Overview of anaesthesia practice Anaesthesia forms the largest single hospital medical speciality and the skills of anaesthetists are used in all aspects of patient care. While perioperative anaesthetic care of the surgical patient is at the core of speciality work, many anaesthetists have a much wider scope of practice which may include: • perioperative preparation of surgical patients • resuscitation stabilisation of patients in the emergency department • pain relief in labour and obstetric anaesthesia • intensive care medicine • transport of acutely ill and injured patients • pre-hospital emergency care • pain medicine • sedation and anaesthesia patients undergoing various procedures outside the operating theatre such as interventional radiology and dental surgery In short, anaesthetics is a varied and complex discipline. This Practice Note will assist in: • identifying the correct discipline of anaesthetist • using the medical notes to identify potential anaesthetic failings • investigating whether there are failings in the anaesthetic care • assessing what injuries may have been caused by that failing • identifying the interaction of an

An introduction to accident and emergency (A&E) medicine Accident and emergency (A&E) medicine is widely regarded as the primary front line role of doctors in the NHS. Emergency medicine doctors and nurses carry out the immediate assessment and treatment of patients with serious and life-threatening illnesses and injuries. As such, the field of practice requires the knowledge and skills for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups, often with other competing and pre-existing health issues. Patients often pose diagnostic challenges and arrive with little information save that which can be obtained by talking to the patient. The challenge is in providing rapid and appropriate treatment in the first hours. An emergency physician must have the necessary expertise which allows them to form a working diagnosis, commence treatment and refer to other appropriate specialists if appropriate. Some emergency physicians develop a subspecialism to bring particular expertise to the practice of emergency medicine. For example, they may become experts in the fields

This Practice Note sets out practical considerations when managing these types of claims, followed by an overview of common types of injury to children occurring during childbirth. It focuses on liability rather than quantum. The usual requirements regarding breach of duty, causation and damages apply. See: • Clinical negligence liability—overview • Clinical negligence damages—overview • Catastrophic claims—overview Informed consent—Montgomery When dealing with birth injury claims you should be familiar with Montgomery which involved a child born with cerebral palsy due to oxygen deprivation during a prolonged labour. The liability issues revolved around the information given to the mother about the mode of delivery and its risks. It has wide-reaching application and has reframed the test for what information should be provided during the consent process. For further guidance on this case and subsequent developments, see Practice Note: Consent in clinical negligence claims—treatment and causation. In CNZ v Royal United Bath Hospitals NHS Foundation Trust the High Court established that Montgomery was not only concerned with antenatal consultations but also applied

This Practice Note begins with a reminder of the importance of Montgomery, followed by an examination of the practical considerations when managing these types of claims. It also provides an overview of common maternal injuries suffered during childbirth. See: Clinical negligence liability—overview for general information regarding breach of duty and causation and Clinical negligence damages—overview for further guidance on damages in clinical negligence claims. Informed consent—Montgomery An increasingly significant aspect of maternity claims is what information was provided regarding choices about labour and delivery. This was explored in the Supreme Court case of Montgomery and is an evolving area of law and clinical practice. Ensure you are up to date with related case law and any changes in the national and local guidelines regarding what mothers should be told. This includes, but is not limited to, decisions regarding a vaginal birth after a caesarean section (CS). In CNZ, the High Court established that Montgomery was not only concerned with antenatal consultations but also applied to decisions made in

Breach of duty For details of the law on breach of duty in clinical negligence claims see Practice Note: Duty of care and breach in clinical negligence claims. Treatment for spinal injuries and conditions often requires a multidiscipline approach which relies on strong communication between teams. Furthermore, such injuries and conditions may occur against a complicated medical background. This increases the risk of problems arising. Ascertain the referrals and transfers between potential defendants, eg: • GPs • ambulance services • community services such as district nursing • hospital Trusts including local community hospitals • major trauma centres • tertiary care providers • private providers • rehabilitation • care services Be aware that sometimes patients choose to see a consultant as both an NHS and private patient. Clarify the roles and referrals within each defendant body. The treatment pathway is likely to involve a range of teams, eg A&E, nursing, orthopaedics and neurosurgery. Causation Causation can be difficult to establish in spinal claims. There may be pre-existing problems that complicate the picture. In

Clinical Negligence Claims Agreement 2024: The Clinical Negligence Claims Agreement 2024 supersedes the COVID-19 Clinical Negligence Protocol (2020) (last updated in June 2021) which was initially created as an emergency measure to adapt clinical negligence claims handling and litigation processes during the coronavirus (COVID-19) pandemic. The 2024 Agreement builds on the previous Protocol with various practices now adopted into everyday claims management. The Agreement is not contractually binding but places an emphasis on collaborative working between the parties. Introduction This Practice Note provides an overview of the claims procedure in clinical negligence cases following service of the initial statements of case. It is limited to claims allocated to the multi-track. General principles of personal injury law apply, but practitioners must also be aware of the specific considerations applicable to clinical negligence claims. Practitioners should be familiar with the Pre-Action Protocol for the Resolution of Clinical Disputes. See Practice Note: The Pre-Action Protocol for the Resolution of Clinical Disputes—6 April 2015 onwards. Clinical negligence litigation can be complex and lengthy. The court must actively

This Practice Note covers the different options for funding clinical negligence claims including legal aid, conditional fee agreements (CFAs) and damages-based agreements (DBAs). It also discusses costs including what can be recovered and qualified one-way cost shifting (QOCS). Funding The usual mechanisms for funding a clinical negligence claim are: • legal aid/public funding • CFA • after the event (ATE) insurance • before the event (BTE) insurance • DBA It is important for the practitioner to make proper enquiries about alternative funding options. The success fee and ATE insurance premium may be disallowed if the solicitor fails to make reasonable enquiries into whether the client could rely on a BTE insurance policy. Various cases have considered whether it was reasonable to switch from legal aid funding to a CFA. In Surrey v Barnet and Chase Farm Hospitals, the Court of Appeal decided that the decision to switch funding from legal aid was unreasonable because the advice provided to the claimants exaggerated the disadvantages of remaining with legal aid funding and

PI & Clinical Negligence analysis: Following a seven-day trial, Jason Coppel QC (sitting as a Deputy Judge of the High Court) dismissed Mrs Jarman’s claim, arising from an alleged delay in diagnosing cauda equina syndrome (CES). The court heard from seven medical experts, all of whom confirmed that they would personally have ordered an emergency MRI within 24 hours of Mrs Jarman’s presentation at A&E with suspected CES. Despite this, the judge accepted that the clinician’s decision to exclude CES on clinical examination would be considered reasonable by a responsible body of orthopaedic surgeons. Furthermore, the judge determined that Mrs Jarman’s neurological condition had not deteriorated over the period of alleged delay, such that she was unable to establish causation. Written by Aidan O’Brien, barrister at Farrar’s Building, Temple.

Psychiatric conditions are complex. People who have mental health challenges are classed as vulnerable and therefore require special care and treatment so that they do not harm themselves and are not exposed to harm by others. Mental health care is expensive. Treatment of psychiatric ill health requires funding, time and expertise and unfortunately all three are in short supply. NHS mental health services are underfunded and understaffed which means that patients can fail to get the level of care and support they need both in hospitals, primary care settings and in the community. When mental health patients are not well cared for and monitored, avoidable harm can occur. Legal issues arising from shortcomings can mean regulatory investigations, service complaints, performance concerns, inquests and tricky medicolegal, ethical or hypothetical scenarios. Where a claim is brought for negligence, the claimant will have to show that their care was such that they suffered foreseeable injury as a result of a breach of duty. Even where a breach of duty is established, establishing the counter-factual through

This new starter guide is a must-read for claimant and defendant lawyers starting out in clinical negligence practice. It provides an introduction to the topic, some key factors to be aware of and a summary of the principle steps in commencing, running and responding to a claim. It is aimed at paralegals, trainee solicitors and those who are new to clinical negligence practice. The Overviews in each of the clinical negligence subtopics in the PI & Clinical Negligence practice area will be a useful starting point. These Overviews give an introduction to each of the subtopics in the PI & Clinical Negligence module with links to relevant content to help navigate the topic covered. In particular, the module contains detailed information on all the procedural stages that may be encountered for different types of clinical negligence claim for both claimant and defendant practitioners. This guide also contains links to help you make the most of the PI & Clinical Negligence materials, including how to sign up for email alerts and contact the Lexis®Ask

PI & Clinical Negligence analysis: In Paul v Royal Wolverhampton NHS Trust and others, the Court of Appeal held that secondary victims can only claim in respect of a horrifying event which occurs at the same time as the defendant’s breach of duty. This is the case whether the claim is one in clinical negligence or for any other form of accident. Recognising that this operates seriously to limit the scope of recovery for secondary victims, not least in clinical negligence cases, the Court of Appeal indicated in its judgment that it was minded to grant permission to appeal to the Supreme Court. So it remains to be seen whether the Supreme Court, assuming the Court of Appeal do give permission to appeal, will adopt such a restrictive approach. Written by Rob Weir QC, barrister at Devereux Chambers, London, who is counsel for Paul.

Across the spectrum of clinical negligence cases between those involving issues of ‘pure diagnosis’ and ‘pure treatment’, claims arising out of negligently performed surgery invariably fall towards the pure treatment end. This will likely be the case notwithstanding that a surgical procedure is often intended to be diagnostic rather than therapeutic. This means that the acts or omissions giving rise to the complaint will be considered through ordinary Bolam and Bolitho principles. See Practice Note: Duty of care and breach in clinical negligence claims. Professional guidelines Clinical guidelines published by the National Institute for Health and Care Excellence (NICE) are useful resources in evidencing expected surgical standards. This is discussed in more detail in the Practice Note: NICE Guidance. The Royal College of Surgeons also has a wide range of publications in which standard surgical techniques and the management of patients are discussed, eg the Good Surgical Practice document. In addition to national guidelines, local protocols are frequently created by NHS Trusts on a wide range of issues such as infection control, failed intubation and prevention