The Amputee Journey Past Present and Future

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I was lucky enough to be invited to attend the amputee journey past, present and future conference hosted by Irwin Mitchell.  The event was held at Old Trafford  & as usual was a great day.

There were so many inspirational speakers in the morning it was quite overwhelming.

Wyn Jenkins an former client of Irwin Mitchell and a very active man had been debilitated following an infection he had got as a result of several operations involving a hip replacement. To improve his quality of life he’d opted to have an above knee amputation.  Following the operation he struggled to rebuild his life and felt he hadn’t really got much support from the NHS to help him ‘push the boundaries’ so after reaching a low in his life pushed himself, until eventually he was able to get back on his bike and start cycling again. Wyn is now full of infectious enthusiam Ambassador for The Douglas Bader Foundation

Andy Reid, a veteran who’d lost both his legs and his arm in Afghanistan in 2009 astounded people with his recovery after spending only 2 weeks in hospital before returning home. He has now become a motivational speaker and is training to complete a 10k run. His ethos being he is a ‘survivior not a victim’.

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Gordon McFadden an amputee of 18 months due to complications of talipes (clubfoot) some 54 years ago. All his life worked as an Engineer and a Carpenter.  He has now dedicated his life to the amputee community and is the founder and Chairman of United Amputees.

Dave Tweed, was involved in a road traffic accident in 2001 and now works as Development officer and Manager for the EAFA, the Amputee Football Team.

Karl Nicholson who is now working with his colleagues towards an entry for the Invictus Games in Sledge Hockey (quite a scary game!).

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In the afternoon the we heard about the very diverse service available for amputees dependending on whether they were via the NHS and the private sector.

Professor Jai Kulkarni, Consultant in Rehabilitation Medicine at University Hospital South Manchester explained how NHS funds were limited & provision for additional limbs were not readily available.

Whilst Mark Ledger, Principle Prosthetist at Blatchfords spoke about the different types of limbs available in the private sector and his work at Headley Court with veterans. 

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The penultimate speaker of the day was Dr Munjed Al Muderis. I felt humbled listening to him. Dr Muderis is quite a remarkable man who fled Sadam Hussain’s regime in Iraq after his collegue was shot dead when he refused to perform surgery to remove peoples ears.  He escaped to Indonesia where he boarded an overcrowed boat to Australia . Once in Australia he was assigned to a refugee camp  until he was eventually released in 2000.  

Now settled in Australia Dr Muderid has now gone on to do some revolutionary work for amputees and is currently the world’s leading osseointegration surgeon.

Our final guest of the day was Michael Swain, who was one Dr Muderis patients He was one of the of hundreds of people whose lives had been changed by the surgery and could not praise his work enough.

The day was thoroughly enjoyable, although the one thing that stood out in my mind was the diversity between the resources available privately or via the Ministry of Defence against those on the NHS. It got me to thinking that there must be a better way that insurance companies and the NHS could work together.

 

 

 

 

 

 

 

 

 

 

 

Accountability for Care in Fast Track Personal Injury

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One of the key components of professional nursing is accountability. It is essential for the well being of the patients safety.

A nurse is professionally trained to care for sick & injured people and has studied at university for a minimum of 3 years.

In 2015, the Nursing and Midwifery Council (NMC) updated  their long standing prep to revalidation. To remain on the nursing register you need to have worked 450 practice hours over a 3 year period, have evidence of professional development and indemnity insurance cover.

The  Royal College of Nursing (RCN) states in its accountability & delegation process, practitioners must:

  • have the ability to perform the activity or intervention
  • accept responsibility for doing the activity
  • have the authority to perform the activity, through delegation and the policies and protocols of the organisation.

and that delegation

“must always be in the best interest of the patient and not performed simply to save time or money.”

When delegating an activity, practitioners must ensure that it this has been done appropriately.

In any health care setting a nurse is required to monitor their  patients progress, document their findings & communicate any concerns with the other health professionals who are involved in the recovery process.

Registered nurses have a duty of care and a legal liability to their patients and like case managers  can be called as witness’s in court and held accountable for their actions.

As we know from Loughlin v Singh when challenged in court the facilitation & progression of care along with cost management are the responsibility of the case manager.

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Since the Jackson reforms in 2013 there seems to have been a divide in the way healthcare is administered in personal injury.

Whilst case managers appear to be taking responsibility for multi-track care, there is no real clarity on who is using their professional judgment to decide what treatment is required on low value cases and who is managing the claimants’s recovery.

The pre action protocol state

The claimant must set out details of rehabilitation in the CNF. The parties should at all stages consider the Rehabilitation Code which may be found at: http://www.iua.co.uk/IUA_Member/Publications ‘

Many are not aware that a revised version of code was released in November 2015 & some believe that as it is only a consideration  that doesn’t need to be adhered too.

However, several of those involved in writing the code have first hand experience on the importance of healthcare provision and understand the value of accountability, which is why additional information has been included for lower value cases.

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Whilst their is a medical expert involved in the claims process, their role is to ensure the person has recovered sufficiently and is receiving the appropriate amount of financial compensation for the injuries. The have no obligation for the management of the injured person treatment or its funding.

In the case of Brown V Haven 2016, it didn’t become apparent until the trial that despite a pro forma invoice for physiotherapy being issued the treatment hadn’t taken place. It was only at this stage the client reported that they no longer required the treatment.  Throughout the case there doesn’t appear to be any reference to the health professional who was accountable for the management of care and the facilitation of the treatment.

If  rehabilitation isn’t managed by the appropriately skilled professionals then this leaves the injured person exposed to vulnerability  in court, and is putting their legal advocate at risk of claims against them.

False Physiotherapy Claim Costs Order For Solicitor

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In the case of  Brown v Haven  in January 2016, the solicitor was ordered to pay the costs associated with a physiotherapy  claim after signing a statement of truth on a schedule of damages for an incorrect claim.

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The claim was based on an invoice for 8 sessions of physiotherapy with charges of £880. The Claimant had not undergone the physiotherapy so the claim was for prospective treatment. However, at the trial the client claimed he no longer wished to pursue such a claim as he was no longer suffering the symptoms.

The solicitor had persisted with the claim for physiotherapy throughout the process despite being challenged by the defendant and it wasn’t until the trial it became apparent that no physiotherapy had actually taken place.

The court found that the solicitor did not have the client’s authority to sign the statement of truth and that the medical agency involved had financial connections with the solicitor.

The claimant was seen by a Dr Boonin on the 7th October 2015  and a report was issued dated the 8th with his electronic signature on it. On the same day invoices for the physiotherapy were produced on a pro forma basis. Boonin’s report recommended 5-6 sessions of  treatment, the invoices were for 8 sessions.

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It is unusual for a physiotherapist to generate a pro forma invoice with a recommended number of treatment sessions before they have met their client. In  health care it is best practice to meet the clients before agreeing any treatment. This is so they can carry out a full assessment of their needs, set goals and formulate a treatment plan with them. Once this has been done the physiotherapist is  usually able to gauge how much treatment is likely to be needed for the client to make a full recovery. If after the final session the client hasn’t fully recovered the therapist will reassess the situation and plan further treatment. The sports medicine information website suggests phyiotherapy should cost between £30-£60 depdending on the nature of the injury.

 

 

 

 

 

 

 

Vouchers for Whiplash Treatment

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Last week Lord Faulks announced that the Ministry of Justice intended to press forward with plans to remove damages for whiplash claims & raise the small claims limit to 5k. The discussion process is due to start once the European elections are out of the way on the 23rd June.

With Neil Sugarman APIL’s president announcing at their conference last week that over 68% of claims fall under that 5k threshold, this has left many solicitors with cause for concern.

Michael Jefferies recently spoke out on the Legal Futures blog

to attract an award for an injury of over £5,000 an individual would normally have to have experienced medical symptoms for well over two years.’

Whilst Donna Scully of Carpenters tweeted her concerns following the accident of a friend’s daughter who was hit by a lorry

‘with a foreign driver, you have to contact the Motor Insurance Bureau to see if there is a UK handling agent, would she be able to do that herself?’

For decades the media has referred to Britain as the whiplash capital of Europe with an estimated 2 billion pounds a year being spent on 1500 claims a day, averaging on 2.7 claims per accident.

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Europe treats whiplash very differently to the UK.  In Sweden, to make a claim the injured person must have been assessed within 3-4 days of the accident, their claim is then settled without the involvement of a solicitor, a similar model is used in Norway.  In France for whiplash to be diagnosed, a doctor is required to have a specific qualification that can identify the injury. Whilst in Germany ‘ no win no fee’ is only considered if the person can prove they don’t have the financial means to hire a lawyer.

There’s been much speculation on what is going to happen, some suggesting that care will replace compensation. If this were to happen then the identification by an appropriately qualified health professional of all injuries as early as possible would be essential. By doing this the person would be assessed holistically ensuring their injuries were identified more accurately and treated earlier, preventing many becoming chronic, thus reducing the number of cases that could potentially be lasting 2 years or more. There is no doubt for a young inexperienced adult the process of contacting the MIB would be considered quite daunting.

In recent years the cost of treatment of whiplash has escalated, yet the most up to date research on the injury shows that self help delivers the best and fastest outcomes.  Rehab Works offer a 30 minute self help assessment to clients who are in need of treatment.  By doing this they believe they are making savings of £2, 500 per case.  Private physiotherapy without administration costs is priced at between £30 -£60 per session depending on location, so it is possible that using an unskilled assessor is advocating unnecessary treatment which is in turn is contributing to the escalating costs of whiplash claims.

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It is accepted that not all whiplash injuries can be treated with self help, but a follow up call from a skilled professional will enable any red flags to be identified which will guarantee the necessary referral is made to the most appropriate person as quickly as possible to ensure continuity of care.

Rehabilitation is about restoring someone to as near to normality as possible, so encouraging someone to manage their own recovery should always be at the forefront of any registered health professional’s mind.  Since the welfare reforms in 2013 most GP surgery’s  have placed physiotherapist on the frontline in their surgeries.  Perhaps utilising these services with the implementation of a voucher service will be the way forward for treatment of those who can’t be managed with self help?

 

 

 

Compensation Will Be Replaced With Care

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At this year’s APIL conference Lord Faulk’s confirmed that the Ministry of Justice intended to push ahead with the reforms in personal injury compensation by scrapping general damages for whiplash and raising the small claims limit.

He stated that ‘ money being paid out is out of all proportion to the injuries sustained’  and is being driven up by an industry that is encouraging claims.

Lord Faulkes

Last month the Aviva released statistics stating that 87% of the public think making a false whiplash claim for compensation is unacceptable compared to 88% who believe drink driving is unacceptable.

Approximately 68% of personal injury claims are settled for less that £5,000 and with rumour that compensation will be replaced with care on lower value claims. It’s time for solicitors and claims handler’s to embrace the 2015 Rehab Code.

In November 2015, the revised rehab code was launched. It highlighting the importance of  getting an appropriately qualified health professionals to assess the injured person’s needs to ensure that they were getting the most suitable treatment at the right time.

In all  healthcare,  whether it be a GP surgery, A&E, a walk in centre or NHS direct,  the first port of call is an assessment/triage by a qualified nurse. The nurse uses their skills to identify what is wrong with the patient so they can facilitate the most appropriate care. This could be a couple of aspirin and an ice pack, a referral to a physiotherapist or a doctor etc.

It needs be remembered that all injuries and individual’s are subjective.

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All nurses have studied for a minimum of 3 years at university most to degree level. This is same amount of time it takes to graduate with a law degree. To retain their qualification nurses are required to practice a certain amount of hours and year and are required to register with the NMC at a cost of £120 a year.

In 2010, there was inquiry in to the Mid Staffordshire Health Care Trust which highlighted that using unqualified people to triage patients was unacceptable as no one could be held accountable for their actions.

Accountability is an essential component of professional nursing practice; accountability also is an essential component of patient safety.

It could be argued that using unqualified people to carry out health assessments is contributing to the increased costs in personal injury claims. A non qualified person runs a risk recommending treatment that is not neccessary to over compensate for their lack of skills.

There is also the potential for the non skilled assessor to overlook signs and symptoms for potential underlying problems as they are not equiped to look at a person hollistically and manage their expectations.

Using a non qualified assessor is exposing those who are sanctioning their recommendations to compensation claims of professional negligence  against them in the future.

For more information on independent nursing assessments call us 0151 348 7000 or click here to e-mail us

 

Portal Referral Form

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What is triage?

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What is triage?

According to the Oxford dictionary triage is a process used ‘ to decide the order of treatment of patients or casualties’

It originated in the 18th Century during the Napoleonic War from the French word trier, which means to separate out and was used to prioritise the care of those wounded on the battlefield.

The categories were

1. Those who were likely to live regardless of what care they received.
2. Those who were likely to die regardless of what treatment they received.
3. Those who if given immediate care it might make a positive difference.

In acute situations, for some medical emergency services a similar model may still be applied. However, the triage model has evolved in general health care.

Simple triage and rapid treatment (START) is a method of triage used by first responders to classify victims during mass major incident and was developed in 1983 by members of the Newport Beach fire department and staff at Hoag Hospital in California and is used in the United States.

The system is divided into a traffic light system, whereby treamtent is prioritised according to the injury.
Immediate (red)
Delayed (yellow)
Walking wounded/minor (green)
Deceased (black)

In the UK triage systems have been implemented in all Accident & Emergency units. triage is performed by an experienced Registered Nurse who uses a systematic & scientific method to assess patients and their conditions. This is to enable the nurse to interpret appropriate clinical features and implement early intervention.

The key objectives of triage are

Early recognition & assessment of a patient’s condition, so treatment is prioritised.
To offer first aid advice.
Reduce delays in treatment.
Initiate immediate diagnostic tests, intervention and appropriate treatment.
To allow the effective utilisation of resources and staff through allocation of patients to appropriately treatment areas according to their conditions.
To ensure and enable direct communication is made with a pre injured care provider/ GP.
To provide documentation of a patient’s condition pre treatment.
To provide appropriately skilled decision making

Registered nurses are trained at degree level for 3 years. They are taught to assess clients/ patients holistically using skills that include reflective practice and research to facilitate care and treatment for their clients so they can promote recovery, well being and independence.

All nurses belong to a professional health register and are required to validate their registration annually with proof of evidence based practice and clinical governance in their field of expertise.

Fastassess is an online independent nurse led  personal injury rehabilitation triage and assessment company For more information on triage please contact us at info@fastassess.co.uk or call us on 0151 348 7000.

Rehab stalwarts launch fast assess

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Our lovely friends at Post Mag have been kind enough to do a press release on our new product FastAssess.

I think I should have popped to the hairdressers before the photo shoot!

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Rehabilitation experts from Accident Rehab & former Managing Director of HCML have joined forces to launch a service designed to make the rehab process more efficient.

Helen Merfield, founder of HCML, pictured left, and Helen Spillards, director of Accident Rehab, pictured right, have launched Fast Assess, which is billed as providing high level telephonic triage and assessments at a lower cost than other market players, while providing consistency and independence for solicitors and insurers.

Commenting on the launch of the service, which coincides with an updated version of the rehab code, Spillards said: “Just over two years ago when the Jackson reforms came in to play there was a noticeable change, and it became apparent that many of those who needed rehabilitation weren’t being assessed properly and as a result weren’t getting the treatment for their injuries until it was too late – leaving their conditions to become chronic.”

Merfield added: “With the recent release of the rehab code, the timing couldn’t be better for delivering a fast, lower cost, medically-led, independent triage/assessment report. Which is exactly what Helen has done. Helping insurers and solicitors meet the 1 December deadline for adopting the new code”

Merfield and Spillards have more than 30 years’ experience in the personal injury sector, have run their own independent case management companies and have been board members of the CMSUK.

Both started their careers in the personal injury market at AIG. Merfield went onto set up HCML and was most recently involved in the review of the rehab code.

Spillards set up her own independent case management company and was involved in the development of the first master degree in case management in the UK.

For more information on FastAssess email us at Helen.Merfield@FastAssess.co.uk or call us on 0151 348 7000

The Rehab Code 2015

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We heard through the grapevine today that the Rehab Code 2015 is in the final stages and there is talk of it being released at the end of September.

Does this mean that insurer’s and solicitors will start working collaboratively?

Defendant- Claimant bonding

They seemed to be getting on well enough after a few drinks!