Practice Area Archives

NHS Litigation Reform: Tees Law submits evidence

Posted on 9 November 202130 March 2025 by Sarah O'Sullivan

In September 2021 the Government’s Health & Social Care Committee launched a new inquiry to examine the case for the reform of NHS litigation.

Our Tier 1 Medical Negligence team represents patients who have suffered avoidable harm as a result of medical accidents. The team, led by Executive Partner Janine Collier, has extensive lived experience of NHS Litigation and is passionate about improving patient safety and giving clients a voice.

Janine and her team have put forward their evidence to the inquiry as they have significant concerns and wish to ensure that patients who have suffered avoidable harm whilst under the care of the NHS are appropriately represented, their voices heard and that access to justice is not compromised.

A need to focus on culture, not costs

The NHS is the largest employer in the UK and one of the largest employers in the world. The cost of NHS litigation must be seen in this context.

Over the past four years, total payments and administration costs under NHS Resolution clinical schemes have remained steady at between roughly 1.5% and 1.6% of the total NHS budget. This is a very low percentage compared to other organisations, where indemnity costs range from 1% to 15%, with almost all over 2%.

The main way to reduce cost – both human and financial – is to reduce avoidable harm.

There is evidence of a “defensive culture”, “dysfunctional teams” and “safety lessons not learned” across the NHS and until this is addressed, lessons will not be learned, change will not be implemented, errors will continue to be not just made, but repeated. The H&SC Committee’s own report into Maternity Safety published in July identifies a culture of blame within NHS Trusts.

Our medical negligence team’s view is that it is morally unacceptable to look to introduce any kind of legal reform which impedes access to justice or appropriate compensation for those who have been injured at the hands of the NHS through no fault of their own. This includes, but is not limited to, a possible introduction of fixed recoverable costs, which would have a disproportionate effect on the most vulnerable in our society.

The full version of our evidence to the inquiry can be viewed here. The outcome of the inquiry is expected in 2022.

Capital Gains Tax on property

Posted on 1 November 202128 March 2025 by Sophie Soraf

Latest update following the budget announcement

In the Autumn Budget 2021 the chancellor avoided making increases to capital gains tax on property.

Instead he offered some good news by extending the reporting and payment deadline for UK residents disposing of UK residential property that results in a CGT liability. You now have 60 days from completion of the disposal to deliver a CGT return and pay any tax due. The deadline has also been extended to 60 days for non-UK residents required to report a direct or indirect disposal of UK land and make a payment of tax.

The change takes effect for disposals that completed on or after 27 October 2021.

What is Capital Gains Tax?

Capital Gains Tax (CGT) is a tax on the profit you make when you sell or ‘dispose of’ an asset that has increased in value since you purchased it. To clarify, you are not taxed on the full amount you make from the sale, only the profit or ‘gain’.

What does it mean to ‘dispose of’ an asset?
Disposing of an asset refers to more than just selling it, and can include:

Gifting or transferring it to somebody else
Exchanging it for another asset
Receiving compensation (e.g. an insurance payout) due to the loss or damage of the asset.

If you are organising your finances, it can be a good idea to talk things through with a wealth management expert. Tees has independent financial advisers you can ask for advice.
When do I have to pay Capital Gains Tax on the property?
You will usually be taxed on the sale of a property if it is a second home or buy-to-let property, or if you have let out part of your main residence. CGT also applies to the sale of commercial premises, land and inherited property. Certain costs, such as legal and estate agency fees, stamp duty or surveying costs, are deductible when calculating your ‘gain’.

However, under most circumstances, you won’t usually be taxed on the sale of your main home due to a tax relief called Private Residence Relief (PRR).

Call our specialist solicitors on 0808 231 1320

What is Private Residence Relief and how do I know if I qualify?
PRR will exempt the gain from CGT when you’re selling a home you have lived in as your main residence for the entire period of ownership. You must meet this and all other PRR criteria to be eligible for the relief. There are a number of scenarios that may limit your entitlement to PRR, including;

Letting out all or part of your main residence (not including having a lodger who shares the house with you)
Using part of your main residence for business purposes only
Generally, the grounds must not exceed 5,000 square metres
You must not have bought the property simply to sell it on for profit.
What are the Capital Gains Tax rules for second homeowners, and what has changed?
People selling a second home or buy-to-let property must pay CGT on any profit they make from the sale after the deduction of any allowable expenses and allowances. The taxable gain is treated as the “top slice” of your income and basic rate taxpayers will be taxed at a rate of 18%, while higher and additional rate taxpayers will be taxed at 28%. As the gain is the top slice of your income it is possible for some of the gain to be taxed at 18% with the rest a 28%.

From 6 April 2020, UK residents selling a home that is not their main residence will have 30 calendar days from the date of completion to notify HMRC of the gain on a new CGT return and pay any CGT owed. This is a significant shortening of the previous deadline; those selling a property liable to CGT prior to the start of the 2020 tax year had until the self-assessment tax return deadline of 31 January following the end of the tax year of sale to notify HMRC and pay any tax due. To highlight the magnitude of the change, taxpayers could have had up to 22 months to make their payment under the old system against just one month now.

As an example, if a property was sold on 5 April 2020, the taxpayer wouldn’t need to notify HMRC and pay CGT until the date their 2019/20 tax return was due, i.e. 31 January 2021. However, if that same property was sold on 6 April 2020, the taxpayer would only have until 6 May 2020 to complete the necessary paperwork and make their payment – a reduction of nearly nine months.

What changes have there been to Private Residence Relief?
There are special rules governing the sale of a home the taxpayer has not always lived in. In circumstances such as these, you may not qualify for full Private Residence Relief, but there may be certain periods that will qualify.

Prior to the 2020/21 tax year, provided the property had been your home at some point in your period of ownership the last 18 months before the property is sold were always eligible for the relief (whether or not the property was your main residence at that time). For sales on or after 6 April 2020, however, this relief period reduced to nine months. For people purchasing a home prior to selling their old one, this effectively halves the grace period within which you can live in your new property without paying CGT on your former home. In practice, this means taxpayers must ensure their old property is sold within nine months to avoid a potential CGT charge. This final period is extended to 36 months in certain limited circumstances, most typically where the taxpayer moves directly from the property in to a care home.

You may also get relief for any periods of absence adding up to three years, or four years if you had to live away from home in the UK for work. You’ll get relief for any period of time you were living outside of the UK for work. You must have lived in your home before and after your absence to qualify, unless work prevented you from doing so.

What about Lettings Relief?
Another important change from 6 April 2020 is the loss of lettings relief in all but extremely limited circumstances. Where a taxpayer previously qualified, this relief previously exempted up to a maximum of £40,000 of a gain from CGT in instances where a former main residence had been subsequently let out. The loss of this relief could cost some taxpayers up to an additional £11,200 in tax. Unfortunately this previously generous relief is now unavailable in most circumstances.

What qualifies as my ‘main residence’ for Capital Gains Tax purposes?
What makes a main residence is a complicated issue in tax law, very simply put it is your home. Home is of course, much, much more than simply where you live and will be relatively easy to identify in most circumstances.

If you own more than one home, you are able to nominate which property you would like to be your main, tax-free residence. This doesn’t have to be the one you live in all, or even most, of the time. You may wish to nominate the property you expect to make the most profit on when you sell it. Once you have purchased a second home, you have two years within which to nominate your main, tax-free residence.

It should be noted that if you are married or in a civil partnership, you can only nominate one property between you.

What will I need to do?
If you sell a UK residential property and a chargeable gain arises you’ll need to report the gain to HMRC on a CGT return and pay the tax within 30 days of completion. HMRC will issue penalties and charge interest if you needed to report a gain/pay tax and failed to do so.

With such a tight deadline, you’ll need to make preparations in advance to ensure compliance with the new 30-day deadline. Unless you are classed under certain categories for whom the use of digital technology cannot reasonably be expected, you are expected to make your CGT return and payment online via HMRC’s government gateway. If you don’t have a government gateway account, you’ll need to apply for one – a process which can take up to 10 working days, so this will need to be factored in. You’ll also need certain details to hand to fill in the required paperwork – these should also be gathered in advance to prevent delays and any potential penalties. The information you’ll need includes:

The date the property was acquired
Costs of purchase and disposal e.g. purchase price, legal, surveying or estate agency fees (these can normally be found on the completion statement from your solicitor)
Costs of eligible home improvements
Earnings in the applicable tax year.
To calculate your taxable gain you will need to deduct the allowable costs (be careful, not all costs are allowable) from the sale proceeds. You can then deduct any allowances calculated such as PRR. Finally, if you haven’t already used it, you can deduct your annual CGT tax-free allowance of £12,300 (2020/21).

It is this “taxable gain” that will be added to your estimated income in order to calculate the tax payable. You’ll pay CGT of 18%, 28% or a combination of the two on the remainder, depending on your tax band.

If you complete a tax return you will also need to include details of the disposal on the return as normal, paying any tax adjustment through self-assessment as normal.

Tees has a dedicated team of tax accountants that can assist you with your rental and capital gains tax reporting requirements. Please do not hesitate to contact us if you would like assistance with your tax reporting obligations.

Government debate: Funding for research into Fertility-related conditions

Posted on 12 October 202130 March 2025 by Sarah O'Sullivan

A debate is due to take place in Parliament on 1st November 2021 in response to a public petition to increase funding for research into Endometriosis and PCOS. The petition is calling for ‘more funding to enable new, extensive and thorough research into female health issues’.

Tees’ Family Law and Fertility expert Caroline Andrews is involved in the provision of information for MPs in order to assist the debate, and has been highlighting the long-term physical and emotional impact on women along with the resulting fertility issues that can occur.

A volunteer trustee of Verity the polycystic ovary syndrome (PCOS) charity, it is Caroline’s view that the strong public response to the petition underlines the chronic underfunding of womens’ health conditions that has taken place in the UK over a number of years.

Conditions such as polycystic ovary syndrome (PCOS) and endometriosis can have a wide-ranging impact on a woman’s life not just on her health, but also on her employment attendance and recourse to fertility treatment. PCOS is a leading issue for women undertaking fertility treatment and the process can be time-consuming and complex with financial and legal issues to contend with at an already difficult time.

If you are affected by one of these conditions and are looking to undergo fertility treatment, you can read Caroline’s article which outlines the important legal considerations and how we can help.

Why do I need legal advice for my fertility treatment?

Posted on 12 October 202118 May 2025 by Sarah O'Sullivan

Fertility treatment can be a stressful time for all involved and therefore it is important to ensure that you are fully aware of your legal position as parents in the future.

Speaking to a solicitor may be the last thing on your mind when undergoing fertility treatment, however it is becoming increasingly necessary to ensure that you take independent legal advice.

Caroline Andrews, family law specialist here at Tees has many years’ experience specialising in fertility and surrogacy law and has leading case law experience on the issue of legal parenthood, as well as an understanding of fertility-related conditions such as PCOS. In this article, Caroline outlines the various legal implications that must be considered by all parties when a child is born through fertility treatment.

Family law judges recommend that “any person considering fertility treatment should ensure that they are familiar with the legal steps around the treatment, given the significant impact it could have both in the short and long term”.

If you are thinking about undergoing fertility treatment, it is important to consider the legal issues. The law can be complex so if you are starting a family, there are some key factors to consider:

Who will be your child’s legal parents?

How does the nature of the treatment and any donors, or forms completed at the clinic, impact on the legal parenthood?

If you are conceiving at a clinic, it is important to understand how the law governs your fertility treatment and affects your rights to information

If you are not using an at home conception, does this change how the law looks at the status of any intended parent?

In addition, if you are conceiving with, or as a known donor or co-parent, being aware of how to manage relationships and expectations to avoid problems later on and knowing where you would stand if there was a dispute between you, are also important considerations that are worth taking the time to discuss with a legal expert ahead of time.

Should I use a fertility clinic?

The Human Fertilisation and Embryology Authority (HFEA) regulates all UK licensed fertility clinics. You must give informed consent to fertility treatment at a UK licensed fertility clinic and this requires a clear understanding of English law and its implications in practice for you, your future child and your donor if you use donor sperm or eggs.

If you don’t have treatment with a licensed clinic the situation is more complicated. There’s a risk that your donor will be considered a parent by law – with all the rights and responsibilities that brings.

What are my options if I am separated from my partner but wish to have a baby?

If you are separated from your spouse or civil partner and you intend to artificially conceive a child as a single parent, you should first obtain expert legal advice. English law states that if you carry the pregnancy then you are your child’s legal mother.

Your spouse or civil partner will be the legal second parent of your child for English legal purposes unless it can be shown your spouse did not consent to your treatment and artificial conception. There will be difficulties with the forms ahead of treatment and presumptions in law after treatment so advice is essential.

What is co-parenting?

Co-parenting is when two people wish to be parents but who are not in a relationship together. This is a rising trend in America and becoming more common here in the UK.

If you carry the pregnancy, you will be your child’s legal parent under English law and your co-parent may acquire legal rights and responsibilities for your child which may or may not accord with your wishes and expectations. Therefore in this situation is extremely important to have a legal expert draft a co-parenting agreement, to ensure that the childcare arrangements are established and agreed on from the start.

A bespoke co-parenting agreement will also be an important tool if a dispute arises with your co-parent or if there is a change in either of your personal circumstances.

Will a known male donor have any legal rights in relation to my baby?

Yes, he may do. Artificial conception with a known donor creates complex legal issues under English law. Your known donor will be the biological father of your child. Irrespective of your wishes, he may also acquire legal status in respect of your child, to the detriment of your legal parental autonomy. He may also acquire unintended financial responsibility for your child.

If you are considering known donation it is strongly advisable to put in place a known donor agreement before conception.

Can I seek fertility treatment abroad?

You may be considering fertility treatment abroad. The HFEA does not regulate the practices of overseas fertility clinics. You should obtain expert legal advice in your destination country because the law may be different from law in the UK. There are a number of concerns as to treatment abroad in relation to medical health and legal impact such as immigration issues for any child.

Can I take time off work for IVF treatment?

There is no specific statutory right to time off work for fertility treatment which can often be time consuming and stressful. However, your employer should treat your medical appointments for IVF treatment like any other medical appointment. Similarly, if you are written off sick by your GP due to the side effects of IVF, your employer should treat your absence as no different to any other sick leave taken not in conjunction with IVF.

If you are at a medical appointment or off sick, you must make sure you follow your employer’s usual sick policy requirements. There are specific rules for surrogates in respect of employment rights. The Tees employment team can advise you fully on your legal employment rights whilst undergoing fertility treatment.

Storage of frozen embryos, egg and sperm

The Department for Health has extended the time limit for frozen embryo, egg and sperm storage for a period of 55 years as long as consent is gained every 10 years. This is to protect people who were finding the previous limit of 10 years was not sufficient.

Fertility organisations had been lobbying the government on this point of law for some time so this extension to the time limit is very welcome.

Other considerations

If you are going through a pregnancy involving a surrogate, there are different interpretations as well as concerns around whether the intended parents can be present for the birth. To combat past lockdown measures, the Family Court has put in place systems to facilitate hearings involving parental orders via telephone and video conferencing to enable matters to progress in spite of disruption due to Covid.

The importance of a well drafted Will

Whether undergoing fertility treatment or conceiving naturally, any prospective parent should think about having a Will drawn up. Your Will should appoint legal guardians for your child in the event of your death and appoint trustees to manage your finances on behalf of your child until your child is old enough to manage these assets. Given the complexities of who is deemed a legal parent, this can impact on who is considered a child under a Will. Therefore, tailored legal advice for your family is essential to protect them.

At Tees, our specialist Wills, Tax and Trusts team can help you prepare a carefully-worded Will to ensure that your child’s interests are fully considered.

Whatever your situation, our legal specialists are here to help guide you. We at Tees understand that undergoing fertility treatment can be an emotional time for you not to mention one that involves considerable cost. The approach of our fertility law specialists is highly empathetic having been involved in the fertility sector at many levels, whilst ensuring that you receive clear advice across the full range of family law issues that you might encounter on your journey to parenthood.

We offer a fixed fee service at competitive rates and can discuss funding options for court cases if an order of the Court is required.

Tees Law appoints new Senior Partner

Posted on 7 October 202130 March 2025 by Sarah O'Sullivan

Tees Law, a leading regional law firm with offices across Cambridgeshire, Essex, and Hertfordshire, is thrilled to announce the appointment of Catherine Mowat as its new Senior Partner. Catherine becomes the firm’s eighth Senior Partner in its 108-year history and the first woman to hold the position. She succeeds David Redfern, who will continue as a Consultant and Non-Executive Chairman of Trust Tees Ltd and Tees Financial Ltd.

A career of dedication and growth

A dedicated member of the Tees family since 1998, Catherine began her career as a trainee in the Bishop’s Stortford office. During her training contract, she had the opportunity to work alongside former Senior Partners Rodney Stock in Commercial Property and Richard Tee in Private Client. It was within the Private Client department that Catherine found her passion, which has shaped her career ever since.

After qualifying as a solicitor in 2000, Catherine became a Partner in 2007. Her career progressed swiftly, and from 2005 to 2008, she balanced a demanding caseload while earning an MBA in Legal Practice. In 2009, she transitioned to the Cambridge office, becoming Head of Office the following year, leading the team for four years.

Expertise in private client law

With over 20 years of experience in Private Client law, Catherine specializes in complex estate administration and succession planning. Her expertise spans wills, powers of attorney, and succession planning for rural clients and high-net-worth individuals. She has also developed significant experience in high-value professional deputyships, often acting as a professional deputy, executor, trustee, and attorney. Under her leadership, the Private Client team in Cambridge has grown substantially, achieving a seven-figure turnover.

Leadership and contributions

In addition to her leadership in Cambridge, Catherine has served as a Director on the firm’s main board, Trust Tees Plc, since 2018. She also contributes to the management of the Private Client department across Tees’ six offices and is a key member of the Cambridge office leadership team.

Life beyond the office

Outside of work, Catherine lives near Saffron Walden. She has a passion for music, singing in local choirs, and serving as a trustee for several charities.

A vision for the future

Reflecting on her appointment, Catherine shared, “It is an enormous privilege and an exciting challenge to take on this responsibility. Tees has grown and evolved over the years, but our core values of empathy, clear communication, and collaboration remain unchanged. As Senior Partner, I aim to uphold these values and ensure they continue to guide everything we do.”

She added, “In a rapidly changing world, agility and adaptability are key. The pandemic underscored our ability to embrace new technologies and hybrid working practices. Moving forward, we must remain open to opportunities and use challenges as a catalyst for growth.”

A fond farewell and exciting future

Ashton Hunt, Group Managing Director at Tees, expressed gratitude for David Redfern’s leadership. “David’s unwavering dedication over his 38-year career has been instrumental in making Tees the successful firm it is today. We are deeply grateful for his contributions and are pleased that he will remain involved as a Consultant and Non-Executive Chairman.”

Ashton continued, “Catherine’s extensive experience and dedication make her an excellent choice for Senior Partner. I have no doubt she will lead Tees to even greater success. We are excited for the future under her leadership.”

Tees Law looks forward to the next chapter, guided by Catherine’s commitment to excellence and innovation.

Do I have to sell my home to pay for care?

Posted on 22 September 202120 March 2025 by Sophie Soraf

The Government’s proposed reforms to health and social care will still leave many people having to pay large amounts in care home fees. However, these costs can often be reduced or even avoided altogether with appropriate planning. This article looks at the rules in England; the rules in different parts of the UK may be different.

The government has announced proposals to change the rules around how much people have to contribute towards care costs and at what stage, funded by a proposed new Health and Social Care Levy.

What are the proposed changes to health and social care funding?

If you need local authority care, the means testing rules are applied to decide how much you must pay towards the care; currently the rules are as follows:

if your capital is above £23,250 (the “upper limit”) you have to pay the care fees in full
you do not have to make a capital contribution to care costs where your capital is less than £14,250 (the “lower limit”) – although you may still have to contribute from your income
between £14,250 and £23,250 you have to make a partial capital contribution (as well as an income contribution, where appropriate)
there is no cap on the maximum care costs you may have to pay over the course of your lifetime.

Under the new proposals:

the lower and upper limits will be increased to £20,000 and £100,000 respectively from October 2023. This means that anyone with capital of less than £100,000 may receive some support towards their care costs (albeit limited) and those with capital of less than £20,000 will not have to make a capital contribution (although may still have to make a contribution from their income)
a lifetime cap of £86,000 on care costs will be introduced from October 2023. This means that you should not have to contribute more than that amount towards your care costs (although the cap isn’t being backdated).

However, it’s important to note that the cap only applies to the cost of actual care and not to other costs such as accommodation, energy, food or water. These costs, particularly the costs of accommodation, can often far outweigh the costs of care, so many people will still face the prospect of very large care bills which will erode their families’ inheritance.

Will I lose my home if I need to pay for care?

The value of your home is included in the assessment of what capital you possess, for means testing in many circumstances. For example, it will be included in the assessment where you no longer occupy your home (e.g. if you are moving into residential care permanently) and none of the other exemptions applies. This may lead to your home having to be sold to fund care fees.

It may be possible to avoid selling your home during your lifetime by entering into a deferred payment arrangement (broadly whereby the fees are repaid from sale of the home after your death). However, interest and fees apply and such arrangements will still reduce your families’ inheritance.

Example where home inherited absolutely

John and Betty jointly own their home, worth £300,000, free of mortgage. They have owned it equally as joint tenants (see below) since acquiring it. The home is their only major asset. No-one else occupies it apart from them.

On John’s death in November 2023, his share in the home passes to Betty as the surviving joint tenant. Unfortunately, Betty’s health declines rapidly after John’s death and she has to move into permanent residential care 12 months later.

The entire value of the home will be included in the means assessment for Betty. Her capital will be above the £100,000 threshold, meaning that she will be liable to pay the fees in full without any local authority funding. The amount she has to pay for care will be capped at £86,000, however her other costs (e.g. accommodation, energy and food) will not be capped.

Can I avoid paying care home fees by making a lifetime gift?

Some people might consider giving their home away during their lifetime to try to get it outside the scope of the means testing rules. There are rules aimed at preventing people from doing this known as the “deprivation of assets” rules. Where these rules apply, the local authority can include the value of the gifted asset when they carry out the means assessment. The “deprivation of assets” rules are complex and specialist legal advice should always be taken on whether or not they will apply.

Those considering gifting their home must also consider the possible significant impact of the gift on their future financial security and independence. With careful drafting of the document, a trust can address some of these concerns. However, the deprivation of assets rules can still apply.

The tax consequences of a gift (whether outright or to trust) must also be carefully considered. Such a gift can in some circumstances trigger immediate tax charges and/or increase your future tax exposure and/or that of your estate. You should always take professional advice before deciding to give away your home or a share in it, both as to whether the gift will achieve the intended objectives and what the legal and tax consequences will be.

Can I use my Will to protect my home from being sold to pay care home fees?

For married couples who do not wish to give away their home, one alternative is to leave the share in the home of the first spouse to die, to an appropriately worded trust under their Wills. While this won’t offer full protection, it will, in many circumstances, significantly reduce (and sometimes eliminate) the exposure to means assessment. Meanwhile, provided the trust is worded appropriately, the survivor can continue to occupy the property for the remainder of their life.

For the trust to work, the couple will need to hold the property as “tenants in common”, rather than as “joint tenants”. Where joint owners hold a property as joint tenants this means that the share in the property of the first to die automatically passes to the survivor. If they hold the property as tenants in common, each joint owner’s share passes under their respective Wills. Where a property is owned as joint tenants, it’s simple for a legal specialist to convert this to a tenancy in common, but you need to get it organised before the first death.

Example where share of home left to appropriate Will trust

The facts are the same as in the previous example above, except that John and Betty convert their ownership of the property, so they hold it as “tenants in common” in equal shares and John leaves his half share in the home to a trust under his Will. Under the terms of the trust, Betty has the right to occupy the home rent free for the rest of her life and John’s half share passes to their children after Betty’s death.

When Betty goes into care, her assets for means assessment purposes will include her own share of the home, but not the share held in John’s Will trust (because that doesn’t belong to her). Hence the share in the Will trust will be protected for the children. Also, the value of Betty’s share of the home for means assessment, is likely to be significantly lower than 50% of the total property value, because it’s the market value of the share that is assessed. The market value of a half share is likely to be much lower than 50% of the whole value, because a half share on its own will be much less marketable.

The Will trust approach also avoids many of the potential downsides of a lifetime trust. The deprivation of assets rules will not generally apply assuming (as will often be the case) that there has been no reduction in the value of anyone’s estate. The trust can be worded in such a way that the inheritance tax and capital gains tax consequences will be broadly similar to those that would apply if the property had been left outright. However, careful drafting and implementation is needed, or the tax consequences could be different. Before the death of the first spouse to die, the trust has no effect, so you can deal with the property as you wish.

One relevant consideration is that, by using a Will trust, the survivor will not be entitled to the capital of the share of the first to die. This will deter people who want absolute control over the home after the first death. Ways to mitigate this include:

the trust can include powers to advance capital at the discretion of the trustees if desired
the survivor can be appointed as one of the trustees so that they are involved in decisions while they have capacity
the terms of the trust can also give the survivor the right to require the trustees to join in the sale and purchase of a replacement property if they wish to move.

Please be aware that the Will trust route will not provide protection if both spouses have to go into care during their joint lifetimes (because the trust does not apply until first death). However, if only one spouse has to go into care during their joint lifetimes, the home would not generally be taken into account for means assessment, provided the other spouse is still living there.

Can I use a Deed of Variation to protect my home from care home fees?

You may have heard that beneficiaries of a Will can vary the terms of the Will (or the destination of a property inherited as surviving joint tenant) within two years of death, by making a Deed of Variation. However, Deeds of Variation can be subject to the “deprivation of assets” rules. So, if you decide to change your Wills, it’s better to do so during your joint lifetimes rather than relying on Deeds of Variation.

Inquest exposes continuing and dangerous risk of restricted items on mental health wards

Posted on 21 September 202130 March 2025 by Sarah O'Sullivan

A jury at Suffolk Coroner’s Court in Ipswich has delivered its conclusion in the tragic case of a Newmarket man who died while under in-patient care at a specialist mental health unit in West Suffolk. The six-day hearing followed a pre-inquest review last March.

HM Senior Coroner for Suffolk, Nigel Parsley, led the investigation into Joshua’s death on 9 September 2019. At the lengthy inquest, the jury concluded that 25-year-old Joshua Sahota died at Wedgwood House mental health unit in Bury St Edmunds as a result of asphyxia by deliberately placing a plastic bag over his head and using a bed sheet around his neck.

Lack of adequate risk assessment

The inquest heard that Joshua was a quiet young man who kept to himself. Staff only got to know him superficially, which limited their ability to assess the risk he posed to himself. Despite being classified as a high suicide risk throughout his admission, no effective measures were implemented to ensure his safety.

Joshua had previously attempted suicide by deliberately driving a car off a bridge onto the A14 near Newmarket. The jury was unable to determine his state of mind at the time of his death but highlighted several contributing factors including:

Insufficient staffing
Inadequate observations and 1-to-1 supervision
Poor documentation
Lack of access to a psychologist
Unclear restricted items policy

Prevention of future deaths report issued

The coroner has raised a ‘Prevention of Future Deaths Report’ not only with the Trust but also directly with the Minister for Mental Health and Patient Safety. This rare step underscores the severity of the restricted items issue at a national level.

Joshua’s admission to wedgwood house

Joshua was admitted to Wedgwood House, located at the West Suffolk Hospital site in Bury St Edmunds. Although the hospital site is under West Suffolk Hospital NHS Foundation Trust, Wedgwood House is managed by the Norfolk and Suffolk NHS Foundation Trust.

The Trust was previously rated as inadequate and placed under special measures in 2017 following a Care Quality Commission (CQC) review. Since November 2018, the Trust has faced 21 Mental Health Act monitoring visits, resulting in 96 required actions.

Unclear policies and inadequate staffing

The inquest exposed that the NHS Trust had no clear local policy regarding the possession of plastic bags, belts, shoelaces, and similar items on the mental health ward. Staff members followed inconsistent practices, leading to uncertainty around which items were permitted.

Additionally, the unit’s care plan for Joshua was deemed inadequate. On the day of his death, the ward was short-staffed, with only three members present instead of the required six. Staff also failed to conduct proper hourly observations, with no adequate observation of Joshua between 3:05 pm and 5:15 pm when he was found unresponsive.

Investigation findings highlight systemic issues

The Trust’s internal investigation further revealed serious shortcomings, including:

Lack of detailed risk assessments
Absence of professional curiosity
Inadequate psychological support due to a long-term shortage of staff
Poor holistic psychosocial assessment of Joshua
Risk management that failed to meet his needs

Confusion over restricted items was evident, with most staff believing plastic bags were not permitted. Despite discussions at a Trust patient safety meeting in October 2017 regarding plastic bags, no subsequent action was recorded.

Family response and call for improvements

Tees Law, representing Joshua’s family, stated that the inquest findings reflect concerns previously raised by Joshua’s father, Malkeet Sahota. These concerns were further exacerbated upon learning of other deaths at Wedgwood House in recent years.

“Joshua’s dad, Malk, and the family are incredibly grateful to the jury for their diligent and thoughtful conclusion, having heard detailed evidence over several days from numerous witnesses. Seeing that the jury recognised Joshua as an intelligent, polite, and well-loved young man is heartening.”

Malkeet Sahota has expressed a strong desire for systemic improvements in mental health care. He welcomed the coroner’s decision to raise a Prevention of Future Deaths Report to the Minister for Mental Health and Patient Safety, particularly regarding the communication of restricted item policies to families and visitors.

“The fact that the Coroner has raised concerns on a national level about restricted items on mental health wards and the importance of communicating these issues with families shows just how vital inquests like Joshua’s are,” Tees Law concluded.

Delayed diagnosis and the role of X-rays, CT scans and MRI scans in medical negligence claims

Posted on 6 August 202118 May 2025 by Sarah O'Sullivan

Radiology, including X-rays, CT scans and MRI scans, is a routine part of healthcare used to identify problems, guide treatment and exclude potential diagnoses. Failures in radiology services can unfortunately lead to failures in identifying potential abnormalities and delayed or misdiagnosis.

Our medical negligence solicitors are experts at dealing with claims resulting from delayed diagnosis, failure to diagnose and misdiagnosis. The team also handles cases involving failures to identify or report on suspicious or abnormal features following an X-ray, CT scan or MRI scan, and failure to make appropriate recommendations for referral.

Sadly, we are seeing a rise in delayed radiology cases as a direct result of the ongoing pressure on the NHS and some underlying factors impacting the delivery of imaging services, resulting in life-changing consequences for patients and their families.

How do delays to scans occur?

When a patient is referred for an x-ray, MRI or CT scan there should be a set time frame within which this is carried out, depending on the reason for the referral. Unfortunately delays in referrals and failings in communication between different departments and health providers can mean that these targets are not met, leaving the patient with a potentially delayed diagnosis.

Once the imaging is undertaken it is then reviewed by the relevant clinician, and a report is prepared. Where possible, images should be compared to any previous order to highlight developments and changes over time, although a clinician’s ability to do this is reliant upon previous imaging being available to them at the right time.

Claims resulting from the failure to identify suspicious features leading to delays in diagnosis of health issues such as cancer have devastating consequences and in some cases have led to the avoidable death of a patient.

Once the scans have been reviewed, any abnormal findings should then lead to referral to further investigation or treatment. Again, delay at this point is a frequent and potentially significant problem, as miscommunications between departments and systems or flagging errors occur due to many different factors.

What is the impact of delayed diagnosis following a scan?

Delays in diagnosis as a result of poor radiology practices can be devastating particularly in cases where patients are suffering from conditions or diseases where timely diagnosis and treatment is of paramount importance, such as cancers or acute respiratory events.

It is not unusual for there to be a number of errors throughout the process, each representing a missed opportunity for earlier diagnosis and treatment, which can ultimately lead to lengthy delays in diagnosis and treatment.

Our medical negligence team has recently dealt with cases involving:

A 7 – 22 month delayed diagnosis of lung cancer following a failure to arrange correct imaging in November 2018 and to follow up abnormalities identified on imaging in March 2019 and February 2020. Diagnosis was not made until September 2020.
Incorrectly reported ultrasound undertaken by an outsourced radiology provider in November 2018, as a result of which the patient suffered a delay in diagnosis of colorectal cancer between approximately November 2018- May 2019 which impacted upon her treatment options and life expectancy.
Failure to identify a lung lesion as suspicious for malignancy on a CT scan and negligently reporting the lesion as a benign pleural cyst. The scan was undertaken at an NHS hospital but the reporting was outsourced to an outside company. As a result, the patient suffered a delay in diagnosis of around 11 months leading to the progression of his disease and denying him the opportunity for curative treatment- ultimately his death could have been avoided.
Failure to identify an abnormality on a chest X-ray and to refer for further investigation. As a result the patient suffered a delay in diagnosis of lung cancer of around 8 months, leading to a loss of life expectancy of around 10 years.
Failure to report a hepatic flexure tumour on CT scans in both June and November 2018. Potentially a further failure to miss an abnormality in November 2017. As a result, our client had a delay in diagnosis of colorectal cancer for 16 months, potentially 24 months.
Failure to refer for appropriate follow up after identifying a vestibular schwannoma (auditory benign tumour) leading to a delay in informing our client of this finding and putting a treatment plan in place of 21 months. As a result of this delay, the tumour grew and our client developed hydrocephalus with associated balance, continence and cognitive symptoms, required admission to hospital for around a month, developed permanent facial palsy with associated visual, cosmetic and speech issues, required shunt insertion surgery and was unable to undergo standard radiotherapy treatment.

What are the factors leading to medical negligence claims relating to radiology?

a concerning shortage of radiologists in the United Kingdom. With radiology services often stretched and under pressure to achieve quotas and targets, the risk of human error increases
systems errors and poor referral methods. Different hospitals, health centres and departments frequently use different systems and referral pathways, making delays and missed requests more likely
outsourcing of radiology. Due to the lack of radiologists a number of NHS Trusts have begun to send imaging to external companies for review, some of which are outside of the UK. Issues in reporting standards in outsourced reports seem to be increasing, and there are additional problems in ensuring the external radiologist is provided with the correct supporting medical records and previous imaging
lack of correct equipment, equipment errors or cost constraints on how many patients may be referred for imaging

A recent report by the Parliamentary and Health Service Ombudsman (PHSO) has shown recurrent failings in the way radiology is reported on and followed up across NHS services, and the PHSO has written to the Government recommending urgent improvement to NHS imaging services be implemented as a priority.

Some important things to consider if you require radiology services

It can be difficult for patients to avoid errors as predominantly it is the reporting of the radiology which is the issue, however there are some practical tips to consider if you find you require radiology:

If referred for radiology ask what the timeframe for this should be and which hospital and department the referral will be made to
Re-iterate your symptoms to the clinician carrying out the imaging, and let them know if anything has changed since your referral
When discussing the results with your clinician, ask whether there were comparisons to any previous imaging or any ambiguous findings
If you are concerned that there has been an error in the reporting of your imaging flag this to the clinician and ask for an immediate review
If you are referred for further investigation or treatment following radiology check what the timeframe for this should be, when you should hear further, whether you need to make an appointment yourself, and who the referral will be made to

Here at Tees we are experienced in dealing with a range of claims relating to issues in radiology, and work with a number of eminent independent experts to ensure that no stone is left unturned in investigating the standard of care provided.

If you are concerned that there were failings in your care or potential delays to your treatment as a result of issues or errors in radiology we work on a no-win, no-fee basis, and would be happy to discuss your experience. We’re here to help.

UK logistics company Trans Orbis Forwarding Limited fights procurement fraud

Posted on 16 July 202127 March 2025 by Sarah O'Sullivan

Trans Orbis Forwarding Limited, a UK-based haulage company, has become the (almost) forgotten victim of a scam involving a European freight exchange. Our dispute resolution team has been steering them through this tricky and stressful situation.

Fraudulent activity on haulage booking platform

Timocom is the largest transport web platform in Europe, allowing jobs for hauliers to be posted and booked on its site. A fraudster succeeded in setting up a fake profile, which claimed to be our client and started accepting genuine bookings from third party suppliers to transport loads from one destination to another across Europe. These were genuine jobs that the fraudster was then paid for.

The fraud was simple: a third party would instruct the ‘Fake Company’ to take a load from, say, Spain to Italy. ‘Fake Company’ would then post the job on Timocom posing as Trans Orbis Forwarding Limited, even using our client’s directors’ name with fake email addresses and telephone numbers. An unsuspecting haulier who had returned to Spain having completed a job in France would then, with an empty rig, pick up the job from Timocom and take the load from Spain to Italy. The third party would then pay ’Fake Company’ for the job, which had legitimately been carried out, and ‘Fake Company’ would then disappear. The unsuspecting haulier would, in the meantime, raise an invoice to our client Trans Orbis Forwarding Limited, who had no knowledge of the job whatsoever, having never been involved in any European haulage!

Trans Orbis Forwarding Limited faced with huge invoices and threats of court proceedings

Trans Orbis Forwarding Limited owner Dave Shaw first sought out the advice of our dispute resolution team having received a worryingly large number of high value invoices for work they had no involvement with, along with letters threatening court action.

Tees support Trans Orbis Forwarding Limited

Polly Kerr, a Senior Associate in our dispute resolution team, set about reporting the matter to the fraud office, and investigating the origin of the claims, which involved resolving a number of jurisdictional issues since the fraud was being perpetrated in Europe. Letters were issued to hauliers across Europe who have invoiced our client for work they were led to believe was carried out. One such haulier said he would be financially ruined because he has never received payment. Another company has recently issued proceedings in Romania and Polly has used our connections to work with a law firm based there and is assisting with the court proceedings process.

Future consequences of the fraud

On the case, Polly said: “This is a clever fraud and whilst our client’s losses are thankfully minimal, hauliers across Europe are being stung multiple times. No one has issued proceedings in England yet but it’s only a matter of time”.

Polly is working with Trans Orbis Forwarding Limited to raise awareness of this kind of procurement fraud within the logistics sector so that other haulage businesses may avoid encountering similar issues. Polly commented: “Ultimately Timocom need to step up on their due diligence. We have been putting pressure on them through this matter to improve their service – we know that this is not an isolated incident as hauliers across Europe have also been affected.”

Our client’s words

Transorbis Forwarding Limited owner Dave Shaw said: “I am so pleased I found Polly and she was able to guide me through this situation. She even found me an English-speaking lawyer in Romania to assist with the proceedings over there. It is a huge relief to be able to send over any potential claims and for Polly to act very swiftly to bat them away and sign post unsuspecting hauliers to the requisite authorities.”

This type of fraud could affect freight forwarders, dispatchers or any company working in manufacturing and trade sectors.

Medical Negligence: Plastic surgery claims

Posted on 6 July 202118 May 2025 by Sarah O'Sullivan

Figures suggest that plastic surgery procedures are starting to become popular again, as more people opt to go under the knife. Sarah Stocker, Solicitor in Tees’ medical negligence team in Cambridge, examines the plastic surgery landscape.

If your plastic surgery doesn’t go as planned, you may have options to seek compensation. Many claims arise when doctors fail to adequately inform patients of the risks and potential complications of their procedures. Without this information, you cannot give proper informed consent.

Understanding informed consent

Since June 2016, the surgeon performing your procedure must personally explain the risks and complications to you. This ensures you provide informed consent. Before 2016, other medical staff could handle this discussion, but you should still have been informed of all risks and signed a consent form.

Post-surgery care and support

Even if your surgery is successful, issues can arise during recovery. You should receive appropriate aftercare, including any necessary medication before discharge. Additionally, you must be provided with contact details for your surgeon or a suitably qualified professional for any complications that occur outside of regular hours.

When can you make a compensation claim?

You may be entitled to make a claim if:

You weren’t given sufficient information about the risks and complications, preventing you from giving informed consent.
Your surgery didn’t meet the expected standards, resulting in ongoing pain, scarring, or asymmetry.
An unqualified individual performed your procedure.
A defective product, like a faulty implant, was used.
You received inadequate aftercare, including missing follow-up appointments, incorrect medication, or delayed treatment for infections.

Trends in plastic surgery

The plastic surgery industry peaked in 2015, valued at approximately £3.6 billion, with 51,140 procedures performed in the UK. However, data from the British Association of Aesthetic Plastic Surgeons (BAAPS) showed a 40% decrease in surgeries in 2016.

Several factors contributed to this decline. Societal attitudes shifted towards embracing natural beauty, amplified by the rise of social media influencers and campaigns featuring diverse body types. Additionally, financial uncertainty led people to be more cautious about spending on elective procedures.

Changes in cosmetic surgery regulations

To improve patient safety and address unethical practices, new guidelines were introduced in June 2016. These rules aim to prevent rogue practitioners from prioritizing profits over patient welfare. Although most procedures are safe, every surgery carries some level of risk.

Risks of plastic surgery

The Royal College of Surgeons defines cosmetic surgery as any invasive procedure performed to alter a person’s appearance for non-medical reasons. Women account for 91% of all cosmetic surgeries. The most common procedures include:

Breast augmentation and reduction
Eyelid surgery
Face lifts and neck lifts
Liposuction
Rhinoplasty (nose jobs)

Among men, rhinoplasty remains the most popular choice.

The General Medical Council (GMC) has made it clear that doctors performing cosmetic procedures must:

Avoid making misleading or exaggerated claims about the procedure.
Provide realistic information about the risks involved.
Refrain from using unethical promotional tactics, such as special offers or competitions that trivialize the decision.

Surgeons must market their services responsibly, ensuring all advertising is factual and transparent.

Things to consider before surgery

Before proceeding with cosmetic surgery, it’s essential to have realistic expectations about the results and the psychological impact of undergoing an invasive procedure.

Key considerations include:

Avoid promises of perfection: A reputable surgeon will not guarantee life-changing results.
No pressure: You should never feel rushed or coerced into making a decision.
Meet your surgeon: Before your surgery, meet the surgeon who will perform the procedure. They should be fully insured and certified in their area of practice.
Check qualifications: Following the 2016 guidelines, surgeons must be on the GMC Specialist Register in a relevant specialty. You can verify their credentials on the GMC website.

The future of plastic surgery

In June 2017, further proposals were introduced to enhance patient protection. These changes would allow patients to confirm if their surgeon has the necessary qualifications through the public medical register.

Currently, any doctor can legally perform cosmetic surgery without formal training. The proposed system would clearly indicate which doctors hold a Royal College of Surgeons certificate in cosmetic surgery.

There have also been calls to ban cosmetic procedures for under-18s after reports emerged of young children being targeted by cosmetic surgery apps. These apps have been criticised for promoting invasive procedures to impressionable young audiences.

Need legal support?

If you have experienced complications before, during, or after cosmetic surgery, contact us today to discuss your options.

Ensuring your business is protected during uncertain times

Posted on 30 June 202130 March 2025 by Sophie Soraf

Businesses across many different sectors are slowly getting back on their feet as the economy continues to improve following the pandemic. This crisis has shown that in times of great challenge, your employees – their skills, knowledge and understanding of how your business ticks – are essential to keeping your business running.

So looking after your employees and your business go hand in hand. In a recent survey, 35% of businesses said one of the top three risks to their business would be an owner becoming critically ill and being unable to work. 52% said they would cease trading within one year were they to lose such a key person, and yet, surprisingly, only 18% had considered cover for the illness or death of a key person. (Source: Legal & General’s State of the Nation Report 2021). That’s very curious but the message of this article is: don’t be that business! There are two key groups of insurance that can help protect your business and employees from financial losses resulting from illness and death.

Policies that protect your business against financial losses resulting from the death or illness of a key staff member or business partner, and
Insurance that provides financial assistance to employees and their families in the event of their death or inability to work.

Protecting your business

When might I need shareholder/partnership protection insurance?

Shareholder or partnership protection cover insures a business against the loss of a shareholder or key business partner, which would likely leave the remaining business owners in a precarious position. With limited companies or partnerships, the main risk is that the deceased owner’s share in the business will be passed on to a family member, who may have little interest in taking over their role.

Essentially, shareholder or partnership protection insurance is a life insurance policy that pays out to the surviving business owners, based on an agreement that they will use the money to purchase the deceased’s outstanding shares in the business.

The cover you take out will depend on your business structure:

Shareholder protection is designed for limited companies, with the life insurance taken out on the lives of the company’s shareholders.

Partnership protection is designed for partnerships and limited liability partnerships, with the life insurance taken out on the lives of the business partners.

The policy might also include critical illness cover, in the event that a partner or shareholder does not wish to continue their involvement in running the business following their treatment or recovery from a serious illness.

Is key person insurance appropriate for my business?

Key person insurance protects businesses against the financial losses incurred if a ‘key’ employee becomes ill or dies while working for the company. This could be a CEO, business partner or senior employee considered essential to the successful running of the business. A payout from this kind of insurance can keep a business trading while recruiting for a replacement or undergoing reorganisation.

Some types of business insurance, such as employers’ liability, are legally required to run a business. Key person insurance is not one of them, but the loss of a key employee could affect the business in many ways.

Clients may react negatively or lose confidence in the business, shareholder confidence could plummet, and the skill, knowledge and experience of the key employee may be difficult, or even impossible, to replace.

Particularly for small businesses, losing a director or head of department could result in the company’s collapse, which is why the financial assistance provided by key person insurance could prove to be a lifeline.

Protecting your employees

How do my employees benefit from death in service insurance?

Also known as relevant life assurance, death in service is a type of insurance that pays out a tax-free lump sum to an employee’s beneficiaries if they die whilst working for your company. They don’t have to be at work or performing a work-related activity to receive the benefit; they simply have to be on the payroll of your company when they die or are diagnosed with a terminal illness.

This type of insurance is the second most valued employment benefit after private medical insurance, as can help your employee’s beneficiaries with costs such as funeral arrangements and living expenses at a very difficult time. The lump sum paid out is usually between two and four times the employee’s basic salary.

How will group private medical insurance benefit my business?

As mentioned above, group private medical insurance is one of the most popular employee benefits a business can offer, and provides your employees (and often their families) with access to private healthcare services.

While it is one of the more expensive employee benefits, private healthcare can offer immeasurable advantages –not only to your employees, but to you as a business. Employees will not be forced to take days off to access healthcare appointments, as private facilities usually offer appointments out of hours. They won’t face lengthy waits for appointments or treatment, so they can get better sooner and return to work more quickly.

The Coronavirus crisis has made us all too aware of the strain and pressure under which the NHS has been placed – there is now a huge backlog of patients waiting for treatments and routine surgical procedures. Offering your employees access to private healthcare is therefore a bigger draw than ever and could greatly help you to attract and retain the best talent.

Is permanent health insurance a good option to protect my employees?

Arranging permanent health insurance (or PHI) on behalf of your employees provides protection for them in the event of an injury or long-term illness that renders them unable to work.

PHI is another name for income protection insurance, but the premiums are paid by the business rather than the individual. The usual payout is between 50% and 75% of an employee’s full salary, potentially until they retire, and it can help your employees continue to pay for key outgoings such as mortgage and childcare costs until they are able to return to work. As such it is often considered by employees to be a more valuable benefit than private medical insurance.

The benefits usually start after a ‘waiting period’ of up to 52 weeks, typically after work-related sickness pay comes to an end.

The wording of PHI polices from different providers can vary greatly in terms of what exactly they cover, so it’s always best to check the fine print. As an employer, they can benefit you by incentivising your employee to return to work as soon as they are ready, in order to regain 100% of their salary.

What benefits your employees, benefits your business

Insuring your business and employees against financial loss, illness and death may be an added expense, but it could be the move that helps your business stay afloat during uncertain times. At Tees, we’re here to discuss your business insurance needs and advise you on which type of policy could deliver the greatest benefits to your organisation.

This material is intended to be for information purposes only and is not intended as an offer or solicitation for the purchase or sale of any financial instrument. Tees is a trading name of Tees Financial Limited which is regulated and authorised by the Financial Conduct Authority. Registered number 211314.

Tees Financial Limited is registered in England and Wales. Registered number 4342506.

Inquest concludes after Suffolk postmaster’s tragic hospital death

Posted on 16 June 202130 March 2025 by Sarah O'Sullivan

An inquest at Suffolk Coroner’s Court in Ipswich, conducted by Mrs. Catherine Wood, has heard evidence regarding care and service delivery issues while investigating the tragic hospital death of a 73-year-old man who had been admitted for treatment of a fractured hip.

Background

The patient, Barry Jefferson, had worked for many years alongside his wife Sarah at their Post Office Stores business in Thurston, near Bury St Edmunds. They were close to finalising plans to sell up and spend more time with family, including their young grandchildren.

On 17 August 2020, Barry tripped at home and fractured his right hip, which had previously been replaced. After relatively straightforward surgery was performed on the periprosthetic fracture at West Suffolk Hospital on 20 August, he was slowly recovering in the orthopaedic ward and appeared to be doing well.

Bloating and swollen abdomen

Placed in a side room due to a positive MRSA test, by 27 August Barry was unwell with nausea and vomiting. During the August Bank Holiday weekend, he told nurses he felt bloated and had a swollen abdomen. The nursing team consulted doctors on call, who prescribed medication for bloating.

Over the course of the bank holiday weekend, Barry became increasingly unwell. Despite repeated escalation from the nursing staff, he was only reviewed by very junior doctors, going five days without review or input from senior clinicians. In addition, following clinical reviews, documentation was often poor or missing, and there appeared to be a lack of understanding of the changing clinical picture.

On Tuesday 1 September, a review by the advanced nurse practitioner pointed to a possible infection, source unknown. At this stage, Barry had not been reviewed by a senior clinician since before the weekend, and there had been no proper investigations into his abdominal distension. Antibiotics and fluids were administered intravenously, but Barry became more unwell overnight and began vomiting.

A consultant conducted a further review in the afternoon and, suspecting a possible bowel obstruction, ordered nil by mouth and an abdominal X-ray. The X-ray that afternoon showed distended loops of small bowel consistent with an obstruction.

Following the X-ray and referral to the surgical team, Barry suffered further deterioration, and an emergency call was activated. Probable irreversible organ failure was suspected when he did not respond to resuscitation treatment by the emergency team. Sadly, he died a short time later.

Care and service delivery issues

Following Barry Jefferson’s death on 2 September, ultimately due to cardiac arrest, a Serious Incident Report was completed by West Suffolk NHS Foundation Trust. This identified a number of care and service delivery issues and pointed to several root causes.

“The report highlighted a series of delays in recognising deterioration in Barry’s condition during that fateful bank holiday weekend and tardiness in seeking senior reviews and investigations,” explains Tees Law, acting for widowed Sarah Jefferson.

“A more timely response earlier in the weekend might have led to a different outcome in this case. Establishing why things went so badly awry has not been helped by a repeated lack of documentation by the junior doctors who reviewed Barry, it being recorded during the inquest that the documentation fell far below what would have been expected from a junior doctor.

“Review by a senior clinician should have occurred sooner, with particular emphasis over the bank holiday weekend. This could have led to an urgent surgical review, with investigations such as the abdominal X-ray and nasogastric tube insertion occurring sooner.

The inquest heard from a senior member of the Hospital Trust who confirmed that the Trust had found that a lack of appropriate senior review over the Bank Holiday weekend led to a failure to recognise Barry’s deterioration, late investigation, and late treatment.

There was further found to be an inconsistent approach to the handover of patients out of hours, leading to poor communication between teams, failure to review or monitor for deterioration, and delay in escalation of a sick patient. The lack of a Sick List meant that patients who required close monitoring were not routinely monitored or reviewed.

Measures implemented

Following the Trust’s internal review, a number of measures have now been put in place, including a revised handover within the surgical division, use of a Sick List during handovers for general surgery and orthopaedic teams, development of a Standard Operating Procedure for a revised handover process, as well as shared learning in respect of escalation of patients and the importance of documentation to junior doctors.

A second ortho-geriatrician to the surgical division is also being recruited to work towards the Trust’s goal of every orthopaedic patient receiving a review by a senior doctor Monday to Friday, with senior surgical review out of hours as needed.

“Sarah Jefferson is grateful to the Coroner for the thorough investigation into Barry’s death. Hopefully, following the Hospital Trust’s findings and the measures that have been implemented since Barry’s death, the incidence of failures to escalate the response to clearly deteriorating patients will have been greatly reduced.”