Medical negligence: Quality of nursing care claims

If you are concerned about the standard of care a relative or loved one is receiving, there are steps you can take to help improve their situation. Our specialist Medical Negligence team offer valuable help and guidance. You can call our Medical Negligence experts on 080o 013 1165 for a free, confidential, no obligation chat.

What to do if a loved one isn’t getting the care they need

Recent reports in the press and by the BBC point to a ‘care crisis’ in the UK, and ongoing issues with the UK’s care system.  A recent report from the Care Quality Commission (CQC) has highlighted the sub-standard levels of care sometimes provided to patients across the UK. They report that many services are underfunded and overstretched, with staff shortages being a major area of concern.

If you have a loved one receiving care, or moving into a care home, they have the right to be treated properly. They might choose to receive domiciliary care at their own home, or through a residential or care home. Sadly, as documented by the press and the BBC, some carers and homes can sometimes fall short in the care they provide to patients.

There is no clear definition of poor care, and there can sometimes be a thin line between poor care, and abuse and neglect. The bottom line is this: is the person getting the support and help they need as identified in their care plan?

Common problems with care and care homes

When problems occur, it’s often due to a neglect of basic care needs, toileting, poor staff behaviour and the general happiness and well-being of the patient. Common issues include:

  • Injuries caused by falls, slips or poor handling by staff
  • Pressure sores
  • Errors in medication
  • Dehydration
  • Malnutrition
  • Late referrals for treatment

Seeing someone suffer because of poor care is emotionally very difficult. You might be worried for their safety, or unsure if you should speak up. However, there are steps you can take to help.

What to do if you have concerns about the quality of care

If you have concerns about the care a friend or relative is receiving, then there are several practical steps you should take. Don’t be afraid to raise a complaint. Although it can be a difficult task to discuss concerns relating to someone’s care, it’s important to remember that they have a right to be treated properly. Care homes and home-care agencies must be registered with the CQC and meet the minimum standards set. By law, all health and social care services must have a procedure in place for dealing with complaints.

As a first step, you should discuss your concerns with the patient. Make your own observations, or if you can’t be there, ask someone else to be present when the carer comes, or in the case of residential or nursing homes, visit the patient so that you can form a first-hand view of the level of care being provided.

Dealing with abuse by carers and care homes

If you suspect that your relative or loved one is receiving poor care or being abused in any way, ask them about it in private. Try to get as much detail as possible. Then, report the matter to the manager responsible for the patient’s care. Ask them for an explanation and an investigation. Follow up on your verbal complaint in writing.

If you witness abuse or have evidence that suggests basic standards aren’t being met, intervene as soon as you can to stop it. Write down what happened, and follow it up with the care manager. Keep copies of all documents relating to your complaint, recording important details like date, time, place and the names of staff involved.

You can also contact your local authority to report a problem – even if they don’t fund the patient’s care. All councils have procedures in place to deal with the care and protection of vulnerable adults. You should also inform the CQC, as they have legal powers to intervene and make care providers improve their service.

Farm health and safety: Legal responsibilities for farmers

On a daily basis, farmers and farm workers are exposed to potentially dangerous machinery, vehicles, chemicals and livestock. Farmers are subjected to all sorts of risks including working at height, dealing with electrical equipment and working near pits and silos. Coupled together with the ever-changing weather conditions it is no surprise that the farming industry has a reputation for having a bad safety record.

Farmers have legal responsibilities for health and safety under various regulations in the UK, such as the Health and Safety at Work etc Act 1974, the Management of Health and Safety at Work Regulations 1999, and the Provision and Use of Work Equipment Regulations 1998.

Under these regulations, farmers have a duty of care to ensure the health, safety, and welfare of their employees, contractors, visitors, and members of the public who may be affected by their activities. This includes providing adequate training, instruction, and supervision to ensure that workers can carry out their work safely, providing suitable equipment and machinery, and maintaining safe working conditions on the farm.

Farmers are also responsible for carrying out risk assessments to identify and manage potential hazards on the farm, and for developing and implementing appropriate health and safety policies and procedures.

At Tees, our regulatory experts are skilled at identifying the applicable rules and regulations for farming and agriculture. We can help clarify the potential effects of these regulations on your business practices.

In relation to compliance with these regulations to maintain good health and safety practices, Jamie Hare, a regulatory law expert, at Tees, examines the obligations of farmers and the steps they should take to fulfil these responsibilities.

What are the benefits of implementing safety measures on farms?

Having some simple safety measures in place can prevent unnecessary non-fatal and fatal accidents from occurring. Managing risks in a sensible way helps to protect your business, your family and your workers. It has the additional benefits of reducing injuries and ill health in your workforce which results in improved productivity and better morale. It also provides a level of protection from potential penalties and prosecution if something serious does occur.

Why is training important for everyone working on a farm?

Providing training is a fundamental yet critical aspect to consider. It is vital that training is extended to all individuals employed on a farm. The Health and Safety at Work etc Act 1974 requires employers and self-employed individuals to provide their workers with relevant information, guidance, training and supervision that is essential to ensure their safety and well-being at work, to the extent that it is reasonably practicable.

What are the specific training requirements in the farming industry?

There are a number of other regulations which include specific training requirements. For example, The Provision and Use of Work Equipment Regulations 1998[DL1]  specifies the need for training for people who use work equipment.  The Management of Health and Safety at Work Regulations 1999 specifies health and safety training should be provided when new people commence employment.

The underlying message is that everyone at work needs to know how to work safely and without risks to health.

How can training help?

Training enables workers to know about the hazards and risks they may face, and the precautions to take (including any emergency procedures) and should help them to carry out their work safely. It will also enable them to know how to use protective measures, such as guards on machines, the start-stop procedure, PPE and safe methods of work.

How can training be carried out?

Training can be provided in a number of ways and can involve various methods. It can be provided by instructions or on-the-job training delivered by an experienced worker. It can be provided by online courses or by attending local colleges and training centres.

How do I assess the risk on a farm?

It is important to be proactive about the health and safety aspects of your farm business. All accidents can be avoided if the risks are properly managed. A risk assessment is a careful look at what, in your business, could cause harm to people, so that you can decide whether you have taken sufficient precautions, or should do more.

This will enable you to find out which areas of your farm pose the greatest risk to health and safety. Once you have identified these potential risks, you can then take practical steps to avoid accidents. The law does not expect you to completely eliminate health and safety risks on your farm, but rather that you take all steps that are reasonably practical to ensure you and your staff work in a safe environment. This means practising sensible risk management and introducing controls that are proportionate to the risks.

What is the aim of a risk assessment and how can it be used to avoid accidents?

The aim of the risk assessment process is to evaluate the risk or hazard, then remove that risk or hazard or minimise the level of risk by adding the necessary control measures. A hazard is anything that might cause harm, such as working from ladders. The risk is the chance that someone could be harmed by the hazard.

The Management of Health and Safety at Work Regulations 1999 places a duty on employers and the self-employed to make a suitable and sufficient assessment of the risks to their own health and safety and that of others from the work they do.

For each hazard, you need to be clear about who might be harmed. Farming activities can possibly pose risks to the health and safety of you and your employees, any casual workers, part-time workers, trainees or apprentices, contractors, and customers. It also extends to walkers, hikers and cyclists that may come onto your land. Public safety should be a part of your overall health and safety policy.

How do I assess the risk?

The first step is to consider how people might be harmed and how that harm may occur. Examples could include being killed by a bale or vehicle, injured by falling through a fragile roof, crushed by livestock, or suffering long-term health problems from breathing in grain dust.

If you can, you must eliminate the hazard altogether, but if you cannot do this, then you must control the risks by considering the following:

  • Introduce a less risky option, e.g., switch to a less harmful chemical.
  • Prevent access to the hazard, e.g., securely cover or fence a slurry pit or guard the dangerous part of a machine.
  • Organise work to reduce exposure to the hazard, e.g., put barriers between people and moving vehicles.
  • Provide personal protective equipment, e.g., clothing or footwear.
  • Provide welfare facilities, e.g., first aid and showers for removing contamination.

What is the 5-step process for approaching risk in the farming industry?

The HSE guidance in relation to health and safety in agriculture sets out a 5-step process to approaching risk.

Step 1: What are the hazards?
Step 2: Who might be harmed and how?
Step 3: Evaluate the risks and decide on precautions
Step 4: Put the results into practice
Step 5: Check controls stay in place and review the assessment.

A risk assessment is not an end in itself. It will not prevent someone from suffering a non-fatal or fatal injury.

This will only happen if you implement the control measures to deal with the hazards and risks you find. If you find there are quite a few improvements needed, big and small, don’t try to do everything at once. Deal with the most important things first, e.g., those that could kill, seriously injure, or cause serious illness.

Farmers will need to ensure that everyone who works on the farm knows about the results of your assessment and understands the controls you have put in place.

Farmers will need to regularly check on the control measures to ensure they are being adhered to and remain in place.

With the developments in ways of work and technology, no workplace remains the same for any length of time. Sooner or later, you will buy new equipment or change ways of working that might bring in new hazards.

If there is a significant change in working practices farmers need to respond to it straight away and review the relevant risk assessments.

What happens if I don’t comply with the regulations?

If a farmer fails to comply with their legal responsibilities for health and safety, they may be prosecuted and face fines or other penalties. In addition, if a worker or member of the public is injured or becomes ill because of the farmer’s failure to provide a safe working environment, the farmer may be liable for compensation claims.

Our regulatory experts can assist in regulatory action including:

  • health, safety and environmental,
  • regulatory enforcement including appeals.
  • inquests

Conveyancing: Glossary of terms

Legal terms can sometimes be confusing – here’s a glossary of conveyancing terms to help you when buying or selling a house.
Anti-money laundering (AML)

Law firms must comply with current anti-money laundering legislation (AML), meaning the laws, regulations, and procedures put in place with the aim of preventing criminals from disguising illegally obtained funds as legitimate income.

Law firms are required to comply with these laws and regulations, which is why they need to verify your ID, and if you are purchasing a property, why they ask for proof of how your funds have been obtained.

Buildings Insurance

The buyer assumes risk from the exchange of contracts, therefore, should arrange to insure the property from the point of exchange onwards. The insurance must (where a mortgage is taken out) be checked by your lawyer before exchange to ensure it complies with your mortgage offer conditions.

The seller should continue their insurance cover until completion to ensure that they are fully protected should a claim arise.

Chancel Repair Liability

Historically, homeowners were obliged to contribute towards the cost of repairs to the chancel of the local parish church. We obtain an indemnity policy on all purchases so that in the unlikely event you are asked by a church to contribute to any costs, they will be covered by the indemnity policy.

Completion

This is when you can collect the keys to the property. The completion date is agreed when contracts are exchanged. If you are buying a new property, your lawyer will advise you when you are able to pick up the keys from the estate agent.

If you are selling, your lawyer will advise you when the sale has completed, and will instruct the estate agent to release the keys to the buyer.

Contract

The legal document setting out details of the property to be bought or sold, the parties involved, the agreed sale/purchase price and any special terms and conditions previously agreed. Conveyancers use a standard form of contract that is approved by the Law Society and contains standard conditions of sale that are incorporated into all contracts for the sale and purchase of a property.

Contract pack

This is sent to the buyer’s solicitor and will contain:

  • the draft contract
  • title documents
  • property information form
  • fittings and contents form
  • leasehold information form (if applicable)
  • energy performance certificate (EPC)
  • any other relevant forms and documents.
Covenants

Obligations and restrictions, known as ‘positive’ and ‘restrictive’ covenants can be attached to a property. Positive covenants are generally an obligation to do something. An example could be an obligation to keep the fences in good repair. Restrictive covenants generally prevent you from doing something. For example, you may be prevented from building any additional structures on the land.

Deposit

If you are purchasing a property, you are required to provide a deposit of 10% of the purchase price (although smaller deposits can be accepted in some circumstances if agreed between the parties).

A lawyer cannot exchange contracts until they are holding your deposit funds (if you are also selling a property, they can use the money available from that transaction towards the deposit on your onward purchase). The deposit monies will be held by solicitors following the exchange of contracts and will not be released to the seller until completion. There are exceptions to this in the case of new build properties, however, at Tees, if this applies to you, your lawyer will discuss this with you.

Disbursements

Disbursements are costs incurred by a law firm on your behalf. The firm will ask for associated funds upfront which they use to pay these disbursements and other administrative charges. Examples of disbursements include the management pack on leasehold sales, or the searches, such as a local authority search.

This money will be held in the law firm’s client account until it is needed. Any money they hold on account that is not used will be refunded to you on completion.

Easement

An easement is the legal right to exercise privileges over another person’s land.  For example, an easement might provide a right of way across a piece of land, or a right to lay pipes or cables.

Enquiries

Enquiries are simply questions raised by the buyer’s solicitor. These questions come to light as they receive information and documentation throughout the course of the transaction.  They may include questions that have arisen from the documentation provided by the seller’s solicitor, the results of the searches, survey, mortgage offer or any additional questions the buyer may wish to raise.

Some of these questions can be answered by the lawyer, others may need your input. However, your lawyer will show you the answers they have given to all enquiries raised.

Energy performance certificate (EPC)

An EPC sets out the energy efficiency of the property on a traffic light system of A to G, with A being the most efficient.  The EPC needs to be obtained upon any sale of a property and will usually be sourced by your lawyer.

Equity

The difference between the value of a property and the figure owed to the mortgage Lender.

Exchange of Contracts

This is the point where the contract becomes legally binding, and a completion date is agreed.  Once exchanged, if you wanted to withdraw from the contract, you would be in breach of contract and forfeiture of your 10% deposit to the seller.

The lawyer will need to have an original, hard copy of the contract signed by you in before they can exchange contracts.

Fixture, fittings and contents form

Provided by the seller’s lawyer, this form is filled out by the seller and sets out what parts of the property are included in the sale and must be agreed by the buyer before purchase.

Freehold (Absolute)

This is a class of property title which gives outright ownership of the property and land on which it stands.

Ground rent

This is a payment specified in a lease that the leaseholder is required to make to the landlord. This is usually paid in yearly or half yearly instalments.

HM Land Registry

The government body that deals with ownership of property and land throughout England and Wales. HM Land Registry must be notified of all matters which affect/alter a property title.  They will update the title documents accordingly.

Joint Tenancy

The term ‘joint tenancy’ refers to a legal arrangement in which two or more people own a property together, each with equal rights and obligations. Joint tenancies can be created by anyone owning a property with more than one other person.

If two people own a property as Joint Tenants they benefit from the right of survivorship, meaning, that if one owner dies, their interest in the property automatically transfers to the remaining owner.

Land Registry official copies

These encompass the information within the title deeds to a property – they are downloaded from the Land Registry and provide the most up to date information on every property that is registered in the UK.

The Title Register confirms the property address, title number, owner(s) and can also detail any restrictions or charges over the property.

The Title plan shows the physical extent of a registered property.

If a property is unregistered, a lawyer would use the title deeds to apply for first registration. Once completed, the Land Registry would then issue Official Copies of the title.

(The) Law Society

The Law Society is the representative body for solicitors in England and Wales.

Leasehold

Leasehold interests are created by the grant of a lease over a property, allowing the owner of the leasehold interest exclusive possession of the property for the term of the lease.

The owner of a leasehold title is registered as the legal owner on the associated leasehold official copy documents.  The freehold ownership is retained by the landlord.

Leasehold property information form

This form is used when dealing with leasehold properties. It provides additional information to the buyer that is relevant only to leasehold properties, for example details of the management company.

(The) Legal Ombudsman

The Legal Ombudsman offers an independent and impartial complaint handling service to all those who are not happy with their legal professional. If you have complained to your own solicitor, they have eight weeks to deal with your complaint. If you are not satisfied by the outcome of the complaint, then you may escalate your complaint to the Legal Ombudsman.

Limited title

Properties are sold with limited title guarantee when the seller has no personal knowledge of the property, for example when personal representatives are selling a property when the registered owner has passed away.

Managing agents

A managing agent is a company employed by the landlord in the case of leasehold properties (usually flats) who are responsible for looking after the maintenance and repair of the building as well as the buildings insurance.

Mortgage deed

The Mortgage deed is the document by which you charge the property to the lender as security for the loan.  The deed must be signed by the borrower and is sent to the Land Registry on completion to register the bank’s charge over the property.

Mortgage Offer

If you need a mortgage, contracts cannot be exchanged until the mortgage offer has been received. Usually, you will receive your mortgage offer copy a few days before your lawyers receive their copy.

It is important to check the terms and conditions of the mortgage offer to ensure you are able to comply with them, and that the amount you are borrowing and the associated terms are correct.

Property information form

Sellers are required to fill this form in and return it to their lawyer. It asks questions regarding boundaries, disputes, services, legal rights, restrictions and other important information about the property. Failure to provide correct information could result in action being taken against you for misrepresentation; in cases where you’re unsure your lawyer should be able to help.

Redemption Statement

This document confirms the amount payable to your mortgage lender on completion of a sale or re-mortgage. There may be a penalty associated with redemption if a fixed rate mortgage is being repaid early.

Searches

The buyer’s solicitor will request several searches which reveal additional information about the property. Your lawyer will send you a report on the search results identifying the main points that you need to be aware of.

The searches that Tees generally request are:

  • local authority search: this reveals any applications for planning permissions that have been made in connection with the property; information on the roads serving the property including any proposals for new roads or railways; any restrictions on the property (such as if the property is in a smoke-controlled zone); and any other relevant information.
  • Drainage search: this reveals whether the property is connected to mains water, drainage and sewage systems and shows the location of the mains in conjunction with the property boundaries.
  • Environmental Search: this is a desktop search which reports on any environmental concerns such as risk of flooding; ground stability and radon gas.
Service charge

A sum paid in the case of leasehold properties (usually flats) to the landlord or management company/agent to cover the cost of items such as any repairs, maintenance or improvements that need to be made to common areas of a property, insurance premiums or administration costs.

Solicitor’s Regulation Authority (SRA) 

The independent regulating body of the Law Society of England and Wales. The SRA can be called upon to deal with disputes if you have received an unsatisfactory service from your solicitor.

Stamp Duty Land Tax (SDLT)

This is a tax which is payable by the purchaser upon completion of the purchase of a property. Generally, the amount of tax due is based upon the purchase price. There are some reliefs and exemptions available in certain circumstances.

Your lawyer will complete the necessary forms and arrange to pay the stamp duty to HMRC (Her Majesty’s Revenue and Customs) on completion. The lawyer will send you a copy of these forms for approval prior to completion of the purchase so that you may sign the same to confirm the details are correct. You are required to transfer us the necessary funds to cover the Stamp Duty after exchange, but prior to completion of the purchase.

Survey

This is a report carried out for the buyer by a surveyor to provide an insight into the physical condition of a property. If there are any concerns that arise from your survey of the property, your lawyer can raise these with the seller’s solicitor, however lawyers are not qualified to give professional advice on the results of a survey – you should consult the relevant professionals for example those in the building trade.

Tenants in Common

Where a property is owned as tenants in common, this means that each owner owns a distinct share of the property (shares can be equal or unequal), the proceeds of which they are entitled to on sale of the property.

With this type of ownership, there is no right of survivorship, so if one owner were to pass away, the property does NOT automatically pass to the surviving owner but instead will pass according to the deceased owner’s Will or probate rules.

Title absolute

This is the strongest form of property ownership and there is very little possibility that ownership could be challenged.

Transfer Deed (TR1)

The document that legally transfers the property from the seller(s) to the buyer(s). It must be signed in the presence of an independent witness (i.e. not a relative, spouse, or someone that currently resides at the same address as you).

Upon completion, this together with any other deeds and documents are sent to the buyer’s lawyers who will arrange for the transfer to be submitted to the Land Registry for the title to be updated.

Vacant Possession

Most properties are sold with vacant possession which means the seller must have vacated on or before completion. There must be no one remaining in occupation and the seller must, as a rule, clear the property of all goods and rubbish except those included in the sale.

Spring Budget 2023

Chancellor of the Exchequer, Jeremy Hunt, delivered his first spring budget on the 15th of March declaring it was “A budget for growth.” The fiscal update included a range of new measures, some of which had been widely trailed prior to budget day, in order to achieve growth “by removing obstacles that stop businesses investing; by tackling labour shortages that stop them recruiting; by breaking down barriers that stop people working; and by harnessing British ingenuity to make us a science and technology superpower.”

OBR forecasts

The Chancellor began his statement by unveiling the latest economic projections produced by the office for budget responsibility (OBR) which he said showed the UK would meet the Prime Minister’s priorities to “halve inflation, reduce debt and get the economy growing.” In relation to the first priority, Mr Hunt said the latest OBR figures suggest inflation will fall from an average rate of 10.7% in the final quarter of last year to 2.9% by the end of 2023. This sharp decline is partly due to some of the chancellor’s budget measures, including the three-month extension to the household energy price guarantee (EPG), which the government had confirmed earlier in the day.

Mr Hunt also said the OBR forecast suggests the UK economy will now avoid a technical recession this year (defined as two consecutive quarters of economic decline) and then expand in each of the remaining years of the five-year forecast period. According to the updated figures, the economy is expected to shrink by 0.2% this year, a significant upgrade from last autumn’s forecast of a 1.4% contraction, with growth then predicted to hit 1.8% in 2024 and 2.5% in 2025, before easing back towards its medium-term potential growth rate of 1.75% by 2028.

The Chancellor’s growth strategy focuses on the four pillars ‘everywhere, enterprise, employment and education,’ as previously outlined in his Bloomberg speech in January.

Everywhere

Mr Hunt spoke about the government’s plans for ‘levelling up,’ including the launch of 12 new investment zones. Across these “12 potential Canary Wharfs,” £80m of support per zone will be available for skills, infrastructure and tax reliefs. Mr Hunt also mentioned specific projects selected for local investment, including:

  • £200m for local regeneration projects and £400m for new levelling up partnerships across England
  • £8.8bn over the next five-year funding period for the city region sustainable transport settlements
  • Up to £8.6m for the Edinburgh festivals, as well as £1.5m for the repair of Cloddach bridge, near Elgin, and £20m for the restoration of the Holyhead breakwater in Anglesey
  • Up to £3m to extend the tackling paramilitarism programme in Northern Ireland.

Enterprise

  • To provide the right conditions for businesses to succeed: A ‘full expensing’ policy will apply from the 1st of April 2023 until the 31st of March 2026 to allow investment in IT, plant or machinery to be deducted in full and immediately from taxable profits
  • an increased rate of relief for loss-making research and development (R&D)-intensive small and medium size enterprises (SMEs) – eligible companies will receive a £27 credit from HMRC for every £100 of R&D investment
  • an extension of higher reliefs for theatres, orchestras, museums and galleries for two further years
  • the medicines and healthcare products regulatory agency (MHRA) will receive £10m extra funding over two years
  • all of the recommendations from Sir Patrick Vallance’s review of pro-innovation regulation of digital technologies are accepted
  • £900m of funding for AI research resources and an exascale computer as well as a commitment to £2.5bn ten-year quantum research and innovation programme through the government’s new quantum strategy
  • innovation accelerators programme – £100m funding for 26 transformative R&D projects
  • AI challenge prize – £1 million prize every year for the next ten years to researchers that drive progress in critical areas of AI.

Employment

The Chancellor turned next to employment, with a suite of new measures to “remove the barriers that stop people who want to from working.” To achieve this, he announced:

Mature workers
  • The expansion of the DWP’s ‘midlife’ MOT scheme, aiming to reach up to 40,000 individuals per year (up from the current 8,000)
  • new ‘returnerships’ scheme to make existing skills programmes more accessible to older workers and help them upskill and retrain
  • a pension tax relief overhaul; see details in the personal taxation and pensions section.
  • people with long-term illnesses and disabilities
  • a white paper on disability benefits reform
  • the abolition of the work capability assessment for disability benefits claimants
  • a new voluntary employment scheme for people with disabilities
  • £406m to increase support for working adults with mental health, musculoskeletal and cardiovascular problems.
Welfare recipients
  • An increase to the Administrative Earnings Threshold
  • a stronger sanctions regime for universal credit claimants.
Care leavers
  • A 50% increase in funding for the staying close programme
  • an increase in the qualifying care relief threshold to £18,140 per year plus £375 to £450 per person cared for per week for 2023/24 and these thresholds will then be index-linked, representing a tax cut worth approximately £450 per year on average.

Education

Mr Hunt then turned to Education, stating that he wants to reform the childcare system, currently “one of the most expensive systems in the world.”

His new proposal will offer 30 free hours of childcare each week to pre-school-age children aged nine months or above in English households where both parents work. It will be phased in on the following timeline:

  • April 2024 – eligible two-year-olds will receive 15 hours of free childcare per week
  • September 2024 – qualifying children aged nine months to two years will receive 15 hours
  • September 2025 – eligible children aged nine months to three years will receive 30 hours.

Also, schools and local authorities will be funded to increase the availability of wraparound care, to enable parents of school-age children to drop them off between 8 am and 6 pm.

To tackle the problem of unaffordable upfront costs, Mr Hunt also announced support for the 700,000 families on universal credit. Another major change involves each staff member in England being able to look after five two-year-olds instead of four, as is already the case in Scotland.

Personal Taxation and Pensions

To encourage over-50s to extend their working lives, the government is increasing tax relief limits on pension contributions and pots – the annual allowance will be raised from £40,000 to £60,000 from April 2023; the lifetime allowance (LTA) charge will be removed from April 2023, and the LTA will be abolished from April 2024. The maximum amount that can be accessed tax free (pension commencement lump sum) will be frozen at its current level of £268,275 (25% of current LTA). From April, the minimum tapered annual allowance (TAA) and the money purchase annual allowance (MPAA) will increase from £4,000 to £10,000 and the adjusted income threshold for the TAA will also rise, from £240,000 to £260,000.

As a reminder, the following changes were previously announced in the Autumn statement 2022:

  • The income tax additional rate threshold (ART) at which 45p becomes payable is lowered from £150,000 to £125,140 from April 2023. The ART for non-savings and non-dividend income will apply to taxpayers in England, Wales and Northern Ireland
  • the dividend allowance reduces from £2,000 to £1,000 from April 2023 and to £500 from April 2024
  • the annual capital gains tax exemption reduces from £12,300 to £6,000 from April 2023 and to £3,000 from April 2024
  • The stamp duty land tax nil-rate threshold for England and Northern Ireland is £250,000 for all purchasers and £425,000 for first-time buyers, remaining in place until 31 March 2025.

In addition:

  • The income tax personal allowance and higher rate threshold remain at £12,570 and £50,270 respectively until April 2028 (rates and thresholds may differ for taxpayers in parts of the UK where income tax is devolved)
  • the basic state pension will increase in April 2023 from £141.85 per week to £156.20 per week, while the full new state pension will rise from £185.15 to £203.85 per week. The standard minimum income guarantee in pension credit will also increase in line with inflation from April 2023 (rather than in line with average earnings growth)
  • inheritance tax (IHT) nil-rate bands remain at £325,000 nil-rate band, £175,000 residence nil-rate band, with taper starting at £2m – fixed at these levels until April 2028
  • national insurance contributions (NICs) upper earnings limit (UEL) and upper profits limit (UPL) are frozen until April 2028
  • The ISA (individual savings account) allowance remains at £20,000 and the JISA (junior individual savings account) allowance and child trust fund annual subscription limits remain at £9,000.

Other key points

  • Potholes fund – an extra £200m for local road maintenance in England in 2023/24
  • alcohol duty – rates frozen until August 2023 then uprated by RPI, draught relief increased to 9.2% for beer and cider and 23% for wine from 1 August 2023
  • fuel duty rates – maintaining the rates of fuel duty at the current levels for an additional 12 months
  • defence spending – an extra £4.95bn for defence over 2023/24 and 2024/25
  • support for veterans – an additional £33m over the next three years
  • swimming pool support fund – over £60m for public swimming pools across England
  • support for charities and community organisations – £100m (England)
  • plastic packaging tax rate – uprated in line with CPI from 1 April 2023
  • launching ‘great British nuclear’ – supporting new nuclear builds, £20bn available for carbon capture, utilisation and storage (CCUS), and extending the climate change agreement scheme for a further two years
  • devolved administrations – receiving an additional £630m through the Barnett formula over 2023/24 and 2024/25 (Scottish government £320m, Welsh government £180m and Northern Ireland executive £130m).
Closing comments

Jeremy Hunt signed off his announcement saying, “today we build for the future with inflation down, debt falling and growth up. The declinists are wrong and the optimists are right. We stick to the plan because the plan is working.”

If you have any queries or need more information on any of the areas covered, or any other financial matter, please do not hesitate to contact us.

Information within this document is based on our current understanding of taxation and can be subject to change in future. It does not provide individual tailored investment advice and is for guidance only. Some rules may vary in different parts of the UK; please ask for details. We cannot assume legal liability for any errors or omissions it might contain. Levels and bases of, and reliefs from, taxation are those currently applying or proposed and are subject to change; their value depends on individual circumstances.

All details are believed to be correct at the time of writing (15 March 2023)

Countdown to the MEES Deadline: What to know

Commercial properties are required to be more energy efficient now than ever before.

EPCs and MEES

It is crucial for all landlords, investors, developers, and tenants to stay informed about the imminent modifications to MEES (Minimum Energy Efficiency Standards) and EPC regulations. Failure to adhere to the 1st April deadline and comply with the necessary measures may result in severe penalties for any involved party.

From 1st April 2023, the rules for commercial properties are changing. Are you ready?

The government has set a target to achieve a reduction of 78% in greenhouse gases by 2035 and net-zero emissions by 2050. The UK Green Building Council estimated that man-made structures are responsible for 40% of total greenhouse gas emissions in the UK. As part of the government’s plan, the rules on Energy Performance Certificates (EPCs) and Minimum Energy Efficiency Standards (MEES) are changing incrementally until 2030.

What are the current EPC ratings permitted under MEES?

Under the current rules, which apply to properties in England and Wales, landlords of commercial properties are prohibited from granting a new lease where the EPC rating is F or G. These are said to be ‘sub-standard’ properties. The current minimum EPC rating permitted under MEES is E.

A ‘new lease’ also includes any extension or renewal of an existing lease.

What are the exemptions for commercial properties under the MEES rules?

There are various exemptions to this rule, which are:

  • Devaluation – where the necessary improvements would damage the property or devalue it by 5% or more you can register a devaluation exemption. You would need to obtain a report from a RICS assessor to rely upon this exemption and any recommendations not covered by the report must still be carried out.
  • Seven-year payback – if the landlord can demonstrate that the initial costs of improvements would exceed the energy savings it would generate over the next seven years then this would not be considered a relevant energy efficient improvement.
  • Consent – where the landlord cannot obtain the necessary consents to carry out the required improvements (such as from a superior landlord or the local planning authority).
  • Improvements already carried out – if the landlord can show that they have carried out all cost-effective improvements to the property (or where there are none to be made) but the property still has a sub-standard EPC rating an ‘all-improvements’ exemption can be registered.

It is important to note that, if you plan to rely upon an exemption, it must first be registered on the government register of exemptions. Also, any exemption must also be renewed every five years for it to continue to apply.

Exemptions are personal and do not pass automatically when the property is sold. Any relevant exemption would need to be registered under the successor’s name.

The main penalty for failing to comply with MEES is a fine. This fine is calculated by reference to the rateable value of the property and the length of the breach, subject to a maximum of £150,000 (per breach). Additionally, there is also the possibility that the landlord’s details will be published on a public register setting out specific details of the breach, causing reputational damage to the landlord.

Non-compliance with MEES is not a criminal offence.

The current rules do not apply to existing leases. This is, however, about to change from April 2023.

1st April 2023 changes

From 1st April 2023, the above rules will apply not only to the grant of new commercial leases (including extensions and renewals of existing leases) but also to the continuation of any existing lease or tenancy agreement of the commercial property.

The exemptions mentioned above continue to apply, subject to the requirement to register and renew any exemption relied upon.

Looking forward

The government plans to require that all commercial properties have an EPC rating of at least B by 2030. It is anticipated that the next change will take effect from 1st April 2027, requiring a minimum EPC rating of C before later rising to B (or higher).

What should you do?

Landlords should review their portfolios to ensure that all existing leases have a valid EPC and consider the current rating.

If your property does not have an EPC, you should contact an energy assessor to arrange a survey. The government website has a function where you can find an accredited assessor local to you by inputting your postcode. As well as creating an EPC, an energy assessor will also prepare a Recommendation Report highlighting potential improvements and the impact this will have on the EPC rating.

If your property is ‘sub-standard’, with a rating of F or G, you should take urgent steps to consider what improvements can be made to bring the EPC rating to a minimum of E. You should also keep in mind the 2027 requirements for an EPC rate of C or higher. Can you take steps now to future proof your property to keep up with the future changes to MEES?

How can Tees help?

The law and guidance surrounding EPCs and MEES are complex and fast-changing. If you wish to discuss this topic further or require advice in connection with a new or existing lease and how the MEES will impact your transaction, please contact our Commercial Property Team.

Tees are here to help

We have many specialist lawyers who are based in:

Cambridgeshire: Cambridge
Essex: BrentwoodChelmsford, and Saffron Walden
Hertfordshire: Bishop’s Stortford and Royston

But we can help you wherever you are in England and Wales.

Polly Kerr talks to ITV Anglia News

ITV News has released a report on the provision of Special Educational Needs and Disabilities (SEND) in East Anglia.

The survey of 500 parents of children with special educational needs (SEN) and disabilities showed there is a significant level of dissatisfaction among families. It also highlighted that there were many service and provision shortcomings.  Additionally, the findings reveal a system that puts hundreds of individuals in debt.
The survey revealed that 32% of parents claimed their child was not receiving the support they were entitled to, as per their Education, Health and Care Plan (EHCP).

Polly Kerr spoke to ITV Anglia News, sharing her thoughts on the current state of SEND provision:

I don’t think it would [change much] because I don’t think there are the school places available or the resources available to be able to affect change now.
It’s going to be like moving the Titanic.

She said thousands of children were being failed.

You can read the full report here:
Thousands of parents and children being failed by special educational needs system, research shows | ITV News Anglia

Building Safety Act: Leaseholder and landlord certificates

What is the Building Safety Act 2022?

The Building Safety Act 2022 is new legislation which has brought major changes to give homeowners and tenants more rights, powers and protection so that homes will be safer all over the country.

If you are a landlord, please refer to our article Building safely act and fire safety act 2022: implications for landlords

Building Safety Act 2022 summary

The Act came into force in June 2022, largely in response to the issues brought to light following the tragic Grenfell disaster, which left some leaseholders facing huge bills to remedy building defects to make buildings safe and preserve the financial value of their properties.

 

A key part of the legislation is to deliver strong protection for qualifying leaseholders from the costs of fixing historical defects and safety problems (such as unsafe external cladding). It makes sure those responsible for past faults are held accountable instead.

What are the leaseholder protections in the building safety act 2022?

The leaseholder protections came into force on 28 June 2022, with new financial protections for leaseholders in relevant buildings with relevant historical safety defects.

The law now requires those who constructed faulty buildings to take responsibility for fixing them, while also granting legal protection to leaseholders from exorbitant bills for historical safety problems.

The government is firm that developers must pay for repairing buildings they were involved in building or renovating, even if they don’t own the building anymore. The law holds building owners or those associated with the developer, responsible for paying for the remediation of historical safety defects.

Courts now have expanded powers to impose liability on related companies, so that legal cases for claims against defective buildings can be brought against companies linked to the developer, preventing them from escaping responsibility by using complex corporate structures.

In cases where a developer can’t be found or has not yet agreed to pay for their own buildings, funds will be provided directly, to cover the cost of fixing cladding systems and remediation, ensuring that no eligible leaseholder has to bear the expense.

Eligible leaseholders are protected from all external cladding system remediation costs. Leaseholders whose property is valued at less than £325,000 in Greater London (£175,000 in other parts of England) or whose building owner has a group net worth of more than £2 million per building as of 14 February 2022, are exempt from historical safety remediation costs.

The law sets a firm cap on contributions from eligible leaseholders for non-cladding defects and interim measures (including the costs of trained personnel to detect and respond to any potential fire hazards i.e: “waking watch” costs), spread over 10 years, with costs already paid since 28 June 2017 counting towards the cap. If the remediation costs exceed the cap, building owners must make up the difference.

The law includes strong measures to ensure those responsible finally rectify dangerous buildings they contributed to and to protect leaseholders from the unjust costs of remediation they previously faced.

 If you’re a leaseholder in England, please refer to the Gov.uk link to check whether you’ll have to pay to replace cladding or to fix other safety problems with your building.

What leases qualify for protection?

There are criteria which must be met in order for a leaseholder to benefit from the protections created by the Act:

  • The lease must be for a single dwelling within a building of above 11 metres high or at least five storeys
  • The lease must be for more than 21 years
  • The leaseholder must pay a service charge
  • The lease must have begun before 14 February 2022 and as of 14 February 2022, either:

a) the dwelling must have been the leaseholder’s only or main home; or

b) the leaseholder did not own more than 3 dwellings in the UK.

What is a Leaseholder Deed of Certificate?

A lease must have satisfied each of these criteria as of 14 February 2022 to qualify for protection and, as evidence of this, the status of a lease on that key date must now be documented in a Leaseholder Deed of Certificate.

The Leaseholder Deed of Certificate will demonstrate whether the leaseholder can be responsible for paying for remediation works. Where the leaseholder can be asked to pay for these works, it enables building owners to calculate the cap on those costs.

The Leaseholder Deed of Certificate contains a series of questions and answers which assess whether the lease meets the required criteria for protection for example:

  • It must contain details of the current leaseholder,
  • who the leaseholder was on 14 February 2022,
  • the price the property was last sold for
  • and whether the lease is a shared ownership lease.

There may also be required additional documents that must accompany the Deed of Certificate, such as evidence of past sales of the property and the price paid.

Notwithstanding the importance of the Leaseholder Deed of Certificate for protecting leaseholders from repair costs, requests for deeds of certificate will become routine in conveyancing transactions and leaseholders planning to sell their properties should be aware of this and prepare in advance if possible.

What should I expect from my landlord or building owner?

The Leaseholder Deed of Certificate outlines the cap on costs the leaseholder can be asked to pay. Equally, a Landlord Certificate is a new requirement under the Building Safety (Leaseholder Protections) (England) Regulations 2022 and contains parallel information to calculate how much the landlord can charge leaseholders for building-safety works.

The Landlord Certificate acts as a permanent record as to the status of the lease on 14 February 2022 and must contain details about the current landlord, who the landlord was on 14 February 2022, their involvement in commissioning the defective work and any remediation works which have been carried out previously.

The landlord must provide leaseholders with a Landlord Certificate in the following circumstances:

  • When the landlord wants to pass on any costs for repairing defects onto a leaseholder through the service charge
  • Within four weeks from receiving notification from a leaseholder that the leaseholder intends to sell their property
  • Within four weeks of the landlord becoming aware of a relevant defect which was not covered by a previous Landlord Certificate; or
  • Within four weeks of a leaseholder requesting a Landlord Certificate.

As with the Leaseholder Deed of Certificate, the Landlord Certificate will also become a necessity in conveyancing transactions and requests for them will become routine.

Leaseholders that are planning to sell their properties should ensure they request a Landlord Certificate as early as possible in the transaction, if not prior to finding a seller, to minimise any potential delays while landlords deal with requests and preparation of the certificates.

If you have any queries arising from the points raised in this article, please contact Amy Barrington who will be very happy to help.

Legal cover insurance: The freedom to choose your preferred solicitor

If you or your business has the benefit of legal cover insurance, chances are you will never need to rely on it. But should a circumstance arise in which it’s necessary to seek legal assistance, it’s important for you to know the full extent of your rights, especially in relation to appointing your own solicitor.

What is Before the Event Insurance?

Before the Event (BTE) Insurance is a type of legal expense cover that may arise as part of a wider insurance policy, such as your home, business, motor or bank insurance. This cover is normally an ‘add-on’ in personal policies, but is also common in a wide variety of business contexts including partnerships, companies, and other corporate organisations.

BTE cover provides you with support in the event that legal assistance becomes necessary. Legal assistance covers a wide variety of circumstances including investigations, inquiries, and legal proceedings. These circumstances can be cumbersome and financially onerous, especially in large commercial settings. Accordingly, BTE insurance is often viewed as a prudent element of the wider business insurance cover policy. BTE insurance may cover an array of eventualities but typically will cover your legal costs including solicitor fees, costs of expert witnesses, court fees and legal costs for the opponent, in the event that they win the claim.

How does BTE cover work?

Most insurers will have a preferred group of solicitors, or ‘panel’, they will refer policyholders to, in the event legal cover is required. The insurers and panel solicitors will agree to fixed fee rates within their terms of appointment which are favourable to the insurers. If legal proceedings are initiated, you will be referred to the insurer’s panel solicitors. There can be benefits to being represented by your insurer’s panel solicitors. For example, panel solicitors will have the relevant expertise for the matter in hand and will have considerable experience in dealing with your type of issue.

Can you instruct Tees to act for you if you are claiming through your insurer?

Yes. Although insurers will place a strong emphasis on you staying with their panel solicitors, there is no obligation for you to do this. In fact, under the Insurance Companies (Legal Expenses Insurance) Regulations Act 1990, policyholders have the freedom to choose their own legal representation.

Indeed, many policyholders prefer to appoint solicitors they know and trust. If you know a solicitor that has represented you before, you may feel this solicitor will serve your interests better, particularly if the legal proceedings are complex or require specialist knowledge. It’s important, therefore, that you are clear on your rights in relation to choosing your own legal representation.

The right to appoint a solicitor of your choice does not arise at the start of your policy. The policy itself is likely to include terms that reference your insurer’s panel solicitors.  It will only be at the point where legal ‘inquiries or proceedings’ begin that your own solicitor can be sought. The definition of ‘proceedings’ is broad and includes initial steps that need to be taken (including consultation, investigation, mediation, as well as other early stages of legal assistance), in addition to claims that go on to require litigation. In Nobile v DAS Rechtsschutz-Versicherungs AG, the court ruled that the policyholder’s right to appoint their own solicitor started as soon as a cause of action arose.

Where circumstances such as these do arise, you can either seek confirmation from your insurer that your own solicitor may be used or alternatively, you can ask your preferred solicitor to contact the insurers directly. In either case, it is advisable to act swiftly, to ensure your solicitor can begin to take steps on your behalf.

Are there any limitations on who I choose to appoint?

If you decide to choose your own solicitor, it will be necessary for your insurer and your solicitor to agree on fees and hourly rates, as well as the scope of the work which will be covered under your policy. It’s essential that you check the terms of your insurance policy to ascertain any restrictions or limitations on fixed hourly rates from the outset. If your insurer’s fixed hourly rates are lower than the rates of your solicitor, the insurer cannot simply refuse to pay towards any of the legal costs.

Insurers may try to insist that your solicitor charges the same hourly rate as their panel solicitors.  This can be a considerably lower rate than your solicitor’s standard rate of work, so it’s important to note that your solicitor is not bound to agree to these terms. The Court of Appeal case of Brown-Quinn & Anor v Equity Syndicate Management Ltd & Anor [2012] states that insurers may restrict the level of recoverable fees, but not to the extent that it renders your freedom of choice meaningless. This means the insurers cannot set their fixed rates for non-panel solicitors so low that you have no real choice of which solicitors may represent you.

HMRC changes in processing option to tax form

From 1 February 2023, HM Revenue and Customs (HMRC) will no longer confirm the existence of an option to tax when requested to do so by property owners or solicitors, except in specific circumstances. These circumstances are limited to where the option to tax was likely to have been notified more than 6 years ago or if the enquiry is from an appointed receiver or insolvency practitioner administering the property in question.

In addition, HMRC will no longer issue option to tax acknowledgement letters once an option to tax has been notified. Property owners will therefore need to keep a record of the notification of their option to tax and we strongly recommend that all notifications are sent to HMRC via email to: optiontotaxnationalunit@hmrc.gov.uk. The email should include in the subject line the full property address and the effective date of the option to tax. This is because an automated response to the email will be received, which can be used as evidence that the option to tax has been notified to HMRC. Property owners and businesses are currently required to keep their VAT records, including options to tax, for six years, however, we advise that these records will now need to be kept throughout the ownership of the property in question to ensure that the correct tax treatment is applied on a sale or lease.

You can read more about the changes on the Goverment website here.

What happens on completion day?

The day of completion is the final step in the house buying and selling process.  It is the pre-arranged date when the financial and legal formalities are concluded, and the ownership of the property is transferred from the seller to the buyer.

On the day of completion, the following steps typically take place:

  • The buyers’ solicitor will transfer the funds to the sellers’ solicitor.
  • Once the funds have been received, the seller’s solicitor will contact the buyer’s solicitor to confirm that the funds have been received and will confirm to the estate agents that the keys can be handed to the buyers.
  • The seller’s solicitor will then send the deeds of the property to the buyer’s solicitor.
  • The buyer’s solicitor will check the deeds to ensure they are in order and that the property has been legally transferred to the buyer. They will then apply for the title to be amended at the land registry.

The buyer is responsible for arranging the connection of utilities, registering with the local council and other services required at the new property.  All of this should be completed from the date of completion.  The buyer will normally be responsible for the building’s insurance from the date of exchange rather than completion.  Your solicitor will make you aware of this at the appropriate time in the process.

The completion date is the date the buyer takes possession of the property and will have been agreed on by both parties in the sale contract. However, on occasion, the completion process may be subject to delays or complications, and it’s always advisable to work with a reputable solicitor and estate agent to ensure a smooth and efficient process.

Answers to common questions about the day of completion day:

What do conveyancing solicitors check on completion day?

Your conveyancing solicitor will handle the legality of transferring the funds, confirming the transaction has been completed, dealing with all the paperwork and deeds, and (if you’re the seller) redeeming or discharging any mortgage secured against the property.

  • Prior to completion, the buyer’s conveyancing solicitor will check all mortgage conditions have been met and request the money from the lender.
  • The seller’s solicitors will request a redemption statement (calculated to the day of completion) if there’s a mortgage on the seller’s property.
  • For the buyer to become the new registered owner of the property, the transfer deed must be signed by the seller (and also sometimes the buyer). This is usually prepared in advance prior to the completion day.
  • Conveyancing solicitors on each side create completion statements of all payments made and received and set out any invoices to be paid on completion.
  • On completion day both solicitors make final checks, and then the buyer’s solicitor will transfer the purchase money via the CHAPS banking system to the seller. For more information on CHAPS, visit the Bank of England website.
  • Once the signed transfer deed and any other deeds are received, the buyer’s solicitor will complete and submit a transfer form to the Land Registry.  This enables the transfer of ownership from the seller to the buyer.
  • Once the seller’s solicitor has received the funds, they’ll confirm completion with the buyer and release the keys from the estate agent. They also ensure specific charges are paid, including the seller’s estate agent fees.
  • The buyer will be notified of the completion they can then move into the property.
What can go wrong on completion day?

On completion day, there are several potential issues that may arise, which could delay or disrupt the process of transferring ownership of a property. One potential issue is a delay in the transfer of funds from the lender to the solicitor and between solicitors in the chain of the sale. These delays may occur due to fraud checks, technical difficulties or a lack of sufficient funds. It’s essential to ensure that all outstanding bills and fees, including stamp duty land tax, if applicable, are settled before completion day to avoid any issues.

There may also be delays with the seller vacating the property on time. It’s important to confirm with your removal company the time of their arrival and be prepared for how long it will take to move your belongings. To minimize disruptions, it’s recommended to do as much packing as possible before completion day.

What time do you normally get the keys on completion day?

The time that keys are handed over on completion day can vary depending on the specific circumstances of the sale. Typically, keys are handed over to the buyer once the funds have been transferred and the legal paperwork has been completed. The exact time of key handover will be agreed upon by the buyer and the seller, and it’s usually coordinated through their solicitors or estate agents.

Usually, the keys are handed over in the afternoon, between 12:00 pm and 4:00 pm, but it can vary. The buyer and the seller can agree on a specific time and date to hand over the keys, based on their availability and the time they need to move out of and into the property.

If the completion process is subject to any delays or complications the keys may be handed over later than expected. Therefore, it’s always advisable to have a plan B.  Open communication with the seller and your solicitor can help avoid these delays.

Should I call my solicitor on completion day?

Your solicitor will call you when completion has happened.  However, it’s a good idea to contact your solicitor on completion day to confirm that the process is proceeding as planned and that all necessary paperwork has been completed. They can also advise you on any final steps that may need to be taken and answer any questions you may have about the property transfer.

In summary, on completion day, you need to make sure the funds are transferred, legal paperwork is completed, arrange for utilities to be connected, register with the local council and other service providers, collect keys, and move into your new property.

Tees Wealth Management listed in Citywire New Model Adviser Top 100

We are proud to announce that our wealth team at Tees has been recognised by Citywire’s New Model Adviser as a Top 100 financial planning firm in 2022.

New Model Adviser is a prominent industry publication and its Top 100 honours the best of the financial planning community, recognising advice firms across the UK who are leading the way in the industry and providing exceptional Client service. As one of the top 100 financial planning firms in the UK, we have been widely praised by our clients, and through our team of experienced professional advisers, we help our clients to realise their financial goals, objectives and dreams, through our bespoke financial planning service.

James Appleby, commented “We are delighted to be named in the New Model Adviser Top 100. This acknowledgment recognises Tees’ commitment to our clients and the communities in which we operate, as well as the high level of professionalism, dedication and client focus demonstrated by the advice team.

Brain injury at birth negligence claims

It is very rare for babies to suffer a serious brain injury at birth. However, the effects can be absolutely devastating and lifelong for babies and their families.

Some signs and symptoms of brain damage can be detected shortly after birth. However, this is not always so and some symptoms may not be apparent until several years later.

Medical negligence claims – baby brain injury due to midwife or doctor negligence

Sometimes, basic errors in care during an otherwise routine pregnancy and labour can, unfortunately, cause or contribute to a devastating birth injury.  If the way your baby’s birth was managed caused a brain injury, you may be able to make a claim on behalf of your child to secure financial compensation for their future needs. Research carried out by the Royal College of Obstetricians and Gynaecologists (RCOG) shows that 854 babies suffered a severe brain injury in 2015. Of these babies, 76% might have had a different outcome with better care.

The 2021/22 HSIB Maternity Investigation Report highlighted problems with the inconsistency in guidance across the NHS, and in some areas, a complete lack of any guidance at all. This has led to inconsistency in maternity care across England. Guidelines should protect the health of the mother and baby, and ensure that any problems are detected at an early stage.  They cover, for example:

  • what an initial assessment of the woman should include
  • the frequency of maternal observations (blood, temperature and pulse)
  • how the baby’s heart rate should be monitored and how to interpret the results
  • how frequently vaginal examinations should be performed
  • the use of pain relief
  • what should be done if things are not progressing as they might
  • interventions that may be taken to help deliver the baby.

Doctors and midwives are only human, but unfortunately, when they make mistakes there can be devastating consequences for babies and their families. Sometimes, medical professionals fail to follow the right procedures during labour. For example, any untoward changes in the baby’s heart rate, could suggest that the baby is in distress and, depending on the level of concern, may mandate an expedited delivery.  If a caregiver fails to correctly interpret the baby’s heart rate and delivery is delayed, this may mean that the baby has been starved of oxygen for longer than should have been the case and that this has caused brain damage.

Examples of mismanagement after birth may include:

  • poor management of resuscitation shortly after birth
  • a failure to treat jaundice
  • a failure to treat  low blood sugar levels promptly.

The most common mistakes tend to occur because of lack of experience, lack of training, poor communication between staff (for example, during a shift change), insufficient staffing levels and fatigue and stress (for example, if the delivery ward is particularly busy midwives might need to look after multiple labouring women at the same time).

If your baby has a brain injury and you are worried about the care you or your baby received, a birth injury claims solicitor can help you find a way forward. Brain-injured babies may have long-term and complex needs, and it is important that any solicitor has the necessary expertise in these cases to help you get the best for your child. Many children with brain injuries go on to lead full and independent lives, but some children may require lifelong care and specialist support (such as adapted housing, equipment and therapy) to help them live their lives to the fullest. At Tees we are committed to helping families get the support and security they need. Our birth injury claims specialists understand what you’re going through, and we can help you get answers about your care. We’ll listen to your experiences, and help you find out what happened. 

Caring for women in labour

There are protocols and guidelines that caregivers should follow when caring for women in labour. These are in place to protect the health of the mother and baby and ensure that any problems are detected at an early stage. They cover, for example:

  • what an initial assessment of the woman should include
  • the frequency maternal observations (blood, temperature and pulse)
  • how the baby’s heart rate should be monitored and how to interpret the results
  • how frequently vaginal examinations should be performed
  • the use of pain relief
  • what should be done if things are not progressing as they might
  • interventions that may be taken to help deliver the baby

Common causes of brain injury at birth

If the brain does not develop properly or if there is damage to the developing brain, this may cause a wide range of physical problems, in addition to behavioural and learning difficulties.

The most common brain injury related to birth trauma is Cerebral Palsy. Cerebral Palsy can occur before birth, during birth or soon after birth.

Problems before birth

Sometimes cerebral palsy can occur before labour and birth.  Some things increase the risk of a baby having a brain injury, for example:

  • problems with the mother’s blood pressure (‘pre-eclampsia’), thyroid, or maternal seizures
  • maternal infections during pregnancy
  • multiple births
  • premature births
Problems during labour

Sometimes cerebral palsy occurs because a baby is starved of oxygen during labour. This is called birth asphyxia. It means that the baby’s oxygen supply or blood flow to the brain was interrupted during birth. Serious complications (acute events) during the early stages of labour or during established labour can interrupt the baby’s oxygen supply.  For example:

  • the placenta separating too early from the uterus (‘placental abruption’)
  • problems with the umbilical cord
  • the baby getting stuck in the birth canal and shoulder dystocia  (where the baby’s head is born but the shoulder gets stuck).

Serious physical injuries can cause brain injury. If the baby suffers a skull, neck or spinal injury (such as a fracture) this can be very serious. Physical injuries can be caused by physical injury to the mother during pregnancy or by instrumental deliveries such as forceps deliveries.

Doctors might recommend an instrumental delivery if the baby needs help to be born. In very rare situations an instrumental delivery can cause brain injury if the instruments injure the baby’s skull (which is very soft), neck or spine. Such injuries are rare, and may be associated with improper or negligent use.

Problems after birth

Sometimes a baby is born in poor condition and it is important that they receive prompt and appropriate resuscitation.  If this does not happen, unfortunately, the baby may be starved of oxygen for too long and may have permanent brain damage.

Other complications after birth include jaundice and low blood sugar levels (‘hypoglycaemia’). Jaundice is relatively common in babies, especially premature babies. It is the yellow colour seen in the skin of many newborns. Jaundice happens when too much bilirubin (a chemical naturally produced by the body) builds up (‘hyperbilirubinemia’). If infant jaundice is treated immediately, there usually isn’t a reason for concern. However, if left untreated, high levels of bilirubin in a baby’s brain can cause a serious condition called acute bilirubin encephalopathy. A very low blood sugar level, if untreated, can also cause cerebral palsy.

For many parents, understanding what happened during their child’s birth – and why – can be extremely important. Whatever caused the baby to be born with a brain injury, it’s an incredibly difficult situation for any parent to go through.

Signs and symptoms of brain injury in babies

The signs and symptoms of brain injury vary and depend on the severity of the injury. Generally speaking, the more serious the injury, the more obvious the symptoms.

Doctors use a grading scale to classify the severity of brain injuries at birth. There are 3 grades: mild (Grade 1), moderate (Grade 2) and severe (Grade 3). More severe injury normally means the initial symptoms and long-term effects will be more serious.

A mild injury (Grade 1 hypoxic ischaemic encephalopathy (‘HIE’)) may not be obvious immediately after a baby’s birth. Parents of babies with mild brain injuries may notice their baby is irritable and has problems sleeping or feeding. Other signs include hyper-alertness or if the baby’s eyes are wide open. Normally, the symptoms of a Grade 1 injury last for the first 24 hours after baby’s birth. If your baby’s birth was particularly difficult, or you suffered complications during delivery, your caregivers may ask you to look out for these symptoms.

Severe brain injuries can cause serious symptoms immediately after birth. These may be immediately noticeable. For example, babies who are born very poorly may be pale and floppy when they’re born.

Symptoms of a moderate (Grade 2 HIE) injury include:

  • lethargy (low energy, lack of movement)
  • reduced muscle tone
  • decreased or absent reflexes (for example, the sucking or gag reflex)
  • clinical seizures
  • pale in colour

Babies who suffer a severe (Grade 3 HIE) injury may exhibit the following symptoms:

  • lack of response to stimulation
  • unable to breathe independently
  • low or no heartbeat
  • lack of muscle tone
  • pale in colour
  • clinical seizures.

In very sad cases, a hypoxic brain injury can even lead to a baby’s death.

Treatment for brain-injured babies at birth

When caregivers suspect a baby may be born in a poor condition, a paediatrician should be called. If an emergency situation arises, help should be summoned quickly. However, this often means that midwives, obstetric doctors and paediatric doctors rush to the mother’s bedside. It can be a very frightening experience for the mother, and those supporting her during labour. Ideally, mothers should be told about the potential for such a situation during their pregnancy (however unlikely it may be).

Resuscitation

A paediatrician will be present for the birth in order to resuscitate the baby (if necessary).

Depending on the seriousness of the baby’s condition, they will usually be admitted to a Special Care or a Neonatal Intensive Care Unit.  Although this can be frightening for parents, it means that poorly babies get the care and support that they need to help their recovery.

Neonatal Therapeutic Hypothermia (infant cooling)

Neonatal Therapeutic Hypothermia (infant cooling) is a relatively new way of treating brain-injured babies at birth. It involves lowering the baby’s body temperature. Research suggests that this can improve the chances of babies starved of oxygen at birth from developing serious brain injuries, such as cerebral palsy.

Oxygen deprivation to the brain can cause a ‘cascade’ of neurological injuries. It causes gradual death of brain cells which in turn can cause brain injury and, in very sad circumstances, it can cause the baby’s death. Cooling therapy works by slowing down your baby’s metabolism, which slows and prevents the death of brain cells following oxygen deprivation. Cooling cannot, however, reverse the brain injury that has already occurred.

If your baby suffered a serious case of oxygen deprivation, they may be ‘actively cooled’. Your baby may be placed on a special cooling mat, or have cooled packs placed around them, to reduce their body temperature. The baby will be looked after in the neonatal care unit and cooled to 33C for 3 days after birth. Alternatively, your baby may be ‘passively cooled’, a process which involves taking early steps not to warm the baby up. Doctors may recommend removing the baby’s bonnet or turning off the heater to keep her/him cooler.

Both treatments are time-sensitive, and guidelines recommend cooling to start within 6 hours of birth. Although infant cooling is relatively new, early research suggests it is effective in improving the chances of brain-injured babies.

Unfortunately, not all brain-injured babies are candidates for infant cooling. Doctors might not recommend it if the baby is premature, has a very low birth weight or has a serious problem with their heart or lungs.

Imaging

If your baby suffered a brain-injury at birth, your doctors should offer an MRI scan or CT scan of the head. These tests examine the baby’s brain and can show signs of injury to the brain. Scans provide doctors with a detailed image of your baby’s brain and skull, and can show if there is bleeding or swelling, ischaemic brain tissue or fractures to the skull.

Prognosis for babies with a brain injury

Every baby is different and their prognosis will depend on the extent of the damage, where the damage occurred and what treatment they received.

It is usually hard to say what the likely course of any future disability may be until the child is older and how, and to what extent they have responded to therapies and support. However, in many cases there are long-term physical, in addition to learning and/or behavioural difficulties.  In some cases, the child may also suffer epilepsy.

Children with cerebral palsy usually need life-long support from a multi-disciplinary team, which may include a Paediatrician, a Neurologist, a Neuropsychologist, an Orthopaedic Surgeon, Physiotherapists, Occupational Therapists, Speech and Language Therapists, social workers, educational psychologist, a mental health specialist.  It can be very difficult to access but such therapies and support are known to significantly improve outcomes.

Some children will grow up to be capable of independent living and meaningful employment. Others, sadly, will not.

Life expectancy also varies enormously. Many children with a mild brain injury will have a normal life expectancy. Those at the more severe end of the spectrum will, sadly, have a considerably shorter life expectancy. If you have any questions or concerns about your child’s prognosis you should talk with your caregiver.

If your child has a brain injury and you are concerned about the care you or your baby received talk to our birth injury claims specialists. We’ll listen to your experience and help you find out what happened. 

Brain injury at birth terminology

Below is a useful glossary of terms which you might hear in connection with brain injuries at birth.

Where appropriate, these terms are explained specifically in the context of brain injuries at birth.

  • Hyperbilirubinemia: a condition whereby there is too much bilirubin in the blood
  • Hypoglycaemia: low blood sugar levels
  • Hypoxia: where part of the body (in this case, the baby’s brain) does not receive enough oxygen
  • Hypoxic ischemic encephalopathy (HIE):  where the baby’s brain does not receive enough oxygen or blood and it causes a problem with the baby’s health
  • Hypothermia: a very low body temperature
  • Neonatal encephalopathy (NE): abnormal signs of brain injury shortly after the baby’s birth
  • Neurological: relating to the nervous system (the brain, spinal cord and nerves).

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