It’s about time the government helped the NHS, not the insurance industry
If passed, the government’s proposals to extend the Fixed Recoverable Costs (FRC) fast track to cover most civil cases up to £100,000 will enable insurance companies to save millions of pounds. In response, law firms will undoubtedly need to re-evaluate their caseloads and consider the most cost-effective ways to approach a claim, with the victim potentially losing out significantly. Alongside these developments looms the inevitability of the trillion-pound insurance industry receiving another healthy boost. Surely, then, it would be reasonable for the industry to contribute some of their savings to an area of society upon which they could have a hugely positive impact?
A brain injury can have a devastating effect and cause a wide range of different symptoms. In this article, Moore Blatch Associate Solicitor, Matthew Tuff, explores the most common effects and symptoms:
This is a common symptom of brain injury. People often feel exhausted much more easily than they did before the accident. The cause of this is not completely clear, but it may occur partly because of the extra effort required to carry out even simple tasks such as walking or talking. After a brain injury, the brain may work less efficiently than before.
Brain injury commonly causes cognitive impairments, such as worsened short term memory, difficulty paying attention and problems processing information. They may forget things that happened only the day before; or keep on repeating the same story, having forgotten that they have told that story several times. As a result of problems concentrating, they may find it difficult to read a book or magazine, or to watch a film from beginning to end.
People may find it hard to follow a conversation, particularly if they are speaking to more than one person at the same time.
They oftenexperience apathy and lack of motivation to carry out activities. This can be confused with laziness by those who do not know about brain injury.
It is not uncommon to have difficulty with planning, anticipating potential obstacles and deciding upon a logical sequence for tasks (for example planning a journey, trying to solve a problem or decide on the correct order in which to carry out a meal preparation). A person may find it hard to weigh up information and make a decision based on that information.
A common symptom is a tendency to ‘think rigidly’, an inability to think flexibly or consider alternative viewpoints.
A brain injury often causes behavioural issues of varying degrees. This can include impulsive behaviour, acting inappropriately in public (such as making offensive observations about complete strangers or sexual comments), feeling emotional and tearful, or outbursts of temper. One consequence of this is that people may find themselves getting into arguments or fights when they have lost their temper or offended some one. Paranoid thinking also be an effect of a traumatic brain injury.
The effects can be so significant that relatives or friends often say that the personality of the brain injury survivor has changed since the accident.
One less common side effect of brain injury is something called ‘pseudobulbar affect’, which can cause sudden episodes of uncontrollable crying that occurs even though the person may not feel particularly sad or a laughter outburst that occurs when they do not feel happy.
People sometimes find that a brain injury affects their balance. They may experience ‘vertigo’ and dizziness, or find that their ability to walk or drive in a straight line is impaired. One condition that may develop as a result of head trauma is Benign Paroxysmal Positional Vertigo (or BPPV). The vestibular system in the inner ear contains ‘crystals’ that help detect movement by sending signals to the brain. BPPV is caused by the crystals being dislodged and moving out of position. Sufferers can experience vertigo when moving their head or even when lying down or turning over in bed. This can often be treated by a procedure called the Epley Manoeuvre (which involves repositioning the crystals).
Injury to the brain can increase the risk of developing epileptic seizures (although the longer time passes after a brain injury, the more the risk normally decreases). In many cases, epilepsy can successfully be treated by medication.
Facial Recognition and Communication Problems
A brain injury survivor may find it harder to recognise the faces of people that they knew before the accident and this can be wrongly confused with rudeness. This symptom can be caused by damage to the temporal lobe in the brain (which helps with the ability to recognise faces).
Individuals may also have difficulty communicating, understanding language and expressing thoughts through language. They may also have difficulties with reading, writing and mathematics.
People may have vision problems after a head injury, such as blurred or double vision. This can be caused in various ways, such by damage to the optic nerve tract, cranial nerves or the occipital lobe (which is a lobe towards the back of the brain and which helps with processing information received from the eyes).
One not very surprising symptom of a head injury is headaches. These can vary in degree and sometimes people find themselves suffering with migraines.
An individual may also suffer with ‘neuropsychiatric’ symptoms such as anxiety and low mood. They may have insomnia. Unfortunately, these can interact with cognitive and behavioural symptoms. For example, if a person is anxious or depressed, this can make it more challenging to focus or concentrate, in turn making it harder to process or remember information. It can exacerbate feelings of paranoia. If you are having disturbed sleep this will make any excessive fatigue even worse.
Having access to rehabilitation or treatment as early as possible after a brain injury is crucial. At Moore Blatch’s Major Trauma Service, arranging rehabilitation for our clients with serious injuries is a high priority. At the outset of the claim, we invite the Defendant’s insurance company to agree to fund treatment for the injured party in order to achieve the best medical outcome. This could include treatment by a neuropsychologist, neuropsychiatrist, speech and language therapist, neuro occupational therapist and neurophysiotherapist (an occupational therapist’s role includes helping people return to everyday functions and activities; a neuro occupational therapist is an occupational therapist who works with brain injury survivors).
In addition, Solicitors at Moore Blatch are Trustees for Headway South West London and Headway Southampton – charities that support brain injury survivors and their families.
A Degloving injury is a severe injury where the outer skin becomes separated from the tissue underneath. Degloving injuries of legs, hands and arms are the most common. Degloving injuries of the head or torso are normally fatal. In this article, Moore Blatch Associate Solicitor, Matthew Tuff, discusses the causes of this particularly distressing injury and explores how the Moore Blatch Major Trauma Service can help on the road to rehabilitation.
Types of Degloving injury
Degloving injuries can be divided into two types – open degloving injuries and closed degloving injuries.
An open degloving injury is where the skin becomes detached and completely torn away from the underlying tissue and muscle, rather like if you imagine a glove on a person’s hand and it is gradually removed in a ‘peeling action’ so that the glove is left inside out.
With a closed degloving injury, the skin and upper level of tissue becomes separated from the deeper tissue, however the skin remains in place, which means that the degloving injury can be harder for the doctors to spot. Often the only visible symptom is a bruise. An MRI scan may be needed to confirm the diagnosis. Closed degloving injuries are much rarer than open injuries.
Degloving injuries often occur in accidents involving heavy machinery. In road traffic accidents, for example, they are often seen amongst cyclists or pedestrians that are involved in collisions with vehicles. They are often accompanied by fractures to the underlying bones, although not always. It is not unusual to see these injuries where a cyclist is run over by a lorry; the tyres are made of a tough material that grips the skin and pulls it away from the deeper tissue.
In accidents at work, degloving injuries may be caused by contact with conveyor belts or roller machines. They usually affect the upper limbs and may also be accompanied by a brachial plexus injury.
Degloving injuries usually necessitate extensive surgery. This may involve skin grafts or revascularisation operations. These injuries often lead to significant blood loss and death of the underlying tissue. More severe injuries may lead to the need for amputation.
At the Moore Blatch Major Trauma Service, we support many individuals with degloving injuries. At the outset of the claim, our focus is to assist the patient meet any rehabilitation needs over and above those that are met by the NHS. When the patient is discharged from hospital victims may find that the support from the statutory services falls away quite sharply even though the patient would benefit from further treatment and equipment. We work hard to ensure that funding is in place to allow treatment to continue and to enable the patient to achieve the best outcome possible.
Headway South West London (HWSWL) is a dedicated charity that helps individuals with brain injury, and their families and carers, across the boroughs of Merton, Kingston, Sutton, Croydon, Richmond and Wandsworth. It provides monthly support meetings for brain injury survivors in Wimbledon, Richmond, Croydon and Balham, a free telephone advice service for social security benefits, an allotment and social trips (to places such as restaurants, the seaside and zoo) every two months.
I, together with two of my colleagues, have been involved with HWSWL for a number of years. Trevor Sterling, Partner at Moore Blatch, is Deputy Chairman of HWSWL. Eman Hassan, Solicitor in the Major Trauma Service at Moore Blatch, is a Trustee. I was a Trustee for many years and continue to assist the Board of Trustees. All three of us specialise in injury claims involving severe brain injuries and it is a pleasure to be able to work with a charity that does crucial work for individuals with brain injuries and their families.
Moore Blatch has a long and proud association with Headway. Martin Usher, who is an Associate Solicitor in the Serious Injury Department, is Chair of Headway Southampton.
Moore Blatch has won a Law Society Excellence Award for Excellence in Business Development. The firm won the award along with law firm Bermans, for a ground-breaking commercial resolution process for SMEs, Escalate.
Becoming a solicitor is the dream of many, but too often there is a belief that there is only one path to achieve this. Here, Eman Hassan explores the different path she followed to become a qualified solicitor at Moore Blatch LLP.
Moore Blatch has been nominated for four awards in this yearâ€™s Law Society Excellence Awards.
We work closely with charities whose aims include supporting people with the types of injuries often encountered in major trauma cases. This benefits our clients because we can put them directly in touch with the relevant charities, and by liaising with these charities, we increase our own knowledge of the services available to support our clients in their recovery.
Aspire is a national charity that provides practical help to people who have been paralysed by Spinal Cord Injury. Their services include:
Tel: 020 8954 5759
Headway promotes understanding of all aspects of brain injury and provides information, support and services to survivors, their families and carers. In addition, Headway campaigns to reduce the incidence of brain injury.
Their services include helping brain injury survivors come to terms with their new circumstances, re-integrate into family and community life, and maximise their opportunities and choices; practical and emotional support for families and carers; local support services through their UK network; and providing practical rehabilitation.
Helpline: 0808 800 2244
The Child Brain Injury Trust is a charity that supports children, young people, their families and professionals and helps them come to terms with what has happened and how to deal with the uncertainty that the future may hold.
Their services include regional child and family support co-ordinators, providing children, young people and families with the support that they need in order to live their lives to the full, within their local community; a helpline providing support for anyone affected by childhood acquired brain injury; legal support services, including assistance in pursuing a claim for welfare benefits; and information on grants and financial assistance.
Moore Blatch are involved in fundraising events to raise funds and awareness to support children who have suffered from a brain injury.
Helpline: 0303 303 2248
Tel: 01869 341075
The Limbless Association provides information and support to the limb-loss community. They aim to support people of all ages and backgrounds through a variety of existing programmes and services.
They offer support to individuals of any age, whether they are about to have an amputation or are already living with congenital or acquired limb-loss and they offer assistance and information to carers, family members and friends if they require it.
They provide a national association of friends and contemporaries through the Limbless Association membership system and provide a single, unified voice for the UK limb-loss community, creating a national union and alliance for UK prosthetic patients.
Tel: 01245 216670
Help line: 0800 644 0185
Rainbow Trust supports over 25% of the 6,000 families in England who have a child aged 0-18 years of age with a life threatening or terminal illness and need the bespoke support they offer. They support the whole family 24/7, 365 days a year, regardless of diagnosis.
They support the whole family including parents, carers, the unwell child, brothers, sisters and grandparents. Any family can receive support from the moment of their child or young person’s diagnosis.
Their support is hugely varied and depends on the needs of the family. Support may include all or some of the following: family support workers, sibling support, home support and hospital support.
Tel: 01372 363438
We work in close partnership with Enham Trust, a leading and approved Independent Advisory Group. Enham Trust, a registered charity, is a pan-disability organisation that works with close to 7,500 individuals each year throughout the South, giving people independence, choice and control in the cornerstone areas of their lives; housing, care, work and skills development.
The Trust provides a range of services including care and support, advice and guidance on budgeting and recruiting personal care assistants, housing support and provision, advice on the changes to disability payments and help with budgeting, numerous skills, training and employment programmes.
Tel: 01264 345800
The Mary Seacole Trust was established to ensure the legacy of Mary Seacole continues to be embraced throughout educational establishments and communities across the UK.
Medical Relations partner, Trevor Sterling, is chair of The Mary Seacole Trust following the unveiling of the statue to honour the Jamaican-born nurse who cared for wounded British soldiers during the Crimean War.
Moore Blatch are proud Baton Holders supporting the charity with their programmes, including inspiring young children through the Young Seacole Ambassadors Programme and promoting diversity through the Diversity and Leadership Programme.
Mavis Nye Foundation (MNF) helps suport victims of asbestos related cancer mesothelioma.
Moore Blatch has been involved with establishing the foundation of Mavis Nye to provide support to victims of asbestos related diseases and Mesothelioma.
community care, private client
The best possible outcome in your recovery from a major trauma will be achieved by appropriate and effective assessment, treatment and rehabilitation. This is our primary focus as major trauma lawyers and to ensure it happens, we work closely with the hospitals and organisations that will provide your care and support.
At a time when NHS budgets are under extreme pressure, we work hard to secure you the highest possible standards of care, whilst also easing the financial burden on the NHS wherever we can.
We have carried out extensive research, which has allowed us to develop a service which not only supports individual patients, but also helps the NHS in particular. This is achieved by supplementing treatment through insurance payments.
Our signposting service is based on a holistic, patient-centric approach that provides you with support and advice from the point of admission onwards, along the various health and social care pathways to your recovery.
There are three elements of your journey following a major trauma: pre-hospital, in-hospital and rehabilitation. The trauma network is designed to ensure that you receive the appropriate treatment for your injuries throughout these stages.
Financial constraints mean that when a major trauma patient is discharged into the community (to go home or to other suitable accommodation) there can often be gaps in provision and support. This can result in delayed hospital discharge or a patient sometimes not having the appropriate level of support.
There is also a huge strain on the NHS to support patients through out-patient rehabilitation, and a shift from health to social care, which results in funding challenges. This means the discharge process is often frustratingly long.
To help overcome this, our team has built up a comprehensive understanding of all the available health and social care routes, so we can support you through your recovery journey, whilst also assisting the NHS and community services in their work.
Whenever possible, we will obtain private funding so you can benefit from an earlier hospital discharge and full support as you move back into the community.
It’s well-known that the NHS is under strain, and to help relieve some of their financial pressures, the Major Trauma team at Moore Blatch is campaigning for a review of the relevant legislation.
The Health and Social Care (Community Health and Standards) Act 2003 states that when insurers, employers who fail to protect their employee, or any other at-fault party make a compensation payment for an injury, they are also liable to pay the NHS charges if the injured person has:
• received NHS treatment at an NHS hospital.
• been provided with NHS ambulance services.
The legislation currently in force places a limit on the amount of NHS charges that can be recovered, which is known as the ‘capped’ tariff amount. The tariff for treatment and ambulance costs is reviewed each financial year and is currently £49,824. In addition, the NHS cannot then recover for both in-patient and out-patient treatment on behalf of the same injured person.
The unintended consequence has been to create a system that now leaves the NHS to pick up the large bulk of the costs, in cases where insurance companies have the resources to contribute.
For someone who has suffered a major trauma, the immediate urgent care and ongoing rehabilitation costs can far exceed the current cap, meaning that the NHS picks up the rest of the bill.
We consider that a review of the cost recovery system for major trauma treatment is long overdue and the government should look at whether the caps on money the NHS can claim from insurers should be raised or abolished altogether. The result would be a more equitable spread of the costs, taking into account the high cost of medical treatment.
We are working hard to maximise injury costs recovery for those trusts that have treated our clients, so that they may continue to help others.