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Clinical Negligence litigation relies on the opinion of medical experts, to identify and establish breach of duty, causation and quantum issues. Many of these medical experts work in both public and private sectors and many of whom have been called forward to healthcare’s front line in the fight against Covid-19. This has created a shortage of available experts to give evidence on liability and/or quantum to support both the Claimant and Defendant.

In 2020, a new protocol was implemented to encourage positive behaviours from Claimant and Defendant lawyers. This protocol can be relied upon throughout the duration of the Covid-19 pandemic and recovery.

This protocol covers issues relating to limitation and extensions of time, telephone calls and emails, service by email (including new proceedings), medical examinations of clients for condition and prognosis reports, exchange of evidence, interim payments, settlement meetings and mediations, BACS payments, cost budgeting, and hearings including adjournments.

[Further information on the protocol can be found at: ]


How Covid-19 has affected us:

The impact upon disclosure of Medical Records

The first stage of a Clinical Negligence claim is for us to access and review the medical records with our experts.  Some NHS trusts and GP practices have risen to the challenge and have continued to provide records within the statutory timescale of 30 days (GDPR 2018), whereas others have struggled significantly, with records taking many months or more to materialise.


It is a difficult call to make to seek a Court order for disclosure (which is the only way to force the issue), when we are all acutely aware of the challenges posed by the pandemic.


The impact on limitation

The Covid-19 protocol allows for an unchallengeable extension to limitation until 3 months after the end of the protocol (for participating organisations).  This has the potential to lead to a significant number of cases where limitation occurs on the same (as yet unknown) date 3 months after the end of the protocol.


In order to avoid this backlog, we seek to agree a fixed limitation date for each file and review and extend it further if necessary.


The impact of self-isolation and working remotely

Like many companies, the pandemic led to a shift in our working dynamics, with all staff initially forced to work remotely.


Since the easing of restrictions many of our staff have been making a phased return to the office. We are also pleased to return to client-facing meetings, where necessary, socially distanced in one of our meeting rooms.


More recently, the NHS Track and Trace app has caused its own challenges with ‘pings’ to numerous members of the team, forcing them to self-isolate for up to 10 days.   Thankfully working remotely is no longer an upheaval and our usual service remains.

Joining the firm in 2021 brought new challenges. Starting a new job in the in the midst of remote working was somewhat daunting as many of our colleagues have yet to return to work in the office. We found that we may know a name from through email, or over the phone, but it proves difficult putting a face to that name when people do attend the office.


The impact of Covid-19 on our work in the future

Covid-19 has caused significant delays within the healthcare sector, with many individual’s treatments being pushed back. Recent news suggests that a potential 13 million patients may be waiting for routine procedures and investigations to be carried out in the next 12 months [].


These delays will undoubtedly lead to an increase in avoidable poor outcomes for patients and their families.


For legal advice relation to Clinical Negligence contact us at


Similar to other medical negligence claims, head and brain injuries can vary greatly in terms of severity. As a result, the amount of compensation that you could receive varies too. It’s unlikely that an online compensation calculator can adequately value your claim.

If you have suffered a brain injury in the last three years that was caused by someone else’s negligence, then you should get in touch with our experienced medical negligence solicitors. Our team are legal professionals with medical knowledge and they can let you know if you have a valid case for brain injury compensation. We can talk you through the whole process.

To help you understand more about brain injury compensation, we have listed the different severities of brain injuries below.


Different Severities of Brain Injury

The figures below are taken from the government published Judicial College Guidelines, which are simply lump sums to illustrate the pain, suffering and loss of amenity you have suffered. However, these figures provide a guideline as to what compensation you  may receive. The figures below are not definitive but they serve as a rough guideline as to what may be expected in various cases.

Severity of InjuryInjury DescriptionPotential Compensation Amount
Very Severe Brain Damage Serious brain damage that has a significant effect on the senses and severe physical limitation. The need for full-time care. The court will consider the degree of understanding the victim has, their life expectancy, and the extent of physical limitation.£247,280 – £354,260
Moderately Severe Brain DamageCases of severe physical or cognitive disability which leave the victim substantially dependent on others and need constant care or other medical requirements. The court will consider the victim’s life expectancy, degree of understanding, degree of dependence on others, the extent of their physical limitations, their ability to communicate, and behavioural abnormalities.£183,150 – £235,790
Moderate Brain Damage (Upper Tier)Moderate to severe damage to intellect and/or changes in personality. An effect on their sight, speech, and other senses, and a serious risk of epilepsy.£131,620 – £192,090
Moderate Brain Damage (Middle Tier)Moderate to modest damage to intellect. The possibility of the victim returning to employment is either greatly reduced or completely removed. Possible risk of epilepsy.£79,530 – £131,620
Moderate Brain Damage (Lower Tier) Concentration and memory are badly affected, and there is a lower risk of epilepsy. There is a reduction in the ability to work, but have very limited dependency on others.£37,760 – £79,530
Less Severe Brain Damage A good recovery has been made with a return to normal social and work life. There may be potential for on-going impairments such as poor concentration, memory loss or mood problems. For the upper end of this bracket, there may be a small risk of epilepsy. The court will consider any permanent disabilities or the chance of permanent disabilities, the severity of the initial injury, any changes in personality, and any depression.£13,430 – £37,760
Minor Brain or Head Injury Cases of minimal brain damage or non-existent. The court will consider the severity of the initial injury, time of recovery, any on-going symptoms, and the presence of headaches.£1,940 – £11,200


Contact BTTJ Medical Negligence for Brain Injury Claims

We understand how upsetting it can be to talk about what has happened and how overwhelming the consequences of negligence are. At BTTJ, we have a team of legal professionals and medical negligence specialists who are exceptionally experienced at handling these types of cases. All advice and information are treated with total confidentiality, compassion, and care.

If you have suffered due to medical negligence and you would like to discuss pursuing a claim for brain injury compensation, then please get in touch with us to see how we can help.

You can call us on 0800 032 2474 or you can send us an email here.

Coventry lawyer and Head of the Medical Negligence team at BTTJ, Tom Barnes, has been awarded membership of the AvMA (Action Against Medical Accidents) Specialist Clinical Negligence Panel for a further five years.

Tom and his BTTJ medical negligence colleague Richard Stanford are the only AvMA panel members within Coventry and Warwickshire.

AvMA was established in 1982 and today the specialist clinical negligence panel is a highly sought after quality mark for medical negligence specialists.

Tom, who is also a member of the Law Society Clinical Negligence Panel, has focused on medical negligence claims since 1988 and represents clients nationwide.  He has also been recognised recently by the Legal 500 which acknowledged Tom’s huge amount of experience in this field.


If you need any advice on medical negligence, please feel free to contact Tom directly on or call 024 7653 1532

Dawn Slow, Medical Negligence lawyer at BTTJ, is currently involved with a complex case that for our client, LWR, combined a claim involving his employer as well as a claim involving medical negligence.


What happened?

The client had an accident at work and injured his knee. He had pre existing arthritis.  7 months after the accident LWR was still in a lot of pain and underwent an arthroscopy, following which he could barely move his knee at all.


What did the experts say?

Experts agreed that LWR should not have undergone the arthroscopy due to the complications his arthritis would cause and to do this operation was negligent.


What did this mean in terms of who should settle?

This made the case much more complex and we now needed to ask “Did the client’s ongoing pain arise from the accident or did it arise from the medical negligence?”.  This was a difficult question as on the face of it the accident injury was a relatively minor one.  However it was necessary to ensure that there was no link between the accident injuries and the injury that occurred as a result of the arthroscopy before making any decision to settle the accident claim.

If there was any link at all between the ongoing pain and the accident injuries then the whole claim for all the injuries, including those arising from the medical negligence, would have to be settled by LWR’s employers.  This is because LWR would not have been referred for the arthroscopy had the accident at work not occurred and therefore all the pain and suffering he had could be directly linked back to the accident at work.

Anyone who suffers an accident where they are making a claim from any third party, who then suffers what is potentially a further injury at the hands of the NHS, must first look to see if the further injuries can be linked to the original accident.   If they can, all the injuries regardless of any negligence on the part of any NHS employee (or other medic), must be claimed as part of the original claim.    Only injuries arising from any medical negligence that there is a fair degree of  certainty cannot be linked back to the original accident should be dealt with as a separate medical negligence claim.  It is extremely important that a client understands the link between the two events and how that link may or may not have been broken so the two events might end up as separate claims.

Two separate experts advised that LWR would have been back to his pre accident condition within 3 months of his accident at work which was before the medical negligence took place.   This meant that the two potential claims could be separated – but, there was a risk that the NHS could argue that the ongoing injuries were due to the accident at work and not due to any negligence on their part – and if a Judge agreed that argument, then, by settling the accident at work claim early, the client might risk not being able to claim for his ongoing injuries against the NHS.


What was the outcome?

LWR needed a lot of very complex and technical legal advice on this which Dawn Slow gave in a way that was easy for LWR to understand – this meant he could make a fully informed decision on which step to take next and whether or not to settle his claim for his accident at work before finalising the medical negligence claim.

LWR’s accident claim was recently successfully settled at £5000 and his medical negligence claim is continuing.



NHS Resolution, which was formerly NHS Litigation Authority, has published research on the motivation of patients making a compensation claim when something has gone wrong with their healthcare.

The research, which was conducted in partnership with The Behavioural Insights Team (BIT), surveyed 728 patients who had made a claim and looked at the incident that had occurred, how the patient felt it had been handled, how any subsequent complaint had been handled and the factors that led to the patient making a claim for compensation.  BIT also did an in-depth telephone interview with 20 past claimants.

The findings show that, in general, the research participants were not satisfied with the reactions of NHS staff following an incident or how their complaint was handled within the NHS.

It found that:

  • 63% of patients who responded felt that they did not receive an explanation for why the incident occurred.
  • Only 31% said they felt they had received an apology.
  • 71% of the people responding did not think that their healthcare provided undertook any actions to investigate the incident in the first instance.
  • Only 6% of respondents felt that actions were taken that would prevent the same incident happening again.
  • The majority rated the response to their complaint as ‘poor or very poor’ in terms of accuracy, empathy, speed of the response and level of detail.


It also found that both internal and external factors motivated patients to make a claim.  Personal motivations included:

  • Wanting to prevent similar things happening to others.
  • Wanting to receive an apology or an explanation for the incident, or to trigger a detailed investigation of the incident.
  • Wanting the clinicians involved to be held to account.
  • Emotional responses (e.g. frustration and anger) brought about by poor incident or complaint handling.
  • Financial compensation.

External motivations included:

  • Suggestions from NHS staff that making a claim would be appropriate
  • Advertising
  • Conversations with friends, family and wider social network


Helen Vernon, who is Chief Executive at NHS Resolution, said “This research confirms that claims for compensation can sometimes be made in the search of answers, which could have been provided when the incident occurred. Being open with patients when they suffer avoidable harm and taking tangible steps to learn from what happened are essential. We would like to thank the patients who spared the time to contribute to this valuable research, which will help us to build on our work with the NHS to improve the response when things go wrong.”


Full details of the research conducted can be found on the NHS Resolution website.

As a Specialist Clinical Negligence Practitioner, I work solely for clients who have suffered as a result of medical negligence.

It is my role to work with clients from their initial contact with us, all the way through to getting the best possible settlement for them.

I find that clients can sometimes feel unsure about getting in touch with a law firm; they do not know what to expect and are concerned about how daunting it may be on top of the challenges they already face due to the negligence.  When I first talk to my clients, I’ll take them through what steps are involved so that they understand what will happen during the claim process.

I am part of a vastly experienced Clinical Negligence team at Brindley Twist Tafft and James (BTTJ) who have members with specialist accreditation from the Law Society and from AvMA (Action Against Medical Accidents) and who fully understand how emotionally difficult bringing a claim may be.  We pride ourselves on making the process as straightforward as possible and do our best to put clients at ease.

Although each case is unique, the actions that I take to pursue compensation for clients that have suffered as a result of negligence can be broadly broken down into 4 main areas (which I also talk about in this video):

  • First I will obtain any relevant medical records – this helps me to establish a timeline of events.
  • Once I’ve assessed the records, I will ask an independent medical expert to assess the case and provide evidence as appropriate. At BTTJ we have a range of excellent independent medical professionals that we work with and will select an expert specific to each case.
  • Once we have received confirmation from an independent expert that negligence has occurred, I will formally make the allegations to the negligent party (the Defendant).
  • Finally I will obtain compensation for the harm that has been caused.

I support my clients throughout this whole process and am always on hand to explain what is happening and answer any questions.

If you have any queries about pursuing a medical negligence claim, please get in touch with us on 024 7653 1532 – or fill out an enquiry form – and we will be happy to help.

Angus Buchanan

Specialist Clinical Negligence Practitioner

Solicitor Richard Stanford was interviewed by the BBC with regards to the unique Clinical Negligence case that was recently concluded with Adam Weitzman QC.

You can watch the BBC story and extract from the interview below…




About the solicitor

Richard Stanford has experience of a very wide range of Clinical Negligence cases including Orthopaedic, Oncological, Urological, Infection, injury during surgery and the management of long term conditions such as diabetes and Crohn’s Disease.  He handles cases from inception to completion, including trial where necessary.

On Wednesday 22 November 2017 Richard Stanford, of Brindley Twist Tafft & James, and Adam Weitzman QC concluded what is believed to be a unique case in Clinical Negligence.

BG had filed a living will/advance directive in 2004 with her local hospital, essentially confirming she did not wish to receive medical treatment nor sustenance if she suffered a significant stroke, having watched her mother suffer for many years having suffered exactly that.

BG then suffered such a stroke and could no longer meaningfully communicate.

Very sadly the hospital had not filed the advance directive in an obvious place. The family were unaware of its existence.

BG spent the next 22 months attempting to refuse food and routinely pulled a feeding tube out. She ultimately underwent surgery so that she was PEG fed.  In the absence of the advance directive this, and all other treatment/intervention, was believed to be in her best interests. The expert evidence confirmed that she understood what was happening to her and around her, and that with hindsight she was indicating she did not wish to be kept alive.

The advance directive was eventually discovered by chance within the records. A discussion with the family took place and BG died in comparative peace within a few days.

The hospital trust accepted liability in their Letter of Response, provided a comprehensive apology and explained that procedures are now in place to prevent further occurrences.

Quantum remained in dispute given the total absence of any similar reported cases. An uplift was sought for aggravated damages given the duration of the unwanted treatment, which constituted repeated assaults.

Settlement was agreed between the parties at £45,000, which will be distributed under the terms of BG’s Will.

It was strange to be arguing that our client’s mother did not die as quickly as she should have…


About the solicitor

Richard Stanford has experience of a very wide range of Clinical Negligence cases including Orthopaedic, Oncological, Urological, Infection, injury during surgery and the management of long term conditions such as diabetes and Crohn’s Disease.  He handles cases from inception to completion, including trial where necessary.

Members of the Society of Clinical Negligence Laywers (SCIL) have campaigned at Westminster against fixed fees for medical negligence claims.

The chairman of SCIL, Stephen Webber, said ‘We believe the most important issue here is patient safety – if there can be improvements and lessons learnt then the level of negligence will be reduced. That must be the starting point for reform’

Lord Justice Jackson published a report in July on fixed costs in which he said a working group should be set up.

A response to a consultation on fixed costs for clinical negligence claims is still being prepared by The Department of Health.

The full story, as reported in the Law Society Gazette can be read here.

On 18 April 2013 Brindley Twist Tafft and James Solicitors and Barrister Teresa Hargreaves of Number 5 Chambers, Birmingham, represented the family of Jessica Strong at the inquest touching her life at Stoke Coroner’s Court. The story of Jessica’s short life and tragic death received coverage in the national press and on local television.


Jessica was born prematurely in Nuneaton and transferred to a specialist baby unit in Stoke, as the local units either did not have space or did not have the facilities to meet her requirements. Initially Jessica thrived despite her prematurity but she then became acutely unwell and sadly passed away at just 11 days old.


A post mortem revealed that baby Jessica had contracted Serratia Marcesans, a common bacteria which thrives in moist conditions and can be found in many bathrooms. The bacteria is readily fought off by adults and children but is aggressive and difficult to treat in the very young. In this particular instance the bacteria was known to have colonised, but not infected, a different baby on the unit and the treating doctors had not considered a link. Jessica only received the correct antibiotics for the infection a matter of hours before her death, by which time the damage was too severe.


Serratia Marcesans was found to have colonised six babies on the unit with another baby dying several days later. The Coroner recorded a narrative verdict that Jessica had died from extreme prematurity and infection spread by human contact, most likely as a result of poor hand washing practice in the unit.


Although the hospital suggested that it could have been members of the public who did not use the hand gels, the family were strongly of the opinion that the spread of infection must have been by hospital staff given that six different babies were colonised by the bacteria. The hospital staff confirmed that hand washing and other hygiene procedures are amongst the best in the country following a review of their practices.


The NHS Litigation Authority which represents the hospital trust made an early admission of liability prior to the inquest and compensation negotiations remain ongoing.


Full story:

Richard Stanford


About the author

Richard Stanford is a Medical Negligence Solicitor at Brindley Twist Tafft & James and is very experienced in a wide range of clinical negligence cases.

A significant number of patients have been recalled as part of an investigation over the treatment given to cancer patients by urologist, and Channel 4’s Embarrassing Bodies’ doctor, Mr Arackal Manu Nair at Solihull Hospital (Heart of England NHS Trust) and the privately-run Spire Parkway Hospital. It is alleged Mr Nair operated on one man who did not have cancer, while leaving another incontinent and infertile.


Mr Arackal Manu Nair, otherwise known as Manu was suspended from his post as an NHS Consultant Urologist at Solihull Hospital when colleagues raised their suspicions about his surgery with hospital bosses and he was referred to the General Medical Council. He has subsequently resigned from his post at the Heart of England NHS Trust.


Concerns over Mr Nair’s operations have led to a recall of Mr Nair’s prostatectomy patients at Spire Parkway Hospital and BMI Priory Hospital, Birmingham. There are approximately 170 radical prostatectomy patients within the NHS who were treated at Solihull Hospital and Spire Healthcare group. A radical prostatectomy is a common surgical procedure to remove the prostate gland where patients are diagnosed with prostate cancer.


We understand that the central issues concern whether patients were properly advised and surgery was undertaken unnecessarily and the degree of the need for surgery. A prostatectomy is a fairly common operation for prostate cancer. It is an extensive operation to remove the whole of the prostate gland, but other treatment options are usually available, all of which should be discussed with the patient.


The Independent hospitals and the Heart of England NHS Trust asked the Royal College of Surgeons to review Mr Manu Nair’s surgical practices both in the NHS and the private sector. It was in light of the result of this review from the Royal College of Surgeons that patients were subsequently recalled.


The investigation into Mr Manu Nair’s practice has echoes of the investigations into the cases of ‘cleavage-sparing mastectomy’ by disgraced Solihull breast surgeon Mr Ian Paterson who performed hundreds of unrecognised operations at Spire Hospital at the Heart of England NHS Trust that breached medical guidelines and left women at a greater risk of breast cancer returning. Mr Paterson also performed unnecessary mastectomies, telling some patients they had cancer when they did not. Victims of Mr Paterson are stepping up their battle for justice and compensation against the Spire Hospitals by launching a petition. See the link provided for more information.


If you are one of the patients who had been recalled you may wish to do the following:

  1. Review the letter you have received following your recall.
  2. Do you wish to take the matter further?
  3. If so would you like an apology and/or compensation?
  4. Have you already lodged a complaint/spoken to solicitors?
  5. Call us to talk through your concerns


We would like anybody who was a patient of Mr Manu Nair to be aware of the issues concerning his work and to have the opportunity, not only to be reassured medically, but to be able to make an informed decision on their rights and available actions.


If you have been treated by any doctor or clinician either as an NHS patient, or as a private patient, and have concerns relating to your treatment then do not hesitate to contact our Clinical Negligence team for a confidential, no-obligation discussion and free advice.


We are able to offer a Conditional Fee Agreement (i.e. no win, no fee) or act under Legal Aid in appropriate circumstances.


Roseanne Elkington & Richard Stanford

Clinical Negligence

November 2015


The work of our Clinical Negligence team is wide and varied, ranging from low value claims for insignificant but unacceptable delays in treatment, to catastrophic brain injury caused by inappropriate medical treatment.


The most common cases we encounter include delays in diagnosing cancer, failure to diagnose fractures, falls in hospital and pressure sores. This article aims to provide more information on the last of those issues.


Pressure sores (or pressure ulcers) are caused when a person remains stationary for too long. The weight of the body prevents normal blood flow to the area which bears the weight, causing the skin and surrounding tissue to be starved of the necessary oxygen, and other components within the blood, to maintain and regenerate the tissue cells.


Pressure sores generally occur on the back of the heels, on the buttocks and on the sacrum (the base of the spine). The heels are especially at risk because the blood flow to the feet is less than elsewhere, there is little tissue between the skin and the bone and, crucially, the area does not usually bear any weight so is poorly adapted to do so.


Pressure sores are graded from 1 to 4 depending upon their severity. Higher graded sores can easily become infected and take years to treat. If infection takes hold (which is not uncommon if they occur in a hospital environment) it can lead to blood poisoning and, all too often, the amputation of affected limbs.


Some people are more at risk of developing pressure sores than others. Factors increasing risk and vulnerability include:

    • Immobility/reduced mobility (which can be through lifestyle or medical issues) will lead to the person spending too long with weight on “at risk” areas – the longer the pressure is applied, the greater the risk.
    • Circulatory problems such as those seen in diabetics or those with cardiac issues. The blood flow is already poor and it will take less pressure for the supply to be affected.
    • Blood disorders such as liver disease which will mean that the “quality” of the blood is below average, and any disruption to the usual supply will have negative effects more quickly.
    • Dermatological issues: If the person’s skin is already compromised through age, disease or long term use of steroids or steroidal cream (as often prescribed for psoriasis and severe eczema) then it will be more susceptible to damage.
    • Mental Health issues can mean that an individual is unable to comprehend or follow instructions in respect of their own care. They may be entirely oblivious to any risks and may move around less than others.
    • Incontinence and Hygiene issues can leave the skin in a compromised state. Exposure to urine especially causes problems due to its proximity to the sacrum and buttocks; aside from the acid content of urine the prolonged dampness can also make the skin more vulnerable.


The risk is multiplied many times for individuals with a combination of the above factors. Because such risk factors are more commonly found in older patients, it is often they who are at the greatest risk, although the problem does not exclusively occur in old age.


Pressure Sores are a well-known challenge and a problem for treating clinicians. Extensive research has been carried out and the general view is that their occurrence (at some grade) may be as high as 10% of all hospital admissions. The costs of treating the same are far in excess of the necessary expenditure to prevent them, not to mention the distress and pain caused to the patient.


The management of patients in hospital who are deemed to be at risk of developing pressure sores is primarily a nursing issue with accurate assessment (initially and ongoing) and appropriate treatment being key to their prevention. The Royal College of Nursing provides the following Quick Reference Guide which is in use in many hospitals throughout the country – please click on the linkl below.


Although primarily a nursing issue all treating clinicians need to be aware of the risks of pressure sores. A particular problem is that some patients who require surgery may be kept stationary on an operating table under general anaesthetic for substantial periods of time. Operating tables are not generally designed with pressure relieving methods in mind, and patients are already at increased risk whilst under anaesthetic as blood flow is already compromised.


A quote from such circumstances appears in the opening pages of the Royal College of Nursing “Pressure Ulcer risk assessment and prevention guidelines” handbook, referenced above:


I had an operation on my gallbladder. I told the staff I was prone to getting pressure sores. They assured me I would not get any while in their care. Low and behold when I came around from the anaesthetic, they found a beauty…it is now six and a half years old


That situation is all too common.


Generally with appropriate care pressure sores should never develop in a modern hospital, even in individuals with a multitude of risk factors.


If you or a friend or relative has developed pressure sores, particularly whilst in hospital, there is a strong possibility that you or they will be entitled to compensation for the same. Should that be the case we invite you to contact our experienced team for free advice, in confidence and without obligation.


Richard Stanford

If you require more general advice or information concerning pressure sores it can be found here: