptoms that should prompt further medical attention, what to do if their condition deteriorates and when they should seek another assessment. The adequacy of such advice may form part of the wider assessment of whether the consultation was appropriately managed. In negligence cases, instructing a GP expert with experience of both primary care and remote consultations can therefore be important. The expert needs to understand not only general clinical practice but also the practical limitations and appropriate use of telephone and video consultations. As virtual consultations become an increasingly familiar feature of primary care, they are likely to feature more frequently in clinical negligence claims. GP expert witnesses can provide the independent clinical perspective needed to distinguish between an unavoidable limitation of remote medicine and a failure to recognise when a patient required further assessment or intervention. q

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MIDWIVES IN WALES SAY UNSAFE STAFFING LEVELS AFFECT THE QUALITY OF CARE [NEW SURVEY DATA from the Royal College of Midwives (RCM)

Cymru has laid bare the scale of the safety crisis in NHS Cymru maternity services – with 94% of midwives saying staffing levels directly affect the care they can provide to women and babies. The findings, from a survey of 219 midwives, maternity support workers and midwifery students in Wales, paint an alarming picture of a workforce on the edge – and lay bare the conditions facing NHS maternity services. In the week of 1-7 June alone, 79% said their unit was not safely staffed – and over the month, 68% said staffing felt unsafe on more than half of their shifts. The data also shows that eight in ten midwives in Wales have considered leaving the profession in the last year, with staffing levels and safety fears cited as the primary factors.

GYNAECOLOGY WAITS WORSEN FOR THIRD MONTH AS DEMAND RISES, RCOG WARNS [ THE LATEST NHS England elective data, covering June 2026,

shows the gynaecology waiting list has increased for a third consecutive month, with demand via new referrals also rising significantly. The gynaecology waiting list now stands at 575,870, with new referrals rising by 14.6% to almost 135,000 – an increase of more than 17,000 on the previous month. This is despite the overall elective waiting list decreasing slightly. More than 11,000 patients have now been waiting over a year for gynaecology care, with the number increasing by 0.8% from the previous month. While the proportion of patients seen within the Government’s 18-week standard improved slightly, from 60.9% to 61%, gynaecology continues to perform below the overall elective position of 65.8%. “The Royal College of Obstetricians and Gynaecologists (RCOG) warned: “Behind these figures are women and girls waiting for gynaecology care who may be living with pain, debilitating symptoms or conditions such as endometriosis, fibroids and heavy menstrual bleeding, which can have a significant impact on their health and quality of life.” At the beginning of the year, RCOG said that 2026 must be a turning point for women’s health, stating: “The Government has recently stated that the renewed Women’s Health Strategy would ‘ensure gynaecology waiting lists fall’ and expand the number of surgical hubs so women can be diagnosed and treated sooner. “But the latest figures show we have not yet seen the change needed. Since the Strategy was renewed in April, the gynaecology waiting list has continued to grow, while demand has increased significantly. Action is needed now. The Government must ensure the commitments in the renewed Strategy are delivered and backed by the investment needed to reduce waiting lists and ensure women can access timely care. “The RCOG is calling on the Government to make tackling gynaecology waiting lists a priority, delivering the commitments in the renewed Women’s Health Strategy and the investment needed to make them a reality. The College will continue to monitor the monthly gynaecology waiting list data and press for action to ensure women and girls can access the care they need without unacceptable delays.” q

Julie Richards, RCM Cymru Director, said: “Midwives are dedicated professionals who want to deliver the safest possible care for women and families. The fact that so many feel unsafe staffing levels affects the care they can give should be a wake-up call to the Welsh Government and employers alike.” The survey also found that unpaid overtime has become routine, with 77% working extra unpaid hours in a single working week and one in five working more than five hours beyond their contracted time for nothing. A third of respondents (33%) did not have 24 consecutive hours free from work during the week surveyed, and 40% did not get the 11 hours of uninterrupted rest every 24 hours that working time regulations are meant to guarantee. 79% have left or considered leaving in the past year. The top reasons are staffing levels, safety concerns, work-life balance and the impact on mental health. Julie Richards added: “When midwives are routinely working unpaid overtime, missing breaks and caring for more women than is safe, it is impossible to ignore the impact that has on both staff and the quality of care. Safe staffing is not optional – it is the foundation of safe maternity services. “These findings show that the pressures facing maternity services have not gone away. Midwives are exhausted, overstretched and too often unable to provide the standard of care they trained to deliver. “What is urgently needed is action: investment in the workforce, fair pay that helps retain experienced staff and a commitment to ensuring every woman can receive safe, high-quality maternity care.” q

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VAGINAL MESH LITIGATION: URINARY, PELVIC AND SURGICAL COMPLICATIONS [VAGINAL MESH LITIGATION has become one of the most

closely scrutinised areas of clinical negligence work in the UK. Claims can arise from the use of mesh to treat stress urinary incontinence, including mid-urethral mesh slings, as well as devices used in the treatment of pelvic organ prolapse. While mesh procedures have provided effective treatment for many patients, a significant number have reported complications that can be persistent, debilitating and difficult to treat. Establishing whether an injury represents an accepted complication or is the result of negligent treatment can require detailed, specialist expert evidence. The complications associated with mesh are varied. Patients may experience chronic pelvic, vaginal or groin pain, recurrent urinary tract infections, difficulty emptying the bladder, continuing urinary incontinence, bleeding, infection and sexual dysfunction. Mesh exposure or erosion can occur, with the material extending into or through surrounding tissues. In more serious cases, mesh can erode into the bladder or urethra, causing significant urinary problems and potentially requiring further surgery. Removal can be technically difficult because mesh may become incorporated into surrounding tissue – and complete removal is not always possible without risking further injury. The circumstances leading to implantation are therefore an important consideration in any claim. An expert may be required to assess whether mesh was an appropriate treatment for the patient's particular condition, taking account of their symptoms, medical history, previous surgery and other available treatment options. The assessment must reflect the clinical knowledge and practice applicable at the time of treatment rather than simply applying present-day standards retrospectively. Consent is another potentially significant issue. Patients may allege that they were not adequately informed about the risks associated with mesh or the alternatives available to them. Expert evidence can assist the court in understanding the nature of the proposed procedure, the risks that were recognised at the time and the alternative treatments that might reasonably have been discussed. The legal test concerning consent must, however, be addressed within the appropriate legal framework and not treated as simply a question of whether the procedure itself was technically successful. The surgical procedure and the immediate post-operative period can generate further allegations. Claims may involve the positioning or placement of the mesh, damage to the bladder or other pelvic structures, infection, failure to recognise an intra-operative complication or inadequate follow-up. A claimant may also allege that continuing symptoms were not investigated appropriately or that referral to a specialist was delayed. The chronology of symptoms can be particularly important. A patient who develops persistent pain, recurrent infections, urinary difficulties or bleeding may require further assessment and investigation. An expert may be asked to determine whether the symptoms should reasonably have raised concerns about mesh-related complications and whether earlier investigation or treatment would have altered the outcome. No single medical speciality will necessarily address every issue. A urogynaecologist with appropriate experience of mesh procedures may be instructed to consider the original indication for treatment, the surgical procedure and subsequent complications. A urologist may be required where bladder or urethral injury, urinary dysfunction or continence problems are central to the claim. Depending on the evidence, additional expertise may be required from a gynaecologist, pain medicine specialist or other relevant clinician. Where the claimant has developed significant psychological consequences, psychiatric or psychological evidence may also be necessary. Causation is frequently one of the most difficult aspects of these

claims. The existence of mesh and the presence of symptoms do not, by themselves, establish negligence. The expert must consider whether any alleged breach caused or materially contributed to the symptoms experienced. This can be complicated where the claimant had pre-existing gynaecological symptoms, had undergone previous surgery or had underlying conditions that could themselves contribute to continuing problems. Where further surgery has been undertaken, expert evidence may also be required concerning the necessity and consequences of mesh removal or revision. The expert may need to consider whether the additional procedure was reasonable, what risks it involved, whether further treatment is likely to be required and what long-term problems or functional limitations can reasonably be attributed to the original treatment. Obtaining comprehensive records at an early stage is essential. These may include GP records, hospital notes, referral letters, consent forms and records relating to subsequent revision or mesh-removal procedures. The expert should also be provided with a clear chronology and questions addressing breach, causation and, where appropriate, prognosis. Vaginal mesh claims are rarely straightforward. They can involve the interaction of surgical decision-making, informed consent and the consequences of further treatment over a prolonged period. Selecting an expert with genuine experience of the particular mesh procedure and complication in question is therefore crucial. Expert evidence can provide the court with the clinical context needed to distinguish an unavoidable complication from an injury that could have been prevented through appropriate treatment and management. q

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THE CRITICAL ROLE OF UROLOGICAL EXPERT EVIDENCE [UROLOGY CLAIMS rarely fit neatly into a single category. They

can arise from delayed diagnosis, surgical complications, failures in follow-up or shortcomings in clinical governance. For the patient, however, the legal issue is often much more straightforward: whether something that should have been recognised or managed differently resulted in a permanent change in quality of life. The breadth of urological practice means that expert evidence is frequently central to establishing what happened. An example of the wider difficulties surrounding clinical negligence and expert evidence is Tarrant v Monkhouse [2025] EWHC 2576 (KB). Although the claim concerned complications following bariatric rather than urological surgery, the judgment provides an important reminder for solicitors dealing with any specialist clinical negligence claim: an expert must possess appropriate expertise, understand the relevant legal principles and be able to explain and defend their opinion. The claimant's expert was criticised during the proceedings for failing to demonstrate an accurate understanding of the Bolam test. That lesson is particularly relevant to urology, where the clinical questions can be highly specialised. An expert instructed in a delayed diagnosis claim may need to examine the patient’s symptoms, referrals and investigations to determine whether a reasonably competent clinician should have recognised the significance of the information available at the time. Cancer claims provide an important example. Haematuria, abnormal prostate findings or other urinary symptoms may require investigation, and a delay in diagnosis can have potentially serious consequences. A urology expert may be asked whether appropriate investigations were undertaken, whether referral occurred within an appropriate timeframe and whether earlier diagnosis may have altered treatment or prognosis. In such cases, the expert’s evidence needs to distinguish between breach of duty and causation: establishing that a diagnosis was delayed does not automatically establish that the delay caused the eventual outcome. Surgical claims present a different set of questions. Urological procedures can involve the kidneys, ureters, bladder, prostate and surrounding structures. Complications may include bleeding, infection, urinary leakage or damage to adjacent organs. An expert may be required to assess whether the complication was an accepted risk of the procedure, whether it was caused by negligent technique, whether it should have been recognised during the operation and whether appropriate action was taken afterwards. Post-operative management can itself become the focus of litigation. Failure to investigate continuing symptoms, act upon abnormal results or arrange appropriate follow-up may result in a condition progressing before treatment is provided. The expert may therefore need to consider a sequence of decisions involving several

clinicians rather than a single episode of care. The importance of expert evidence is reflected in the continuing level of urological litigation. A recent 2026 analysis of litigation within NHS England found that urology remains an area exposed to clinical negligence claims, reflecting the complexity of cancer pathways. The consequences can extend considerably beyond any original injury. Urinary incontinence, chronic pain, sexual dysfunction and the need for further surgery may have profound effects on employment, relationships and everyday life. Further expert evidence may consequently be required to address prognosis, future treatment, rehabilitation or care. For solicitors, the selection of the expert should reflect the precise clinical issue. A consultant urologist specialising in urological oncology may be appropriate for a delayed cancer diagnosis, whereas a specialist with extensive experience of reconstructive, endoscopic or pelvic surgery may be more suitable where operative injury is alleged. In complex cases, urology evidence may need to be considered alongside oncology, radiology, nephrology or other specialist opinion. Above all, the expert’s role is independent. The purpose is not to establish that treatment was poor simply because the outcome was serious, but to assist the court in determining whether the care met the required standard. The recent judicial scrutiny of expert evidence demonstrates that specialist knowledge alone is not enough. An effective urology expert must understand the limits of their expertise, engage fairly with opposing evidence and communicate complex medical issues clearly. Selecting the right expert at an early stage can therefore be fundamental to establishing both the merits and the value of a urological clinical negligence claim. q

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THE EVIDENCE BEHIND THE IMAGE [

WHEN INSTRUCTED as an expert witness, a radiologist has a responsibility that extends well beyond identifying abnormalities on a scan. Their role is to provide the court with an independent and objective opinion on the interpretation of medical imaging and, where relevant, to consider whether significant findings should reasonably have been recognised, reported and acted upon at the time. Radiological evidence can be central in a wide range of litigation. Clinical negligence claims involving missed fractures, delayed cancer diagnosis, spinal pathology and internal injuries are obvious examples, but radiology expertise can also be relevant to personal injury, industrial disease and other disputes where imaging forms part of the evidence. The expert’s task is to examine the imaging in its proper clinical and chronological context rather than retrospectively judging an earlier interpretation solely with the benefit of hindsight. When reviewing a case, a radiology expert normally expects to receive the original imaging, rather than relying solely on written reports. This may include X-rays, CT scans, MRIs, ultrasound, mammography or other appropriate imaging. Access to the original imaging is particularly important where the allegation concerns a missed or incorrectly interpreted abnormality. The report records what was identified at the time, but reviewing the images allows the expert to form an independent opinion about what they actually demonstrate. The clinical information available to the reporting radiologist is also important because imaging cannot always be interpreted in isolation. The patient’s symptoms, relevant history, previous imaging and findings from clinical examination can all affect how an image should reasonably have been assessed. In a suspected fracture, for example, the mechanism of injury and precise site of symptoms may be highly relevant. In suspected cancer, the sequence of investigations and the patient's presenting symptoms can be critical to understanding whether an abnormality should have prompted further investigation. A common area of instruction concerns an alleged failure to diagnose cancer at an earlier stage. The expert may be asked to review imaging performed months or years before the eventual diagnosis and determine whether a lesion was visible at that earlier point. This requires careful assessment of the original images and comparison with subsequent examinations. The fact that a later scan shows an established tumour does not, in itself, demonstrate that the tumour should have been identified on an earlier study. Its size, appearance, location and imaging characteristics all need to be considered. Similar principles apply to alleged missed fractures or spinal injuries. Some abnormalities are readily apparent, whereas others can be subtle or difficult to distinguish from normal anatomical structures. The expert must consider what a reasonably competent radiologist should have identified from the images and clinical information available at the time. Causation may present a separate and more complex question. Identifying an abnormality does not necessarily establish that an earlier diagnosis would have altered the claimant’s outcome. The radiologist may therefore be asked to distinguish between the radiological issue – what was visible and when – and the wider medical question of what difference an earlier diagnosis would have made. The latter may require evidence from another discipline, such as an oncologist, surgeon or orthopaedic specialist. Industrial disease claims can involve a further range of imaging issues. Chest X-rays and CT scans may be reviewed in cases involving asbestos exposure or other occupational respiratory diseases. The expert may be required to comment on the presence and extent of abnormalities while also considering different possible causes. In such cases, imaging evidence may form one part of a much wider clinical and occupational history. Independence is fundamental to the role. A radiologist instructed as an expert witness owes their overriding duty to the court rather than to the party who has instructed them. If the imaging does not support the allegations being made, that conclusion must be stated clearly.

Equally, where the images demonstrate an abnormality that appears to have been overlooked, the report should explain precisely what is shown and why it is significant. The final report must translate highly technical imaging evidence into language that can be understood by legal teams without compromising medical accuracy. If the matter proceeds to court, the radiologist may be required to give oral evidence and explain the imaging findings under questioning. The value of radiological expert evidence ultimately lies in providing an objective assessment of what the imaging demonstrates, what could reasonably have been recognised at the relevant time and, where appropriate, how those findings relate to the wider issues of breach and causation. A thorough review of the original images, supported by the clinical chronology and relevant records, is essential to producing reliable and defensible expert evidence. q

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PAEDIATRIC ANAESTHESIA: EXPERT EVIDENCE IN CHILD HEALTHCARE CLAIMS [ANAESTHESIA IN CHILDREN and young people presents

particular clinical challenges and requires specialist knowledge of paediatric anatomy, physiology and development. Children are not simply smaller versions of adult patients – factors such as age, weight, underlying health and communication ability can all influence anaesthetic planning and management. In medico-legal practice, specialist paediatric anaesthetic evidence may be required where there is an allegation that a child suffered injury as a result of inadequate anaesthetic management, monitoring, airway management, medication or pain control. Safe paediatric anaesthesia begins before the child enters the operating theatre. Pre-operative assessment provides an opportunity to identify factors that may increase anaesthetic risk and to plan appropriately. The expert may therefore consider the child's age and weight, medical history, previous anaesthetic experiences, allergies, current medication and the proposed surgical procedure. Particular attention may be required where there is a history of respiratory disease, congenital heart disease, neurological impairment, obstructive sleep apnoea or other significant medical conditions. The urgency and nature of the procedure are also relevant. A child requiring emergency surgery may present very differently from one undergoing planned treatment and the expert must assess the clinical circumstances that existed at the time. Airway management is a central consideration in paediatric anaesthesia. Children's airways differ anatomically from those of adults and relatively small changes can have significant consequences. Young children may deteriorate rapidly if airway obstruction or respiratory compromise develops. Medication administration is another important area of paediatric anaesthetic practice. Drug doses commonly need to be calculated according to the child’s weight, age and clinical circumstances. Appropriate preparation, checking and administration are therefore essential. The expert may be instructed to consider whether the correct medication and dose were administered, whether equipment was appropriate for the child’s size and whether the child’s physiological status was adequately monitored throughout the procedure. Fluid management and temperature control can also be particularly important in younger patients. The perioperative period requires careful attention to the child’s changing physiological requirements, with appropriate monitoring continuing into recovery. Anaesthetic care does not end when the operation is completed.

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Effective postoperative pain management is an important component of paediatric perioperative care and should be appropriate to the child’s age and condition. A medico-legal expert may examine whether pain was assessed adequately, whether appropriate analgesia was provided and whether the child’s response was monitored. Paediatric anaesthesia can involve recognised risks even where care is appropriate. Potential complications can include airway obstruction, respiratory depression, cardiovascular instability, allergic reactions, medication errors and problems associated with aspiration or inadequate ventilation. The key medico-legal issue is therefore not simply whether a complication occurred, but whether it was appropriately anticipated, recognised and managed. Where deterioration occurs, the paediatric anaesthetic expert may examine the sequence and timing of events, including when the abnormality was first identified, what action was taken, whether appropriate assistance was requested and whether escalation and emergency intervention were timely. The expert may be asked to address several distinct questions: Was the pre-operative assessment adequate? Was the anaesthetic plan reasonable? Were appropriate drugs, doses and equipment used? Was monitoring sufficient? Were complications recognised promptly? Was the response appropriate? Did any alleged departure from accepted practice cause additional injury? The final question of causation is particularly important. An adverse outcome does not automatically demonstrate negligent care. Children can experience serious anaesthetic complications despite appropriate planning and treatment. The expert must therefore distinguish between an unavoidable or recognised complication and an outcome that may have resulted from a failure to meet the appropriate standard. Cases involving children require particular sensitivity because the consequences of an adverse perioperative event may extend throughout childhood and into adulthood. Where a significant injury has occurred, the court may need to understand not only the immediate clinical consequences but also the potential impact on development, function and future care requirements. By reconstructing the perioperative pathway from assessment and preparation through anaesthesia, recovery and subsequent management, the expert witness can assist the court in distinguishing a recognised complication from potentially avoidable harm. q

ONE IN TEN NHS DENTAL PRACTICES HAVE STOPPED PROVIDING NHS CARE SINCE 2017, ANALYSIS FINDS [

THE NHS has lost around 600 dental practices providing general NHS dentistry in England since 2017, with almost every part of the country seeing a decline as more practices move towards private care, new analysis from the Nuffield Trust reveals. The analysis shows the proportion of dental practices offering general NHS dentistry has fallen from around 65% in 2017 to around 56% in 2026. Over the same period, the number of practices holding an NHS general dental contract has fallen by around 600 – equivalent to around one in ten NHS dental practices – while the number of practices without an NHS contract, largely private or specialist providers, has increased by almost 1,000. The decline has been almost universal across England, with the number of NHS dental practices falling in 41 of the country's 42 integrated care boards. However, the impact is not evenly spread. The South West and East of England have seen particularly steep declines, highlighting persistent regional inequalities in access that reflect longstanding problems with the NHS dental contract. The analysis suggests the trend has accelerated since the Covid-19 pandemic,

as growing pressures within the NHS dental contract have continued to push practices away from NHS work. While reforms introduced in April, including making urgent dental care a contractual requirement and increasing payments for some complex treatments, should improve access to urgent care, the authors argue they do not address the underlying incentives driving practices away from NHS dentistry. The authors warn that this trend may help explain the poor results from the GP Patient Survey, which showed that half of adults have not sought an NHS dental appointment in the past two years. Among those who did not try, one in four said it was because they did not believe they would be able to get an appointment. Of those who attempted to get a new appointment, just 38% were successful. The Nuffield Trust says the success of the government's promised fundamental contract reform should be judged not simply by changes to the payment system, but by whether it succeeds in bringing practices back into NHS dentistry and reversing the long-term decline in access. Paying practices to care for a population, based on local need rather than the number of individual treatments they complete, would create

stronger incentives for dentists and help restore access based on need, not ability to pay. Responding to the analysis, Professor Martyn Cobourne, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons of England, said: “We have consistently called for fundamental reform of the NHS dental contract, and the Nuffield Trust’s analysis reinforces the need to move beyond incremental changes. We need a sustainable NHS dental service that improves access for patients and puts prevention at the centre. “While the changes already introduced to the contract are welcome, they must be part of wider reform that addresses the factors driving practices and clinicians away from NHS dentistry. The Government should now deliver the next phase of its promised dental contract reforms and set out a clear route to sustainable NHS dentistry and improved access for patients. “Regular NHS dental care helps prevent disease and identify problems early. When patients cannot access care, conditions can become more serious and require more complex treatment, placing additional pressure on already stretched hospital services and patients facing longer waits for the care they need.” q

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FACIAL TRAUMA COMPLICATIONS AND THE MEDICOLEGAL IMPLICATIONS By Mr Zaid Sadiq, Consultant Oral & Maxillofacial Surgeon

[FACIAL TRAUMA occurs most commonly during road traffic

accidents, falls, assaults and sports-related injuries. It is most likely to occur in men aged 20-40 years. As the bones of the face and skull protect the brain and major sensory organs, the consequences of facial trauma can be extremely serious. Although associated with significant levels of morbidity, facial trauma is generally not considered to be life-threatening in its own right, but it can give rise to complications that may result in the death of the patient. Less serious complications may still require prompt treatment to avoid irreversible damage. Airway obstruction is one of the most serious consequences of facial trauma. It may be apparent at the time of the injury, due to inhalation of a foreign body or narrowing of the airway following displacement of a fracture and any associated bleeding. However, it can also arise in the hours or days following the initial incident if soft tissue injury leads to significant swelling and oedema. It is therefore important that patients are monitored closely for any breathing difficulties. Undiagnosed cervical spinal injuries are also a major concern and, in order to prevent irreversible neurological injury, it is probably safer to assume that the patient has sustained this type of injury until it is definitively ruled out. Cerebrospinal fluid leaks may lead to the development of meningitis but as presentation can be delayed, identification is not always straightforward. The majority of facial trauma incidents result in one or more fractured bones. Fractures in the eye socket can be associated with injuries to the eye itself which, if undiagnosed, can lead to sight loss. Although most cases of double vision resolve spontaneously, persistent cases can indicate misplaced or trapped soft tissue requiring further evaluation. Malposition of the lower eyelid is also common and requires careful retraction of the soft tissues in the periorbital region if it is to be avoided. Displacement of the eyeball occurs relatively frequently and can be particularly challenging to correct if it is associated with significant scarring in the area. While facial fractures are common, a failure to diagnose them can lead to later complications. For example, reconstruction of the nasal bones has a much lower success rate if delayed. If the healed bones are poorly aligned, breathing difficulties can arise. Fractures in the cheek bones can lead to asymmetry of the face and may even impact on the function of the eye. However, good repair in this area is difficult and the risk of complications is high. Fractures to the jaw occur in nearly 75% of all incidents of facial trauma. Inadequately treated fractures can lead to misalignment of the teeth, infection, delayed or abnormal bone healing and nerve damage. Healing can also be affected by the amount of movement this area is subjected to. Stresses across the fracture or the screws holding it together may lead to bone resorption, resulting in further instability. In the most severe cases, non-union of the bone may result. As well as potential disruption to the airway, jawbone fractures

may lead to difficulties with eating and speaking. Many patients report pain and problems with chewing or swallowing, leading to dietary changes, several months after injury. There may be emotional effects too, with many patients reporting dissatisfaction with their newly restricted diet, psychological symptoms and poorer social functioning. The physical consequences of facial trauma, such as scarring and loss of functionality, are obvious but the psychological burden of this type of injury is less visible and may not be immediately apparent. However, the need for psychological assessment and treatment following facial trauma is becoming increasingly understood. Patients with facial injuries report increased levels of anxiety, depression, acute stress reaction, post-traumatic stress disorder and substance misuse, which can add a considerable additional burden to the physical consequences of their injuries. Not surprisingly, patients with significant post-injury deformities experience worse psychological outcomes, as do those who suffered extreme distress during the actual incident. However, there is no consistent relationship between the cause of the injury – whether assault, road traffic accident or workplace incident – and the psychological outcome. Currently, there is no standardised practice for the psychological screening of facial trauma patients, and there is little evidence to suggest the optimum timing for such assessment. While assessment could take place in hospital, this approach would miss those who are not admitted as inpatients. Therefore, referral of patients to mental health services may be more effective if it is incorporated into outpatient appointments. Severe facial trauma can result in significant functional, aesthetic and psychological complications. As many patients are relatively young, the effects of this type of injury may be experienced for many decades. It is not only patients who experience a decreased quality of life: close family members are often affected too. As well as taking steps to improve the physical outcome of facial trauma, early psychological support is needed. Therefore, a holistic approach involving close collaboration between surgeons and providers of mental health services will give the best outcome for patients with facial trauma. q • Mr Zaid Sadiq, Consultant Oral & Maxillofacial Surgeon, is dual qualified in medicine and dentistry, as well as having completed the Cardiff University LLM medico legal degree – Legal Aspects of Medical Practice. He can accept both adult and paediatric medicolegal instructions in a range of specialist areas for either claimant or defendant. He has a keen interest in cancer, reconstructive surgery and tissue engineering, as well as providing a spectrum of oral and maxillofacial practice. Email info@medicolegal-partners.com, call 020 7118 0650 or visit www.medicolegal-partners.com to instruct. www.yourexpertwitness.co.uk

DIABETES AND OBESITY: WHO IS TO BLAME? [

THE RELATIONSHIP BETWEEN obesity and type 2 diabetes is one of the most complex issues confronting modern healthcare. Both conditions are on the rise and the question of responsibility is increasingly entering legal proceedings. Was the patient adequately warned about the risks? Were opportunities to intervene missed? Did healthcare professionals recognise the warning signs early enough? Are lifestyle, genetics and social circumstances the more significant factors? These are not questions that can always be answered by simply examining medical records. In some cases, specialist expert evidence is essential to establish what should reasonably have happened and whether a failure in care contributed to the outcome. Obesity is a recognised risk factor for developing type 2 diabetes, but the relationship is not straightforward. Genetic susceptibility, age, family history, diet, physical activity, medication and underlying conditions can all play a part. Importantly, obesity does not inevitably lead to diabetes – and people who are not obese can also develop the disease. For legal professionals dealing with clinical negligence claims, this distinction can be crucial. A patient may allege that earlier identification of obesity, elevated blood glucose or other risk factors would have resulted in intervention that prevented or delayed the onset of diabetes.

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Conversely, a defendant may argue that the development of diabetes was multifactorial and could not reasonably have been prevented. This is where an appropriately qualified expert witness can provide valuable independent evidence. An endocrinologist or diabetologist may be instructed to consider whether diabetes was appropriately diagnosed and managed, whether relevant investigations should have been undertaken, and whether treatment complied with accepted clinical standards. A specialist in obesity medicine may examine weight-management interventions, including whether appropriate advice, monitoring, referral or treatment was offered. The expert may also be required to consider causation. It is one thing to identify a potential shortcoming in treatment; it is another to establish that the shortcoming caused, or materially contributed to, the onset of diabetes. For example, if a patient’s diabetes was diagnosed several years later than it should have been, the expert may need to assess whether earlier diagnosis could have altered the patient’s prognosis. There can also be significant questions surrounding the management of complications. Poorly controlled diabetes can contribute to cardiovascular disease, kidney problems, neuropathy, visual impairment and other serious consequences. An expert may therefore be asked to determine whether appropriate monitoring and intervention could have reduced the risk or severity of subsequent complications. However, expert evidence should not become an exercise in apportioning moral blame. Obesity and diabetes involve an intricate combination of biological, behavioural and environmental influences. The role of the expert is not to criticise a patient’s lifestyle, but to provide an objective opinion based on the evidence and accepted medical practice. The choice of expert is therefore important. A case involving misdiagnosis may require an endocrinologist, while a claim centred on weight-management failures may call for an obesity medicine specialist. In more complicated litigation, evidence from several disciplines may be necessary. Ultimately, the question is rarely simply ‘who is to blame?’. Instead, it is whether the healthcare provided met the required standard and, if not, whether that failure made a difference. An experienced expert witness can help the court separate the many contributing factors from the evidence that actually matters, providing the clinical clarity needed to determine where responsibility properly lies. q

MENTAL CAPACITY, COGNITIVE AND PSYCHOMETRIC TESTING: UNDERSTANDING THE DIFFERENCES

[IN LEGAL PROCEEDINGS, questions

concerning a person’s ability to make decisions, understand information or function effectively may require specialist assessment. Mental capacity, cognitive and psychometric testing are related areas, but they address distinctly different questions. Understanding these differences is important when instructing an appropriate expert witness. Mental capacity assessment is concerned with whether an individual has the ability to make a particular decision at a particular time. Under the Mental Capacity Act 2005, capacity is decision-specific rather than a general judgement about a person's abilities. An assessment considers whether the individual can understand, retain, use or weigh relevant information and communicate their decision. The circumstances and complexity of the decision are therefore highly relevant. A person may have capacity to make some decisions but lack capacity to make others. Cognitive testing, by contrast, examines aspects of how the brain processes information. Depending on the assessment required, this may include memory, attention, concentration, processing speed, reasoning and visuospatial abilities. Cognitive assessment can help

identify strengths and weaknesses and may be particularly relevant following brain injury, neurological illness, psychological trauma or other conditions affecting cognitive functioning. Cognitive tests do not, in themselves, determine whether someone has legal capacity. Instead, they can provide evidence about the underlying cognitive abilities that may influence a person’s ability to make and communicate decisions. Psychometric testing is a broader term covering the structured measurement of psychological characteristics and abilities using standardised tests. Depending on the assessment’s purpose, psychometric instruments may examine cognitive ability, emotional functioning, behaviour or particular psychological symptoms. Tests are administered and interpreted according to established procedures, allowing an individual’s results to be compared with appropriate normative data. In medico-legal work, psychometric testing can therefore form part of a wider psychological or neuropsychological assessment. It may help an expert understand whether reported difficulties are consistent with the individual’s overall presentation and identify patterns of functioning that warrant further investigation.

These distinctions are particularly important in litigation. A solicitor may require an expert to establish whether a claimant understood the implications of a particular decision, whereas another case may require detailed investigation of memory and executive functioning following a traumatic brain injury. In other cases, standardised psychological testing may be necessary to evaluate personality, emotional symptoms or cognitive performance. Instructing the appropriate expert will depend on the question being asked. Mental capacity assessment may involve professionals with specific expertise in capacity legislation, while cognitive and psychometric assessment may require a clinical psychologist, neuropsychologist or other appropriately qualified specialist. Ultimately, these assessments should not be regarded as interchangeable. Mental capacity asks whether a person can make a specific decision; cognitive testing examines underlying thinking abilities; and psychometric testing uses standardised measures to assess psychological or cognitive characteristics. Properly applied, each can provide independent evidence in cases where an individual's decision-making ability or psychological and cognitive functioning is disputed. q

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THE CRITICAL ROLE OF REHABILITATION MEDICINE EXPERTISE IN MEDICO-LEGAL PRACTICE By Dr Sohail Salam, Consultant in Rehabilitation Medicine

[

THE MEDICO-LEGAL ASSESSMENT of individuals with neurological injury demands clinical precision, prognostic insight and functional interpretation that extend well beyond acute medical diagnosis. Rehabilitation Medicine focuses on evaluating function, recovery potential and long-term needs – domains that directly influence compensation quantum, care planning, equipment provision, vocational outcomes and life expectancy. For solicitors and barristers, expert evidence relating to rehabilitation medicine provides clarity in cases where disability, recovery and future needs are central to determining fair settlements.

Brain injury: functional interpretation for legal purposes

Brain injury – whether arising from traumatic mechanisms (TBI) or vascular events such as stroke – results in a spectrum of cognitive, physical, behavioural and psychosocial impairments. These deficits are often underrepresented in acute medical documentation yet are central to determining long-term functional capacity and rehabilitation potential. Common sequelae include executive dysfunction, behavioural change, fatigue, slowed cognitive processing, communication difficulties, motor weakness, sensory disturbance and vocational limitations. A comprehensive medico-legal assessment requires structured interpretation of these impairments and their impact on independence, safety and daily functioning. A rehabilitation medicine expert provides: • Structured analysis of cognitive, physical, behavioural and psychosocial consequences of brain injury • Evidence-based prognostication informed by recognised recovery trajectories for both traumatic and vascular injuries • Cases of therapy requirements, environmental adaptations and realistic functional expectations • Assessment of long-term risks, including spasticity, pain, secondary complications and deterioration in complex cases This integrated approach ensures that medico-legal reports accurately reflect both current impairment and anticipated future needs.

Diagnosis of concussion: clinical and medico-legal considerations

Concussion, or mild traumatic brain injury, presents unique diagnostic challenges due to its typically subtle and transient clinical features. Despite frequently normal neuro-imaging findings, concussion can have profound and lasting impacts on daily functioning, employment and family life. Symptoms such as headache, dizziness, cognitive difficulties, emotional lability and fatigue may persist, significantly affecting quality of life. Diagnosis is primarily clinical, relying on detailed history-taking and symptom assessment, as CT and MRI often fail to detect microscopic injury. This ‘scan negative’ nature complicates medicolegal evaluations, requiring careful correlation of clinical findings with reported symptoms and functional limitations. Rehabilitation medicine experts play a crucial role in elucidating these consequences, guiding management strategies and providing balanced medico-legal opinions that reflect the nuanced nature of concussion.

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Polytrauma injuries

Polytrauma represents a high severity injury pattern involving multiple body systems, often with a combination of orthopaedic, neurological, visceral and soft tissue trauma. These cases are medically complex and carry significant longterm functional implications. The interaction between injuries – such as fractures, nerve damage, pulmonary contusions, abdominal trauma and associated brain injury – creates a rehabilitation profile that cannot be understood by examining each injury in isolation. A rehabilitation medicine consultant provides a holistic, systemwide interpretation of polytrauma, addressing: • Interdependency of injuries: including how pain, weakness, spasticity, fatigue and cognitive impairment interact to limit function • Recovery potential: considering the cumulative effect of musculoskeletal, neurological and organ injuries • Long-term therapy and care requirements: including physiotherapy, occupational therapy, spasticity management, pain control and psychological support • Risk of secondary complications: such as post traumatic arthritis, chronic pain syndromes, contractures, respiratory compromise and functional deterioration Polytrauma cases require expert evidence that integrates all injury domains into a single, coherent functional prognosis.

Prolonged disorders of consciousness (PDOC)

Prolonged disorders of consciousness represent one of the most complex and sensitive areas within neuro-rehabilitation and medicolegal practice. Individuals in a vegetative or minimally conscious state require highly specialised assessment to determine the level of awareness, the trajectory of recovery and the long-term implications for care, therapy and safeguarding A rehabilitation medicine consultant provides: • Diagnostic clarification: using recognised behavioural assessment tools • Prognostic opinion: informed by injury mechanism, duration of impaired consciousness and comorbidities • Comprehensive care planning: encompassing 24 hour nursing requirements, positioning regimes, spasticity and contracture management, respiratory care, nutrition and risk mitigation • Long-term expectations: including the likelihood of medical complications, stability of condition and realistic functional outcomes

Life expectancy: importance in medico-legal claims

Life expectancy calculation is a pivotal component of medicolegal assessments, directly influencing the valuation of claims and structuring of future care provisions. Accurate estimation requires integration of clinical factors, injury severity, comorbidities and functional status. Rehabilitation medicine experts apply evidence-based methodologies to project realistic life expectancy, informing compensation for care costs, loss of earnings and other long-term financial implications. This aspect is particularly critical in cases involving severe neurological injury, spinal cord injury, TBI, stroke, amputees and complex medical conditions where mortality risk is elevated. Precise

projections ensure equitable settlements that reflect the claimant’s anticipated lifespan and care needs.

Spinal cord injury: prognosis, complications and lifelong needs

Spinal cord injury cases require precise interpretation of neurological level, injury completeness and expected functional gains. Legal professionals rely on expert evidence that accurately predicts mobility potential, continence outcomes, equipment and housing requirements and secondary complications such as spasticity, autonomic dysfunction and pressure injury risk. Rehabilitation medicine provides the functional context necessary to quantify long‑term needs and future risks.

Cerebral palsy

Cerebral palsy encompasses a group of permanent movement and posture disorders caused by non-progressive disturbances in the developing fetal or infant brain. Medico-legal assessment considers the timing and severity of injury, lifelong functional impairments, secondary complications, and impact on education and vocational potential.

Cauda equina syndrome

Cauda equina syndrome results from compression of the cauda equina nerve roots, often requiring urgent surgical intervention. Medico-legal evaluation addresses neurological deficits, timing of diagnosis and treatment, and long-term consequences such as bladder, bowel, sexual dysfunction and lower limb weakness. Rehabilitation medicine expertise is essential for quantifying functional limitations and projecting future care needs.

Paediatric to young adult transition

Children with neurological injuries – whether congenital, developmental or acquired – experience significant changes in

functional ability, independence and care needs as they transition into adolescence and early adulthood. Growth, musculoskeletal development, evolving cognitive maturity and increasing social expectations all influence functional outcomes. For medico-legal purposes, prognostic opinions must be revisited during this transition phase. A rehabilitation medicine consultant provides a developmentally informed, age-specific assessment addressing emerging functional abilities, anticipated changes in mobility and communication, evolving therapy and equipment needs, and risks associated with puberty, growth and spasticity progression. A new condition and prognosis report is often essential from age 16-20 to support accurate quantification and future planning.

Why solicitors and barristers rely on rehabilitation medicine experts

In medico-legal practice, the central questions revolve around function: current ability, expected recovery, required supports, foreseeable complications and realistic life expectancy. Rehabilitation medicine experts are uniquely equipped to answer these questions with clarity and authority, providing reports that withstand scrutiny, prognoses grounded in clinical evidence, structured reasoning and balanced opinions supporting fair settlements.

Conclusion

For cases involving brain injury, spinal cord injury, neurological disease, polytrauma, PDOC or amputee rehabilitation, the involvement of a rehabilitation medicine expert is essential. The specialty’s holistic, functional and prognostic approach ensures medico-legal evidence is comprehensive and aligned with the realities of longterm disability. Solicitors and barristers benefit from expert input that clarifies complexity, anticipates future needs and supports accurate quantification – making rehabilitation medicine a cornerstone of modern medico-legal practice. q

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BRAIN INJURY LITIGATION: FROM RUGBY PITCH TO COURT [

THE HIGH COURT litigation brought by former rugby players against the sport’s governing bodies currently illustrates the importance of specialist neuropsychological evidence in complex brain injury claims. The proceedings involve separate claims by former rugby union and rugby league players who allege that repeated concussive and subconcussive impacts during their playing careers contributed to serious neurological conditions. The defendants dispute the claims and deny the alleged breaches of duty. The litigation reached a significant procedural stage in July when the High Court considered applications by the defendants to strike out a large number of claims. The applications concerned alleged failures by the claimants’ legal representatives to comply with disclosure orders requiring medical material to be provided, including recordings of ‘neurology interviews’ conducted before the litigation began. The court had not determined the underlying allegations of brain injury at that stage; the immediate issue concerned compliance with procedural orders and disclosure of relevant evidence. The case demonstrates why expert evidence needs to be obtained at an early stage. Neurological conditions can be complex, and the effects of brain injury are not necessarily obvious from a person’s physical appearance. A claimant may have relatively little visible physical impairment while experiencing difficulties with memory and concentration. A neurologist may be instructed to consider the diagnosis, neurological history and possible relationship between repeated head trauma and subsequent symptoms. A neuropsychologist can provide complementary

evidence by assessing cognitive functioning. A neuropsychological assessment can be particularly relevant to questions of memory and attention. These difficulties may affect a person’s ability to organise tasks, solve problems, make decisions and manage everyday responsibilities. Such impairments can have consequences for employment, relationships and independent living even where conventional neurological examination does not fully demonstrate the extent of the claimant's difficulties. Expert evidence must also consider alternative explanations. Symptoms following a brain injury may overlap with the effects of pain, fatigue, psychological difficulties, medication or pre-existing conditions. An expert must therefore consider the evidence objectively rather than simply attributing every reported symptom to the alleged injury. The rugby litigation also highlights the importance of disclosing the material upon which expert opinions are based. The recent proceedings have involved disputes concerning neurological interviews, neuropsychological assessments, brain scans and other medical evidence. This reinforces the importance of ensuring that relevant investigations and assessments are properly documented. Where cognitive impairment is established, expert evidence may extend beyond diagnosis. A neuropsychologist may be asked to consider neurorehabilitation needs and strategies to compensate for persistent difficulties. Evidence may also assist in assessing the claimant’s ability to return to work, manage daily activities and function independently. The current rugby proceedings demonstrate the scale and complexity brain injury litigation can reach. q

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MENTAL HEALTH AND SUBSTANCE USE DISORDERS POSE COMPLEX QUESTIONS [CASES INVOLVING substance misuse and mental health can

present some of the most complex questions for the courts. Alcohol and drug use may influence mood, behaviour, impulse control and the ability to make informed decisions. At the same time, psychiatric illness may contribute to substance misuse, creating a complicated relationship often described as dual diagnosis or co-occurring mental health and substance use disorders. In such cases, expert evidence can be essential in helping the court distinguish between the effects of intoxication, withdrawal, substance dependence and an underlying psychiatric disorder. The expert’s task is not to determine the legal outcome, but to provide an independent clinical opinion based on the available evidence. One important area is mental capacity and decision making. Substance misuse does not automatically mean that an individual lacks capacity. An expert may need to consider whether, at the relevant time, the person's ability to understand, retain, use or weigh information was affected by intoxication, withdrawal, cognitive impairment or another psychiatric condition. Where capacity is disputed, the timing of symptoms and the person's mental state can be particularly significant. Substance misuse may also be relevant to offending behaviour. Experts can examine the relationship between an individual’s psychiatric presentation, substance use and the alleged behaviour. This may involve considering whether substances exacerbated pre-existing mental illness, whether offending occurred during periods of intoxication or withdrawal, and whether impulsivity, disinhibition, delusions or other symptoms played a role. Such evidence can assist the court without assuming that substance use itself provides an explanation or justification for offending. Vulnerability and safeguarding are equally important. Individuals affected by severe mental illness and substance dependence may be particularly vulnerable to exploitation, coercion, self-neglect or harm from others. An expert can assess the individual’s psychological functioning, ability to recognise risks and capacity to protect their own interests. This can be particularly relevant where safeguarding decisions or concerns about exploitation arise. Expert assessment may also contribute to risk assessment and detention decisions. Where there are concerns about violence, self-harm or neglect, an expert can consider relevant historical and current risk factors, the relationship between substance use and psychiatric symptoms, and the likely impact of treatment or abstinence. Importantly, a risk assessment should be evidence-based rather than simply equating a diagnosis or history of substance misuse with dangerousness. Detention can raise further questions about an individual’s mental state, treatment needs and level of risk. Expert evidence may assist the court in understanding whether psychiatric symptoms, substance dependence or both are contributing to the person’s behaviour and whether appropriate treatment and safeguards are available. The concept of dual diagnosis is particularly important because treating one problem in isolation may fail to address the other. Substance misuse can worsen psychiatric symptoms, while untreated mental illness can increase reliance on alcohol or drugs. An expert may therefore consider the chronology of both conditions, previous treatment, periods of abstinence, relapse patterns and response to intervention. Ultimately, expert evidence provides the court with a framework for understanding behaviour and decision-making in their proper clinical context. By carefully separating psychiatric illness, substance effects, dependence, withdrawal and situational factors, the expert can help the court reach informed conclusions while recognising the complex and often cyclical relationship between mental illness and substance misuse. q www.yourexpertwitness.co.uk

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Your Expert Witness A to Z guide of Expert Witness websites MEDICO-LEGAL SECTION David Berry PhD FRC Path MFSSoc MRSC Independent Toxicology Consultant Specialist in Clinical and Forensic Toxicology with particular emphasis on drugs (both illicit and therapeutic) and alcohol.

Mr Kim Hakin FRCS FRCOphth

www.toxicologyservices.co.uk

www.kimhakin.com

Mr Timothy Burge MBChB FRCS FRCS(Plast) DMCC MSc

Mr Vijay Joshi MBChB, LL.B (Hons), FRCSEd (C-Th), PGCert (Medical Law)

Consultant Burns & Plastic Surgeon • Cosmetic and aesthetic surgery of the breast and trunk • Burns • Trauma • Scars Clinics in Birmingham, Bristol, Cardiff, London and Salisbury.

www.clifton-plastic-surgery.co.uk

Consultant Thoracic Surgeon Personal injury and clinical negligence cases relating to diseases and injuries of the chest. Preparation of medicolegal reports and giving evidence in court.

www.thoracicexpertwitness.co.uk

Professor Paul J Ciclitira MB PhD FRCP MRCS FRCP AGAF

Atul Khanna FRCS (Plast)

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

Consultant Plastic, Reconstructive and Hand Surgeon • Hand surgery • Soft tissue injury • Burns management • Medical negligence in cosmetic surgery

www.profpaulciclitira.co.uk

www.atulkhanna.co.uk/expert-witness/

Mr Philip Coleridge Smith DM MA BCh FRCS

Dr Raj Kumar – Dental Expert

20 years of: • Defendant instructions • Claimant instructions • Single joint expert • Court experience

Causation and Liability and Condition and Prognosis Reports • General dentistry • Cosmetic dentistry • Patient consent • Dental implantology • Orthodontics • Facial aesthetics

Consultant Vascular Surgeon

www.adsummedicolegal.com & www.britishveininstitute.com

07802 456 804 | info@dentalexpert.me | www.dentalexpert.me

Dr Sam Creavin MPhil MBChB MRCP(UK) MRCGP PhD CUBS

Kulvinder Lall Consultant Cardiothoracic Surgeon

General Medical Practitioner • Delayed diagnosis: cancer, sepsis, spinal disorders, ectopic pregnancy, diabetes, heart disease • Instructed by GMC and NHS resolutions 60/40 split • Quick turnaround. Authoritative, logical and reasoned reports.

www.gpexpertwitness.com

Instructions taken in cases relating to cardiac and thoracic surgery, including aspects relating to surgical care and those following trauma to the structures of the chest.

www.kulvinderlall.com

Chris Dawson MS FRCS LLDip

Mr Brian Leatherbarrow BSc MBChB DO FRCS FRCOphth

www.chrisdawson.org.uk

www.medicolegalophthalmology.co.uk

Consultant Urologist with 22 years experience of medico legal report writing and expert witness work and has completed over 2,100 reports. He also regularly completes Fitness to Practice reports for the General Medical Council.

Consultant Ophthalmic, Oculoplastic & Orbital Surgeon • Complications of cosmetic eyelid surgery • Eyelid reconstructive surgery • Eyelid and orbital tumours and trauma • Loss of an eye / socket reconstructive surgery • Thyroid eye disease • Ptosis surgery

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

Mr Richard Matthews MB BS FRCS FRCSE MAE

www.markduxbury.info/medicolegal

www.richardmatthewsmedicolegal.uk

Consultant Hepatobiliary, Pancreatic & General Surgeon • General & emergency surgery • Hernia surgery • Liver & pancreatic surgery • Gallbladder & biliary surgery • Laparoscopic surgery • Hepatobiliary surgery

PLASTIC & HAND SURGEON Mr Matthews is well versed in the provision of Medical Reports relating to Personal Injury ranging from scarring through trauma, including burns and scalds, to non-bony hand injuries.

Equip2Speak

Mr Lindsay Muir MB MCh(Orth) FRCS(Orth)

Medico-legal Consultancy for Assistive Technology (AT) & Speech and Language Therapy (SLT)

• Specialists in Brain and Spinal Injury • Justified Evidence & Expertise in Immediate & Lifetime Needs • Experienced in Complex & High-Value Claims • Claimant/Defendant/Joint Instruction

www.equip2speak.co.uk

Dr Lance N. Forbat BSc (Hons) MD FRCP FRCP (Glasgow) Consultant Cardiologist Experienced in writing medico-legal reports on all aspects of adult cardiology – specialising in angina, heart failure, arrhythmias and pacing.

www.heartattacksymptoms.co.uk 94

Consultant Ophthalmic Surgeon and Expert Witness on ophthalmological matters

www.yourexpertwitness.co.uk

Consultant Hand Surgeon • Amputation • Nerve injury • Dupuytren’s disease • Scaphoid fracture • Finger fracture • Tendon injury • Hand surgery • Wrist fracture

www.tmhc.co.uk

Mr Abraham Odumala

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

Consultant Orthopaedic Surgeon – Upper Limb Specialist. Expertise in all upper limb conditions and treatment. Shoulder, elbow, wristand hand injuries.

www.yorkshire-upperlimb.co.uk

Dr Shanthi Paramothayan

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

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

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

BSc PhD MBBS LLM MScMedEd FHEA FCCP FRCP

www.paramothayan.com Jonathan Park Consultant Ophthalmologist MB ChB (Hons) BSc (Hons) FRCOphth

Clinical negligence (ophthalmology) and personal injury (non-surgical ocular trauma) cases. Can act on behalf of either claimant or defendant or as a Single Joint Expert.

www.expertwitnesspathologist.co.uk

Dr Ian Starke MSc MD FRCP Stroke Medicine and Medicine for the Elderly Reports and examinations for clinical negligence and personal injury cases in stroke medicine and geriatric medicine

www.jonathan-park.co.uk

www.expertwitnessinstrokes.co.uk

Dr Nick Plowman MA MD FRCP FRCR

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

Consultant in Clinical Oncology Specialist areas of expertise include radiation therapy, chemotherapy, immunotherapy and genomics as well as delay in diagnosis. This applies to adults and children.

drnickplowman.com

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

Dr Stuart Porter Chartered Physiotherapist

Lymm Eye Clinic

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

Specialist areas of expertise include: • Clinical negligence • Breach of duty • Allegations of inappropriate contact • Assessment of adults • HCPC investigations.

Lymm Eye Clinic are a team of leading, independent ophthalmology experts covering all aspects of ophthalmology.

https://physiowitness.co.uk/

www.lymmeyeclinic.co.uk

Dr Samy Sadek MBBS BSc MCEM FCEM

DR S V MEDICALS (Mr Sen Venkat)

Consultant in Emergency Medicine & Pre-Hospital Care • Minor injuries • Major trauma • Medical emergencies • Criminal and forensic cases • Reports on survivability and cause of death.

MSc Ortho (London) FRCS Consultant Orthopaedic Surgeon

• Whiplash injuries • General trauma • Sports injuries • Clinical negligence work • Joint replacement surgery of hip and knee • Hand, shoulder, elbow and wrist injury

www.drsamysadek.com

www.drsvmedicals.co.uk

Mr Sameer Singh MBBS BSc FRCS Orth

Consultant Orthopaedic Surgeon • All aspects of trauma – soft tissue and bone injuries • Upper and lower limb disorders and injuries • Whiplash injuries • Expert Witness for defence and claimant

Ms Leyla Ziyal MPhil AFBPsS CPsychol HCPC Registered clinical Neuropsychologist • Neuropsychological assessment and rehabilitation • Depression • Occupational stress • PTSD • Anxiety

www.orthopaedicexpertwitness.net

www.accentpsychology.co.uk

Clinic locations – London, Milton Keynes and Bedford

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CHOOSING THE RIGHT MEDICINES EXPERT: DOES THE EXPERTISE MATCH THE QUESTION? By Dr Malcolm VandenBurg BSc MBBS FFPM FRCP, Registered as a Specialist in General Internal Medicine with a licence to practice, Consulting Pharmaceutical Physician and Forensic Clinical Pharmacologist

[WHEN A LEGAL CASE involves a

medicine or drug, the obvious first step may appear to be straightforward: instruct an expert in pharmacology. But which expert? A pharmacist, pharmacologist, clinical pharmacologist and medically qualified clinical pharmacologist have different training, professional responsibilities and areas of competence. Even among medically qualified experts there is a further important distinction between being GMC registered and continuing to hold a current GMC licence to practise. These differences matter because the fundamental question is not simply whether an expert understands the drug, it is whether that expert has the appropriate expertise to answer the particular question being put before the court. Getting that decision right at the beginning can avoid delay, additional expense and potentially difficult challenges to an expert's competence later in proceedings.

Dr VandenBurg pictured with his Practice Manager Katie Vallance BSc (Hons) at the Sussex Law Society Ball 2026. Image credit: Nick Ford Photography

Start with the question, not the title

There is no universally ‘best’ medicines expert. A pharmacist may be precisely the right expert where the issue concerns dispensing, labelling, storage, pharmacy procedures or another matter falling within pharmacy practice. Where the question concerns the underlying science of a substance – its mechanism of action, pharmacokinetics, pharmacodynamics, interactions or toxicology – a pharmacologist may be appropriate. Clinical pharmacology takes this further by considering how pharmacological science applies in patients. However, the title ‘clinical pharmacologist’ does not necessarily mean that the individual is medically qualified. That distinction becomes important when an opinion moves from explaining what a drug can do to determining what it is likely to have done to a particular person in particular clinical circumstances. A medically qualified clinical pharmacologist brings together pharmacological expertise with medical training. That allows consideration not only of the pharmacology, but of the patient’s physiology, disease, diagnosis, concurrent treatment and overall clinical picture. Where the expert also holds a current GMC licence to practise, there is another important dimension: continuing clinical accountability and the ability, where appropriate, legally to interview and clinically examine the person concerned. The distinction between GMC registration and a current licence to practise is substantive; a licence entails continuing appraisal, revalidation and fitness-to-practise requirements.

Every medicine can have an effect

A central principle of clinical pharmacology is easily overlooked: every medication can have an effect. That effect may be the intended therapeutic response. It may be an adverse reaction. It may arise from interaction with another

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medicine, an underlying disease or characteristics of the individual taking it. Consequently, knowing that someone took a particular drug is rarely enough. Age, sex, ethnicity, physiology, co-existing disease, concurrent medication and illegal substances may all affect an individual’s response. Two people taking the same dose of the same medicine need not experience precisely the same effects. That becomes particularly important in forensic clinical pharmacology, where questions may concern cognition, mens rea, behaviour, capacity, memory, automatism, criminal responsibility or ability to drive. The expert therefore has to move beyond asking: “What does this drug do?” to the much more important medico-legal question: “What is this drug likely to have done in this individual, at this time and in these circumstances?”

Why the full medical history matters

Answering the question properly frequently requires full medical records. A medication list alone may reveal very little about causation. Age, sex, ethnicity, underlying disease, previous and concurrent medication and illegal substances, investigations and the clinical chronology can all affect an individual’s response to a drug. Without that information, it may simply not be possible to give a complete and properly reasoned opinion. Obtaining those records is not always straightforward. Where the individual is the claimant or defendant, access may be relatively uncomplicated. Greater difficulty can arise where relevant records relate to another party or witness and questions of medical confidentiality are raised. In such circumstances, the expert should not fill gaps in the evidence with assumptions. If I consider particular medical records are necessary to answer the question put to me, I will explain precisely why they are clinically relevant. Where necessary, I am willing to attend court

and explain to the judge why access to those records is required before I can provide a complete expert opinion. This is particularly important in clinical and forensic pharmacology because the effect of a medicine cannot properly be separated from the individual taking it. The same medicine and dose may have markedly different consequences depending upon the person's physiology, disease, concurrent medication, illegal substances and other individual factors.

The clinical and forensic perspective

The medically qualified clinical forensic pharmacologist therefore occupies an unusual intersection between drug science, clinical medicine and legal evidence. The role may involve assessing prescribing and adverse reactions in a clinical negligence claim, but it can equally involve considering whether prescribed or illicit substances affected behaviour, judgement, memory or capacity in criminal proceedings. A current licence to practise can also be important where examination of a claimant, defendant or other individual forms part of the assessment. Whatever the instruction, however, the expert’s overriding duty remains to the court. Expert evidence should not be shaped to produce the answer sought by the party paying the fee. Instructions can properly come from either side. In my own practice I am willing to accept instructions from claimants or defendants, provided the question falls within my expertise and sufficient evidence can be obtained to answer it properly.

Sometimes the most useful expert opinion is that the available evidence does not support the proposition advanced.

Get the expertise right at the outset

The increasing complexity of medicines and modern clinical care makes precise expert selection more, not less important. The question for those instructing should therefore not simply be: “Do we need a pharmacology expert?” It should be: “What question are we asking, and which expert has the qualifications, clinical experience and current professional standing to answer it?” A pharmacist, pharmacologist, clinical pharmacologist and medically qualified clinical pharmacologist can each provide important expertise. But their roles are not interchangeable. Where the issue requires the pharmacology to be interpreted in the context of disease, physiology, concurrent medication, other illegal substances and the circumstances of an individual patient, medical qualification and current clinical practice may become fundamental to the opinion. The right expert is ultimately not the person with the most impressive title; it is the person whose expertise matches the questions the court needs answered. q • For further information or enquiries contact Dr VandenBurg on 07850 049 134, email consultrum@hotmail.com or visit www.malcolmvandenburg.co.uk. Alternatively contact practice manager Katie Vallance on 07712 644697 or email katie.vallance@proton.me.

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DELAYED DIAGNOSIS AND TREATMENT: A MEDICO-LEGAL PERSPECTIVE [WITH CONTINUED PRESSURE on NHS services, questions

concerning delayed diagnosis, delayed treatment and failures to escalate care remain important issues in clinical negligence litigation. Although NHS performance has improved in some areas during 2026, substantial waiting lists remain. In March 2026, for example, NHS England reported over 7 million referral-to-treatment pathways awaiting treatment, with around 6 million individual patients represented. For the medico-legal expert, however, a lengthy waiting time does not automatically establish negligence. The central questions are whether the care provided met the appropriate standard, whether there was an avoidable failure to diagnose or act, and whether that failure caused or materially contributed to the patient's subsequent injury or deterioration. Delayed diagnosis can arise in many settings, including general practice, emergency departments and outpatient clinics. A patient’s symptoms may be attributed to a less serious condition, investigations may not be arranged or followed up appropriately, abnormal results may not be acted upon, or a referral may fail to reach the appropriate specialist service. In hospital, deterioration may also be missed where observations, investigations or clinical reviews are inadequate, or where concerns are not appropriately escalated. The issue of standard of care is therefore fundamental. An expert must consider what a reasonably competent practitioner, exercising appropriate skill and care, should have done in the circumstances. This requires considering the information available at the time rather than hindsight based on the eventual diagnosis. The expert may need to examine clinical records, referral correspondence, prescribing records, telephone consultations and communications between different healthcare professionals. Escalation of care is particularly important where there are signs of deterioration or where initial management has failed to resolve the patient’s problem. NHS England has placed increasing emphasis on recognising deterioration and ensuring that patients, relatives and staff can raise concerns. Its July 2026 patient-safety update reported that Martha’s Rule had supported earlier intervention for more than 1,000 patients during its first year, including around 400 transfers to higher levels of care. The medico-legal assessment must then move beyond breach of duty to causation. A delay may represent a departure from appropriate practice without necessarily causing additional injury. Conversely, even a relatively short delay can be significant where a condition is timecritical. The expert may therefore be asked to consider what would probably have happened had the diagnosis been made earlier. This can be particularly complex in cases involving cancer, infection, cardiovascular disease, neurological conditions, fractures and any potentially life-threatening conditions. The expert may need to distinguish between the natural progression of the underlying disease and harm attributable to the alleged delay. This can involve considering whether earlier intervention may have altered treatment options, reduced complications, improved prognosis or avoided additional disability. Waiting-list cases require similar care. A lengthy NHS waiting time does not, by itself, demonstrate substandard clinical care. Nevertheless, where a patient’s condition changes while waiting, there may be a duty to reassess the situation, communicate appropriate information and respond to evidence that the patient’s clinical priority has altered. NHS England introduced minimum standards for planned patient care in July 2026, including clearer communication about referrals, regular updates during waiting periods and information about what patients should do if their condition worsens.

Ultimately, these claims require a careful reconstruction of the patient's clinical journey. A suitably experienced expert witness can identify the point at which a diagnosis should reasonably have been considered, determine whether appropriate investigations or referrals were undertaken, assess whether escalation was required and, crucially, explain the likely consequences of any delay. The value of expert evidence lies not simply in identifying an error, but in establishing whether the care fell below the required standard and whether that breach made a meaningful difference to the patient’s eventual outcome. In an increasingly pressured healthcare environment, that distinction between an unfortunate outcome and avoidable clinical harm is central to a robust medico-legal assessment. q

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INCREASED RISK IDENTIFIED WITH CERTAIN MODULAR NECK HIP REPLACEMENTS [ A REVIEW by the Medicines and

Healthcare products Regulatory Agency (MHRA) has identified increased risks of wear and corrosion associated with certain cobalt-chrome modular neck hip replacements. As a precautionary measure, NHS trusts and hospitals are being advised to identify patients with these devices and invite them for a clinical review to inform them of the potential risks and discuss whether ongoing monitoring is required based on their symptoms or clinical findings. The advice applies to hip replacement constructs using cobalt-chrome dual taper modular neck components manufactured by Aesculap AG (Metha modular), LimaCorporate (H-Max-M), Smith and Nephew (SMF), Stryker (ABG II modular) and Symbios (HARMONY modular and SPS modular). The affected devices were available in the UK between 2007 and 2019, and the available data suggests around 750 patients currently have these particular hip replacements implanted. These devices are no longer available in the UK. For context, more than 100,000 hip replacements of all types are performed in the UK each year. While most patients implanted with these hip replacements have well-functioning hips and are unlikely to develop serious problems, a small number may develop problems in the tissues around the hip that could lead to the need for revision surgery. Dr Alison Cave, MHRA Chief Safety Officer, said: “If you have an affected hip replacement device implanted, you should expect to be contacted by your surgeon or implanting hospital for a clinical assessment as soon as practically possible. There is no need for you to contact your surgeon or implanting hospital directly. “Anyone experiencing new or unexpected symptoms, including pain, stiffness or instability related to any implant should speak to their surgeon or the hospital where their surgery was performed. Please also report it to the MHRA via the Yellow Card scheme or the Incident Reporting & Investigation Centre if you are in Scotland.” In the meantime, if patients experience any new or unexpected symptoms including pain, stiffness or instability, they should speak

to their implanting surgeon or the hospital where their surgery was performed in the first instance. This latest action follows an MHRA review of Profemur cobalt-chrome modular neck hip replacements, published in 2025, which identified increased risks of wear, corrosion and device fracture associated with those devices. Following that work, the MHRA reviewed all other cobalt-chrome dual taper modular neck hip replacement systems that have been available on the UK market. The review found that rates of revision surgery linked to metal wear varied between different implant systems. It also identified potential increased risks of wear and corrosion associated with the additional interfaces present in these designs. In some cases, this may cause reactions in the tissue around the implant and lead to revision surgery. The MHRA did not find evidence of a higher-than-expected rate of device fracture among the implant systems covered by this review. Based on the available evidence, the review concluded that all patients with the potentially affected devices should be followed up. q

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FIVE ORTHOPAEDIC MEDICOLEGAL ISSUES EVERY PERSONAL INJURY LAWYER SHOULD HAVE ON THEIR RADAR By Mr Simon Wimsey FRCS (Tr & Orth), Consultant Orthopaedic Surgeon

[ORTHOPAEDIC UPPER LIMB AND HAND CLAIMS continue to

present unique medicolegal challenges. Despite advances in imaging, surgical techniques and rehabilitation, many disputes now centre less on diagnosis and more on causation, functional impact and the credibility of ongoing symptoms. For medicolegal experts, there are five areas currently generating significant debate. 1. The MRI confirms pathology but the patient has no clinical signs One of the most common pitfalls in litigation is over-reliance on imaging. MRI and ultrasound have become increasingly sensitive, but sensitivity is not synonymous with clinical significance. Asymptomatic rotator cuff tears, TFCC abnormalities, labral changes, thumb CMC osteoarthritis and degenerative tendon pathology are common incidental findings, particularly with advancing age. Several systematic reviews have demonstrated high rates of ‘abnormal’ shoulder MRI findings in pain-free individuals, reminding experts and lawyers alike that imaging cannot establish causation in isolation. The question is not what the scan shows, but whether the imaging explains the patient's presentation. My aim in medicolegal reporting is to correlate it with the mechanism of injury, examination findings, chronology and functional progression. A scan should support the clinical diagnosis, not replace it. 2. Surveillance: helpful evidence or a misleading snapshot? Video surveillance continues to appear in personal injury litigation, but its interpretation requires caution. Modern surveillance often captures isolated activities that may appear inconsistent with reported disability. Yet upper limb disorders, particularly chronic pain conditions, frequently fluctuate. A claimant may manage a brief episode of lifting or gardening yet be unable to sustain repetitive activity over an eight-hour working day. The medicolegal question is rarely whether someone can perform a task once. The question is whether they can perform it reliably, repeatedly and without significant symptom exacerbation. Surveillance should therefore be considered alongside examination findings, treatment history and the wider clinical picture rather than viewed as determinative evidence. 3. Function is becoming more important than diagnosis Courts increasingly want to understand what an injury actually prevents someone from doing. Traditional impairment ratings remain useful, but functional capacity is often more relevant when considering loss of earnings, future employment and care needs. A software engineer with persistent ulnar neuropathy may lose more occupational function than a manual worker recovering uneventfully from a distal radius fracture. Patient-reported outcome measures such as the QuickDASH can provide useful supporting evidence, but they should never replace objective examination. The modern medicolegal assessment focuses on function rather than pathology alone. 4. Peripheral nerve injuries Peripheral nerve injuries continue to generate disproportionately complex litigation. High-resolution ultrasound and improved electrodiagnostic studies

have enhanced diagnostic accuracy for median, ulnar and radial nerve pathology. However, delayed presentation, evolving symptoms and overlap with cervical radiculopathy or diabetic neuropathy frequently complicate causation. Another recurring issue is whether trauma genuinely precipitated conditions such as carpal tunnel syndrome or simply accelerated symptoms in an already vulnerable nerve. Objective neurological examination remains essential. Equally important is understanding the limitations of nerve conduction studies, particularly in early or intermittent compression neuropathies where results may initially be normal. The ability to distinguish between pre-existing but clinically asymptomatic lesions is a topic which I discuss frequently with counsel. 5. CRPS: early recognition matters more than ever Complex Regional Pain Syndrome remains one of the most challenging diagnoses in personal injury litigation. The adoption of the Budapest diagnostic criteria has improved consistency, but disputes continue regarding timing of diagnosis, documentation of objective signs and differentiation from prolonged post-traumatic pain. Recent evidence continues to emphasise that early recognition, prompt physiotherapy and multidisciplinary pain management are associated with improved outcomes, whereas delayed diagnosis may contribute to chronic disability. For medicolegal experts, careful review of contemporaneous medical records is often more informative than retrospective descriptions of symptoms years later. The presence or absence of documented swelling, colour change, temperature asymmetry or sudomotor disturbance frequently becomes pivotal when confirming or refuting the diagnosis.

Looking ahead

Perhaps the greatest expectation placed upon today's medicolegal expert is transparency. Courts increasingly value reports that clearly explain the reasoning process, acknowledge uncertainty where appropriate, distinguish facts from opinion and engage with competing medical explanations. Unsupported assertions are less persuasive than evidence-based analysis grounded in contemporary clinical practice and published literature. For lawyers, early instruction with comprehensive medical records, pre-accident primary care documentation, occupational information and sequential imaging remains essential. These materials often determine whether an expert can confidently address causation, prognosis and the extent to which ongoing symptoms are attributable to the index accident. Ultimately, successful resolution of upper limb and hand personal injury claims depends not only on accurate diagnosis but also on a careful analysis of mechanism of injury, pre-existing pathology, functional consequences and future risk. As diagnostic capabilities and treatment options continue to evolve, the role of the orthopaedic medicolegal expert becomes increasingly focused on providing objective, well-reasoned opinions that assist the court rather than advocate for either party. Such evidence remains central to achieving fair and proportionate outcomes in modern personal injury litigation. q www.yourexpertwitness.co.uk

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THE ANATOMY OF A CAUDA EQUINA CLAIM [

CAUDA EQUINA SYNDROME (CES) is one of the most serious neurological emergencies encountered in spinal medicine, and claims arising from delayed diagnosis or treatment are particularly complex. For solicitors handling a negligence claim, expert evidence is often central to establishing what happened, whether the standard of care was breached and whether that breach caused the claimant’s injury. The cauda equina is a bundle of nerves at the lower end of the spinal cord that supplies the bladder, bowel, lower limbs and areas of sensation around the buttocks and genital region. CES occurs when these nerves become compressed, most commonly as a result of a large lumbar disc prolapse, although spinal stenosis, tumours, infection, trauma and other conditions can also be responsible. Symptoms can include severe lower back and leg pain, altered sensation and changes in bladder or bowel function. Urinary difficulties, particularly loss of sensation or control, are regarded as important warning signs. Because prolonged compression can result in permanent neurological damage, timely recognition and treatment are critical. The difficulty in litigation is that CES can present in different ways and the early symptoms may overlap with more common spinal conditions. The expert therefore needs to consider not simply what the eventual diagnosis was, but what a reasonably competent clinician should have recognised from the information available at the time. Claims frequently concern an alleged failure to recognise red-flag symptoms, inadequate neurological examination, failure to arrange appropriate investigations, or an unreasonable delay in obtaining an MRI scan or specialist spinal assessment. Other allegations may relate to delays in surgery after CES has been confirmed. A claimant may argue that earlier intervention would have prevented, or substantially reduced, permanent bladder, bowel, sexual or lowerlimb dysfunction. Establishing this requires careful analysis of the clinical chronology, imaging, symptoms and the likely progression of the underlying condition. Different experts may be required depending upon the allegations and stage of the claim. A consultant spinal surgeon or neurosurgeon may provide evidence on diagnosis, appropriate investigation, surgical decision-making and whether the treatment provided was reasonable. A consultant neurologist can assist with the neurological presentation, examination findings, diagnosis and resulting neurological impairment. A neuroradiologist or appropriately experienced radiologist may be required to interpret MRI scans and determine the extent and significance of nerve compression. Where bladder or bowel dysfunction is a major feature, urological or colorectal expertise may also be relevant. A pain medicine specialist, rehabilitation physician or other expert may be required to address continuing symptoms and functional consequences. Importantly, medical evidence concerning breach of duty is only part of the picture. A care or rehabilitation expert may assist with the claimant’s future care requirements, while an occupational therapist can assess the practical impact of disability on everyday activities. In appropriate cases, additional experts may address psychological injury, employment and financial consequences. Solicitors should consider the precise issues requiring expert evidence before selecting an expert. The expert should have appropriate qualifications, current or sufficiently recent clinical experience and demonstrable expertise in the particular issue under consideration. At the early stage of a claim, an expert may be instructed to provide

an initial screening opinion on whether there appears to be a viable case. If the claim progresses, a more detailed report may be required, incorporating the complete medical records, imaging and witness evidence. It is also important to distinguish between breach and causation. An expert may conclude that there was an unacceptable delay, but that does not necessarily establish that the delay caused the claimant’s eventual disability. A robust expert report should address both questions separately and explain the reasoning clearly. CES claims are often highly dependent upon chronology. Obtaining the complete medical records – ambulance records, emergency department documentation, nursing observations, MRI reports and images, and operative records – at an early stage can be invaluable. Solicitors should also ensure that experts are given the relevant factual evidence and are asked focused questions. Where several specialties are involved, their evidence should be coordinated so that apparent disagreements are properly understood rather than overlooked. The correct expertise can therefore make a significant difference to the investigation and presentation of a CES claim. Early identification of the clinical issues, followed by careful selection of appropriately experienced experts, can help establish whether there was a breach of duty, whether that breach caused avoidable injury, and the extent of the claimant’s resulting losses. q

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GETTING TO GRIPS WITH HAND AND WRIST INJURIES [

THE HAND IS FUNDAMENTAL to communication, employment, personal care and independence, while the wrist provides the stability and movement necessary for grip and dexterity. For the expert witness, the task is therefore not simply to identify an injury, but to explain its functional significance, assess the treatment pathway and provide an evidence-based opinion on prognosis and future needs. Instructions may arise following road traffic collisions, workplace accidents, falls, sporting injuries or clinical negligence. They can involve fractures, tendon and nerve injuries, soft-tissue damage, reconstructive surgery or complex disorders affecting the hand and wrist. Expert evidence may be required to establish the nature and extent of the injury, whether treatment was appropriate, whether complications have developed and what further intervention may reasonably be required.

Assessing the injury

A detailed review of the clinical history is fundamental. The expert will consider the mechanism of injury, imaging, operative records and subsequent rehabilitation. Where appropriate, the expert may also undertake a physical examination to assess range of movement and functional use. The distinction between an anatomical injury and its functional consequences is particularly important. A fracture may have united satisfactorily but left the claimant with stiffness, altered wrist mechanics or post-traumatic arthritis. Similarly, a tendon injury may have been repaired successfully but resulted in adhesions or restricted movement. The expert must determine whether the reported limitations are consistent with the clinical evidence. Nerve and tendon injuries can be particularly challenging from an expert witness perspective. Damage to a nerve may result in sensory loss, weakness, impaired dexterity or neuropathic pain, while tendon injury can affect the ability to flex or extend the fingers and wrist. The expert will consider whether the injury was recognised promptly and whether appropriate investigation, repair and rehabilitation were undertaken. Where surgery has been performed, operative records may provide important evidence regarding the extent of damage and the structures involved. Rehabilitation is also highly relevant. Following tendon repair, for example, carefully controlled mobilisation is necessary to balance protection of the repair against the risk of stiffness and adhesions. Where recovery has been less successful than anticipated, the expert may need to determine whether this represents a recognised complication, an unavoidable consequence of the original injury or a potential failure in treatment. Complex fractures may involve the joint surface, multiple bones or associated soft-tissue structures. The expert witness may be asked to consider whether conservative or surgical management was appropriate and whether the chosen procedure achieved the necessary alignment and stability. Severe trauma may require reconstructive procedures, including tendon reconstruction, nerve repair, grafting or other techniques designed to restore coverage and function. Such procedures may involve several stages and expectations of recovery must be considered realistically. An expert’s opinion should distinguish between a technically successful procedure and a successful functional outcome. Even appropriately performed reconstruction cannot always restore a

severely injured hand to its pre-injury state. Cases involving cerebral palsy can present additional complexity. Although the neurological injury underlying cerebral palsy is nonprogressive, individuals may experience changing musculoskeletal consequences, including spasticity, contractures, abnormal muscle balance and limitations in hand and wrist function. Where a claimant with cerebral palsy subsequently sustains a traumatic hand or wrist injury, establishing the pre-accident baseline becomes particularly important. The expert must consider what the claimant could do before the injury and what additional impairment resulted from the incident. This may require detailed consideration of previous medical records, therapy assessments, occupational evidence and accounts from the claimant or carers. A claimant may already have reduced grip or restricted dexterity but nevertheless have developed effective strategies for managing everyday activities. A subsequent injury may disrupt those adaptations and produce a disproportionately significant functional effect. Management of upper-limb difficulties associated with cerebral palsy is individualised. Depending upon the presentation, treatment may involve physiotherapy, occupational therapy, splinting or surgical procedures designed to improve positioning and function. For the expert witness, it is important to distinguish treatment aimed at managing the underlying effects of cerebral palsy from treatment required as a consequence of a subsequent injury. The expert may also need to consider whether additional rehabilitation, equipment or adaptations are required because the claimant's existing functional capacity has been reduced.

Causation, prognosis and future needs

One of the most important responsibilities of the expert witness is to address causation. Identifying a clinical abnormality does not, in itself, establish that it was caused by the accident or resulted from negligent treatment. The expert must consider the available evidence and, where appropriate, distinguish pre-existing conditions, natural progression, recognised complications and injury-related impairment. Prognosis should similarly be evidence-based, taking into account the time since injury, response to treatment, rehabilitation undertaken and potential future interventions. Future needs may include specialist equipment or adaptations. In complex cases, collaboration between hand surgeons, neurologists, rehabilitation specialists, occupational therapists and other professionals may be appropriate. The role of the hand and wrist expert witness is ultimately to provide the court with an impartial, clinically reasoned opinion. The expert should not simply advocate for the claimant or defendant, but analyse the evidence and explain the medical issues in terms that can be understood by the court. Complex hand and wrist injuries can have consequences that are not immediately obvious from imaging or surgical records. By assessing the injury alongside function, rehabilitation and future treatment requirements, an experienced expert witness can help establish the true impact of the injury and provide the court with a sound basis upon which to assess breach, causation, prognosis and future needs. q www.yourexpertwitness.co.uk

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SKIN CAMOUFLAGE AND TATTOO EXPERTISE: ASSESSING THE IMPACT OF VISIBLE DIFFERENCE [VISIBLE DIFFERENCES arising from

injury, surgery, burns, scarring, skin conditions or other trauma can have consequences extending far beyond the physical appearance of the affected area. In personal injury and clinical negligence claims, the psychological and practical impact of a visible difference may be an important component of the evidence. A specialist skin camouflage or medical tattoo expert can provide the court with valuable insight into how appearance may be improved, the options available and the potential effect on an individual’s everyday life. Skin camouflage involves the skilled use of specialised cosmetic products to reduce the visibility of scars, pigmentation differences and other skin irregularities. A practitioner may assess the colour, texture, location and extent of a visible difference before determining whether camouflage is appropriate and what level of improvement might realistically be achieved. The expert can explain the practical requirements of using camouflage, including application, maintenance and the circumstances in which it may be difficult or unsuitable. Medical tattooing, sometimes known as

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micropigmentation, is a different specialist intervention. It can be used in appropriate cases to improve the appearance of scars, pigmentation differences or areas where normal skin colouring has been altered. Depending on the circumstances, specialist tattooing may help create a closer visual match between affected and unaffected skin. The expert can explain what treatment may involve, whether more than one session could be required, its limitations and whether results can be expected to remain stable over time. In litigation, the expert’s role is not simply to comment on appearance. They can help the court understand the functional and social consequences of a visible difference. A claimant may experience reduced confidence, embarrassment or anxiety about being seen by others. They may avoid social situations, photographs, relationships, leisure activities or particular forms of clothing. The extent of these effects can vary considerably between individuals and may depend on the location and prominence of the visible difference. Employment may also be affected. Some individuals may feel uncomfortable in customerfacing roles, interviews or workplaces where

their appearance is highly visible. Others may alter their career choices or experience difficulties with confidence when interacting with colleagues or the public. An expert can explain how available camouflage or tattooing techniques might assist, while recognising that treatment cannot necessarily remove the underlying psychological impact. Quality of life is therefore an important consideration. Expert evidence can help distinguish between the physical characteristics of a scar or skin difference and the practical implications of attempting to manage its appearance. For the court, independent evidence from a suitably experienced skin camouflage or medical tattoo expert can provide a clearer understanding of what improvement is realistically achievable, what treatment may be required and how visible difference may affect confidence, social functioning, employment and day-to-day quality of life. This can be particularly valuable when assessing both the claimant’s current position and the potential need for future specialist treatment. q

ASSESSING INJURY: THE PHYSIOTHERAPIST’S ROLE [IN CLINICAL NEGLIGENCE and personal injury litigation, the choice

of expert witness can significantly influence the strength and clarity of a claim. While medical specialists may be essential for establishing diagnosis, treatment and causation, there are circumstances in which a physiotherapist is uniquely placed to address the practical consequences of an injury and its impact on a claimant's mobility and independence. Physiotherapy expertise is particularly valuable because it focuses not simply on the underlying medical condition, but on how that condition affects a person’s ability to move and function in everyday life. This distinction is particularly important when assessing the consequences of orthopaedic injuries, neurological conditions, spinal disorders and injuries sustained through accidents or inadequate treatment. A consultant surgeon may be able to explain the nature of an injury, whether surgery was appropriate and the likely medical outcome. A neurologist may provide an opinion on neurological damage, while a general practitioner or other physician may address diagnosis and treatment. However, these specialists may not be best placed to provide detailed evidence about functional mobility, physical limitations, rehabilitation requirements and the practical assistance a claimant may need. A suitably experienced physiotherapist can assess these issues from a different perspective. Their expertise encompasses movement, strength, balance, coordination and functional ability. They can examine how an injury affects activities such as walking, climbing stairs, standing, transferring from a chair or bed, lifting and carrying out domestic tasks. Where appropriate, they can also consider the claimant's ability to return to work, participate in hobbies or undertake other activities that formed part of their normal life before the injury. This practical assessment can be particularly important when a claimant’s symptoms are difficult to quantify. Pain may be subjective, but its functional consequences can often be demonstrated through an assessment of movement and physical capability. A physiotherapy expert can consider the claimant’s reported symptoms alongside clinical findings and functional presentation, providing the court with evidence of how the injury manifests in everyday activities. Physiotherapists can also play an important role in considering rehabilitation. An expert may be asked to determine whether physiotherapy is required, what form that treatment should take, its likely frequency and duration, and whether further rehabilitation could improve the claimant’s function. They may also provide evidence concerning appropriate exercises, strengthening programmes, mobility aids or other interventions. In cases involving serious or long-term disability, the physiotherapist’s evidence may extend to future needs. A claimant may require continuing rehabilitation, assistance with mobility or adaptations to maintain independence. The expert can assess the likely trajectory of recovery and identify functional limitations that may remain even after other medical treatment has been completed.

Physiotherapy evidence can also complement, rather than replace, that of other specialists. A surgeon may establish that an operation was necessary or that a complication occurred, but the physiotherapist can explain what the resulting impairment means in practical terms. Similarly, where a neurological expert identifies nerve damage, the physiotherapist can assess its effect on functional independence. Selecting a physiotherapy expert therefore requires consideration of the precise issues in dispute. The expert should have relevant clinical experience and an understanding of the particular injury or disability involved. Experience of medico-legal reporting, assessment of longterm functional limitations and the preparation of evidence for court is also valuable. A physiotherapist’s contribution can ultimately provide an important bridge between medical diagnosis and the claimant’s everyday experience. By translating injury and impairment into measurable functional consequences, the expert can help the court understand not only what has happened medically, but what it means for the claimant's ability to live, work and function independently. In many cases, that practical evidence can be just as important as the diagnosis itself. q

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BCS COMMENTS ON THE GOVERNMENT’S CARDIOVASCULAR FRAMEWORK [

THE GOVERNMENT has recently published the Cardiovascular Disease Modern Service Framework (CVD MSF). Aligned with the NHS 10-Year Health Plan, the framework sets its focus on prevention, with its delivery model designed to tackle health inequalities through a cardiovascularkidney-metabolic approach. Cardiovascular disease (CVD) is one of the main causes of premature death, with an estimated 33,000 lives being lost from heart disease or stroke every year. The Government has reiterated their goal to reduce premature mortality from heart disease and stroke by 25% in the next 10 years. The British Cardiovascular Society (BCS) has been involved in shaping the framework prior to its publication, in collaboration with other organisations and health experts, through their responses to open consultations and contributions in feedback sessions. Professor André Ng MBE sFBCS, BCS President, said: “We welcome the publication of the CVD MSF and strongly support its ambitious vision to reduce premature cardiovascular mortality through earlier detection, prevention and more integrated cardiovascular-kidney-metabolic care. The emphasis on tackling inequalities, improving risk factor management and strengthening rehabilitation represents an important step forward for cardiovascular care in England. “Successful implementation, however, will depend on realistic workforce and resource planning. Delivering this transformation cannot be achieved by shifting activity into community settings alone; it must be matched by sustained investment across the entire cardiovascular pathway, including specialist secondary care services, diagnostics, cardiac physiology, imaging and multidisciplinary teams – people who already have heart disease must not be left behind, in simple pursuit of prevention.

“Heart failure affects more than 1% of the UK population, and delivering appropriate care to all the affected patients will require considerable investment in heart failure services, both in primary and secondary care. “It is important to remember that the typical patient with heart failure is very much older, and has many more comorbidities, than the patients included in clinical trials. Whilst the targets are laudable, enthusiasm must be tempered by the need to continue relevant and robust research to inform best practice. “Secondary care expertise will remain fundamental to delivering effective primary and secondary prevention, supporting diagnosis, initiating complex and life-saving therapies and ensuring equitable access to specialist care. “We also acknowledge the weakness in primary and secondary interfaces which need to be addressed to improve efficiency and ensure continuity of care.

“While the framework rightly recognises atrial fibrillation (AF) as a major cardiovascular risk factor, the BCS believes greater emphasis should be placed on its detection and comprehensive management. AF is one of the most preventable causes of stroke, yet opportunities remain to improve systematic case finding, anticoagulation, rhythm control, integrated long-term management and the use of digital technologies and virtual care models. “Greater prominence should also be given to the role of specialist cardiovascular services in supporting these pathways. “The BCS looks forward to working with the Department of Health and Social Care, government and partners to ensure the delivery plan is adequately resourced and that implementation reflects the essential contribution of both primary and secondary care in achieving the framework’s ambitious goals.” q

FUNDING BOOST FOR NEW SCOTTISH RESEARCH NETWORK [

THE BRITISH HEART FOUNDATION (BHF) have announced a new national research network to tackle Scotland’s heart health challenge. The Cardiovascular Academic Network of Scotland (CLANS) will bring together world-leading researchers, NHS clinicians, universities and patients to accelerate scientific breakthroughs and translate them into lifesaving care. CLANS is being made possible through a £5m investment from the British Heart Foundation, and partnership with the Chief Scientist Office and the NHS Research Scotland research networks. Led jointly by the Universities of Edinburgh and Glasgow, CLANS is the first formal collaboration across institutions, designed to galvanise their collective impact and supercharge research to fast-track progress. According to the BHF: “Despite decades of scientific progress, CVD continues to devastate communities and is responsible for more than a quarter of all deaths in Scotland “Research has helped transform survival from cardiovascular diseases over previous decades, but progress cannot be taken for granted. With mortality improvements stalling and the future burden of CVD expected to rise, CLANS is essential to develop better ways to prevent, diagnose and treat these conditions.” q

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PUTTING YOUR BEST FOOT FORWARD IN LITIGATION [

PODIATRY PLAYS an increasingly important role in medico-legal assessment where an injury or condition affecting the foot, ankle or lower limb has resulted in pain, impaired mobility or loss of function. The podiatrist’s expertise extends well beyond treating routine foot problems, encompassing musculoskeletal assessment, biomechanics, gait analysis, injury management and rehabilitation. For solicitors dealing with personal injury, clinical negligence, occupational injury or road traffic accident claims, appropriately qualified podiatry evidence can provide an important understanding of how an injury has affected a claimant's ability to walk, work, exercise and undertake everyday activities. It can also help establish the likely treatment and rehabilitation required in the future.

Establishing the diagnosis

A comprehensive assessment is the starting point for an appropriate treatment pathway. A podiatrist may consider the history of the injury, symptoms, functional limitations and the progression of the condition. Clinical examination can include assessment of range of movement in the joint, muscle strength, stability, pressure distribution and walking pattern. Where appropriate, diagnostic imaging and other investigations will form part of the assessment. In a medicolegal context, it is particularly important to distinguish the original injury from subsequent complications and pre-existing conditions. A claimant who develops persistent foot or ankle pain following an accident may have suffered an identifiable structural injury, but continuing symptoms may also result from muscle weakness, joint stiffness or compensatory changes in gait. Establishing the relationship between these factors can be critical when considering causation and prognosis. Traumatic injuries involving the foot and ankle can range from relatively straightforward sprains to complex fractures and multiple soft-tissue injuries. Tendon and ligament damage may be particularly significant because these structures contribute directly to stability and movement. Achilles tendon injuries, for example, can substantially affect propulsion and walking. Damage to the ankle ligaments may result in chronic instability and recurrent sprains, while injuries to the plantar structures can produce prolonged pain during weight-bearing. Fractures can present additional challenges. Even where a fracture heals satisfactorily, the patient may experience altered joint movement, stiffness, weakness or post-traumatic arthritis. In some cases, malalignment or changes in load distribution can produce continuing symptoms and functional limitations. A podiatrist may therefore be asked to consider whether the injury was appropriately assessed and treated, whether rehabilitation was adequate and whether continuing disability is consistent with the original trauma. Gait assessment can provide valuable evidence when evaluating functional consequences. A person who has sustained an injury may unconsciously alter the way they walk to protect a painful area. Over time, this compensation can become established and place additional stress on other structures. Biomechanical assessment considers how the foot and lower limb interact during standing and movement. Factors such as joint restriction, limb alignment, muscle imbalance, excessive or insufficient foot motion and altered loading patterns may contribute to symptoms.

These issues can be particularly relevant where a claimant reports difficulty walking for prolonged periods, standing at work, climbing stairs or participating in recreational activities. An expert assessment can help explain the relationship between the original injury, altered mechanics and ongoing functional impairment.

Treatment and rehabilitation

Treatment will depend upon the diagnosis and severity of the condition. Conservative management may include activity modification, appropriate footwear, exercises, stretching and strengthening programmes, orthotic devices and physical therapies. More significant injuries may require immobilisation, specialist intervention or surgical treatment. Rehabilitation should be tailored to the individual and their functional requirements. The objective is not simply to reduce pain but to restore strength, stability, mobility and confidence. Progressive rehabilitation may be necessary following fractures, tendon injuries and ligament damage, with treatment developing as tissue healing progresses. Where mobility remains restricted, multidisciplinary rehabilitation may be appropriate. Podiatrists can work alongside physiotherapists, orthopaedic specialists, occupational therapists and pain management professionals to address the different components of disability. For medico-legal purposes, consideration should also be given to whether the claimant has received appropriate rehabilitation and whether further treatment is likely to improve their condition. An expert may be required to provide recommendations concerning future orthoses, specialist footwear, therapy, exercise programmes or other interventions. Not every patient follows an uncomplicated recovery pathway. Persistent pain can occur following trauma even where structural healing has taken place. Posttraumatic arthritis, nerve injury, scar tissue, altered biomechanics and complex regional pain syndromes can all have profound consequences for mobility. The expert must therefore consider the claimant's current presentation alongside the medical evidence and history. It is important to differentiate symptoms caused by the accident from those attributable to unrelated or pre-existing pathology. The functional consequences may be substantial. Difficulty walking can affect employment, driving, household activities, childcare, social participation and independence. In some cases, a claimant may require adaptations or assistance with everyday activities. Instructing an appropriately experienced podiatry expert can provide the court with a detailed assessment of the relationship between injury, biomechanics, treatment and function. The expert can consider whether the diagnosis was appropriate, whether treatment and rehabilitation followed a reasonable pathway, whether complications were foreseeable and what treatment may be required in the future. Importantly, medico-legal podiatry evidence should not simply catalogue symptoms. It should explain the functional significance of the condition and, where possible, relate clinical findings to objective evidence. For solicitors, a comprehensive podiatry assessment can therefore be particularly valuable in cases where the claimant’s principal complaint is not simply pain, but an enduring reduction in mobility and quality of life. By examining diagnosis, treatment and rehabilitation as interconnected elements, the podiatry expert can help establish both the current impact of an injury and the likely pathway towards future recovery or long-term management. q www.yourexpertwitness.co.uk

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THE COMPLEXITIES OF BURN INJURY CLAIMS [BURN INJURIES can be among the most complex forms of trauma to assess

and treat. Their severity may not always be immediately apparent, however the consequences can extend far beyond the initial wound to include infection, scarring, psychological injury and the need for reconstructive surgery. From a medico-legal perspective, the quality and timeliness of the initial assessment and subsequent treatment can therefore be highly significant when determining whether an injury was appropriately managed. The first priority is always the patient’s immediate safety. Treatment should address the source of the injury, circulation, pain and the prevention of further tissue damage. The British Burn Association (BBA) provides guidance covering first aid, pre-hospital management, assessment of burn severity, dressings, analgesia and referral. Accurate assessment is fundamental. The clinician should establish the affected areas, including the estimated total body surface area, burn depth and the presence of associated injuries. Thermal, chemical and electrical burns can present differently and may require different management. Particular care is necessary when the face, hands, feet, genitalia or major joints are involved. Inhalation injury must also be considered, particularly following exposure to fire or smoke. From a medico-legal standpoint, documentation is particularly important. Records should demonstrate what was observed, what assessments were undertaken, the treatment provided, the patient's response and the rationale for important clinical decisions. Photographic documentation, where appropriate and undertaken in accordance with relevant policies, can also provide valuable evidence of the initial injury and subsequent healing. Correct referral is another crucial consideration. Not every burn requires treatment within a specialist burns centre, but injuries meeting appropriate referral criteria should be escalated promptly. National Burn Care Referral Guidance is intended to ensure that patients reach a service with the appropriate expertise and specialist resources for their injury. The BBA’s current standards also emphasise agreed protocols covering initial assessment, airway and inhalation injury, fluid resuscitation and the need for procedures such as escharotomy. Treatment does not end when the wound has closed. Follow-up is essential to identify infection, delayed healing, scarring, contractures and functional limitations. Patients may require specialist dressings, pressure therapy, physiotherapy, occupational therapy or reconstructive surgery. Psychological consequences can also be substantial, particularly where burns have resulted in visible disfigurement, pain or loss of function from a traumatic experience. In a clinical negligence claim, an expert may therefore be asked to consider whether the treatment provided met an appropriate standard at each stage of the patient’s care. This can include assessing whether the injury was correctly diagnosed, whether its severity was recognised, whether appropriate first aid and acute treatment were provided, whether referral was timely, whether surgery or specialist intervention was indicated, and whether appropriate follow-up and rehabilitation were arranged. Importantly, an expert should distinguish between a poor outcome and negligent treatment. Serious burns can produce significant complications despite appropriate and timely care. The medico-legal assessment must therefore consider the evidence available at the time, accepted practice and the likely consequences of any alleged delay or omission. A suitably experienced burns expert can provide an independent assessment of the patient’s clinical journey, identify potential departures from appropriate practice and, where supported by the evidence, explain whether those departures materially contributed to the eventual outcome. The BBA itself maintains a list of members who have volunteered to undertake medico-legal work, although it makes clear that inclusion on the list is not an endorsement or recommendation. Ultimately, correctly managing a burn injury requires much more than treating the wound. It involves prompt assessment, appropriate escalation, specialist treatment where necessary and long-term rehabilitation. From a medico-legal perspective, understanding each stage of that pathway is essential when determining whether the standard of care was appropriate and what consequences may have resulted from any alleged failure in treatment. q www.yourexpertwitness.co.uk

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DIABETIC FOOT DISEASE – IS AMPUTATION AVOIDABLE? By Philip Coleridge Smith DM MA BCh FRCS, Consultant Vascular Surgeon, Medical Director of the British Vein Institute and Emeritus Reader in Surgery at UCL Medical School

[DIABETES IS NOW a common condition affecting patients in the UK

and leads to presentation to vascular surgeons as diabetic foot problems. Foot ulceration is common and leads to about 6,000 minor amputations per year and about 2,000 major lower limb amputations in the UK. Type 2 diabetes is very common and accounts for 90%-95% of all diabetes cases. Worldwide, hundreds of millions of people live with the condition, and numbers continue to rise across all age groups and regions. It is predominantly a condition seen in westernised countries where about 1 in 10 of the population live with the condition, a significant proportion remaining undiagnosed. Type 2 diabetes usually occurs in people over the age of 45 years, although there has been a rise in the proportion of younger people presenting with the condition.

Complications of diabetes

Clinical problems due to damage to the microcirculation The only part of the circulatory system which can readily be examined is that of the retina of the eye. Part of standard diabetic care involves periodic inspection of the retina by use of an optical instrument or by the more modern method of Optical Coherence Tomography (OCT) scanning. These examinations detect damage to the retinal blood supply at an early stage of injury. The nailfold circulation can also be observed, although this is less commonly performed as a routine investigation in diabetes. The findings in poorly controlled diabetes include dilation of capillaries and the presence of convolution. In more advanced stages, fewer capillaries are seen and the remaining ones dilate and become more tortuous in order to compensate for the destroyed ones. One of the tissues most commonly damaged by capillary and small vessel destruction, in addition to the retina, is the peripheral nerves. These are often affected at an early stage of diabetes, if poorly controlled. It is standard practice to test sensation in the feet as part of routine monitoring in diabetes. This is the first region to be affected by loss of sensation and neuropathy can lead to diabetic foot ulceration. The microcirculation of the kidneys may also be affected and damage here leads to loss of normal kidney function. In the heart, reduced contraction strength may lead to poor pumping efficiency and heart failure. In the brain diabetes may give rise to the risk of stroke, memory loss vascular dementia and Alzheimer’s disease. Unstable blood sugar levels can also lead to mood shifts and confusion. Diabetes causes peripheral artery disease by maintaining chronically high blood sugar levels. This high glucose damages and inflames the inner lining of the arteries, accelerating the build up of fatty cholesterol plaques that narrow and harden blood vessels in the limbs.

Foot conditions attributable to diabetes arise from peripheral neuropathy, leading to loss of sensation in the foot, and from lower limb arterial disease. Other problems arising in diabetes include diabetic retinopathy, leading to reduced vision or loss of vision. Damage to the microcirculation of the kidneys leads to loss of normal kidney function and eventually to end stage renal failure, requiring renal replacement therapy such as dialysis or to the need for renal transplantation. The underlying mechanism of all of these conditions is damage to the microcirculation of the body, including capillaries, venules and arterioles. The circulation of the body provides nutrition to all tissues but is the main system damaged by diabetes. Because blood vessels are present in almost all parts of the body damage to the circulatory system is wide-ranging in its effects. The damage to the parts of the microcirculation include the following components: Capillaries: the tiny, single-cell-thick vessels, where oxygen and nutrients transfer to tissues, experience structural thickening and loss of normal function. Arterioles: small muscular arteries that control blood pressure and flow into capillary beds become stiff and lose their ability to widen properly. Venules: small veins that drain capillary blood can also experience wall stiffening and sclerosis. Endothelial cells: the inner cellular lining is damaged by oxidative stress, reducing its ability to produce protective relaxing factors like nitric oxide. Pericytes: specialised cells wrapped around capillaries die off, causing the small vessels to weaken and leak. High blood glucose in patients with poorly controlled diabetes damages the microcirculation because tiny blood vessels (capillaries) cannot Angiogram of the lower calf and foot in a block extra sugar from entering their lining cells. diabetic patient. In the calf, the arteries are Inside these cells, excess glucose triggers irregular and occluded in places (yellow harmful chemical reactions, creates toxic stress arrows). In the foot, the vascular system and builds stiff, sticky molecules that thicken has largely been destroyed with few or no vessel walls, cause leaks and cut off healthy vessels visible (green arrow) prejudicing blood flow. the tissues of the foot

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Prevention of complications in diabetes

All complications arising from diabetes are minimised when good diabetic control is achieved. Patients are encouraged to measure their blood glucose levels regularly and to attend diabetic clinics where monitoring of the retina and peripheral nerves can be done. Blood tests will indicate the adequacy of diabetic control. Since diabetic control is heavily determined by the patient’s compliance with diet and drug treatment, much responsibility for the prevention of diabetic complications lies with the patient.

Litigation in cases of diabetic foot ulceration and peripheral arterial disease

I have advised in cases of amputation of toes and lower limbs in which the claimant alleges that a minor episode of mismanagement of a foot ulcer has given rise to the loss of one or more toes. Subsequent review of the medical records showed a long history of poor compliance with

advice from physicians concerning management of diabetes or complete abandonment of treatment. It may then be difficult to attribute loss of a toe or the limb to a single episode of mismanagement of a wound. A further problem is that the damage caused by a substantial period of poor diabetic control is likely to be irremediable. Peripheral neuropathy cannot be reversed and loss of vision or renal function is likely to be permanent, even when the patient resumes careful diabetic monitoring and control. The peripheral vascular system is often affected by arterial disease which can be managed by angioplasty or bypass procedures. However, loss of the microcirculation in the foot (pictured) is permanent and no satisfactory replacement treatment has been devised. Therefore, amputation of toes or the forefoot may be inevitable in such patients, although minor distal amputations are useful in avoiding the need for a major limb amputation. A feature of diabetes is that it tends to reduce life expectancy. Type 2 diabetes reduces life expectancy by about 6-10 years, although reduction of life expectancy is dependent on the age at diagnosis and the quality of diabetic control. Patients with the poorest levels of diabetic control have a risk of death and limb amputation which is increased ten-fold compared to those who maintain good control. The need for a minor amputation increases the risk of a major amputation. Observational studies show that life expectancy after major amputation in a diabetic patient is about three years.

Conclusions for litigation in diabetic claimants

The above summary of problems facing vascular surgeons in diabetic patients indicates some of the issues which may cause difficulty with litigation in diabetic claimants. In many of the cases where I have advised, a long history of poor diabetic control is then followed by an episode of limb ischaemia or foot infection leading to loss of a toe or the limb. The outcome may have been prejudiced by poor or neglectful diabetic control. The context of the alleged negligence has to be assessed carefully in the light of the severity of diabetic disease and likely effects of poor quality care. q

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AMD AUDIT RESULTS HIGHLIGHT THE INCREASING PRESSURE ON SERVICES [THE ROYAL COLLEGE OF OPHTHALMOLOGISTS (RCOpth) is

calling on all providers of NHS-funded age-related macular degeneration (AMD) treatment to ensure all their patients start being treated within 14 days of referral to give them the best possible outcome. Results from the latest National Ophthalmology Database (NOD) Audit age-related macular degeneration report show that, disappointingly, the proportion of patients receiving their first treatment within two weeks of referral has fallen from around 40% to 30% in the last year. Introducing the audit report, the College’s former President, Professor Ben Burton, said: “Whilst we don’t know the reason for this reduction, I can’t help wondering if the hundreds of millions of pounds spent on reducing cataract waiting lists could have been better spent on making sure patients with treatable, irreversible causes of blindness get treatment on time.” The report’s focus is on patients starting treatment for wet AMD in one or both eyes in the 2023 NHS year (1 April 2023 to 31 March 2024). The audit analysed data from almost 29,000 eyes and more than 26,000 patients starting treatment during the period. All providers of NHS-funded AMD treatment were invited to take part and to submit routinely collected healthcare data for analysis. Results after the first year of treatment were available from 75 centres in England, Northern Ireland, Scotland, Wales and Guernsey. Key findings from this year’s audit include: • The average age when treatment was started was over 80 years and 61% of those treated were women. Just under 32% of patients started treatment within 14 days of referral from primary care, and the initial three monthly injections during the loading phase of treatment was completed within 10 weeks in just over 66% of eyes. • The most frequent number of injections per eye in the first year of treatment was seven and the median interval between injections at the end of the first year was 10 weeks. More than 74% of injections were administered by trained staff who were not doctors, such as nurses or optometrists. • The best outcomes were observed in eyes with better vision at the start of treatment, in younger people and in second treated eyes. ‘Good’ vision was retained in most eyes with this level of vision at the start of treatment but eyes with ‘poor’ vision at the start of treatment rarely achieved ‘good’ vision after one year of treatment. These findings reinforce the importance of prompt referral, initial assessment, diagnosis and treatment initiation. • The risk of serious infection (presumed infectious endophthalmitis) was approximately one case per 5,000 injections, failing to meet the acceptable performance threshold of one case per 6,000 injections. • Data on delayed follow-up visits was available for 46% of patients. Among those with available data, planned treatment was delayed by two weeks or more on at least two occasions in over half of patients. Clinical lead for Medical Retina and Macular Services at Manchester Royal Eye Hospital, Romi Chhabra, said: “Participation in the NOD audit continues to grow, and the data it generates is becoming ever more valuable as the treatment landscape evolves. “This report captures NHS Year 2023 – a critical baseline ahead of significant change. The mandated introduction of biosimilars under NHS England commissioning guidance in 2025 is expected to reshape prescribing patterns considerably, though its real-world impact will only become fully visible in audit data over coming years. “Alongside this, the guidance also supports a shift towards longeracting therapies where appropriate, with real potential to reduce treatment burden on patients and ease pressure on already stretched services. There has never been a more important time to participate in national audit, giving providers the evidence they need to benchmark

performance, identify best practice and negotiate with confidence with Integrated Care Boards. “Resolving data quality challenges, particularly around extraction from certain electronic medical record systems, remains an urgent national priority because, the more complete our data, the more powerful the tool.” q

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GOC PUBLISHES UPDATED HEARINGS AND INDICATIVE SANCTIONS GUIDANCE [THE GENERAL OPTICAL COUNCIL (GOC) has

published updated Hearings and Indicative Sanctions guidance, which improves clarity for Fitness to Practise Committees (FtPCs) when considering applying sanctions as part of fitness to practise proceedings. The updated guidance forms part of the GOC’s ongoing commitment to improve transparency and trust in its fitness to practise process. Last year, the GOC held a consultation on the proposed changes, receiving feedback and views from a range of stakeholders including professional bodies, public bodies, membership organisations and others, including the Professional Standards Authority (PSA). In response to feedback received, the GOC made improvements to make the guidance clearer and easier to navigate. These include: • A clear definition of hearsay, including examples to support FtPCs when applications rely on hearsay evidence. • An explanation of factors such as situational vulnerability and special measures that might support vulnerable witnesses in providing best evidence. • Minor edits to the language to reflect a more balanced approach to dishonesty. • Updated section on Review Hearings to better reflect circumstances where a Review Hearing might be required. • Clear definitions to distinguish between sexual harassment and sexual motivation. Carole Auchterlonie, Director of Regulatory Operations at the GOC, said: “Firstly, I’d like to thank everyone that responded to our consultation. Your feedback has been important to ensure that the guidance is up-to-date and fit for purpose. “We’ve listened to your feedback and where appropriate, we have made updates to the guidance so that is clearer, without being prescriptive, for our committees when considering whether or not to apply sanctions. “This updated guidance marks an important next step in our journey to improve our fitness to practise process and make sure it’s fair for all involved.” The updated guidance will apply to all future hearings from 20 July 2026. The previous guidance will apply for any part heard hearings which started before 20 July 2026 and have not yet concluded. q

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MEDICO-LEGAL EXPERTS ACCIDENT & EMERGENCY MEDICINE

DENTAL & ORTHODONTIC EXPERTS

CARDIOLOGISTS & CARDIOTHORACIC SURGEONS

ENDOCRINOLOGY

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ENT CONSULTANTS

GENERAL SURGEONS

HAEMATOLOGY

GASTROINTESTINAL & COLORECTAL SURGEONS

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MIDWIFERY

NEONATAL MEDICINE

NEUROLOGY

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NEUROSURGEONS

NEUROTHERAPY

OBSTETRICS & GYNAECOLOGY

OCCUPATIONAL MEDICINE & THERAPY

NURSING, CARE & REHABILITATION CONSULTANTS

OPHTHALMIC SURGEONS

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ORTHOPAEDIC SURGEONS

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ORTHOTICS

OSTEOPATHS

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PHYSICIANS

PLASTIC & HAND SURGEONS

PSYCHIATRISTS & PSYCHOLOGISTS

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SPEECH & LANGUAGE THERAPY

STROKE MEDICINE

RADIOLOGISTS

THORACIC SURGEONS

SKIN CAMOUFLAGE CONSULTANTS

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UROLOGICAL SURGEONS

EXPERTS

The following experts offer

VASCULAR SURGEONS

EXPERTS FOR MEDIA is a regular section in Your Expert Witness for experts who wish to offer their views and the benefit of their experience to the vast range of print and broadcast media. Ever wondered how news teams find the experts they consult to explain the ramifications of breaking news stories, seemingly at the drop of a hat? Or how the producers of TV drama series ensure their stories are accurate and reflect the realities of the professions they portray? The fact is that researchers consult registers of experts and expert periodicals just as lawyers do. In fact, Your Expert Witness is receiving an increasing number of enquiries from media researchers and public relations agencies looking to locate appropriate experts to inform their clients. Experts for Media is therefore an ideal space to attract their attention. For prices and to book your space, contact Ian on 0161 710 3880 or via ian@dmmonline.co.uk. 130

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FOR MEDIA their expertise to the media Joanne Caffrey

Expert Witness & Trainer Ms Joanne Caffrey undertakes expert witness instructions in cases relating to the following police topics: • Use of force • Custody procedures • Drink/drug driving • Ligature deaths

Mr Jonathan Luck

FRCS FRCOphth Consultant Ophthalmologist

T: 07528 800 720 E: joanne_caffrey@sky.com

Mr Jonathan Luck has over 20 years of experience in medicolegal work. Experience of giving evidence in court including cross examination. Rapid turnaround of reports. Full consulting and diagnostic facility for Condition and Prognosis reports. Holder of the Bond Solon Cardiff University Civil Expert Witness Certificate. E: jon.luck@nhs.net W: www.jonathanluckmedicolegal.org.uk

Professor Stephen Clark

Chris Makin FCA FCMI FAE QDR MCIArb

BMedSci(Hons) BM BS DM FFST MAMSE RCPathME FACS FESC FACC DLM FRCP FRCS

Consultant Cardiothoracic & Cardiopulmonary Transplant Surgeon

Chartered Accountant • Accredited Civil Mediator • Accredited Expert Determiner

Professor Clark has extensive experience in medicolegal and coronial expert witness work. He can be instructed nationwide in personal injury and clinical negligence cases relating to all aspects of cardiothoracic surgery and transplantation.

Chris Makin was one of the first chartered accountants to become an Accredited Forensic Accountant and Expert Witness. He is also an accredited civil and commercial mediator and an accredited expert determiner. Over the last 30 years he has given expert evidence at least 100 times and worked on a vast range of cases.

T: 0191 213 7445 M: 07779 273388 E: stephen.clark18@nhs.net and clarkmedicolegal@icloud.com

T: 01924 495888 or 07887 660072 E: chris@chrismakin.co.uk W: www.chrismakin.co.uk

Mr Jeremy Crew

Mr Luke Meleagros BSc MBBS MD FRCS

Mr Jeremy Crew has offered a medicolegal service for over sixteen years. He provides expert medical opinion, medico-legal reports and court attendance on all aspects of urology including clinical negligence, personal injury and criminal matters.

Mr Meleagros Completes 3-4 expert reports per month on medical negligence cases and abdominal injury/major abdominal trauma cases. He has reported extensively on cases involving abdominal laparoscopy surgery and hernia surgery.

T: 01865 307433 or 07508 617949 E: jeremycrew@urologyoxford.com W: www.oxfordurology.co.uk

T: 0208 527 0977 E: L.Meleagros@btinternet.com Sec: jawdobson@gmail.com

Dr Daniel Jones MA, MEWI Cert

Kathryn Thorndycraft-Pope

Daniel is the UK’s foremost authority on the ecology and management of Japanese Knotweed, Himalayan Balsam, and Giant Hogweed. He is the lead author of the world’s largest field trial on Japanese Knotweed control, a study that has fundamentally changed how government and industry manages infestations. As a Full Member of The Academy (MA) and a Certified Expert Witness (MEWI Cert), he provides commercially independent testimony that is indispensable for both claimants and defendants in civil claims.

FHDI provides an independent document examination service, giving unbiased professional advice for criminal or civil litigation. • Handwriting • Alterations • Indentations • Authenticity

MA MD BChir(Cantab) FRCS(Urol) Consultant Urological Surgeon

Ecological Consultant

Consultant Surgeon

Examination of Documents and Handwriting

T: +44 (0)29 2120 3283 E: daniel@advancedinvasives.com W: www.advancedinvasives.com

T: 01569 764508 M: 07710 655838 E: fhdi@icloud.com W: www.forensichandwriting.co.uk

Laird Assessors

Mr Dmytro Tupchiienko

Laird Assessors are the UK’s leading independent automotive expert witness firm supporting claimant, defendant and criminal solicitors – from instruction to court. Laird provide intelligence to the automotive world predominantly relating to crashed vehicles.

Dmytro Tupchiienko is a forensic criminologist, forensic linguist, forensic accountant and forensic IT specialist focusing on risk and compliance issues and regulatory work. He is a Certified Expert Witness for civil cases and criminal cases in England and Wales (holder of Cardiff University Bond Solon Expert Witness Certificate) and in Scotland (holder of the University of Aberdeen Bond Solon Expert Witness Certificate).

Automotive Expert

T: 0151 342 9961 E: enquiries@laird-assessors.com W: www.laird-assessors.com

Forensic Accountant and Forensic Linguist

T: 07824 612 873 E: d.tupchiienko@gmail.com W: mondale.uk www.yourexpertwitness.co.uk

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