Shared Insights - sharing learning and experience across healthcare

In our latest Shared Insights session chaired by Samantha Paxman and Sarah Stork we were pleased to be joined by Stephen Kennedy, General manager Nottinghamshire Healthcare NHS Foundation Trust and Dr Paul MacAllister, Consultant Forensic Psychiatrist - Clinical Director, Devon Community Forensic and Prison Service - Devon Partnership NHS Trust. Samantha gave an overview of inquests in relation to deaths in custody looking at 3 key themes of documentation provision, communication and decision making. Paul and Stephen discussed managing the unique challenges of healthcare in a prison setting, including integration, collaboration between prison and healthcare staff and discharge and continuity of care in the community. We also looked at when things go wrong, including PPO investigations, embedding learning and implementing change.

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Rachael Morris is a Partner specialising in resolving clinical negligence claims, in particular involving complex obstetric and neurological injuries, acting on behalf of NHS Resolution and various Trusts.

Kate Cheshire is Head of Midwifery and Neonatal Services at the Royal Wolverhampton NHS Trust. She gave an insight into what the Trust has been doing from ward to Board, in order to share and implement the IEAs and improve care and safety in maternity services.

Dr Brian McKaig is Chief Medical Officer at The Royal Wolverhampton NHS Trust. He has held several managerial roles within RWT including Clinical Director for Gastroenterology, Revalidation Lead (2012-2020) and Deputy Medical Director (2017- 2021). He gave his perspective on the impact of Ockenden at Board level.

Sarah Blackwell is Fetal Monitoring Lead for UHL and founder of the National Fetal Monitoring Network. She spoke about the role of the Network, how it has grown significantly from humble beginnings and reflected on the impact of Ockenden and how the Network can continue to help support clinicians. Sarah also runs the Monitoring May event with Catherine Hopley.

Catherine Hopley is Inpatient Matron at Barnsley Hospital NHS Foundation Trust. In her previous role as Fetal Monitoring Lead for Mid Yorkshire Hospitals NHS Trust she established Monitoring May which she continues to run with Sarah Blackwell (see previous page). She explained what it involves and how to join in.

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Sarah Barclay is the founder of The Medical Mediation Foundation, a not for profit organisation established in 2010 to provide mediation and conflict resolution training to NHS hospitals. She is an accredited mediator and has been co director of The Evelina Resolution Project which has been providing mediation and conflict management training to clinical and non clinical staff at the Evelina London Children's Hospital since 2012. Sarah has a Masters degree in' Medical Law and Ethics from King's College London and is a former award winning BBC social affairs presenter.

Annie McBain is Head of Legal at Barts Health NHS Trust. Annie is a Lawyer with over eight years of medical law experience,including in house at an NHS Trust, claimant clinical negligence and at NHS Resolution as a Senior Early Notification Case Manager.

Bev Hunt is the Safety and Learning Lead for mediation at NHS Resolution. She is a Registered General Nurse and Registered Midwife. She joined NHS Resolution in April 2018, as Safety and Learning Lead for North England. She is passionate about improving patient safety through lessons learnt and sharing information. Bev is helping to shape the Safety and Learning contribution in clinical negligence claims that are mediated to support trusts and GPs in extracting clinical learning, disseminate themes across the wider NHS and improve patient safety.

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Vicky Nevin is a Policy and Public Affairs Manager at NSPCC and as an introduction to this session gave an overview around Child Protection and key statistics and multiagency safeguarding partnerships.

Naomi De Silva is an Associate at Browne Jacobson and specialises in claims against Children’s Services providers and claims under the HRA and DPA. Naomi has extensive family court proceedings experience and previously worked in a family law practice representing children and families. Naomi explained that often there can be limited collaboration between Local Authorities and NHS organisations in matters involving care proceedings and set out what Trusts can do to help clinicians who are asked to give evidence.

Marilyn Whittle is the Legal Services Director at Sheffield Children’s NHS Foundation Trust. She spoke about the issues facing the Trust with regards to child safeguarding and what can be done to support clinicians during childcare proceedings.

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Mark Barnett is a Partner in our Advisory & Inquests teams and advises health and social care providers and commissioners on issues around the Mental Capacity Act, deprivation of liberty and Court of Protection applications. Mark also regularly represents clients in Inquests and delivers training on a wide range of healthcare related topics. He spoke about Mental Health Units (Use of Force) Act 2018.

Rebecca Fitzpatrick is one of the leading national specialists in mental health law, with 20 years of experience in the field including work in relation to the Mental Health Act, the Court of Protection (mental capacity issues), the High Court (complex treatment cases, e.g. involving children), the Administrative Court (judicial review, human rights and community care issues) and the Coroner’s Court. She sits as a fee-paid First-Tier Tribunal judge (mental health) and also regularly lectures in the above areas of law to a range of professionals, including the Royal College of Psychiatrists. She spoke about when it may be lawful to depart from statutory guidance & short term powers of restraint under common law/miscellaneous powers.

Richard Idle is the Named Nurse for Adult Safeguarding at SFH, and was previously a mental health nurse specialist at the Trust. He set out the practical steps his Trust has taken to implement the Guidance.

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Rebecca Fitzpatrick, Partner, Browne Jacobson, is one of the leading national specialists in mental health law, with 20 years of experience in the field including work in relation to the Mental Health Act, the Court of Protection (mental capacity issues), the High Court (complex treatment cases, e.g. involving children), the Administrative Court (judicial review, human rights and community care issues) and the Coroner’s Court. She sits as a fee-paid First-Tier Tribunal judge (mental health) and also regularly lectures in the above areas of law to a range of professionals, including the Royal College of Psychiatrists. She spoke about the legal framework for managing maternal mental health issues.

Kara Dent is a Consultant in Obstetrics with over 20 years of experience in High Risk Obstetrics and Fetal-Maternal Medicine and a special interest in diabetes in pregnancy. She is Clinical Director for Obstetrics at University Hospitals of Derby and Burton NHS Foundation Trust (UHDB). She spoke about the obstetrician’s perspective.

Dr Sally Arnold, Perinatal Psychiatrist, Midlands Partnership NHS Foundation Trust, is a general adult psychiatrist who has a special interest in perinatal psychiatry. She is due to take up a consultant post on the mother and baby unit in Staffordshire next month. During her training she has had an interest in psychiatry for women and the impact obstetric and gynaecological conditions can have on a woman's presentation. This has included publications in PMDD, posters at international conferences on substance use in pregnancy, an interest in gender dysphoria and undertaking a diploma in obstetrics and gynaecology. Currently Sally is undertaking a masters in medical ethics and law. She set out 5 practical tips about the psychiatrist’s perspective.

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We were delighted to be joined by Dr Nigel Sturrock, Regional Medical Director for the Midlands at NHS England and NHS Improvement. He gave an overview of the pressures placed on the NHS by the pandemic, including the impact on urgent and emergency care, elective procedures and staffing.

We also had a number of speakers from Browne Jacobson

Helen Badger advises on a wide range of HR and employment matters, including disciplinary and grievance issues in the workplace, TUPE, equal pay, workforce change, discrimination and variation of terms and conditions of employment. She spoke about mandatory vaccination for staff.

James Arrowsmith leads the Children’s Services and Abuse team, working with a wide range of clients across the country to support delivery of services and address historical and recent allegations of abuse, child sexual exploitation and other complaints relating to children and children's services. His role includes advice on obligations, policy, process and risk, incident management, and supporting safeguarding teams in extracting learning from incidents. He spoke about developments expected in 2022 relating to children’s social care.

Ed Pollard specialises in healthcare advisory law. He has many years’ experience as a solicitor acting on behalf of NHS trusts. His work includes inquests, mental health law, the Court of Protection, the deprivation of Liberty Safeguards, fitness to practice and data protection issues. He spoke about likely developments and issues relating to inquests in the coming year.

Damian Whitlam specialises in defending medical malpractice claims on behalf of health care providers including public bodies (including NHS Trusts and NHS Resolution), individual clinicians, corporate organisations and medical malpractice insurers. He gave a claims update setting out 5 things to look out for in 2022.

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This Shared Insights Safeguarding Forum was hosted by Clare Shepherd, Senior Associate, and Lisa Newboult, Named Professional in Safeguarding Adults and Mental Capacity Act (United Lincolnshire Hospitals NHS Trust). We were also delighted to be joined by Marlon Fullick, CEO of LSA Secure Limited.

This session focused on issues, legal framework and practical solutions in:

• Discharge planning
• Restraint
• Conveyance to and from hospital.

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In our second Coroner’s Question Time we were delighted to be joined by three experienced Coroners, Zak Golombeck, Area Coroner for Manchester City, Ivan Cartwright, Area Coroner for Leicester City and South Leicestershire and Gordon Clow, Assistant Coroner for Nottingham and Nottinghamshire.

Issues considered by the panel

• An outline of the current backlog and the pandemic recovery plan implemented in their jurisdiction.
• Their jurisdiction’s approach to the message from the Chief Coroner that inquest hearings should now be returning to normality.
• What allowance is being made by Coroners in respect of care and governance issues that arose because of the pandemic.
• What allowances Coroners can make for clinical witnesses to try to minimise avoidable disruption to clinical recovery and make reasonable adjustments where clinical staff have reached burnout.

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Sarah Stork, Senior Associate at Browne Jacobson chaired the session.

Samantha Paxman, Partner (Barrister), Browne Jacobson began the discussion with themes seen arising from inquests.

We were also delighted to be joined by:

Dr Asim Yusuf, Consultant Psychiatrist, Black Country Healthcare NHS Foundation Trust, who discussed his experiences and learning from participating in RCAs.

Dr Sally Arnold, General Adult Psychiatrist, Midlands Partnership NHS Foundation Trust, who provided the clinician’s perspective of preparing for and attending inquests and set out her practical tips.

Mandy Ford, Head of Risk Management, Dorset County Hospital NHS Foundation Trust, who took us through what she and her Trust had learned from a difficult case.

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Kathryn Fearn, Associate Director of Legal Services at University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) introduced the session and explained she had requested a Shared Insights call on this topic due to a spike in incidents with the hope of sharing good practice.

Rebecca Fitzpatrick, Helen Badger and Carl May-Smith, Partners at Browne Jacobson provided an overview of the legal frameworks in place that can assist Trusts when managing violent, abusive and racist patients. They focused on the legal aspects from the patient perspective, employment concerns and regulatory aspects. 

We were delighted to be joined by Sergeant Ben Wildman, of Derbyshire Constabulary who spoke about the Police perspective when it comes to managing violent, abusive and racist patients and what Trusts can do to assist the police in investigating these incidents.

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Victoria Colclough, Senior Associate at Browne Jacobson chaired the Quarterly Safeguarding Forum

Rebecca Fitzpatrick, Partner at Browne Jacobson spoke about the difficulties faced by professionals when dealing with challenging family members and highlighted the legal frameworks and mechanisms that can be implemented to manage these behaviours in order to protect staff and keep the patient’s best interests at the centre of decision making.

We were delighted to be joined by Catherine Keay, Head of Commissioning for Mental Health, Learning Disabilities and Autism at NHS Lincolnshire Clinical Commissioning Group who spoke about the CCG’s experiences of working with some of their more challenging families and provided some practical tips on how to manage these complex situations.

We were also pleased to be joined by Lisa Newboult, Named Professional Safeguarding Nurse at United Lincolnshire Hospitals NHS Trust who provided her valuable insight into managing challenging family members in order to ensure Trusts are acting in their patient’s best interests.

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Rachael Morris, Partner at Browne Jacobson spoke on how this session would mark World Patient Safety Day which this year has a theme of safe maternal and newborn care. She provided an overview of the implementation of the Ockenden Immediate and Essential actions.

Amelia Newbold, Risk Management Lead at Browne Jacobson provided an overview of how Heads of Legal can support clinical improvement work.

We were delighted to be joined by Dr Angie Doshani Consultant Obstetrician and Gynaecologist at University Hospitals of Leicester NHS Trust (UHL) and Elaine Broughton, Head of Midwifery at UHL, who spoke about the impact of Ockenden at their Trust, the practical steps they have taken to implement the actions required, and shared practical tips for disseminating learning.

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In this Shared Insights session, we discussed the future of interaction between NHS Trusts and Local Government amidst a drive for better integrated care; the new Liberty Protection Safeguard legislation due to come into force in April 2022, and the challenges of collaborative working between organisations.

We were delighted to be joined by:

Adam Lent, Chief Executive of think tank New Local, which specialises in advising public services with a network of over 60 local councils.

Mark Barnett, Partner in our Advisory and Inquests team at Browne Jacobson. He advises health and social care providers on issues involving the Mental Capacity Act, deprivation of liberty and Court of Protection applications.

Naomi De Silva, Associate at Browne Jacobson. Naomi specialises in claims against Children’s Services providers and claims under the HRA and DPA.

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The first part of this Shared Insights session was led by Sharon Fletcher, Associate Safety and Learning Lead at NHS Resolution who, prior to the pandemic, started some work looking at the themes and learning arising from Operating Theatre claims between 2010 and 2020.

We were also delighted to be joined by Mr Arthur Stephen, Consultant Orthopaedic Surgeon and Divisional Director for Surgical Services at University Hospitals of Derby and Burton NHS Foundation Trust (UHDB). Mr Stephen chairs the Trust Harm Review Committee at UHDB and is the lead for surgical service recovery at UHDB. He led a discussion about the challenges faced by NHS Trusts as they seek to restore surgical and other services post-pandemic.

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Each speaker provided their unique perspective and learning outcomes from dealing with eating disorder patients.

Catherine Flannery, Associate at Browne Jacobson outlined what is required from a legal perspective for a successful application to the Court of Protection (CoP).

Claire Noble, Case Manager in the Mental Health, Learning Disabilities, Autism & CAMHS Commissioning Team for NHS Lincolnshire Clinical Commissioning Group spoke about challenges faced by CCGs and set out some practical learning points.

Majella Wright, a Specialist Nurse Practitioner at St Barnabas Hospice, an independent charity providing care for people living with life limiting illnesses, offered insights from her work with patients who have reached the terminal phase of their illness and their families.

Lisa Newboult, Named Professional in Safeguarding Adults and Mental Capacity Act at United Lincolnshire Hospitals NHS Trust spoke about the importance of having a Care Co-Ordinator.

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In this Shared Insights session we discussed how different Coroners are approaching recovery from the pandemic. The session was chaired by Nicola Evans, Consultant, Browne Jacobson.

We were delighted to be joined by a panel of Coroners to answer questions from NHS Organisations as we plan for the increased court activity that recovery will bring:

Mr Zak Golombeck, Area Coroner for Manchester City

Dr Robert Hunter, Senior Coroner for Derby and Derbyshire

Mr Gordon Clow, Assistant Coroner for Nottingham and Nottinghamshire

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In this Shared Insights session, we discussed the learning from the Paterson Inquiry and the implications for in-house legal teams, patient safety, clinical governance, workforce culture and large-scale reviews.

We were delighted to be joined by Jacqui Atkinson, Partner Browne Jacobson; Kathryn Fearn, Associate Director of Legal Services at University Hospitals of Derby and Burton NHS Foundation Trust; and Alison Bell, Advocacy and Improvement (Freedom to Speak Up) Senior Manager at NHS Improvement.

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Helen Badger, Partner at Browne Jacobson provided an insight into the legal issues arising from Covid-19 related illness, including long COVID and PTSD.

Claire Parker, Senior Programme Lead (Health and Wellbeing) at NHS England and NHS Improvement outlined the range of national support available to NHS colleagues for health and wellbeing.

Carl May-Smith, Partner at Browne Jacobson gave practical guidance on dealing with HSE investigations where staff have tragically died during the pandemic.

Nicola Evans, Solicitor-Advocate at Browne Jacobson outlined the Coroner’s guidance on holding an inquest in the circumstances of a staff death during the pandemic.

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For this session, we were delighted to be joined by Sangita Bodalia, Head of Early Notification (Legal) at NHS Resolution who discussed the changes to improve and streamline the investigation process for cases under the Early Notification (EN) Scheme (changes which came into effect from 1 April 2021).

We were also delighted to be joined by Sandy Lewis, Associate Director of Maternity Investigation Programme and Amanda Morgan, Regional Lead for Maternity Investigations (South) from HSIB who provided an update on the process for HSIB maternity investigations.

Together, Sangita, Sandy and Amanda discussed the interface between the HSIB and EN investigations.

Kelly Buckley, Senior Associate at Browne Jacobson also provided a Panel perspective and an overview of the process for those EN cases where it is appropriate for Panel to be instructed.

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Lorna Hardman, Partner at Browne Jacobson spoke of her role as head of the firm’s clinical negligence practice and explained that the purpose of this session was to focus on the issues that Trust legal teams have faced over the last 12 months during the Covid-19 pandemic.

Lorna and Rebecca Taylor-Onion, Senior Associate at Browne Jacobson, have been focused on indemnity issues stemming from the pandemic. In the early stages of the pandemic they were involved with indemnity arrangements with the private sector and discharging patients to care homes. More recently they have advised on some of the indemnity issues arising from the challenges of the vaccination programme.

Rishipal Singh, Solicitor & Team Leader at NHS Resolution spoke of the challenging year everyone has faced and his experience of being involved in supporting NHS Resolution’s Covid-19 claims handling processes.

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This was the first Shared Insights “Safeguarding Forum” which will run quarterly.

Laura Nazar, Senior Associate at Browne Jacobson outlined the practical challenges involved in managing legal proceedings for complex patients. She spoke of her experiences and provided top tips on how to overcome these challenges.

Karen Aucott at Nottingham University Hospitals NHS Trust provided an insight on how to manage complex patients when they are admitted to a ward at an Acute Trust. She discussed the importance of regular MDT meetings and family input.

Lisa Newboult at United Lincolnshire Hospitals NHS Trust discussed her role as Named Professional in Safeguarding Adults and Mental Capacity Act. Lisa explained her role as ‘project manager’ in complex cases and what this role entails.

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Sian Brown, Partner at Browne Jacobson spoke of her role as head of the Early Maternity team which focuses primarily on supporting the NHS Early Notification team and helping Trusts with cases where babies have died following birth or where mothers have sustained severe injuries during childbirth. She spoke of the consequences of these claims and the current focus on safety in maternity services.

Kelly Buckley, Senior Associate at Browne Jacobson provided insight into the Ockenden report and the 7 “Immediate and Essential Actions” outlined.

Amelia Newbold, Risk Management Lead at Browne Jacobson set out an overview of the key themes seen in obstetric claims and inquests with a focus on those themes she thinks will be more prevalent in the claims landscape post Ockenden.

Jo Hartley, Associate Director of Midwifery and Neonatal Services, Dorset County Hospital NHS Foundation Trust spoke about the impact of Ockenden at her Trust and the practical steps they have taken to implement the actions required.

Elita Mazzocchi RM, NHS Resolution shared the links between the immediate and essential actions outlined in the Ockenden report and the NHS Resolution Maternity Safety Actions.

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Rebecca Fitzpatrick, Partner at Browne Jacobson is one of the leading national specialists in mental health law. She spoke about the main challenges faced in complex cases when patients present to acute Trusts but also have complex mental health needs.

Lisa Newboult, Named Professional Safeguarding Adults and Mental Capacity Act at United Lincolnshire Hospitals NHS Trust (ULH) provided an Acute Trust’s perspective and explained some of the practical measures put in place at ULH to help staff improve patient outcomes.

Dr Adaeze Bradshaw, Clinical Director and Consultant Psychiatrist at Lincolnshire Partnership NHS Foundation Trust shared her experiences as a Community Psychiatrist dealing with eating disorders and Child and Adolescent Mental Health Services (CAMHS). She set out some of the steps taken within her Trust when managing these complex cases.

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Charlotte Harpin, Partner at Browne Jacobson spoke about the key legal principles that apply when processing requests for access to confidential information and gave some practical tips on how to deal with issues that might arise when Trusts are dealing with complex information requests.

Marilyn Whittle, Head of Legal and Governance at Sheffield Children’s NHS Foundation Trust, joined to tell us some of the in-house complexities of dealing with confidentiality and disclosure of information to third parties such as the police.

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Nicola is a Solicitor-Advocate who has specialised in health law for more than two decades. This included over a decade working at senior level within the NHS as the Associate Director of Legal Services at University Hospitals of Derby and Burton NHS FT (“UHDB”). Nicola now acts for a wide range of NHS organisations and NHS Resolution advising on complex health law queries and representing NHS Trusts at Coroner’s inquests, appearing in numerous jurisdictions. Nicola has extensive experience supporting clinicians through the inquest process and is one of the key speakers on the Mock Inquest training course.

Nicola was joined by Dr Robert Hunter, HM Senior Coroner for Derby and Derbyshire to talk about the implications of the Supreme Court’s decision in Maughan and the impact that Covid-19 continues to have on the Coroner’s courts. 

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Damian Whitlam, Partner at Browne Jacobson, advises NHS Trusts and NHS Resolution in resolving patient disputes efficiently and fairly, on indemnity issues with potential third parties and helps NHS organisations learn from claims to drive improvements in patient care.

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Luke is a barrister at Browne Jacobson and provides advice, drafting and advocacy spanning criminal regulatory, coronial and associated civil matters. He works closely with NHS and public bodies throughout the lifetime of a case.

He was joined by Kathryn Fearn, Associate Director of Legal Services at University Hospitals of Derby and Burton NHS Foundation Trust (UHDB).

Kathryn and Luke spoke about their experience dealing with anti-Covid protesters at UHDB. They emphasised the importance of Trusts developing a written plan so that you are ready to act quickly if anti-Covid or anti-vaccination protesters come on to your site to protest. Browne Jacobson recently assisted UHDB to deal with protesters on site and develop a plan to be followed if they return to site.

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Helen is a Partner at Browne Jacobson specialising in employment within health, social care and education. She advises on a wide range of HR and employment matters, including disciplinary and grievance issues in the workplace, TUPE, equal pay, workforce change, discrimination and variation of terms and conditions of employment.

Helen provided some practical tips to share with HR colleagues on issues which may cause employee relations issues and litigation in 2021.

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Carl May-Smith is a partner and barrister specialising in regulatory and criminal law, with a particular focus on the health and care sector. Carl provides a broad variety of advice including in respect of health and care standards (CQC and others), health & safety, fire safety and police investigations. His clients include care providers (independent and NHS) as well as commissioners and investors in the sector.

Carl provided an update on what individuals and NHS organisations should expect from the regulators in 2021.

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Dealing with the dishonest Claimant – Practical guidance for NHS Trusts, 15 December 2020 >

The impact of the Covid-19 pandemic on consent, 1 December 2020 >

The Mental Capacity Act - when to go to the Court of Protection - practical guidance for NHS Trusts, 17 November 2020 >

External investigations and prosecutions in the NHS, 3 November 2020 >

Preparing for remote inquest hearings and dealing with inquests in a pandemic, 20 October 2020 >

The Duty of Candour - family and patient engagement, 6 October 2020 >

Learning from claims - effective triangulation of data, 22 September 2020 >

Supporting clinicians through investigations, complaints, claims and inquests, 8 September 2020 >

Commissioning an independent review of services, clinical departments or clinicians, 28 July 2020 >

NHS whistleblowing post Covid-19 – common pitfalls and best practice, 14 July 2020 >

The benefits of mediation for NHS trusts, 30 June 2020 >

Collaborative working with patients' solicitors courts – claims and litigation update, 16 June 2020 >

Maternity Investigations, the Early Notification scheme and HSIB, 2 June 2020 >

Managing PPE and inquests in the healthcare sector, 19 May 2020 >