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Collaboration is key to get the best patient outcomes

Closer collaboration between serious injury solicitors and healthcare professionals can lead to improved outcomes for patients, says physiotherapist-turned-lawyer Glen Whitehead, of Irwin Mitchell.

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In years gone by, the relationship between rehabilitation professionals and law firms perhaps wasn’t always the easiest.

But having been a physiotherapist for over 20 years before moving into serious injury law, I have seen from both sides of the fence how relations have improved over time; benefitting patient outcomes in the process.

Historically, healthcare professionals could be somewhat defensive in their dealings with serious injury solicitors.

Certainly when I started out as a physiotherapist in the mid-nineties, litigation generally had negative connotations among my peers and superiors in the therapy community.

This view was explored in the work of Kendall and colleagues in 1997 who introduced us to the concept of Psychosocial Yellow Flags.

When assessing injured individuals and their risk of long term disabilities the presence of litigation was identified as a key influencing factor and was considered to have a detrimental effect upon treatment outcomes.

 Just a few years later more coloured flags were created in order to sub-divide Kendall’s list into smaller groups.

They included factors considered to be within the individual’s control but also highlighted those which may arise from external pressures.

Main and Burton highlighted the presence of conflict arising from an injury claim as an obstacle to recovery.  

At a time when an injured claimant relies heavily upon those around them, close support was perceived to be a negative influence.

The perceived conflict introduced through a personal injury claim and the presence of ‘over solicitous family and healthcare providers’ were given the unenviable symbol of Black Flags, a colour historically reserved for death, punishment and mourning.      

 There was a general belief that, until litigation was concluded, rehabilitation could not progress. I can recall in some physiotherapy out-patient departments the policy was to discharge patients who reported that they had an ongoing claim, advising them to return for treatment once the claim had concluded.

Looking back on this now and contemplating how many patients were discharged rather than exploring more a collaborative solution makes me thankful for the progress we have made over the years.  

Happily the scenario has now changed, with attitudes moving on in recent years and relationships between healthcare professionals and the legal sector now largely good, thus easing the patient-centered rehab process.

In my opinion the two professions are now more closely aligned than ever before. I attribute this to significant changes within the legal sector but also a more accepting approach by those I still encounter in the Physiotherapy profession.

My current and previous roles have shown me that there is actually a lot of common ground between these two worlds.

People often comment on how big a change it must have been to shift from physiotherapy to law. But there are a surprising number of similarities between the two roles with certain skillsets central to both.

As a physiotherapist my knowledge of anatomy, physiology and biomechanics provided the foundation of my approach to diagnosis and treatment.  Today I still rely upon a core body of knowledge and learning but this is founded upon statute and common law. 

Analytical skills are also a common thread.  I have found that the reasoning applied daily as a Physiotherapist is just as important as a Solicitor and forms the basis for my legal analysis, drawing on the same reasoning skills developed over many years.

 As with Physiotherapy, the field of serious injury law is very client-centred and therefore having the interpersonal and soft skills to work with people is essential.

A patient presenting in my clinic would report a key problem, provide a list of symptoms, express a fear of the unknown and an expectation that I would be able to help.

As I meet new legal clients for the first time, the ability to gather information, provide an explanation of the key issues and offer reassurance that I can help provides the same immense job satisfaction.

It forms an important part of what I do and I am privileged to have this new role which still affords me the opportunity to provide that safe pair of hands.

It is clear to me that these are all requirements for both professions. It turns out things aren’t as different as many think.

In my role as a solicitor, I also have the advantage of being able to see and discuss things from a medical perspective.

Partly this means helping colleagues with opinions on medical records, or in deciphering the many abbreviations and acronyms used in healthcare.

But I also regularly have the opportunity to sit in on conferences with consultants and often discuss technical aspects of their reports, an arena in which I feel comfortable having worked with them on a clinical level for two decades. 

Since qualifying in law I have reconnected with many of my contacts from the healthcare world, regularly presenting training sessions for medical staff on the legal process and collaborative working.

The sessions have taken place in hospitals and community settings with a view to further building channels of communication.

The training sessions offer a great opportunity for open dialogue between the two sectors which I truly believe is the key to ensuring continued development of the relationship.

Healthcare professionals who would like to explore this training opportunity further can contact me at the email address at the foot of this article and I welcome further discussions on this theme.

From the sessions so far it is encouraging to see that both groups are evermore understanding of what the other is looking for in delivering the best possible outcomes.

This reflects what I have seen in recent years where there has been a definite shift to more collaboration by all in pursuit of a better service for the client.

The Rehabilitation Code and Serious Injury Guide have been pivotal in aiding this, with an overriding push for early access to rehabilitation.

This collaborative spirit, which helps to prioritise the needs of the client, is also now increasingly evident among defendant firms.

Often, they too want to collaborate more closely with rehab teams and support earlier interventions, which is a big and positive change.

Of course, some companies and insurers are more focused on rehabilitation than others, but we definitely see a growing recognition that collaboration to promote recovery at an early stage is a lot better than trying to deal with problems further down the line.

As I know only too well, working in rehabilitation can be immensely hard work. It’s full on, emotionally and physically, and there are constant changes, resource issues and challenges.

But as lawyers and healthcare professionals we’re all working towards the same outcome – to achieve the best results for the people who need it.

By continuing to build these relationships between the legal and healthcare professions, we are doing all we can to achieve that.

Glen can be contacted at Glen.Whitehead@irwinmitchell.com or through Twitter @LegalZeal

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Legal

Proposed changes to our armed forces’ ability to secure justice

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In personal injury claims, there is a three year time limit (in the vast majority, but not all, cases) to start a claim, writes Irwin Mitchell’s David Withers.

If an injured person fails to start Court Proceedings within the three year period and there are no exceptions that apply, they run the risk of the Court finding that their claim has become “statute barred”.

In other words, the Defendant would have a complete defence, even if the breach of duty (fault) had been obvious.

Under the Limitation Act 1980, the Courts have the discretion to allow cases to proceed even if they are brought out of time.

This discretion is often used when injured people have not been able to issue Court Proceedings for a number of very valid reasons.

So, cases can proceed, even if they have been brought out of time, the Government is intending to change the law for our armed forces.

The Overseas Operations (Service Personnel and Veterans) Bill would apply a finite deadline of six years for claims for death or injury of a member of the armed forces.

There would be no ability to extend this arbitrary period of time, regardless of how exceptional the circumstances were.

This would place the Ministry of Defence in a much more advantageous position than any other Defendant in the country.

Part 1 of Schedule 2 states:“The court shall not under this section dis-apply any provision of section 11 in its application to an overseas armed forces action if the action was brought after the expiration of the period of six years from the section 11 relevant date”.

There are a plethora of examples when the Ministry of Defence’s negligence may result in significant psychiatric injury to armed forces personnel meaning that there may be an understandable delay in individual exercising their civil rights.

The Government has indicated that the Overseas Operations (Service Personnel and Veterans) Bill will be “providing greater legal protections to armed forces personnel and veterans serving on military operations overseas”; it is difficult to see how this is true.

As the proposed law stands to be, members of the Armed Forces and the Security Services, on the same operation, would have two different outcomes having been victims of the same negligent conduct.

David Withers  is a partner and solicitor-advocate at Irwin Mitchell LLP, leading a team specialising in neuro-trauma and other serious injuries such as amputations or significant poly-trauma.

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Legal

Bereavement damages – an overview

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The thorny issue of bereavement damages in fatal accident cases has recently raised its head again on one of my cases, writes associate solicitor Lauren Haas. Since so few of the families I encounter are aware of bereavement damages it may be useful to summarise the current law in this area and set out what the potential issues are.

What are bereavement damages?

Bereavement damages are a fixed sum of money which can be claimed on the unlawful death of a loved one.

They are separate from any financial dependency claim, which can of course also be brought.

Unlike a lot of other jurisdictions in Europe and the world, within the English jurisdiction we are very restrictive in our approach to bereavement damages.

Who can claim?

The current legal position allows you to claim the bereavement award if you are:

  • The spouse or civil partner of the deceased; or if no such eligible claimants exist, then
  • In cases involving the death of a child under 18, the parents if the child was “legitimate”, or the mother if the child was “illegitimate” ie mother and father were not married.

The question of who can actually claim this award has caused some controversy and outrage in recent years.

In 2017, a case in the Court of Appeal (Smith v Lancashire Teaching Hospitals NHS Foundation Trust) resulted in the Court of Appeal dragging the rather outmoded position on eligible claimants into a 21st century setting by ruling that cohabitants who have lived together for two years or more (for at least two years immediately prior to death) can claim for bereavement damages.

However – beware! As is the case for parents, where both an eligible cohabitant and spouse are eligible to claim bereavement damages then the award is divided equally between them.

Who cannot claim for bereavement damages?

Despite the fact that some cohabitants are now entitled to bereavement damages, the list of people entitled to a bereavement award remains very restricted.

The following individuals are not entitled to a bereavement award:

  • Cohabitants of less than 2 years
  • Parents of an adult child who is over the age of 18
  • The unmarried father of a child under the age of 18
  • Children who have lost a parent (regardless of the child’s age)
  • Siblings
  • Grandparents.

How much can be claimed for bereavement damages?

Following a consultation by the Government in reaction to the Smith v Lancashire case mentioned above, the award for bereavement in fatal accident claims was increased from £12,980 to £15,120 in March 2020 (after seven years of no increase at all).

The new award level applies to deaths on or after 1 May 2020.

However, the Ministry of Justice’s reiterated view is that bereavement damages are token in nature and have intentionally been limited in scope to a very restricted pool of individuals.

Commentary

“What price is a loved one’s life?” is probably one of the most emotive issues lawyers deal with in fatal accident cases.

The answer is of course that no money can ever compensate for the death of a beloved family member, but it adds to the hurt of families already dealing with a loved one’s death to find out what level of bereavement damages are actually set at and how restrictive in scope they are.

As a serious injury lawyer, it has been my experience that this restrictive approach can cause real heartache and anger at a time when families are in an exceptionally emotive state of mind anyway.

Careful and early management of the expectations of the families involved in fatal accident cases in respect of bereavement damages is therefore key.

A multitude of legal commentators have sought to emphasise the inequality and unfairness of the current legal position.

The Association of Personal Injury Lawyers (APIL) carried out consumer research in 2013, in which more than half of the 2,000 people surveyed thought bereavement damages should be more than £100,000, while three-quarters of people wanted the levels set on a case-by-case basis.

In addition, the current legal position does not reflect modern society’s view of and the proliferation of so-called “illegitimate” children ie children not born to a married couple.

It is a fact of life that (depending on the studies one consults) around 30-50% of babies are born out of wedlock.

That means a lot of fathers will fall outside of the scope of bereavement damage.

Children are prevented from claiming bereavement damages for parents in any case, which has caused many an expression of outrage when explaining the law to families.

As a comparison, in Spain or Greece you would likely be able to claim damages of around €80,000-100,000 for a bereavement which is caused by an unlawful act.

In Scotland, every case is looked at on its own merits and this has resulted in awards solely for bereavement damages reaching up to £140,000.

Unfortunately, a policy change by the Government is highly unlikely at the present time.

Lauren Haas is an associate solicitor specialising in serious injury and fatality cases at Irwin Mitchell. 

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Legal

Driverless vehicles and injury

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The Government has recently indicated that they are intending to consult on changing the law in the near future so as to allow level three automated vehicles on the road, writes David Withers of Irwin Mitchell.

There are six levels of automation:

Level 0: The driver performs all of the tasks associated with driving the vehicle;
Level 1: Some driving features are included but the driver controls the vehicle;
Level 2: The vehicle has automated functions but the driver must monitor the environment and be ready to take control at all times;
Level 3: The driver is a necessity but does not need to monitor the environment at all times;
Level 4: The vehicle can perform all driving functions under certain conditions;
Level 5: The vehicle can perform all driving functions under all conditions.

The proposed consultation is likely to see level 3 vehicles being allowed on the UK roads, in addition to levels 0, 1 and 2 vehicles.

The call for evidence will look at the Automated Lane Keeping System (“ALKS”) – an automated system that can take over control of the vehicle at low speeds, keeping it in lane on motorways.

Drivers may be able to “delegate” the task of driving the vehicle. ALKS can keep a vehicle within its lane and control its movement for extended periods of time.

However, at all times, the driver must be able and ready to resume control when promoted by the vehicle or in an emergency situation.

Transport Minister Rachel Maclean said: “Automated technology could make driving safer, smoother and easier for motorists and the UK should be the first country to see these benefits, attracting manufacturers to develop and test new technologies.

“The UK’s work in this area is world leading and the results from this call for evidence could be a significant step forward for this exciting technology. Following the approval of ALKS Regulation in June 2020 by the United Nations Economic Commission for Europe (UNECE) – of which the UK is a member – the technology is likely to be available in cars entering the UK market from Spring 2021.

“The government is acting now to ensure that regulation is ready where necessary for its introduction”.

The Government’s call for evidence will ask whether vehicles using this technology should be legally defined as an automated vehicle, which would mean the technology provider would be responsible for the safety of the vehicle when the system is engaged, rather than the driver.

Under the Consumer Protection Act 1987, a manufacturer is strictly liable for any damage caused “wholly or partly” by a defect in a product.

In addition, the manufacturer may be liable for a breach of contract and / or negligence, albeit the breach would have to be proven, as a breach of contract and negligence do not (in usual circumstances) attract strict liability.

Under the Automated and Electric Vehicles Act 2018, if damage is caused by an automated vehicle when driving itself, the insurer would be liable for the damage.

There is currently uncertainty due to a gap in the legislation whether an insurer or a manufacturer would be liable in circumstances when damage is caused partially by an automated system and partially due to driver error.

It may be the case that both the manufacturer and the driver could be held liable.

Personally, I think it is fantastic that the UK is keen to lead the way with automated vehicles. However, any further automation of vehicles must be carefully considered.

Automation can lead to complacency amongst drivers. If Level 3 automated vehicles are allowed on the roads, the driver does not need to monitor the environment at all times. The Government has suggested that level 3 vehicles may be allowed on motorways and other roads subjected to a 70 miles per hour speed limit.

Although there will of course be extensive testing, we know that products including those designed to automate the driving experience can and do fail.

I would urge the Government to ensure that we adopt an incremental approach to any automation of driving vehicles so as to discourage complacency and increase the risks that we face when driving on the roads.

In addition, I think provision should be made to ensure that the legal framework insofar as insurance and responsibility is clear.

David is a partner and solicitor-advocate at Irwin Mitchell LLP, leading a team specialising in neuro-trauma and other serious injuries such as amputations or significant poly-trauma.

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