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Assessing the cost of missed enhanced care opportunities in confused patients When a confused elderly patient is admitted to hospital with a high falls risk, the expectation is clear: policies should trigger timely assessments that safeguard the individual’s wellbeing. Yet in this case, despite comprehensive Trust policies and evident warning signs, an enhanced care nursing assessment was never actioned. The patient suffered a fractured arm following an unwitnessed fall —an outcome a nursing expert concluded was entirely avoidable. Missed nursing interventions: where policy met inaction Although this patient was appropriately identified as high risk for falls and had a care plan in place, the failure to implement enhanced care planning is where the breach occurred. The Trust’s own documentation highlighted: A requirement to complete enhanced care assessments for patients who appear to lack capacity, especially after a fall. Cohorting or eyesight-level care as standard when confusion or mobility issues are present. Risk assessment within six hours of ward admission. Despite these expectations, nursing records failed to reflect any completed enhanced care assessment, even after clear incidents—including an earlier fall and nursing concerns about bed mobility. “Cohorting care would have likely prevented the fall that led to the fracture. There were missed opportunities to act.”— Independent Nurse Expert, Apex Experts Why enhanced care nursing assessments matter An enhanced care nursing assessment  is a critical tool used by hospitals to determine when a patient requires one-to-one or increased observation. It is particularly vital when a patient: Presents with acute confusion or delirium . Is at risk of self-harm or accidental injury. Has fallen or is likely to fall due to impaired cognition or mobility. In this case, the patient’s cognitive status was noted early in her admission. Nursing staff expressed concern about her ability to mobilise safely, but this did not trigger escalation to enhanced care pathways—despite Trust guidelines clearly supporting such action. Learning for litigation and clinical governance This incident is a textbook example of how: High-quality policies are not enough without clinical follow-through. Nursing documentation must reflect proactive risk management. Timely enhanced care nursing assessment processes should be embedded in admission protocols. Litigation teams will note that despite the medical staff’s rationale for not undertaking a formal capacity assessment, nursing staff still had a duty to protect the patient using the tools available to them—particularly after the first fall.

Addressing Failures in Nursing Breach Documentation in Acute Care Settings In acute hospital settings , documentation is the thread that binds care delivery to patient safety. When that thread unravels, the consequences can be profound. In this case, an elderly patient with a history of stroke, cardiac failure, and recurrent falls deteriorated over the course of their admission. Despite presenting with several red flags, failures in nursing breach documentation undermined safe care delivery and timely escalation. The nursing expert’s review found critical gaps in fluid balance monitoring , food intake recording, and care planning—especially during key clinical deterioration. These omissions prevented vital nutritional intervention and stroke assessment at a point where action might have made a difference. Why accurate documentation is the foundation of effective care Several days into the patient’s hospital stay, symptoms of a stroke became apparent to family members. Though nursing notes later recorded that medical staff were informed, delays and inconsistent records blurred the timeline. By the time neuroimaging was carried out the following day, the window for thrombolysis had passed. Meanwhile, the patient showed signs of declining intake and increasing confusion. Despite clear risk factors including congestive cardiac failure and diuretic use, there was: No fluid balance charting for an extended period No food diary despite evident nutritional decline A delayed referral to a dietitian No effective care plan reflecting escalating risks These failures in nursing breach documentation weakened the chain of care and resulted in missed opportunities for timely intervention. How breach in documentation compounds medico-legal liability A failure to record does not only weaken patient care—it weakens a Trust’s ability to defend its actions in court. In this case: Key records were either missing or lacked narrative reasoning. Documentation did not match the patient’s clinical picture. Delays in escalation were noted but could not be justified with evidence. From a legal standpoint, poor or absent documentation equates to poor care—even if some actions were carried out verbally or non-formally. The absence of audit trails renders clinical decisions opaque and potentially indefensible. Embedding nursing breach documentation into governance learning This case provides a crucial reminder that: Documentation is not an optional task; it is a clinical act. Failure to escalate must be recorded and explained. Fluid balance, food intake, and care plans should always reflect the patient’s clinical risk in real-time. Nursing breach documentation is a recurrent theme in litigation—and this case shows how something as simple as a missed chart can shape the entire medico-legal outcome.

Why Nursing Observations Are Under Legal Scrutiny In today’s clinical negligence litigation landscape, accurate and timely nursing documentation is more than best practice—it's a legal imperative. At Apex Experts, our nurse expert witnesses are frequently instructed in cases where a failure to escalate deteriorating conditions has led to patient harm and liability. This article is drawn from a redacted expert witness report, based on a real case, where lapses in early warning score (EWS) management and documentation formed the core of the claim. The findings, though nearly a decade old, remain critical in 2025 in light of the latest NICE guidance , regulatory reforms, and evolving digital health standards. The Case at a Glance: Deterioration, Documentation, and Duty The patient in question presented with clinical indicators of sepsis. Over a 48-hour period, the National Early Warning Score 2 ( NEWS2 )  system recorded scores consistently ranging from 5 to 7—suggesting the need for immediate medical review. However, there was: No evidence of escalation to medical staff; Gaps in nursing entries over several shifts; No consultant notes until after clinical deterioration. Our expert concluded that the nursing team did not meet the required legal standard of care, as defined by the tests set out in Bolam v Friern Hospital Management Committee  (1957)  and refined in Bolitho v City & Hackney HA  (1996) . The absence of escalation and documentation significantly contributed to the patient’s decline. Clinical Failures with Legal Implications 1. Ignored Escalation Protocols - Raised EWS results with no response are not mere oversights—they are breaches of clinical duty under NEWS2 escalation policies . 2. Incomplete Nursing Records - The report cited a breach of the Nursing & Midwifery Council (NMC) Code , which requires comprehensive, contemporaneous documentation as evidence of safe practice. 3. Systemic Handover Failures - Lack of evidence of communication between nursing and medical teams reflected a failure to meet interdisciplinary care expectations, breaching NHS England’s 2023 Safety Improvement Standards . Why This Still Matters in 2025 The issues raised in this case mirror themes consistently flagged by the Healthcare Safety Investigation Branch (HSIB) . With healthcare systems facing post-pandemic staff shortages, rising litigation, and digitisation mandates, there’s now zero tolerance for lapses in EWS documentation and escalation. Poor record-keeping is no longer a technical fault—it’s seen as a barrier to safe, defensible care. Legal professionals are increasingly using real-time audit trails and metadata from EHRs to assess claims of breach and causation. How a Nursing Expert Witness Report Strengthens Legal Claims Our expert panel is trained in CPR Part 35 compliance and brings deep sector insight into standards of nursing care. In this case, our expert: Interpreted the clinical context within the Bolam/Bolitho legal framework; Assessed trust policies against national best practice; Provided opinion on causation and systemic versus individual failure. Whether acting for claimant or defence, this objectivity is what sets apart reliable expert testimony in nursing litigation. At Apex Experts we Provide: Independent expert witness reports in nursing, AHP and medical cases Clinical negligence assessments (including breach & causation) Medical records sorting and pagination Training for legal teams on interpreting nursing evidence With over 200 regulated clinicians in our Expert Directory, Apex Experts is the trusted name in high-quality, court-compliant reporting.

Nursing and care home fees can be extremely expensive. Some of our nurses have practised in nursing homes charging as much as £1500 per week! If the patient is assessed as having a primary health need then the NHS should fund their continuing healthcare. Both care homes and in-home care can use the funds. CHC funding is not means tested and covers 100% of the care costs. Contact us to start the process or read below to find out more first. There are lots of people and firms that offer assistance with CHC claims but the process is not a legal process – it is clinical. Decisions about CHC are based on the opinion of a multi-disciplinary (nursing and others) team. Therefore, the assistance should be clinician led or heavily supported. As nurses, we understand the nursing issues and when discussing with fellow clinicians (such as decision panels) we therefore have creditability and share an understanding. The Process The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care outlines the full process. For ease here is a breakdown of the process: Identification Stage: where a patient or an individual is considered and assessed for CHC funding. This is obviously a crucial stage and patients are missed. If you think either you or someone you care for are eligible then get in contact with us. If there is any doubt of eligibility, a checklist (stage 2) will be completed – it does not take long! Checklist Stage: a ‘NHS Continuing Healthcare Checklist’ is completed by a trained member of staff (usually a nurse or social worker). There are 12 sections that need to be scored. The scores are then totted up and if the required scores are achieved then a full assessment will be carried out. The checklist should be completed prior to discharge (from hospital/secondary care) into a nursing home or social care. The local CCG (Clinical Commissioning Group) is responsible for conducting the assessment if the individual is within their own home or a nursing home. Fast Track Assessment: A process is available for those patients who are approaching the end of their life. Allowing the full assessment to be circumvented and funding awarded. That process is set out within the ‘Framework’ and we are often asked to assist and/or advise. MDT Assessment – Decision Support Tool ‘DST’ Stage: if, during the checklist stage, sufficient scores are awarded then a DST document should be carried out by a multi-disciplinary team of clinicians. The team will assess the individual against the criteria in the National Framework. The DST form will allow the clinicians to document the needs of the individual. Then, once this assessment is done, the team will consider whether the identified needs result in sufficient nature, intensity, complexity and unpredictability. A conclusion will be drawn and a decision made as to whether funding should be allocated or not. Decision Panel Stage: The MDT assessment (the DST process) will be presented to ‘Panel’ who will decide funding having taken into account the MST assessment. We help and assist with the initial application for CHC funding, clinically assess an individual patient and present our clinical opinions and contribute to assessment meetings. If the panels do not find in the favour of the patient, and, following assessment we feel that the decision is wrong, we assist and lead an appeal. If you wish to start the process, email us today at info@apexexperts.co.uk or call us on 0203 633 2213.

When Standard Catheter Protocols Fail: A Medico-Legal Case Review In this case review, we examine a real-world scenario where a nursing expert witness report identified significant lapses in catheter care within a rehabilitation unit. The patient, an elderly man recovering from surgery, developed a life-threatening infection. The findings shed light on how seemingly minor documentation and escalation failures can culminate in severe outcomes—and legal exposure. Thorough written records—paired with clinical insight—form the backbone of defensible nursing care in medico-legal contexts. Background of the Case The report, compiled by an Apex nurse expert with over 25 years of clinical experience, assessed whether the standard of nursing care—specifically catheter care—met the expected level. The patient, initially recovering from a fractured neck of femur and COPD , was re-catheterised multiple times due to urinary retention. Over time, signs of sepsis emerged, including: Strong, offensive-smelling urine Abdominal and genital pain Late escalation to urology Delayed investigation of symptoms What the Nursing Expert Witness Report Found Meticulous clinical note-taking remains a cornerstone of both safe patient care and defensible medico-legal practice. The nursing expert witness report identified several key failings: Incomplete catheter care plans No documented rationale for failed catheterisation attempts Delayed recognition of sepsis symptoms Lack of documentation on family-reported concerns Disrespectful language in nursing notes (e.g., dismissive of patient's distress) Despite initial good practice during hospital admission, the report concluded that the care in the rehabilitation unit breached acceptable nursing standards. “In my opinion, the general documentation and catheter care at the rehab centre was generally poor and falls below a reasonable standard.”— Apex Nurse Expert Report Legal and Clinical Implications The report applied the Bolam and Bolitho tests , concluding that the care would not be supported by a responsible body of nurses. However, causation was deferred to a medical expert, highlighting the collaborative nature of multidisciplinary evidence in clinical negligence cases. This case exemplifies how nursing documentation, if insufficient, can directly lead to allegations of negligence. Why a Nursing Expert Witness Report Matters in 2025 With the rise of digital records and litigation involving catheter-associated infections, solicitors, insurers, and Trusts must: Ensure compliance with RCN catheter care guidance Maintain clear escalation pathways Train nurses in medico-legal documentation best practices

Growing Our Tissue Viability Nursing Expertise Tissue viability nursing plays a vital role in safeguarding patients, preventing harm, and upholding clinical standards. When questions arise in a legal context, the insight of experienced nurses becomes essential. That’s where Tissue Viability Nursing Expert Witnesses step in - and where you, as a senior nurse, can make a meaningful impact. At Apex Experts, we’re expanding our expert witness services and are seeking senior Tissue Viability Nurses become a part of our panel. Our casework is wide-ranging—spanning litigation, inquests, regulatory matters, and complex safeguarding reviews. Across all of these areas, our clients rely on clear, independent clinical opinion of the highest calibre. This is a professionally supported, flexible consultancy opportunity where your nursing insight directly informs standards, decision-making, and justice. Your Clinical Expertise. A Voice That Matters. As a Tissue Viability Nursing Expert Witness, your role will involve reviewing and commenting on the care provided in cases that often include: Prevention, assessment, and treatment of pressure ulcers Post-operative wound management and surgical site infections Documentation and escalation of wound care concerns Multidisciplinary planning involving tissue viability Complex or palliative wound care decisions You may be instructed by legal teams (for both Claimants and Defendants), NHS trusts, independent providers, coroners, or regulators. In each case, your duty is to offer an informed, impartial opinion on whether the care met appropriate professional standards. We provide comprehensive support - free training, secure systems, structured templates, and case guidance - to help you deliver consistent, confident reports. Who We Are – And What Sets Us Apart Apex Experts is an established medico-legal practice specialising in expert witness work across nursing and healthcare fields. We support experienced clinicians in stepping into expert witness work with professionalism, efficiency, and ongoing guidance. We manage all logistical aspects of expert instruction so you can focus on what matters most - your expert opinion. You’ll have access to: Full administrative support, including client communication, deadline tracking, secure document handling, guidance on report structure and presentation, and management of invoicing and payments Free, comprehensive training in CPR Part 35 compliance and expert report writing Secure, encrypted cloud systems for managing case documentation Continuous professional development and mentoring opportunities We are transparent, responsive, and committed to the high standards expected in expert nursing testimony. Work That Fits Around You This consultancy role is fully remote and designed to be flexible around your clinical practice. You decide which cases to accept, how many to take on, and when you’re available. We work collaboratively with you to agree realistic timelines for report submission. Key Features: Self-directed working – no minimum caseload or fixed hours Autonomy in your opinion – your independence is always respected Prompt payment – you’re paid within 30 days of invoicing, regardless of client delays No obligation – you can decline cases without pressure or penalty This is ideal for experienced nurses who want to complement their clinical roles with work that draws on their leadership, judgement, and attention to detail. Who We’re Looking For We’re seeking highly experienced nursing professionals who can speak with authority on care standards. You must be: NMC-registered, with current clinical practice in tissue viability Working at Band 7 or above Holding 10+ years of post-registration experience Skilled in written communication, critical thinking, and clinical analysis Committed to impartiality, confidentiality, and professional conduct You do not need prior experience in medico-legal work - we provide full training and guidance. What we require is clinical insight, accountability, and a strong sense of professional responsibility. What You’ll Gain By joining Apex Experts, you’ll be contributing to a more informed, accurate, and fair representation of nursing care in legal and regulatory proceedings. You'll become a trusted part of a professional, well-supported practice that values your time, expertise, and autonomy. Benefits include: Professionally rewarding work with wide-reaching impact Enhanced career profile and recognition as an expert witness Flexible consultancy with no disruption to your clinical role Full administrative support from our team Opportunities for learning and development in medico-legal practice You’ll help ensure that nursing standards are accurately reflected and fairly assessed in complex legal and healthcare contexts. Ready to Explore This Opportunity? If you're a senior Tissue Viability Nurse with a commitment to high standards, clarity, and professional integrity, this role offers a meaningful new direction for your expertise. Interested? We're more than happy to have a friendly, informal conversation to help you explore whether expert witness work is right for you. From there, we support every step of onboarding, including documentation, training, and case readiness. Please feel free to get in touch with us at info@apexexperts.co.uk or visit www.apexexperts.co.uk  and fill out our Contact Us form.

A non-medical prescriber (NMP) is a healthcare professional, other than a doctor or dentist, who is trained and qualified to prescribe medicines. Who Are Non-Medical Prescribers (NMPs)? A non-medical prescriber (NMP) is a healthcare professional other than a doctor or dentist who is legally permitted to prescribe medicines after completing accredited training. NMPs are fully qualified to assess, diagnose, and manage patients within their area of competence, including issuing prescriptions. Common types of non-medical prescribers include: Nurse Independent Prescribers (NIPs) - Nurses who can prescribe any medicine for any medical condition within their competence. Pharmacist Independent Prescribers (PIPs) - Pharmacists who, after postgraduate training, can prescribe autonomously. Physiotherapists and Podiatrists - Some of whom have extended prescribing rights relevant to musculoskeletal and chronic care. Paramedics - Who may now be trained to prescribe medications independently, especially in emergency care settings. Each of these professionals is regulated by their respective councils (e.g., NMC , GPhC , HCPC ) and must demonstrate clinical reasoning and adherence to current guidance, such as the NICE guidelines or local formularies. Understanding the Role of Non-Medical Prescribers in Expert Witness Work In the evolving arena of healthcare and legal accountability, one role that continues to grow in importance is that of the non-medical prescriber in the medico-legal sector. These professionals are reshaping how prescribing decisions are evaluated in legal contexts, particularly in cases of alleged clinical negligence or medication-related harm. With healthcare systems under increasing pressure and the complexity of treatment pathways intensifying, the scope of prescribing has extended beyond the traditional domain of doctors. How Do Non-Medical Prescribers Fit into the Medico-Legal Sector? In medico-legal practice, the focus is often on whether a particular action or inaction meets the legal threshold for clinical negligence, as outlined in Bolam v. Friern Hospital Management Committee (1957) and Bolitho v. City and Hackney Health Authority (1997) . This includes reviewing prescribing decisions, drug interactions, contraindications, and timing. Non-medical prescribers are often uniquely placed to provide expert commentary in these areas. In particular, NMPs are instructed in medico-legal cases to: Evaluate whether prescribing protocols were followed appropriately. Assess if decisions were made in accordance with national or local guidelines. Review the prescriber's clinical rationale and decision-making process. Determine if the harm was foreseeable and avoidable within professional standards. This makes NMPs valuable as expert witnesses in both claimant and defendant cases, where clarity on the prescribing timeline and decision-making process is crucial. Conclusion As prescribing rights continue to evolve and the demands on the healthcare system grow, non-medical prescribers are playing an increasingly significant role - not only in patient care, but also in the medico-legal sector. Their practical experience, grounded clinical judgment, and adherence to best practice guidelines make them essential allies in understanding, evaluating, and adjudicating cases involving prescription decisions. For legal professionals seeking comprehensive, credible, and cost-effective expert opinion, non-medical prescribers in the medico-legal sector are a resource that should not be overlooked. For further information on our expert witness services, recruitment, or anything else, please contact us at info@apexexperts.co.uk or visit our contact us page to send us a message - we can't wait to hear from you!

Clinical care settings like this underscore the high-stakes nature of future care claims in catastrophic injury cases. What Clarke v Poole Means for Autonomy, Medical Testing, and Expert Evidence On 11 April 2025, the Court of Appeal granted permission to appeal on all grounds in the high-profile case of Clarke v Poole & Ors  [2025] EWCA Civ 447 . This move reopens the legal debate around a claimant’s right to refuse medical testing, even when the outcome may materially affect the damages awarded in a personal injury claim. This Court of Appeal personal injury decision in 2025 has significant implications for expert witnesses, particularly those involved in neurology, psychiatry, and life expectancy assessment. At issue is whether the court can or should order a stay of proceedings when a claimant declines testing central to the defendant's case on quantum. Background to the Case Samantha Clarke, aged 31 at the time of a serious 2018 road traffic accident, suffered a catastrophic brain injury that now necessitates full-time care. Liability was admitted in 2020. Her provisional claim exceeds £22 million—mostly related to future care costs. The aftermath of road traffic collisions often leaves behind both visible wreckage and lifelong, invisible injuries—central to claims like Clarke v Poole. The defendants allege Clarke may suffer from myotonic dystrophy type 1 (DM1) , a progressive, inherited condition affecting life expectancy. Her mother and maternal grandfather carry the gene, and there is a 50% chance Clarke does too. If confirmed, her claim could be reduced by around £10 million. To clarify whether DM1 is active, the defendants requested electromyographic (EMG) testing, which involves inserting multiple fine needles into muscles. Clarke refused, citing a profound psychological aversion and a long-standing desire not to know her genetic status. Expert psychological opinion supported the claim that forcing the issue could damage her mental health. Chronology of Key Events 2018: Ms Clarke is injured and later exhibits signs (e.g., ptosis) that may indicate DM1. 2020: Consent judgment on liability. 2022–23: Defendants request EMG testing to assess for DM1. Ms Clarke refuses, citing the emotional and psychological impact of a potential diagnosis. April 2024: The High Court stays the damages claim unless she consents to testing. July 2024: First permission to appeal refused by Nicola Davies LJ. Sept 2024: Claimant invokes CPR 52.30  to reopen the refusal decision. Feb 2025: The Court of Appeal agrees: permission to appeal granted on all grounds. Judicial decisions in complex personal injury cases like Clarke v Poole hinge on the balance between legal fairness and personal autonomy. The Legal Journey In June 2024, the High Court ordered a stay on her claim for future loss unless Clarke agreed to testing. That decision was appealed, but initial permission to appeal was denied by Nicola Davies LJ in August 2024. In February 2025, the Claimant’s team sought to reopen that decision under CPR 52.30—an exceptional route permitted only where real injustice might occur. On 11 April 2025, Lord Justice Underhill and Lady Justice Whipple ruled that permission to appeal should be granted on all five grounds, including: Whether Laycock v Lagoe requires a two-stage test or whether courts must apply a third-stage balancing of autonomy vs fairness; Whether the testing request interferes with bodily integrity and personal autonomy; The failure to properly consider the psychological harm associated with even deciding to test. Lady Justice Whipple described personal autonomy as “the issue which stands at the centre of this appeal.” Legal and Ethical Themes Raised This appeal raises foundational questions for the medico-legal and expert witness fields: Can the court compel EMG testing where the claimant raises real psychological objections? Does the claimant’s refusal limit the defendant’s ability to obtain a fair trial on quantum? How should courts weigh physical evidence against the right to not know a diagnosis that could harm mental health? Is Laycock’s “two-stage test” still good law, or has it evolved into a three-stage proportionality exercise as argued by the High Court? Clarke v Poole sits at the intersection of legal principle, ethical autonomy, and the role of expert medical opinion—challenging courts to balance all three. These issues lie at the crossroads of ethics, law, and expert evidence. What This Means for Medico-Legal Experts At Apex Experts, this case underscores the vital role of medical expert evidence in shaping not only the substance of claims but also their procedural dynamics. The decision reinforces the need for: Balanced, independent opinion from neurologists and neuropsychologists on both symptoms and psychological resilience; Psychiatric evaluations that address capacity, mental health risk, and choice in the context of complex injuries; Enhanced collaboration across disciplines where testing intersects with autonomy and prognosis. Importantly, this case signals to all experts that their assessments may directly influence judicial decisions about autonomy and bodily intervention. Conclusion: What the Court of Appeal Personal Injury Decision Means for Claims in 2025 The Court of Appeal’s decision to hear Clarke v Poole  reopens a pivotal discussion at the heart of personal injury litigation in 2025: how far the courts can go in compelling medical testing when it conflicts with a claimant’s psychological wellbeing and autonomy. This appeal is set to clarify the limits of judicial intervention in cases involving disputed diagnoses—particularly where future losses hinge on expert evidence and genetic uncertainty. The outcome is poised to shape how similar claims are approached in the future, especially those involving progressive conditions, psychiatric vulnerability, or ethical refusals of medical procedures.

Landmark Sheffield Ruling Highlights Family Court's Duty to Protect Children The Family Court at Sheffield has delivered a landmark decision in Sheffield City Council v The Mother & The Father & Ors  [2025] EWFC 116 (B) , involving the removal of five children from the care of their parents due to sustained exposure to domestic violence, emotional abuse, and chronic neglect. This ruling serves as a clear affirmation of the court’s duty to prioritise child welfare, even against complex familial bonds. Symbolising trust and vulnerability, this image underscores the importance of safeguarding decisions in child welfare cases. Background of the Case This case was brought by Sheffield City Council after long-term concerns about the wellbeing of five children aged between 3 and 14. Despite prior interventions, the children continued to suffer from: Emotional harm from witnessing domestic abuse. Neglect of hygiene, nutrition, and schooling. One child (Child C) presenting with unexplained bruising, prompting specialist paediatric investigation. Over time, the children's emotional development deteriorated, leading to heightened concerns from teachers, social workers, and medical professionals. Chronology of Key Events Early 2024: Bruising observed on Child C. Medical evidence suggested it could not be explained by natural causes, triggering court involvement. March–April 2025: An eight-day composite final hearing heard testimony from teachers, social workers, expert witnesses, and both parents. 1 May 2025: Judgment delivered. The court found that all five children were at continuing risk of significant harm  and issued final care and placement orders. The family court’s role is central in making life-changing decisions to protect children at risk. Court’s Findings His Honour Judge Marson found: Long-term neglect of basic and emotional needs. Parental minimisation of domestic violence, with the father described as volatile and the mother as lacking insight. Evidence of trauma in all children, especially Child C, who became visibly distressed by parental contact. The judge applied the Children Act 1989, section 31(2) threshold , confirming that the standard of care fell well below what a reasonable parent would provide. A quiet moment reflecting the complexity of safeguarding decisions in family court proceedings. Final Orders Made Child A (14) and Child B (12): Long-term foster placement together, with structured sibling and parental contact. Child C (7): Separate therapeutic foster care, minimal contact initially to aid recovery. Child D (4) and Child E (3): Approved for adoption outside the birth family due to age and level of risk. Expert Witness Reflections on Family Court Care Order Proceedings This case relied heavily on timely and credible family court care order expert witness evidence, particularly in paediatrics and clinical psychology , to inform the court’s risk assessments and care planning. The court relied on detailed assessments from paediatricians and clinical psychologists to evaluate the ongoing risk of harm to each child. Their expert opinions, presented with clarity and independence, directly informed the court’s care planning and final orders. At Apex Experts, we are committed to assisting legal teams and local authorities with high-quality, evidence-based expertise. Our specialist reports help ensure that children’s voices are accurately represented and that safeguarding decisions are grounded in clear, credible professional opinion.

Introducing Catherine Chadwick RMN: A Specialist Mental Health Nursing Expert Witness Catherine Chadwick is a highly experienced Registered Mental Health Nurse (RMN) and former Senior Lecturer in Mental Health Nursing. Her career spans across high-acuity environments including adolescent and adult acute units, forensic services, community mental health, and secure facilities. Until recently, she served as a Senior Clinical Nurse Specialist and Professional Lead within a child and adolescent mental health service. In this capacity, she not only provided care but also led investigations into serious incidents, contributed to policy development, and advised NHS Trusts on nursing governance and care standards. As Clinical Lead and Non-Medical Prescriber, Catherine provides clinical leadership, direct patient care, and oversight of a team of nurse prescribers. She acts as the CQC-Registered Manager, develops service protocols, supervises complex cases, and ensures delivery of safe, evidence-based ADHD treatment in line with national standards. Her knowledge is underpinned by years of direct clinical engagement, making her uniquely positioned to comment on both theory and real-world practice. In her capacity as an expert witness, Catherine provides objective, evidence-based opinions on the standards of mental health nursing care. She is particularly recognised for her meticulous ability to interpret clinical records and behavioural presentations within the broader context of nursing practice, aligning her assessments with NMC standards, NICE guidance, and multidisciplinary expectations. Case Study: Examining Failures in Multidisciplinary Mental Health Care In one particularly complex instruction, Catherine was asked to provide her expert opinion on the care delivered to a patient detained under the Mental Health Act within a secure inpatient mental health facility. The patient presented with significant psychiatric complexity, including a primary diagnosis of post-traumatic stress disorder (PTSD) and traits consistent with borderline and dependent personality disorders. Their clinical history documented a persistent and escalating pattern of self-injurious behaviours, including recurrent ligature use and the ingestion of hazardous foreign objects. The event under scrutiny began when the patient swallowed a pen - an act that, due to its potential for internal injury, required immediate medical attention. They were transferred to an acute general hospital, where they underwent emergency abdominal surgery to remove the object and manage the resulting complications. While the initial crisis was appropriately addressed in the physical health setting, concerns arose following their return to the mental health unit for post-operative care. Upon their reintegration into the psychiatric environment, the patient began to exhibit signs of physical distress: ongoing abdominal pain, increasing wound discomfort, and indications of possible infection. Despite the known risk of complications following abdominal surgery, especially in patients with repeated self-harm behaviours and complex psychosocial needs, the care team did not appear to respond with sufficient urgency. There were repeated delays in clinical escalation, fragmented documentation, and a concerning absence of integrated monitoring between physical and mental health indicators. Catherine’s comprehensive review of the case records revealed a pattern of missed opportunities to intervene appropriately. Nursing notes and observation charts reflected inconsistent documentation of the patient’s post-surgical symptoms, with no clear rationale for why decisions were delayed or dismissed. There was no evidence of timely escalation to the medical team when signs of infection began to emerge. The lack of a structured, multidisciplinary follow-up plan - despite the high-risk nature of the patient - compounded the issue. One of the most troubling aspects of the case, as Catherine outlined in her report, was the apparent disconnect between mental health care planning and physical health monitoring. The patient’s symptoms were frequently attributed to behavioural distress or psychological manipulation, rather than being assessed clinically and holistically. As a result, their genuine physical needs were not met with appropriate care responses. Catherine also highlighted the absence of adaptive care planning. Despite the patient’s known history of complex self-harming behaviour, there was little evidence that the clinical team adjusted their care strategies or risk management framework in response to their deteriorating condition. Instead, care plans remained largely static, and the multidisciplinary team did not appear to engage in dynamic clinical review. In her expert opinion, the care delivered fell significantly below the standard expected of a reasonably competent mental health nurse working within such a setting. The failure to assess, document, escalate, and manage the patient’s physical symptoms in a timely manner constituted a breach of duty. Catherine made it clear that the patient’s subsequent re-admission to hospital, and the considerable discomfort they experienced during this period, were likely preventable. Her written evidence contributed critically to the legal case, offering a detailed account of where care delivery broke down and how professional nursing standards were not met. Drawing on national guidance and her own clinical leadership experience, Catherine provided the court with clear, structured reasoning to support her conclusions. Her report not only helped to clarify individual accountability but also reinforced the importance of integrated, patient-centred care in mental health settings. Conclusion This case underscores the crucial contribution of a specialist mental health nursing expert in both healthcare accountability and legal proceedings. Catherine’s analysis not only clarified what went wrong but offered a measured framework for what should have occurred. Her insights were grounded in the fundamentals of good nursing care: observation, escalation, documentation, and professional judgement. For healthcare providers, it serves as a reminder that clinical responsiveness must be consistent and patient-centred. For legal professionals, it highlights how expert testimony can translate clinical complexity into clear, actionable findings.

What is a Pressure Sore? Pressure sores, also known as pressure ulcers or bedsores, are areas of damage to the skin and the tissue underneath . They are a significant yet preventable harm associated with inadequate patient care. These wounds, which form over bony prominences due to unrelieved pressure, remain a frequent concern in hospitals, care homes, and community settings. Pressure ulcers are graded from Category 1 (non-blanching erythema) to Category 4 (full-thickness tissue loss). They can be extremely painful, debilitating, and in advanced cases lead to infection, sepsis, or death. As preventable injuries, pressure sores frequently feature in medico-legal cases where standards of nursing care are called into question. In these scenarios, the insight of a Tissue Viability Nursing Expert  becomes critical for understanding whether a breach of duty occurred, and whether that breach led to patient harm. How Do Pressure Sores Develop? A sacrum pressure sore - one of the most common areas for pressure sores to develop. Pressure sores develop when blood flow to skin and tissue is restricted by sustained pressure, shear, or friction. Over time, this lack of oxygen causes tissue breakdown and cell death. Patients most at risk are those who are immobile, post-operative, frail, malnourished, or incontinent. Without regular repositioning, adequate skin inspections, and appropriate use of pressure-relieving equipment, tissue damage can occur in a matter of hours. Other common high-risk pressure sore areas include the heels, hips and elbows . When Do Pressure Sores Become a Legal Issue? In the medico-legal world, pressure sores often represent an alleged failure in fundamental care. Claims may arise when: Risk assessments (e.g. Waterlow Score ) are not completed or acted upon Repositioning schedules are missed or undocumented Early signs of tissue damage are not escalated Documentation of care is missing, vague, or inaccurate Equipment (e.g. pressure-relieving mattresses) is not used appropriately or timely The Waterlow Chart - a valuable tool that takes a holistic approach to assessing and preventing the risk of pressure sores developing. Coroners, solicitors, and regulators frequently turn to an independent Tissue Viability Nursing expert witness to determine if the pressure sore was avoidable and whether the care provided fell below the expected standard as defined in Bolam v. Friern Hospital Management Committee (1957) and Bolitho v. City and Hackney Health Authority (1997) . The Role of a Tissue Viability Nursing Expert Witness A Tissue Viability Nursing expert witness is a senior nurse who will provide impartial, objective, evidence-based analysis to determine if there is a breach of duty in the standard of care provided. Their responsibilities include: Reviewing nursing records and wound charts Evaluating whether pressure ulcer prevention protocols were followed Assessing whether a sore could have been avoided Clarifying timelines of deterioration and care delivery Providing CPR Part 35-compliant reports and Court-ready evidence Their expert opinions help establish whether a pressure injury resulted from substandard care, or whether the injury was unpreventable due to the patient's overall condition. What Sets Apex Experts Apart in Pressure Sore Expert Witness Cases? We are experienced in providing top-quality expert advice in pressure sore litigation. We exclusively work with nursing professionals at the top of their field, who have first-hand clinical experience in Tissue Viability Nursing and pressure sore management and prevention. Our Tissue Viability Nursing expert witnesses are trained to deliver clear, objective and impartial expert advice that holds up under legal scrutiny. For further information on our expert witness services, recruitment, or anything else, please contact us at info@apexexperts.co.uk or visit our contact us page to send us a message - we can't wait to hear from you!

Mental Health Awareness Week: Looking Back, and Looking Ahead Last week’s Mental Health Awareness Week (12th - 18th May 2025) was a timely reminder of how important it is to talk about mental health. But more than that, it was a chance to celebrate and acknowledge the people who dedicate their careers to supporting others through emotional distress, crisis, and recovery: mental health nurses. At Apex Experts, we want to extend a heartfelt thank you to these professionals, whose work often goes unseen but never unnoticed. The Vital Role of Mental Health Nurses in Every Setting Mental health nurses do so much more than provide clinical care. They are listeners, advocates, crisis managers, and sometimes the only constant in a person’s care journey. They work in hospitals, in people’s homes, in schools, prisons, and community teams. And in each setting, they bring empathy, skill, and strength. Nurses provide crucial support in multiple ways and we are proud to support our panel of experienced Nursing Expert Witnesses. The vital role of mental health nurses extends far beyond bedside care, they are critical to recovery, safety, and dignity for countless individuals navigating mental illness . Their impact is felt not just by patients, but by families, colleagues, and wider communities. Their role requires resilience, emotional intelligence, and deep compassion - all while navigating complex systems and often limited resources. It’s not easy, but it’s essential. Let’s Keep the Momentum Going It’s easy to speak about mental health one week of the year. But the real impact comes when we carry those conversations forward, by recognising the value of mental health nurses not just in May, but all year round. These professionals are key to early intervention, crisis response, and ongoing recovery support. They help people feel safe, heard, and human. They make the difference between surviving and healing. Mental Health Nurses in Medico-Legal Work Many of the mental health nurses we work with at Apex bring their knowledge into the legal and regulatory space as expert witnesses . Their insights can be crucial in shaping fair outcomes, highlighting systemic issues, and ensuring care standards are upheld. Supporting the People Who Support Others Our role at Apex Experts is to support nurses - not just in expert witness work, but as individuals. We provide training, administrative support, flexibility, and a team that understands the emotional realities of the job . To Every Mental Health Nurse: Thank You As we reflect on this year’s Mental Health Awareness Week, our message is simple: thank you. Thank you for the work you do, the people you support, and the difference you make. And most importantly, thank you for showing up with kindness, even on the hardest days. For further information on our expert witness services, recruitment, or anything else, please contact us at info@apexexperts.co.uk  or visit our contact us page to send us a message  - we can't wait to hear from you!