News Category 3
FREE CHAPTER from ‘A Practical Guide to Clinical Negligence – 2nd Edition’ by Geoffrey Simpson-Scott

09/10/20. Modern clinical negligence litigation remains complex. It requires the detailed and accurate assessment of the case; an understanding of many different areas of medicine and clinical practice; and the ability to marshal seemingly ambiguous evidence in a way which best meets your client’s needs.
The second edition of this book provides practical guidance to practitioners across 8 chapters covering proportionate case preparation, evidential analysis, negotiation style all illustrated with reported case law. The case list and index provide quicker access to the relevant points you will encounter.
CHAPTER ONE – COSTS & FUNDING
Introduction
Improving results through avoiding ambiguity and adopting a planned approach to managing your caseload remains one of the central themes of this book. This chapter considers why it is essential to get the funding options right at the start of the case in order to avoid fundamental cost recovery problems arising at the end of it. In so doing, it is helpful to consider the costs issues which are likely to arise during the case so that you can have the correct sort of evidence on file to either head off the problem(s) or persuasively deal with them as needed.
Funding
As clinical negligence cases are proportionately more complicated than many other types of civil litigation of comparable value, the costs tend to be higher. This is an attractive lure for claimant firms but not necessarily for claimants themselves. Defendant organisations regularly publish figures purporting to show that claimants’ costs are excessive and the average claimant cannot take the risk of having to bear legal fees. However, the position post-Jackson is that they are expected to bear at least some of the costs. Clients are consumers of legal services and lawyers are increasingly finding ourselves part of a professional services industry.
This creates fertile ground for conflict on almost every clinical negligence case and so practitioners need a sound plan to deal with it. The winner is entitled to recover their proportionate costs of being required to prosecute or defend the action from the loser. The loser is entitled to seek to minimise these costs and seek assurances that professional obligations (such as the indemnity principal) have been properly complied with. This can leave the clients paying for the shortfall.
Accordingly, it is essential to get the funding and funding advice right from the start. Achieving this will make both your client’s and your position much more secure. There is little point in doing an excellent job in winning the case if you then do not get paid for it.
As one case finishes, another starts. You have cases at various stages from initial assessment to costs recovery. The same funding and costs issues are likely to arise again and again on these cases, although not all of them will arise on every case. Using the lessons learned from one case will help you on the others. Developing a professional process which allows you to replicate success again and again will allow you to control your case progression much better.
Client Care Information
A clear explanation of the funding method and potential costs liabilities needs to be given to your client before any substantive work is undertaken. Most firms seek to cover all of the bases by sending out a detailed client care information pack with the initial explanatory letter. Many clients find the morass of information they receive confusing and so will often not fully understand the minutiae. They tend to appreciate that there is some risk of paying something and will often need to be given a clearer explanation of what their potential liability and obligations are. It is advisable to keep a clear record of what they were told (including any amounts they might need to pay and possible scenarios which might lead to this) in case you need to prove that they were given the correct advice later in the case. Given the day-to-day pressures of running a case, this can be easily overlooked by even the most experienced of practitioners. If the task is delegated to junior colleagues, an effective supervision mechanism needs to be employed and maintained to ensure compliance with these requirements because the act of delegation by itself is rarely sufficient to satisfy a costs judge.
A commonly encountered issue at the conclusion of a case is whether the retainer itself was enforceable. There is no requirement that this possibility should be raised during the life of the case and so the risk is that too much time has elapsed to correct any problems. Even if a relief from sanctions application (under CPR 3.9) is possible, the additional cost, delay and risk this causes is undesirable to your client and your firm. The status of all of the fee-earners who may deal with the case needs to be agreed in advance by your client along with the hourly rates your firm intends to charge for them (see Pilbrow v Pearless de Rougemont & Co (A Firm) [1999] 3 All E R 355, CA). This is particularly so where the hourly rates charged are unusually high (e.g. Swain v J C & A Ltd [2018] EWHC B3 (Costs), para. 27). If a fee earner does work on the case but has not been properly described, then those fees are irrecoverable from the losing party.
It is also entirely possible that the different documents in the client care pack have been updated at different times and so include different rates. If this is not corrected, then the lower rates will usually be applied. Where the rates change during the life of a case, then that must also have been notified to your client with suitable written evidence being kept on your file. Although the client care information is privileged, the losing party will often request sight of it having raised the issue of non-compliance in the points of dispute.
Public Funding
The availability of public funding is now so limited so as to be the exception rather than the rule. If your firm does hold a legal aid Franchise, then the Manual provides detailed guidance on the requirements to be followed.
All claimants’ solicitors are under a duty to advise on all of the available funding options. If a prospective client appears to be eligible for public funding, then this means advising them of this and signposting them onto a franchised firm even if this means losing the case. However, one of the issues with public funding is that the hourly rates allowed for experts are still relatively low. This means that your preferred expert may well refuse to act. As the defendant is usually not so constrained, there is a genuine risk of inequality of arms and this can justify advice that public funding is not the best option. If so, then it is usually advisable not to charge the client additional liabilities so that they are in the same position as if public funding had been used.
Considerable care needs to be taken in the advice given to claimants when switching from legal aid to a CFA (e.g. covering the prospects of success, how this affects the success fee and level of ATE premium, the reasonableness of changing the funding and how the legal aid costs & scope limits have been complied with) following decisions such as XDE v North Middlesex University Hospital Trust [2020] EWCA Civ 543, Surrey v Barnet and Chase Farm Hospitals NHS Trust [2018] EWCA Civ 451 and AB v Mid Cheshire NHSFT [2019] EWHC 1889 (QB). As a general guideline, it is advisable to allow the claimant to make a fully informed decision which, perhaps years later, can objectively be seen to have been in their best interests.
Before the Event Legal Expenses Insurance (BTE LEI)
BTE LEI is now commonly included with other insurance policies. The advantage to the claimant is that they obtain a substantial amount of legal cover for little or no additional cost. This is more beneficial to claimants and defendants than After the Event (ATE) insurance policies which have higher premiums and so their availability and suitability needs to be carefully considered at the start of the case.
There may be valid reasons for not using the BTE policy. The indemnity limit may not be sufficient to cover the costs of the entire case to trial. The limit is usually intended to be divided equally between the claimant’s and defendants’ costs. If you have a multiple defendant case, then this can reduce the amount of cover available for each party’s adverse costs and disbursements significantly. The scope of the cover and any exclusions need to be carefully checked to ensure that the particular type of case you are dealing with is covered by the policy. For example, omissions of care or the acceleration of an injury may appear to be excluded and clarification needed.
The claimant ought to be asked for a copy of their insurance policies (rather than ‘legal expenses’ insurance policies which might confuse them) and a clear record kept of these being checked by you.
It is likely that the BTE insurer will require a formal application to be made before it will agree to indemnify your costs. Any costs which you incur before this may well not be covered by the policy. Most BTE insurers have selected a panel of specialist firms of solicitors whom they prefer to instruct and so a freedom of choice application will often be required.
Freedom of choice remains a somewhat vexed question in practice. The European Court of Justice’s ruling in Eschig v UNIQA Sachversicherung AG (C-199/08, 10/9/2009) appears to require insurers to allow freedom of choice in ‘proceedings’ (which does not necessarily mean just ‘issued proceedings’) as a result of the relevant EU Directive (now Directive 2009/138/EC, Article 201(1)(a)). However, the Financial Ombudsman Service interprets the enabling regulations (the Insurance Companies (Legal Expenses Insurance) Regulations 1990) as allowing insurers to refuse granting Freedom of Choice to non-Panel firms pre-proceedings. The FSO’s website (www.financial-ombudsman.org.uk/publications/
technical_notes/legal-expenses.html) confirms that it will look at each complaint on its merits but will not criticize a refusal unless there are exceptional circumstances.
The panel firm will usually be asked to assess the freedom of choice question and the merits of the case at the same time. It is advisable to send them a helpful breakdown of the proposed case on limitation, breach of duty, causation of damage and quantum issues; the core supporting evidence; and a summary of the proportionate investigative steps you wish to take in order to minimise the risk of delays occurring. If you can show that you have carefully considered the case, then the chances of agreeing to your request for funding are greatly improved.
In Orde van Vlaamse Balies & Another v Ministerraad [C-667/10, 11/12/
2019], it was held that this freedom to choose one’s own lawyer must also apply to mediation (which comes within the definition of ‘proceedings’ in Article 201(1)(a))
Conditional Fee Agreements
The Legal Aid, Sentencing & Punishment of Offenders Act 2012 (‘LASPO’) allows a success fee of up to 25% of the claimant’s damages for past losses and PSLA to be deducted from their damages. Accordingly, a claimant who agrees to this method of funding is likely to receive less compensation than a client who has BTE insurance. This relative disadvantage to clients can only partially justified on the basis that parliament has imposed this change and so the client still needs to be properly advised if problems are to be avoided.
One of the aims of the Jackson reforms was to reduce the amount of satellite costs litigation by making a failure to advise clients properly a regulatory client care issue rather than an inter partes issue over whether the success fee had to be paid. Accordingly, the issue should be one between the client and their advisors. If a complaint is raised, it is likely to result in delays to completing the case whilst the complaint (and possibly a solicitor-own client Detailed Assessment) is resolved. This is likely to reduce cash flow and profitability. However, XDE (supra) shows that a challenge to the recoverable part of the ATE premium can also prevent recovery of the success fee.
It is often assumed that the success fee cap (under the Conditional Fee Agreements Order 2013) means that no detailed risk assessment would be needed. However, because 25% is a cap, the success fee can be anywhere between 0-25%. This range creates the scope for clients shopping around and seeking an explanation as to why you set the success fee at a given amount.
If it is always set at 0%, then there is probably little need to do a separate risk assessment. However, this does not necessarily make good business sense or reflect the realities of each case. If it is always set at 25%, then a risk assessment helps to show the client why you consider that the risks justifies this and may demonstrate that your competitors have missed an important risk in the case. Another alternative is to carry out some investigative work before setting the success fee (although this must be funded some other way).
Whatever system is adopted, it must be properly explained to the client so they can make an informed decision. This is essential in children’s cases. CPR Part 21 requires that the advice given to the litigation friend about how the success fee was set be disclosed to the court before the infant approval hearing along with a witness statement from the litigation friend confirming why they agreed to this. The relevant risks are those relating to the child only not anyone else. Although these rules technically only apply to cases worth under £25,000, it is difficult to see why less protection would be afforded to children with more valuable cases. A bespoke approach to each case is advisable (see A & M v Royal Mail Group [2015] EW Misc B24 (CC)).
The relevance of consumer protection legislation should also not be underestimated. The Consumer (Information, Cancellation & Additional Charges) Regulations 2013 set out specific requirements for advising any consumer of their right to cancel the contract where it is not signed at the place of business. Since most CFAs are sent out to clients for signature and return, that solicitor must ensure that the cancellation rights have been properly explained. Cox v Woodlands Manor Care Home Ltd [2015] EWCA Civ 415 confirms that failing to do so renders the entire CFA unenforceable and so also prevents the recovery of base costs against the losing party as the indemnity principle has been breached. Although the cancellation point was not in issue in AH v Lewisham Hospital NHS Trust [2016] EWHC B3 (Costs), at para. 69, Deputy Master Campbell made an observation that Cox “…is illustrative of the fact that the quality of the advice is capable of having a significant bearing on how much the paying party is required to pay under a costs order even where the client takes no issue with that advice.”
After the Event Legal Expenses Insurance
Qualified One-Way Costs Shifting (‘QOCS’) operates so as to greatly reduce the risk of paying the defendant’s costs if the case is lost. Post-Jackson, the ATE insurance premium is generally unrecoverable from the losing defendant. However, unlike in personal injury actions, part of the ATE premium may be recoverable in clinical negligence actions (see The Courts & Legal Services Act 1990, s58C (as amended) and the Recovery of Costs Insurance Premiums in Clinical Negligence Proceedings (No. 2) Regulations 2013, Regulation 3). The key word here is ‘may’ and so it is prudent to notify the defendant that you will be seeking to include the recoverable part of the premium in any monetary settlement as soon as is practicable after taking out the policy. The pre-Jackson practice of giving notice in the letter of claim remains relevant.
At present, the recoverable part of the premium insures against the costs of obtaining expert evidence on liability issues. It may also cover the risk of failing to beat an opponent’s Part 36 offer. The irrecoverable part of the premium tends to cover a wider set of risks and is paid by the claimant out of their damages. The available products vary between providers and new products are always a possibility so the precise terms of the product on offer need to be considered and agreed to by the client (including their cancellation rights).
Accordingly, the client must decide whether they want to pay for insurance. If they do not, then another means of disbursement funding must be found. There are companies who offer specific disbursement-only funding credit, but a detailed consideration of these (and other) options is outside the scope of this book. Whilst leaving the ATE application until after the letter of response has been received may seem an attractive course of action, if a denial is received, it may lead to cover being justifiably refused or a higher premium being paid by the claimant.
The same considerations as were discussed above for CFA advice apply to the ATE advice. The reasonableness of a fairly typical ATE product was considered in Nokes v Heart of England Foundation NHS Trust [2015] EWHC B6 (Costs). Although the premium was found to be reasonable on the facts, it left open the possibility that the issue could be revisited if defendants could find better evidence on another case. In McNenemy v Peterborough & Stamford Hospitals NHS Trust [2017] EWCA Civ 1941, it was held that the premium was recoverable even if the expert report had not actually been obtained. In West & Demouilpied v Stockport NHSFT [2019] EWCA Civ 1220, a comprehensive fact-finding exercise was undertaken and block-rated premiums were effectively found to be reasonable and proportionate. It remains possible that further satellite litigation may focus on further sub-issues surrounding ATE premiums as not every possibility was covered off. However, at present, challenges based on a comparison with another policy should be at an end.
Costs
Although the general rule that costs follow the event remains intact (CPR 44.2(2)(a)); the court has a wide discretion in deciding whether to award costs (CPR 44.2(1) and 44.2(2)(b)). Relevant factors include the conduct of all parties; the extent to which the winner has succeeded on all issues they pursued; and the effect of settlement offers made and refused (CPR 44.2(4) & (5)). The court may order that only some of the winner’s costs need to be paid (see CPR 44.2(6)(a-g)) so recovery may be less than 100% even before the assessment begins.
The standard order for ‘100%’ recovery is that the loser pays the winner’s costs on the standard basis, to be assessed if not agreed. This does not mean that the winner is likely to recover all of their costs. The twin precepts are that the costs must have been reasonably and proportionately incurred. As this is a question of fact, each case is likely to have significant scope for argument over the amount to be paid. At the start of the case, the client needs to be advised as to who will meet any shortfall and in what circumstances they might become liable. As the costs arguments are largely predictable, your client will expect you to minimise any losses or else expect your firm to bear them.
Proportionality
The Jackson reforms redefined this and ‘necessity’ is no longer considered relevant. That said, clinical negligence claims are usually complex enough to include what would have previously been described as ‘necessary’ within the new definition.
CPR 1.1 requires courts to deal with cases at a proportionate cost. CPR 44.3 sets out the test for assessing this for costs incurred after 1st April 2013. Specifically, CPR 44.3(5) sets out a 5-stage test:
“(5) Costs incurred are proportionate if they bear a reasonable relationship to –
-
The sums in issue in the proceedings;
-
The value of any non-monetary relief in issue in the proceedings;
-
The complexity of the litigation;
-
Any additional work generated by the conduct of the paying party; and
-
Any wider factors involved in the proceedings such as reputation or public importance.”
There is much scope for interpretation because there is no genuinely authoritative guidance. This rule does not prioritise any one factor. However, it is usually assumed that the emphasis is on 5(a). There is no stipulation that costs must be less than the amount recovered although this is the interpretation which should be contended for by the losing party. Costs awards higher than the damages award are well-known and this can be the position adopted by the winner. Costs which are less than the damages are not automatically or prima facie proportionate and so the loser is entitled to seek further reductions. The winner needs to have been planning to address this from the outset not least because the court can make a costs order at any time (CPR 1.1) and the case is likely to be costs budgeted.
The value of non-monetary relief is usually the least important of these factors in clinical negligence. However, if receiving an apology (for example) is especially important to a claimant, then this is likely to be relevant. The timing of the apology or the failure to provide one would then also be relevant considerations.
The complexity of the litigation appears to provide much greater support to the winner. However, the point is often made that the case is not, in fact, complex when compared to other clinical negligence cases and given the evident expertise of the solicitor who has just won it. Other common arguments are that one-expert cases are obviously not complicated or that suitable admissions render the case a simple one. This is not obviously wrong in the absence of contemporaneous evidence accrued during the life of the case even though the CPR is intended to cover all types of civil litigation. If you want to persuade the court that your position is the more reasonable, then the winner is well advised to have plenty of evidence showing that they raised specific points regarding the complexity of the matter during the case whilst the loser ought to be able to prove that they sought to keep costs down due to the case’s relative simplicity.
‘Additional work’ or ‘conduct’ arguments (5(d)) are very often useful in this context although they need quite a lot of advanced preparation to be persuasive. The paying party is understandably unlikely to accept that their approach to the case increased costs even when faced with carefully prepared evidence. This means that an assessment hearing is more likely to occur. Conversely, the paying party may raise conduct issues under CPR 44.2(4) & (5) even though CPR 44.3(5) refers only to the paying party’s conduct. It is useful to bear in mind that the loser’s costs draftsman is likely to have prepared such points from their client’s file so the winner ought to plan ahead for this by raising conduct issues in correspondence. At the very least, the response you will get gives you advanced notice of your opponent’s position and may help to resolve the issue more quickly. Malmstein v Bohinc [2019] EWHC 1386 (Ch) emphasises the importance of providing directly supportive evidence.
‘Wider factors’ (5(e)) may appear to be less relevant. However, a proportion of cases will be fully defended on the basis that the medic’s professional reputation can only be exonerated by forcing discontinuance or winning at trial. This argument is often persuasive to a judge even where there is no evidence presented that the medic’s reputation has actually suffered. However, if the defendant is allowed to use this argument, then the claimant ought also be able to rely on it to show that the costs of the action increased unnecessarily as a result of the refusal to settle.
Reasonableness
Reasonableness is subordinate to proportionality. It is not mentioned in CPR 44.3(5). There is a 2-stage test in assessing costs. Firstly, the court assesses the reasonableness of the costs by analysing the individual items in the Bill, the time reasonably spent on these items and the CPR 44.5(3) factors. Having done so, the judge should then take a step back and decide whether the total figure is proportionate. If it is not, then it should be reduced accordingly (see Malmstein, supra). As the previous test of whether the costs were ‘reasonably and necessarily incurred’ (under Lowndes v Home Office [2002] EWCA Civ 365) is now incorrect, reasonableness depends on proportionality not necessity. If an item of costs looks disproportionate in either being incurred or the amount that was spent on it, then it is probably also unreasonable on the standard basis (where uncertainty is resolved in the paying party’s favour). However, the courts still hear arguments that the deduction for unreasonableness is sufficient to also cover proportionality (Malmstein, supra). An example of the difficulties some judges are having in separating the two precepts is provided by Savoye and Savoye Ltd v Spicers Ltd [2015] EWHC 33 (TCC).
Reasonableness has separate relevance if the assessment is on the indemnity basis as proportionality is irrelevant (CPR 44.3(3) does not refer to it) and uncertainty is resolved in favour of the receiving party.
Helpful Case Law
It remains difficult to provide much useful guidance on this issue beyond saying that making it clear in contemporaneous attendance notes and correspondence explaining why you felt that any given costs item was or was not reasonable and proportionate is likely to assist the court in reaching a reasoned decision on this difficult issue. However, many cases do not reach an assessment so you (or your costs draftsman) need to be able to persuasively negotiate the issue.
Such guidance as is available needs to be cited in its proper context. Presently, the general position can perhaps best be illustrated by Ted Baker plc v Axa Insurance UK plc [2014] EWHC 4178 (Comm). Lord Neuberger said obiter that “…disproportionate costs, whether necessarily or reasonably incurred, should not be recoverable from the paying party. To put the point quite simply, necessity does not render costs proportionate.”
In Hobbs v Guy’s & St Thomas’ NHSFT [2015] EWHC B20 (Costs) the claimant’s costs in a fairly straightforward case settling pre-issue were reduced significantly because they had not been reasonably incurred and then because they were still disproportionate. However, Master O’Hare also said (at para. 35) that “Even in modest value clinical negligence claims it is necessary to incur costs … clinical negligence claims have more complexity and involve more work than do other claims of similar value.”
In May & Another v Wavell Group plc & Another [2016] EWHC B16 (Costs), the claimant’s costs were approximately 9 times the value of the pre-issue settlement (partly because a QC had been instructed via direct access). Reasonable costs were assessed at approximately four times the settlement value and then this was reduced to less than 1½ times on proportionality grounds. At para. 35, Master Rowley said “The amount that can be recovered from the paying party is not the minimum sum necessary to bring or defend the case successfully. It is a sum … only a contribution to that receiving party’s costs in many modest cases.” Similarly, at para. 42 that proportionality “will require legal representatives to inform their clients that, even if successful, they will receive no more than a contribution to the costs that will be incurred” and that this is intended to promote settlement. This creates the risk of the client paying a considerable shortfall, possibly even exceeding the value of their damages. However, at para. 45, the Master also said that “Sir Rupert Jackson refers to the possibility of low value but complex litigation incurring costs above the value of the damages” so does not preclude recoverable costs exceeding damages.
BNM v MGN Ltd [2016] EWHC B13 (Costs) provides the first indication that judges are prepared to give a ratio to assist in determining proportionality. At para. 49, Master Gordon-Saker states that base costs of over 3 times the settlement value must be disproportionate and costs of around 1½ times would be proportionate.
In Murrells v Cambridge University NHSFT [2017] EWHC B2 (Costs), the 100% success fee was found to be too high because the prospects of success were better than 50/50. An 82% success fee was substituted (para. 9). However, the already-reduced base costs were considered to be proportionate and the complexity of a modestly valued clinical claim was recognised (para. 52)
In Rezek-Clarke v Moorfields Eye Hospital NHSFT [2017] EWHC B5 (Costs), reference was made to the need for the experts’ fees to be reasonable and proportionate. At para. 23, Master Simons reduced some of these fees and noted with some approbation the practice of charging large fees for addendum reports. At para. 25, he noted that costs of over £70,000 bore no reasonable relationship to the agreed damages of £3,250.
This is an area which is likely to continue to see satellite litigation.
Qualified One-Way Costs Shifting (QOCS)
QOCS protects the losing claimant from paying the defendant’s proportionate costs. As this protection is not guaranteed in every case so caution is needed. The injury element of a clinical negligence claim brings it within the scope of the definition under CPR 44.13(1). However, a pre-action disclosure application is not covered.
A successful claimant may be awarded damages but fail to beat the defendant’s Part 36 offer. In that case, the claimant stands to lose the damages which go towards paying the defendant’s costs. CPR 44.14 allows an order for the full amount of the defendant’s costs to be paid (in this case from the date the relevant period of the offer expired) but then limits the payment to the amount of damages recovered. In short, the claimant would get a pyrrhic victory but their solicitor can claim some of the costs (up to the point when the offer should have been accepted). Conversely, QOCS protection puts defendants in substantially the same position as they were when public funding used to be more widely available. In most cases, if they win, they bear their own costs because there is no award of damages. However, in Ho v Adelekun [2020] EWCA Civ 517, the court’s power under CPR 1998 Part 44.12(1) to set off defendants’ costs entitlement against claimant’ costs was applied to a QOCS case. This will now be considered by the Supreme Court.
Whether this is likely to result in defendants making low Part 36 offers on cases they believe will fail is open to question. CPR 44.15 allows them to recover their costs in full where the case has been struck out but this is a relatively rare occurrence in clinical negligence cases. CPR 44.16 may provide a more fruitful avenue, however. If the claimant is found to be fundamentally dishonest, then the defendant will be entitled to apply to the court to recover all of its costs. The judge then needs to decide whether it is just to allow this. What amounts to fundamental dishonesty is itself still very unclear which creates risks for both sides.
Wagenaar v Weekend Travel Ltd & Another [2014] EWCA Civ 1105 has held that QOCS is not ultra vires and does not apply to Part 20 Proceedings. Accordingly, separately represented defendants in clinical negligence actions appear not to be able to invoke QOCS protection against each other.
Costs Budgeting
QOCS may be resulting in lower and less-controversial costs budgets from defendants for these reasons. Alternatively, it may be that it is in their interests to file budgets at the lower end of the reasonable range in order to improve their chances of reducing their potential exposure to the claimant’s costs. Costs budgets which are properly linked to the remaining issues on the case do provide excellent opportunities to reduce costs. However, budgets which are simply too high or low do not achieve this.
The key practical question is knowing how to correctly price the remaining work on the case. If you underestimate it, then you will end up either having to try to get a revised budget approved or face difficulties with your client. Accordingly, it can be safer to over-estimate the work even though the purpose of costs budgets is to assist the court in its duty to prevent disproportionate costs being incurred. Tactically, it is in the defendant’s interests to have lower budgets imposed for both sides because the burden of proof of negligence is on the claimant. As will be seen in later chapters, the claimant generally bears the risk of leaving stones unturned. However, a defendant who has a ‘low’ budget agreed but then finds the claimant has had a ‘high’ budget approved has only succeeded in hobbling themselves.
The disparity between the parties’ budgets is also skewed further because the claimant is likely to have already incurred significant costs in investigating and attempting to settle the case pre-proceedings. Front loading a case remains reasonable; Jackson LJ made it clear in his 12th pre-implementation lecture (https://www.judiciary.gov.uk/wp-content/
uploads/JCO/Documents/Speeches/lj-jackson-twelfth-lecture-
implementation-programme-22032012.pdf) that he expected meritorious cases to settle pre-proceedings.
Incurred costs, however, cannot be budgeted; the best that the court can do is to record an adverse comment as to the amount that has been incurred and to take that amount into account when budgeting the remaining phases. This issue is not helped by the time it takes for Costs CMCs to be listed. A combined hearing (directions and costs) is typically listed for 90 minutes which has resulted in significant listing delays at the RCJ. In the County Court, if the CCMC is listed separately, there are examples of it taking place well into the directions timetable, as late as after expert evidence has been exchanged.
The parties’ respective budgets tend to raise the same issues seen at the end of the case. Accordingly, points relating to excessive hourly rates, hours spent, simplicity of the case, etc are frequently raised by defendants to counter what are arguably unreasonably high budgets prepared by claimants. CPR PD3E 7.3 provides that the courts approval will relate only to the total for each phase of the budget rather than performing a detailed assessment. It will consider whether the proposed figures are within a reasonable and proportionate range (with reference to the CPR 44.3(5) factors considered above). However, in doing so, the court may take into account the constituent elements of those figures.
As the prescribed budget form (Precedent H) requires details of hourly rates, hours spent and disbursements, this creates the opportunity for each side to invite the judge to have regard to those figures because they are used in calculating the phase totals. In Yeo v Times Newspapers Ltd [2015] EWHC 209 (QB) Warby J offered this guidance at para. 65:
“It seems to me that whilst the question of whether the totals are reasonable and proportionate will always be the overall criterion, the courts may need to consider rates and estimated hours. The approach may need to be tailored to the case before the court.”
In cases where the costs run to six or seven figures, Warby J felt that this was all the more likely. Where a costs budget has been carefully prepared with reference to the issues still in dispute, it entirely reasonable for the costs to exceed £100,000 even in modestly valued claims. However, a successful challenge to an opponent’s budget is a case management decision and therefore very difficult to appeal (see Havenga v Gateshead NHS Foundation Trust & Another [2014] EWHC B25 (QB)).
In many cases, however, it is possible to agree most or all of a proposed budget. The QBD Masters in particular require evidence of the early exchange of costs information and offers being made in respect of the disputed phases. Other courts require a summary of the issues in dispute to be exchanged; and failing to do so can lead to wasted costs orders being made.
The risk of being limited to court fees only for failing to file a correct budget on time is a significant incentive for claimants to adopt an overly cautious approach. Contingencies ought to be included if they appear to be reasonably necessary (but cannot be included in a budget phase) and there is no guarantee that permission will be granted later for the budget to be revised if this is not done.
All-in-all, costs budgeting is only likely to prove effective if both sides make a determined effort to narrow the issues in dispute to what is genuinely needed to resolve the proceedings. The more that remains in dispute, the higher the costs are likely to be. The judge needs to be presented with clear evidence of this in order to properly understand why these issues remain in dispute and the costs associated with them. They can then make a more reasoned decision also whether the costs of pursing those issues are proportionate and reasonable rather than making ‘harsh’ decisions on the facts as arguably occurred in Havenga (ibid.). The later chapters consider this in further detail.
Effect On Assessments
Once a budgeted case has concluded, the loser is still entitled to seek confirmation that the approved total for each phase has not been exceeded even where the total bill is within the budget’s total. Accordingly, you need to have in place an effective system of checking the running total being spent on each phase. If it appears that a phase will be exceeded, then a prospective application for an amended budget will need to be considered. The risk is that your opponent or the court will need to see evidence of why this was not dealt with in the first budget so you need to be prepared to have good evidence on file as to how the problem has arisen since then.
As long as the budgeted phases are within the approved totals, then there ought to be little scope for arguing that further reductions should be made. However, it is likely that the budget was approved but the court’s position on the hourly rates claimed was reserved. Thus, the traditional arguments over hourly rates remain.
The guideline hourly rates (GHRs) can be found here: https://www.gov.uk/solicitors-guideline-hourly-rates . They have not changed since 2010 and Lord Dyson MR has confirmed that “[t]he existing rates will remain in force for the foreseeable future, and will remain a component in the assessment of costs, along with the application by the judiciary of proportionality and costs management.” (https://www.judiciary.gov.uk/
publications/guideline-hourly-rates/ 17th April 2015). However, on 6th March 2020, the Civil Procedure Rules Committee decided that another review will be held.
It is important to remember that GHRs are for summary assessment not detailed assessment. In Higgs v Camden & Islington Health Authority [2003] EWHC 15 (QB), Fulford J held that they were of only limited assistance in that catastrophic injury case and the criteria set out in the CPR (i.e. those factors considered above) were relevant. He also stated at para. 51:
“Further the guideline figures are not supposed to replace the experience and knowledge of those familiar with the local area and the field generally… it is expressly recognised in the Guide that costs and fees exceeding the guidelines may well be justified in an appropriate case as an exercise of discretion.”
In Choudhury v Kingston Hospital NHS Trust [2006] EWHC 90057 (Costs), Master Rogers emphasised that relying on past decisions on hourly rates is unhelpful and each case must turn on its own facts. However, he did not feel constrained by the guideline rates where there was evidence of complexity and of how the solicitor’s experience contributed to winning the case. At para. 65, he commented:
“The rates claimed are higher than set out in the SCCO Guide to Hourly Rates, but, as been said many times, that is a document which is intended to govern fast track matters concluding in one day, and other interlocutory matters that conclude in the same period, the rates set out therein are not intended to cover the generality of litigation.”
In Ohpen Operations UK Ltd v Invesco Fund Managers Ltd [2019] EWHC 2504 (TCC), O’Farrell J (para. 14) stated that “[i]t is unhelpful that the guidelines are based on rates fixed in 2010…as they are not helpful in determining reasonable rates in 2019.” At para. 15 she continued: “The hourly rates cannot be considered in isolation when assessing the reasonableness of the costs incurred; it is but one factor that forms part of the skill, time and effort allocated to the application. It may be reasonable for a party to pay higher hourly rates to secure the necessary level of expertise, if that ensures appropriate direction in the case, including settlement strategy, with the effect of avoiding wasted costs and providing overall value.”
It is also true that the GHRs are comprised of generalised rates from a basket of local law firms doing a range of work. Accordingly, a specialist area such as clinical negligence is not well represented and a higher rate is justifiable. However, proportionality was not in issue in Ohpen (see para. 16) whereas it often is in clinical negligence. In Re RBS Rights Issue Litigation [2017] EWHC 1217 (ChD), Hillyard J said (at para. 134) “… litigants are free to pay for a Rolls Royce service but not to charge it all to the other side.” It is frequently contended that the GHR will be applied by the costs judge on the facts of the case. Just as inevitably, this means negotiating the best rate you can and carefully picking those cases you allow to go to an assessment hearing. Planning out the evidence you need from the start of the case greatly assists in getting the best result for you, your firm and your client.
The hourly rates claimed in the budget and bill of costs should be accurate and identical. In MXX v United Lincolnshire NHS Trust [2018] EWHC B23, Master Rowley held that the appropriate sanction where the budget and the final bill of costs contain different hourly rates is to disallow the time claimed in the bill claimed for creating and maintaining the budget as this is where the error occurred (para. 68). This followed his reasoning in Tucker v Hampshire Hospitals NHS Trust & Griffiths (19/5/2017, unreported). However, on appeal ([2019] EWHC 1624 (QB)), Slade J noted that the clear guidance as to what amounted to ‘unreasonable and improper conduct’ under CPR 1998 Rule 44.11 in respect of a bill of costs in Gempride Ltd v Bamrah & Another [2018] EWCA Civ 1367 required this issue to be reconsidered by the Master in the specific context of a costs budget.
Costs Orders
It is also useful to bear in mind the different types of costs orders which the court has permission to make. These are listed in CPR PD44 para.4.2. Knowing when to use these greatly increases your ability to deal with pre-trial applications and limiting the damage to your client or maximising the prospects of success. They can make the difference between paying your opponent’s costs or not.
One area that needs very careful advanced preparation is where you are dealing with multiple opponents. The basic problem is that, because costs follow the event, you may succeed against one party but lose against another, thus reducing or wiping out your client’s win. In order to avoid this, it is advisable to plan ahead from the start in any case where you face (or might face) multiple opponents (including Part 20 claims). The preferable order is a Sanderson Order (Sanderson v Blyth Theatre Co [1903] 2 KB 53) which orders the losing party to pay the costs of the other successful parties directly. The next best order is a Bullock Order (Bullock v London General Omnibus Co. [1907] 1 KB 264) which requires your client to pay the costs of the other successful parties put allows you to reclaim those costs from the loser.
As NHS Resolution usually does not take issue where you succeed against one Trust but fail against another, this risk tends to be underestimated. It is a very real risk when GPs and hospital Trusts are sued or private treatment is in issue (and the doctor and clinic are separately pursued). It is unclear the extent to which it arises when English and Welsh hospitals are pursued concurrently. The increasing prevalence of private hospitals carrying out NHS treatment also makes this issue relevant.
The need for careful, advanced preparation arises from the fact that you will need to prove that it was reasonable for you to involve the other successful parties so that costs should not follow the event. To do this, there needs to be good evidence that the way in which the unsuccessful party pursued its case meant that your client could not safely release the other parties before they incurred significant costs. You also need evidence to show that you did not delay in trying to release them after it became apparent that they would win. This requires evidence of communication on these issues and of genuine attempts to act reasonably which is why it cannot be left until discontinuance is needed.
Following Swift v Carpenter [2020] EWCA Civ 165, it seems unlikely that a protective costs order is available in private litigation, even where the issues are as significant as in this case (viz. the effect of the negative discount rate on accommodation claims). However, as the decision was essentially based on public policy reasons, it is possible this may change. Taken in conjunction of the potentially unlimited costs liability of third-party funders following Chapelgate Credit Opportunity Master Fund Ltd v Money & Others [2020] EWCA Civ 246 the risks associated with making genuinely ground-breaking legal challenges in clinical negligence are very significant.
Conclusion
The key point to take from this chapter is that it is necessary to ensure that your approach to costs and funding issues are proactive and not reactive. If you get the structure correct from the start, then it is much easier to maintain it throughout the life of the case. The losing party is fully entitled to take advantage of any aspect of the case which has not been properly prepared and the court will actively seek to maintain costs at a proportionate level. Accordingly, the winner needs to remove as many of the potential ambiguities which arise in practice by keeping clear, contemporaneous evidence that they provided proper advice to their client, acted reasonably and used their experience effectively.
MORE INFORMATION / PURCHASE THE BOOK ONLINE
Image: public domain from https://pixabay.com/en/doctor-medical-medicine-health-563428/
Clinical Consent: Where Are We Now? - Ruwena Khan, Park Square Barristers

1. 30/09/20. Clinical negligence litigation continues apace; the doctor-patient relationship ever-evolving, medical professional guidance adapting and incremental changes to the common law running in tandem. Who knows how the law will change, if at all, following what we hope will eventually be a swift and safe conclusion to the current global pandemic. Will there be significant numbers of cases brought in relation Covid-19 medical treatment: inadequate facilities and staff being made available; insufficient PPE being utilised whilst treating patients; consent not being lawfully obtained? Will there be claims which allege that the knock-on effect on other areas of medical care, such as reduced cancer screening, resulted in delays in diagnosis and consequent treatment?
2. Estimates published last year put the total cost of outstanding compensation claims at £83 billion, although that figure includes both pre- and post-issue cases. NHS England’s total budget in 2018-19 was £129 billion. These figures seem startling. Clearly, in general terms, as society develops there is an increase in social media usage, awareness of rights and advertising and the numbers of those seeking to make claims increase. However, the figures reflect the unfortunate reality that the area of clinical negligence law most often involves significant compensation sums being sought due to the impact of the alleged negligence that has taken place, most often in birth injury claims which require life-long monetary assistance. Moreover, the area of clinical negligence does not just involve money as the central focus - far from it - patients and families most often seek responses to unanswered questions and often they see the claims process as the best way forward.
3. This article reviews how ‘consent’ has changed in clinical negligence litigation over the years and provides an update on relevant recent case law, particularly in light of Montgomery v Lanarkshire Health Board [2015] UKSC 11 and the increasing importance of patient autonomy.
From Bolam to Montgomery
4. Every clinical negligence practitioner will be more than familiar with Bolam v Friern Hospital Management Committee [1957] 1 WLR 582. McNair J set the basic test as to whether a medical professional has met the required standard of reasonable care and skill:
“The test is the standard of the ordinary skilled man exercising and professing to have that special skill…[A doctor] is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art…Putting it the other way round, a man is not negligent if he is acting in accordance with such a practice, merely because there is a body of opinion who would take a contrary view.”
5. The claim was brought by a patient who was suffering from mental illness and during the course of electro-convulsive therapy, sustained acetabular fracture injuries. Although he had signed a consent form, he had not been warned of the risk of fracture, nor had he been given relaxant drugs. McNair J directed the jury to utilise the above test in relation to both the issue of the relaxant drugs and the issue of consent. This emphasises that at that time, and for many decades thereafter, the patient’s right to be informed of the risks of their own treatment, and how far that right extended, was to be determined by the medical profession.
6. In Sidaway v Board of Governors of the Bethlem Royal Hospital & Maudsley Hospital & Others [1985] AC 871, in an appeal by the patient from a decision of the Court of Appeal, the issue was whether a neurosurgeon failed to exercise due care in the advice he gave his patient when recommending an operation as he failed to warn her of the risk of damage to her spinal cord which in fact occurred. The difficulties with the Bolam test in the context of informed consent were highlighted, although ultimately the majority of the House of Lords held that the doctor had to decide what ought to be said and how it should be said. Lord Scarman’s dissenting judgment, however, asserted that the Bolam test was inappropriate when dealing with issues of informed consent;
“…is it right that medical judgment should determine whether there exists a duty to warn of risk and its scope? It would be a strange conclusion if the courts should be led to conclude that our law, which undoubtedly recognises a right in the patient to decide whether he will accept or reject the treatment proposed, should permit the doctors to determine whether and in what circumstances a duty arises requiring the doctor to warn his patient of the risks inherent in the treatment which he proposes.”
7. Although not a case concerning informed consent, in Bolitho v City and Hackney Health Authority [1998] AC 232, steps were taken to move away from enabling medical opinion to dictate the standard of care. The House of Lords accepted that when determining whether a medical professional had acted in accordance with a reasonable body of opinion, the court had to consider whether such opinion had a logical basis. Lord Brown-Wilkinson opined:
“The use of these adjectives – responsible, reasonable and respectable – all show that the court has to be satisfied that the exponents of the body of opinion relied upon can demonstrate that such opinion has a logical basis.”
8. Via a number of other subsequent cases (e.g. Pearce v United Bristol Healthcare NHS Trust [1998] 5 WLUK 361 and Chester v Afshar [2004] UKHL 41) which had tacitly attempted to move away from the Bolam test over the years since Sidaway, the Supreme Court in Montgomery finally took Lord Scarman’s dissenting judgment as the starting point. In Montgomery, M was not informed by her treating consultant obstetrician that there was a 9-10% risk of shoulder dystocia occurring during the birthing process. During the delivery, shoulder dystocia occurred and the baby was deprived of oxygen due to occlusion of the umbilical cord and he was born with severe disabilities.
9. The Supreme Court held that an adult person of sound mind was entitled to decide which, if any, of the available forms of treatment to undergo, and their consent had to be obtained before treatment interfering with their bodily integrity was undertaken. Doctors were under a duty to take reasonable care to ensure that patients were aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.
“The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should be reasonably aware that the particular patient would be likely to attach significance to it.”
10. Exceptions were noted at paragraph 88 of Montgomery, however. A doctor is entitled to withhold from the patient information as to a risk if they reasonably consider that its disclosure would be seriously detrimental to the patient’s health. The doctor is also excused from conferring with the patient in circumstances of necessity. Furthermore, as is noted in the case of Duce below, a clinician is not required to warn of a risk of which they could not reasonably be taken to be aware, therefore still taking into consideration the Bolam test.
11. Nonetheless, after nearly six decades, the Supreme Court allowed the law to catch up with the turning tides of society to assert that it was the patient’s basic human right to make their own decision.
Informed Consent – Case Law since Montgomery
Spencer v Hillingdon Hospital NHS Trust [2015] EWHC 1058 (QB)
12. The patient had suffered a deep vein thrombosis, followed by a pulmonary embolism on each lung, after surgery for an inguinal hernia. He clamed that hospital staff had not advised him of the risk of a thrombosis or embolism and that he had not been made aware of the signs and symptoms or the importance of seeking medical help. In applying Montgomery, Judge Collender QC held that members of the medical profession had a duty of care to advise and inform patients of anything which the ordinary sensible patient would be justifiably aggrieved not to have been told when fully appraised of its significance. In this particular instance, the duty of care had been breached as modern, safe and responsible medical practice should have warranted the giving of that advice to patients undergoing general anaesthetic.
13. The focus espoused by the Deputy High Court Judge was on the “ordinary sensible patient” and whether they would feel “justifiably aggrieved”.
Thefaut v Johnston [2017] EWHC 497 (QB)
14. The patient underwent surgery to try and alleviate the severe pain in her back and the numbness in her left leg. However, the surgery exacerbated her left leg pain and did not resolve her back pain. She alleged that had she been properly advised she would have known that the chances of a full recovery (approximately 50%) from her back pain in particular were nowhere near as optimistic as portrayed (not far off 90%) and she would not have consented to surgery at all. Mr Justice Green held that the doctor had not met the test in Montgomery.
15. Reference was made to the modus operandi of communication as espoused in Montgomery at paragraph 90. Firstly, “dialogue” was central and as Green J noted, in modern times that could include dialogue via skype or over the phone (more so in the Age of Covid-19). Secondly, there was a need to de-jargonise communications to ensure that the message is conveyed in a comprehensible manner.
16. Mr Justice Green disagreed with the view put forward in Spencer. The test was not just that of the ‘ordinary sensible patient’, relating to objectivity alone, as the Montgomery test required consideration of a subjective element. Furthermore, Montgomery did not require consideration of whether a patient was left feeling ‘justifiably aggrieved’ but rather the test was what a “…reasonable person in the patient’s position would be likely to attach significance to…” ‘Materiality’ depends, of course, on context.
Gallardo v Imperial College Healthcare NHS Trust [2017] EWHC 3147 (QB)
17. The patient underwent major abdominal surgery in 2001 immediately following a CT scan which had showed a mass on his stomach and a malignant tumour was removed. In 2006 he began suffering abdominal pain again which he sought to be investigated. In November 2010 his previous consultant explained that the first operation in 2001 was for a malignant tumour. The patient alleged that he had never been informed that the tumour was malignant and that there was a risk of recurrence which required him to have regular check-ups and CT scans. He underwent major complex surgery in 2011. Experts agreed that the consultant should have advised regular CT scans were necessary. Had that been done then it was likely that the tumour would have been diagnosed in 2006 and further surgery would have taken place four years earlier when the tumour would have been smaller.
18. The Judge held that it was a patient’s right to be informed of the outcome of any treatment, the prognosis, and the options for follow-up care and treatment. Information should only be withheld in exceptional circumstances, and for clear and persuasive therapeutic reasons. Discussion should occur as soon as the patient was well enough to participate fully. Furthermore, significant criticism was placed on the absence of any note or record of discussions with the patient as to his treatment and prognosis, including the need for regular scans and check-ups. The omission to set it out in writing was a “glaring failure” (paragraph 62).
Duce v Worcestershire Acute Hospitals NHS Trust [2018] EWCA Civ 1307
19. The appellant patient alleged that the Trust had negligently failed to warn her of the risk of developing chronic post-surgical pain following a total abdominal hysterectomy and bilateral salpingo-oophorectomy in 2008. The Court of Appeal upheld the decision of the lower court that the claim failed at the first hurdle as the state of medical knowledge had to be considered at the time that the alleged negligence occurred. As of 2008 the existence of a risk of such post-operative pain was insufficient to justify the imposition of a duty to warn of such a risk. Therefore, Montgomery was still followed as a clinician was not required to warn of a risk of which they could not reasonably be taken to be aware.
20. Additionally, when considering the issue of causation, the Court of Appeal accepted that the Judge had considered in detail the appellant’s long history of symptoms from which she hoped to gain relief by undergoing surgery and the fact that she had been made aware of a number of other quite serious risks but, still sought to undergo surgery. That history was justifiably rightly considered to weigh in favour of her choosing to undergo surgery when she did, even if a different warning as to the risk of pain had been given.
Diamond v Royal Devon & Exeter NHS Foundation Trust [2019] EWCA Civ 585
21. The patient had not been properly informed of her options before consenting to a hernia repair procedure – this breach of duty was upheld by the Court of Appeal. However, she was unable to establish that a freestanding claim in damages arose from the NHS Trust’s failure to warn her that a mesh-based procedure might risk future pregnancies. The facts established that she would still have opted for the mesh-based, rather than suture based, procedure had she been properly advised.
NKX (By his L/F NMK) v Barts Health NHS Trust [2020] EWHC 828 (QB)
22. A claim was brought for alleged birth injury, namely severe neuro-disability consequent upon an acute near total hypoxic-ischaemic insult. The Deputy High Court Judge held that there was no breach of duty in relation to the antenatal counselling that had been provided to the claimant’s mother as she had been given sufficient warning of the risk of undergoing monitoring by intermittent auscultation as opposed to continuous foetal monitoring and the correspondence and birth plan had made it clear that the Consultant Midwife’s preference was for continuous rather than intermittent monitoring.
23. However, when the claimant’s mother went into labour at 41 weeks’ gestation, the Judge was critical of the absence of counselling and re-assessment of risks which was necessary as there was a very real possibility that the mother would change her mind if provided with a sober re-assessment of the risks and benefits at that particular juncture, including that the maternity unit was very busy and the Midwife was not capable of managing the mother’s specific labour plan with intermittent auscultation. It was established that with further counselling and re-assessment on the night of labour, continuous foetal monitoring would have been accepted by the claimant’s parents and ultimately foetal heart abnormalities would have been noted sooner.
24. Although the case also dealt with issues concerning delivery, namely the delay in seeking obstetric assistance, the High Court emphasised that the patient’s right to make their own decisions with all material risks and information being disclosed was of central importance and that the need for a patient’s decision to be an informed one is continuous as risks and circumstances can change and evolve, particularly during the labour process.
ABC v St George’s Healthcare NHS Trust and Others [2020] EWHC 455 (QB)
25. What of a duty to provide information and details of risks to those not ordinarily considered a patient? The claimant’s father had killed her mother and had been detained under the Mental Health Act 1983 at a hospital run by the second defendant. He received care from a multi-disciplinary team led by a consultant forensic psychiatrist, which included family therapy sessions also attended by the claimant. It was suspected that the father might be suffering from Huntington’s disease, a genetic condition, but initially he refused to undergo any tests and further was adamant that neither of his daughters, including the claimant, should be informed of the suspected diagnosis as it could impact their decision to have children. The issue was whether the patient’s confidentiality should be breached in the public interest as per the guidelines for psychiatrists at the time. The decision was made not to breach his confidentiality. The father’s diagnosis was confirmed when the claimant was 20 weeks pregnant but, the claimant was not aware of the diagnosis until accidentally informed of the same after her baby had been born. The claimant submitted that the defendants owed her a duty of care to balance her interest in being alerted to the genetic risk against the interest of her father in having his confidentiality preserved and the public interest in maintaining confidentiality.
26. Whilst it was accepted that the claimant was a patient of the family therapy team, the information about her father’s diagnosis was acquired in the context of her father’s treatment and management, rather than the family therapy. She was not in a doctor-patient relationship with the forensic psychiatrist. However, in the unique factual circumstances of the case, which Mrs Justice Yip DBE was very clear to underscore, it was held that a close proximal relationship arose with the second defendant as the clinicians had significant information about the claimant’s circumstances and direct communication with her. They had foreseen the possibility of psychological harm to her and the loss of opportunity to terminate the pregnancy. It was fair, just and reasonable to impose a legal duty on them to balance her interest in being alerted to the genetic risk against the interest of her father and the public interest in confidentiality.
27. Nonetheless, there was no breach of the duty of care as a proper exercise of judgment had been made by the forensic psychiatrist. He had balanced the patient’s safety, taken advice from a geneticist and heard competing arguments. There was room for reasonable disagreement as to the exercise of that judgement, as demonstrated by the lack of consensus between the many expert witnesses. The decision was supported by a responsible body of medical opinion. In any event, the claimant had not proven on the balance of probabilities that she would have undergone a termination if notified of the diagnosis during pregnancy.
28. Mrs Justice Yip DBE did note (paragraph 180) that following Montgomery“the old paternalistic view that a doctor might withhold information about risks because it is the doctor’s assessment that it is better for the patient not to know is no longer good law. Had the information about the genetic risk come to the defendants in the context of a patient relationship with the claimant, they would have been bound to disclose it.”
Informed Consent in Practice
29. There may well have previously been no legal doctrine of informed consent but, that does not mean the medical and healthcare professions had not already been highlighting and reinforcing the importance of patient autonomy in their own guidance for many years.
30. Wider, national guidance has been obtainable at length from bodies such as the General Medical Council (‘Consent: patients and doctors making decisions together’, 2008 onwards), the Department of Health (‘Better information, better choices, better health: Putting information at the centre of health’ 2004; ‘NHS Toolkit for producing patient information’ 2003) and the National Institute for Health and Care Excellence. The NHS Wales Governance e-manual has a section on ‘Patient Consent’ which notes:
“It is a general legal and ethical principle that valid consent must be obtained before starting treatment or physical investigation or providing personal care for a patient. All NHS organisations are therefore required to have robust policies and procedures in place to ensure patient consent is obtained appropriately”
It highlights that the taking of consent is not a single event (as was held in the case of NKX (By his L/F NMK)). It further emphasises the need to review local policies to ensure consistency with the new Guide to Consent for Examination or Treatment 2017, itself revised following Montgomery. Indeed, local/individual NHS Trusts ordinarily have their own practices as to obtaining informed consent reflected in policy and procedural documents.
31. Further, different clinical areas usually have their own specific guidance related to the taking of informed consent. By way of example, Pubic Health (England) has guidance related to obtaining informed consent for cancer screening, last updated in December 2018: “For participants to make an informed decision and therefore give valid consent, they should be provided with sufficient information and support about the screening process.” The Royal College of Anaesthetists, back in February 2003, produced ‘Raising the Standard: Information for Patients’.
32. In conjunction with the above, medical professionals have been able to find assistance by way of pro forma documentation in obtaining consent, although invariably each case differs and some cases may require further matters to be discussed, additional notes to be made and risks to be considered than contained within such documents. For example, the NHS in Wales produced a revised NHS Wales Model Policy together with consent forms to support the practical application of the consent guidance. Public Health (England) has provided sample letters to be utilised in cancer screening cases where patients wish to refuse screening to ensure that they understand the implications of what they are doing.
33. Information leaflets together with written correspondence and verbal communication all lead to the patient having a clearer understanding of the benefits and disadvantages of treatment and care and to ensure that consent is validly obtained. As repeated in Thefaut, the importance of open and clear dialogue in the doctor-patient relationship, whether via electronic means or otherwise, cannot be overstated. The importance of contemporaneous medical notes, ideally with written consent, goes hand in hand with this. If oral consent is given, it can be useful to have a permitted family member or friend with the patient to ensure that information is relayed understandably, and cynically, to have a witness present.
Conclusion
34. With the backdrop of fundamental rights being recognised by the European Convention on Human Rights and the Human Rights Act 1998, society’s continual move towards individual autonomy and the freedom to make one’s own life choices, it was inevitable that the Bolam test could not stand to remain the deciding factor in clinical negligence litigation involving issues of patient consent. Montgomery finally gave legal scope to the notion that the patient’s right to make an informed decision based on known material medical risks is of central importance, a right that has long been recognised by medical and healthcare professionals and bodies alike.
35. Cases since Montgomery confirm that taking consent is not a single event but a process of discussion, of weighing up the options and providing support to patients to enable them to make the right decision for them as individuals. It requires an ability to communicate clearly through open dialogue. Effectively, individual patient autonomy is guided and promoted through collaborative teamwork with their medical and healthcare professionals.
36. Clinical consent – where are we now? A much better place.
RUWENA KHAN
PARK SQUARE BARRISTERS
Image: public domain from https://pixabay.com/en/hospital-ward-hospital-medical-room-1338585/
Griffiths v TUI UK Limited [2020] EWHC 2268 (QB): The Court may not depart from uncontroverted expert evidence - Sam Way, Devereux Chambers

24/09/20. In a judgment which will have wide-ranging implications across lower value personal injury claims, Martin Spencer J has confirmed that where a court is presented with uncontroverted expert evidence which complies with the requirements for admissibility under CPR Part 35, the Court cannot depart from that evidence. Although the judgment does not break new ground, it provides valuable resistance against arguments aimed at undermining expert evidence which often find favour with District Judges.
Background
The Claimant purchased an all-inclusive holiday to a holiday in Turkey. Save for a burger eaten at the airport and a single meal out, he ate all of his meals at the hotel provided by the Defendant. During the holiday he fell ill, suffering from stomach cramps and diarrhoea. A stool sample taken during the holiday showed both parasitic and viral pathogens.
In his claim, the Claimant did not commit to any particular cause of the illness, despite the medical report served with the Particulars of Claim opining that the cause was food, drink or fluids consumed at the hotel. The Claimant was put to proof as to the cause of his illness by the Defendant. Despite the Defendant obtaining permission to serve its own expert evidence in respect of causation, it did not obtain any expert evidence, not did the Defendant ask any Part 35 questions of the Claimant’s expert or require the Claimant’s expert to attend for cross-examination.
At trial, HHJ Truman accepted the Claimant’s factual evidence, but went on to endorse the Defendant’s criticisms of the expert’s report, including his reasoning and the basis on which he reached his opinion on causation. In the face of the Claimant’s expert evidence in support, HHJ Truman found that the Claimant had failed to prove his case on causation and dismissed the claim.
The decision
On appeal, Martin Spencer J noted that “where an expert’s opinion is disputed, that opinion will carry little weight if, on proper analysis, the opinion is little more than assertion on the part of the expert.” (paragraph 29). However, the Claimant’s expert’s evidence was not dispute. It was therefore the only evidence before the Court on the issue of causation; the Defendant having failed to lead any evidence of its own on the topic and having failed to undermine the factual basis on which the report was made. Martin Spencer J drew a distinction between the analysis to which an expert report could be subjected to depending on whether it was in dispute or is uncontroverted: “what the court is not entitled to do, where an expert report is uncontroverted, is subject the report to the same kind of analysis and critique as if it were evaluation a controverted or contested report, where it had to decide the weight of the report in order to decide whether it was to be preferred to other, controverting evidence such as an expert on the other side or competing factual evidence. Once a report is truly uncontroverted, the role of the court falls away.” (paragraph 33)
This did not, however, mean that the Court was always barred from analysing the content of an expert report where there was no competing evidence. Even an uncontroverted expert report must meet the minimum standards for admissibility set out in the Practice Direction to CPR Part 35. Those criteria determine whether the expert’s report is acceptable to be admitted in evidence. But once it has been admitted, the court is not called on to evaluate the weight to be attached to the report unless there is some competing evidence or the basis on which the report has been reached has been undermined. As the Defendant had not led its own evidence on causation, and HHJ Truman had accepted the Claimant’s factual case, he was not entitled to effectively ascribe “nil weight” to the report (paragraph 37). By doing so HHJ Truman had erred.
Further, a report may nonetheless be rejected if it constituted a bare ipse dixit, i.e. that it merely states an entirely unsubstantiated conclusion. The expert report in this case, was not a bare, unsupported opinion (although that did not mean that the reasoning was not subject to justified criticism), and Martin Spencer J doubted whether any report which complies with the Practice Direction to CPR Part 35 could constitute a bare ipse dixit such that it could be properly ascribed no weight.
Comment
Although this case concerned expert evidence on causation of gastric illness suffered on a package holiday (a subject which is notoriously difficult to prove), Martin Spencer J’s comments are of universal application. Defendants often consider that it is disproportionate to obtain their own expert evidence on a topic, particularly in low value disputes, and instead seek to undermine the Claimant’s expert evidence. This judgment clarifies that such a strategy is a high-risk approach. Unless a Defendant successfully undermines the factual basis on which the report was reached, it will not be open to the Court to depart from the Claimant’s expert’s view. In expressing the limits of running a case which relies on the Court rejecting the Claimant’s evidence, Martin Spencer J has provided Claimants, particularly those involved in low value disputes, with a vital tool.
SAM WAY
Devereux
14 September 2020
Image ©iStockphoto.com/Elerium
The White Book must not be thrown out of the window! - Mark James, Temple Garden Chambers

23/09/20. Nearly 600,000 personal injury cases valued at less than £25,000 are commenced in the Pre-Action Protocol for Low Value Personal Injury Claims in Road Traffic Accidents (“the PAP”) each year. Many are settled or drop out of the PAP (e.g. because liability is disputed). However, a significant minority are stayed under paras. 5.7 and/or 7.12 of the PAP, using the Part 8 procedure under CPR 8BPD, to stop time running under the Limitation Act 1980 and/or to allow the claimant time to obtain expert reports. Birkenhead County Court alone deals with around 13,000 Stage 3 or stay cases every year. Should the claimant wish to proceed it is necessary to apply to lift the stay. Until recently, authority on how the court should deal with a contested application to lift the stay has been scant. The White Book (2020) cites Lyle v Alliance Insurance plc, unreported, 21 December 2017, where a Circuit Judge upheld a decision of the District Judge not to lift the stay and to strike out the claim where the claim had turned out to be worth more than £25,000 and the delay had caused prejudice to the defendant. But that is all. The issue of how to deal with applications to lift stays granted under the PAP, particularly where the case was clearly not appropriate for the PAP, arose starkly in Cable v London Victoria Insurance Company Limited, [2020] EWCA Civ 1015. The Court of Appeal has now given guidance.
Facts
The claim arose out of a RTA on 1 September 2014. Three weeks later a claims notification form was submitted through the Ministry of Justice Portal (part of Stage 1 of the PAP). Liability was admitted. A GP’s report followed shortly afterwards. This described a minor whiplash injury but also described symptoms of headache, dizziness and disorientation. The GP recommended the instruction of a neurologist who saw the claimant in April 2015. The report was finalised in January 2016. It was noted that some aspects of the claimant’s condition had deteriorated, that he was struggling with light and high pitched tinnitus and was unable to work. The claimant lost his job in December 2015. At the time of the accident, the claimant had been earning about £130,000 pa albeit he had received considerable pay while off sick. The neurologist thought that the claimant’s condition would improve such that he would become symptom-free and that no lasting damage would arise. None of this was disclosed to the defendant’s insurers. A year after his first report, the neurologist produced a second report. The January 2017 report identified a deterioration in the claimant’s condition and referred, for the first time, to his migraine headaches. Contrary to his earlier optimism, the neurologist now thought that the claimant’s condition, which he described as “a severe neurological state,” had become chronic. By this time, the claimant’s solicitors knew, or should have known, that the case was worth far in excess of £25,000. They still did not disclose the neurologist’s report or respond to the defendant’s insurers repeated requests for updates. Instead, on 25 July 2017, with the primary limitation period fast approaching, a Part 8 claim form was issued seeking a stay ex parte on the basis that a stay was necessary to comply with the PAP. The court duly stayed the claim for 13 months (to 20 August 2018) and directed the claim form be sent to the defendant by 20 August 2017. The claimant did not comply with this order until February 2018. On 17 August 2018 the claimant’s solicitors disclosed, for the first time, the two reports of the neurologist. On 18 August 2018 the claimant applied, ex parte, to lift the stay. On 21 August 2018 the application was granted on terms that the claimant serve an amended claim form and Particulars of Claim by 4 September 2018. This was not done until 26 September 2018. The Schedule pleaded out a claim for over £2.2M. The defendant applied to strike out. The claimant cross-applied for relief from sanction by reason of his failure to comply with the order of 21 August 2018.
The decisions of the courts below
On 17 October 2018 District Judge Campbell set aside the order lifting the stay and struck out the case. She approached the issue as one of whether, in her discretion she should lift the stay and allow the claim to be transferred to the CPR Part 7 process (under CPR r. 8.1(3)). She considered that one factor, amongst others that weighed against the claimant was that his conduct (or rather that of his solicitors) amounted to an abuse of process. She thought that this conduct had prejudiced the defendant. While it was not strictly necessary for her to do so (as she had already struck out the claim) DJ Campbell refused the claimant’s application for relief from sanction. When dealing with the third limb of the Denton criteria (all the circumstances) DJ Campbell commented that this was the claimant’s second breach of a court order and that:
“[The claimant’s solicitors] failed to identify to the defendant’s solicitors the potential of this case for some four years. They failed to correspond with the defendants in any meaningful way over four years and, for all those reasons, I find that if I were to accede to a request for relief from sanction in a case set against that background, I might as well just throw the White Book out of the window and say, “anything goes!”
The claimant’s appeal to HHJ Wood QC was dismissed albeit the Circuit Judge said he would have allowed the appeal in relation to the relief from sanction application had he not found that the District Judge was right to strike out the claim. The claimant appealed to the Court of Appeal. The defendant cross-appealed against the relief from sanction decision.
Decision
The Court of Appeal allowed the appeal. It held that the courts below had erred in not applying a twofold test: (1) was the claimant’s conduct an abuse of process; and, if it was an abuse, (2) was it proportionate to strike out the claim? The approach in Lyle v Allianz was wrong. No matter the mechanism by which the debate comes before the court, the judge must grapple with the central dispute: should the claim be allowed to proceed or should it be struck out? That issue will be informed, but not decided by, the answer to the prior question: has there been an abuse of the process? Further, DJ Campbell had proceeded on the erroneous basis that an abuse of process would, at the very least, give rise to a prima facie right to strike out the claim. By treating the issue of strike out as determined by her prior decision not to transfer the claim to the Part 7 procedure, DJ Campbell had reduced the striking out of the claim to “an administrative afterthought.” It was wrong to regard the striking out of the claim as an act of kindness, putting useless proceedings (because the stay had not been lifted) out of their misery.
On the first issue, the Court of Appeal found that the claimant’s solicitors had abused the court’s process in three respects: (a) when they issued the Part 8 claim form they knew, or ought to have known, that this was not a Part 8 claim. They should have issued under Part 7; (b) they sought a stay to comply with Stage 2 of the PAP when the knew, or ought to have known, that the PAP was inapplicable to the claim; and, (c) they did not intend to, and did not in fact, use the stay of proceedings for the purpose for which it was sought and granted. The appeal against this aspect of DJ Campbell’s judgment failed.
On the second issue, the Court of Appeal held that the District Judge had gone wrong. This was because the District Judge: (a) had downplayed the proportionality of bringing the claim to an end; (b) had wrongly assumed that striking out the claim was the primary solution; (c) had made findings as to the prejudice suffered by the respondent which were not in evidence and which were unjustified; and, (d) failed to give any proper weight to the consequences of striking out the claim and depriving the claimant of his Article 6 rights. The delay had principally occurred within the limitation period. Had the claimant followed the correct procedure and issued a Part 7 claim in the summer/autumn of 2017, the defendant could have agreed to stay the claim to allow the full Personal Injury Pre-Action Protocol process (for multi-track cases) to be followed. The delay of one year would not cause the case to be case managed differently. There was no evidence that the absence of this one year delay would have made any difference to the claimant’s medical treatment. There was no loss of any limitation defence. There was no evidence to support the DJ’s finding that the insurer was prejudiced by not being able to set an accurate reserve at an early stage. On the other hand, the claimant was not personally responsible for the catalogue of errors made by his solicitors. His claim form was issued within the limitation period. If that claim was struck out, he would have to start all over again, this time with a professional negligence claim against his current solicitors, with all the risk and uncertainty, not to say cost, that such a claim would involve. Moreover, that would be a loss of a chance claim, which is inevitably an inferior type of satellite claim, compared to the personal injury claim against a defendant who had admitted liability. Lesser sanctions were appropriate.
On the respondent’s notice, the Court of Appeal held that the District Judge had also erred in refusing to grant relief from sanction. Both the claimant’s defaults in progressing the claim and the further 3 weeks delay in serving an amended claim form and amended particulars of claim “could be met by sanctions from within the White Book rather than by its defenestration.” Liability had been admitted and the claimant had provided “the heart” of his amended claim when his solicitors served the two reports from the neurologist in August 2018.
Accordingly, the appeal would be allowed on terms that the claimant must pay the defendant’s costs up to, and including, the hearing before DJ Campbell. Interest on special damage to the same date would be disallowed. The claim should continue under CPR Part 7.
Practice Points
1. The PAP procedure should be used only for cases within the £25,000 limit.
2. Where fresh medical evidence shows that the claim is worth more than £25,000, or is otherwise unsuitable for the PAP procedure, the claim should be taken out of the PAP (under rule 7.76) and taken out timeously.
3. Where limitation is due to expire or a stay is otherwise required, care must be taken to accurately value the claim to ensure it really is suitable for the CPR 8BPD procedure before the statement of value is completed and verified by a statement of truth. An inaccurate statement of value may result in a finding that the court’s process has been abused, as well as, possibly, professional conduct issues.
4. Where the claimant runs into difficulty obtaining medical evidence it is important to communicate those difficulties to the defendant.
5. Where a stay is obtained, the claimant must get on with acquiring the relevant expert evidence timeously, ideally keeping the defendant informed of progress.
6. Prolonged periods of delay may result in the defendant applying to strike out.
7. Where the defendant relies on the delay as causing prejudice, the precise prejudice relied on should be addressed in the evidence in support.
8. The claimant’s evidence should clearly explain the reasons for any delay.
9. Any application to strike out should be determined following the twofold test: (1) was the claimant’s conduct an abuse of process; and, if it was an abuse, (2) was it proportionate to strike out the claim?
Image ©iStockphoto.com/Mark-W-R
Summary of Recent Cases, September 2020

21/09/20. Here is a summary of the recent notable court cases over the past month. You can also receive these for free by registering for our PI Brief Update newsletter. Just select "Free Newsletter" from the menu at the top of this page and fill in your email address.
Summary of Recent Cases - Substantive Law
Campbell (A protected party who proceeds by his father and litigation friend Donald Campbell) v Advantage Insurance Company Ltd [2020] EWHC 2210 (QB)
The Claimant attended a nightclub in Cheltenham along with two friends, the brothers Dean and Aaron Brown. Dean had driven them to the nightclub in his car. All three were drinking at the nightclub. The Claimant was later assisted to Dean's car and placed in the front passenger seat. He was drunk and leaned out of the vehicle to be sick on the ground. The brothers went back to the club to continue drinking and returned about an hour later. At that point, the car would not start. Aaron returned to the club to find some jump leads. When he came back the car was gone. At about 4am, the car drove headlong into an articulated lorry. Dean was killed, and the Claimant, who had managed to move to the rear seat, survived but sustained extremely serious injuries. He brought a claim for those injuries and resulting losses.
The Defendant admitted primary liability, but alleged contributory negligence on the basis that the Claimant had knowingly allowed himself to be driven by Dean, whom he knew or ought to have known was not fit to drive due to his intoxicated state; and because the Claimant did not wear a seatbelt. The court had directed for the issues of liability and causation to be dealt with as preliminary matters.
Before the trial began, Aaron committed suicide. Before his death, he provided written witness statements for the Claimant's solicitors and for the Defendant's. The Claimant was in a minimally conscious state and was unable to give evidence on his own behalf. There was evidence from the Claimant's father and the Claimant's girlfriend, as well as the lorry driver, and emergency responders. The court also had the benefit of a post mortem and forensic toxicology reports for Dean Brown, as well as police reports, collision investigation reports and medico-legal reports.
HHJ Robinson (sitting as a judge of the High Court) made the following factual findings:
• On balance of probabilities Aaron put the seat belt on the Claimant after he was brought to the car, and the Claimant was still wearing it when the brothers returned an hour later.
• The toxicology report showed that Dean had used cannabis some time before his death. The test results were suggestive of heavy and/or regular use. He was over the legal driving limit for alcohol.
• At the time of collision neither the Claimant nor Dean were wearing seatbelts.
• The Claimant was most likely lying across the rear seat at the time of collision. On balance of probabilities, Dean had taken the initiative to assist the Claimant from the front passenger seat and into the back seat prior to driving off.
HHJ Robinson then proceeded to consider whether the Claimant had capacity to consent to being moved into the back seat of the car, and to being driven by Dean. The Claimant's state of awareness generally, and specifically his knowledge of Dean's level of intoxication were inexorably linked to the issue of capacity. He found that by the time the Claimant was put into the front seat he must have been aware that Dean had drunk a great deal of alcohol. It was then necessary to determine what the Claimant's state of awareness and capacity were when the brothers returned an hour later.
Pursuant to the Mental Capacity Act 2005, there is a presumption of capacity. The question of capacity is time and issue specific. HHJ Robinson found that the evidence of the Claimant's previous alcohol consumption was insufficient to displace the presumption of capacity to consent to moving position into the back of the car. If the Claimant had capacity to consent to change position in the car, then he also had capacity to consent to being driven in the car. If his intention was to leave the car before it was driven off, he would not have got into the back seat. He knew that the vehicle belonged to Dean and that Dean would likely drive it. HHJ Robinson further found that the Claimant was aware the Dean had consumed enough alcohol to impair his ability to drive safely.
HHJ Robinson considered the relevant leading cases on contributory negligence, Owens v Brimmell [1977] QB 857, Froom v Butcher [1976] QB 286 andBooth v White [2003] EWCA Civ 1708. If contrary to his findings, the Claimant was unable to make his own assessment of Dean's fitness to drive due to his intoxication, it was necessary to consider what a reasonable man in the Claimant's shoes would have done, adopting the test in Booth v White. In this case a reasonable man was a man who was able to assess the driver's ability to drive safely. Had the Claimant been able to make such an assessment he would have concluded that Dean had consumed so much alcohol that his ability to drive safely was impaired.
It was argued on behalf of the Claimant that he did not have capacity to consent to anything. The Claimant relied on Spearman v Royal United Bath Hospitals NHS Foundation Trust [2017] EWHC 3027, where the claimant, who suffered from Type 1 diabetes and brain damage from an accident, gained access to a flat roof at a hospital. He climbed over the safety fence surrounding the roof terrace and sustained serious injuries when falling to the ground. In that case, Martin Spencer J found that there was no contributory negligence as the law did not penalise a person for being ill or of unsound mind. HHJ Robinson held that this judgment did not apply to self-induced intoxication. It also appeared thoroughly unattractive that a person who deliberately consumed "so much alcohol that they are unable to appreciate the foolishness of their decision" would be in a better position in law than someone who is mildly drunk.
HHJ Robinson then considered the authorities relevant to contributory negligence and seatbelts. He found that the Claimant had capacity to decide whether to wear a seatbelt, and had decided not to do so. He considered the Claimant's argument that Dean owed a duty to assist or encourage him to wear his seatbelt, but found that this approach was unduly paternalistic. The speed of the impact and the Claimant's height, complicated the assessment of the potential protective effect of the seatbelt. The expert evidence did not show that wearing a seat belt would have made a "considerable difference" such that the Claimant's injuries would have been a "good deal less severe" (Froom v Butcher).
HHJ Robinson took account of the fact that (1) there was no evidence of a prior agreement that Dean would drive the Claimant from the club; (2) the Claimant had not been with Dean during the entire time Dean was drinking; and (3) it was likely that the decision to be driven by Dean had been taken without a great deal of thought. In the circumstances, the appropriate degree of contributory fault on the Claimant's part was 20%.
Summary of Recent Cases - Costs
Finsbury Food Group Plc v Scott Dover [2020] EWHC 2176 (QB)
The Claimant, who was employed by the Defendant, was injured in the course of his employment, and was left with a permanently damaged middle finger. The claim was initially valued at less than £25,000, thus falling within the remit of the Pre-Action Protocol for Low Value Personal Injury (Employers' Liability and Public Liability) Claims ("the Protocol"). The Defendant failed to respond to the CNF which was uploaded to the portal, and accordingly, the claim exited the Protocol. Counsel advised on quantum in conference after the case exited the Protocol. The case ultimately settled for £70,000 and the Claimant submitted a Bill of Costs, including Counsel's fee of £650 plus VAT.
The CPR provides that in a claim which has been issued under Stage 3 of the Protocol procedure, the cost of counsel's fee for an advice on valuation is fixed at £150 plus VAT, pursuant to CPR 45.23B and Table 6A. Where a claim starts within the Protocol, but no longer continues within it, CPR 45.29I provides that the cost of any advice from counsel, as provided for in the relevant Protocol, may be recovered.
The Defendant's primary case was that there was no entitlement to recover Counsel's fee, on the basis that it had been incurred after the claim left the Protocol and that no such fee was payable under the provisions applicable to a claim which had exited the Protocol. Alternatively, it was argued that the cost of Counsel's advice was limited to £150 plus VAT. The Costs Officer rejected the Defendant's arguments and held that the provisions permitted recovery of the fee for advising in conference as a disbursement. The fee was, however, assessed down to £500 plus VAT.
The Defendant appealed to the Senior Courts Costs Office, where Master Brown dismissed the appeal. He found that CPR 45.23B and Table 6A did not apply to ex Protocol claims, as it was clear from CPR 45.16 and 45.17 that the fixed costs regime under CPR 45 section III only applied to claims which have been or should have been started under PD 8B, and not ones that had for any reason left the Protocol. Master Brown granted permission to appeal to the High Court...
The appeal was heard by HHJ Lambert, and the only remaining issue before her was whether CPR 45.29I (2)(c) limited the quantum of counsel's fee to £150 plus VAT. Having set out the correct approach to interpreting the relevant CPR rule, HHJ Lambert considered the grammatical meaning of the provision. She found that viewed linguistically, the meaning of CPR 45.29I (2)(c) was clear and unambiguous. The phrase "as provided for in the relevant Protocol" was not referring to the cost as set out in the Protocol, but to the type of disbursement there provided. Subsection (2)(c) must be read in conjunction with subsections (1)(a) and (b), which permit the court to allow a claim for a disbursement "of the type mentioned in paragraphs 2 or 3" but prohibited a claim for a disbursement of a type not listed. Accordingly, the purpose of subparagraph (2) is to list the type of disbursements that are allowed. This was also the only logical construction of CPR 45.29I (2)(c). The cost of other disbursements referred to in subparagraph (2) are fixed neither by the Protocol nor the rules, save for subparagraph (g) where the upper limit of the claim is expressly set out. Furthermore, the Provision relied upon by the Defendant concerned claims where settlement had been reached at Stage 2, and was therefore inapt when considering claims which had left the Protocol. Finally, if the drafter had intended to fix the costs of legal advice for a claim outside the Protocol, they could easily have included a provision to this effect as had been done in Section III.
HHJ Lambert then proceeded to consider whether the grammatical meaning of the provision led to an absurd outcome or an outcome which the drafter could not reasonably have intended. She did not consider that this was the case. Claims that fall off the Protocol are a mixed bag. Some would be of a complexity and value, where there was nothing absurd about the costs of valuation advice not being fixed. Moreover, it would be strange to see the same fixed fee be recoverable in a straight forward claim of lower value, as a higher value claim involving loss of earning and handicap on the labour market. Further, the costs are not unchecked and are subject to assessment. The drafting of Section IIIA also suggests a greater degree of flexibility.
Accordingly, the appeal was dismissed.
Summary of Recent Cases - Civil Procedure
Domeney (widow & administratrix of the estate of Albert Domeney, deceased) v (1) Rees (2) Advantage Insurance Co Ltd [2020] EWHC 2115 (QB)
The Claimant's husband was killed in a road traffic accident, which occurred when the Defendant turned his car directly across the path of the deceased's motorbike. The First Defendant was convicted of causing death by careless driving whilst over the prescribed limit of a specified controlled drug (cannabis). There were no independent witnesses to the accident, but three other drivers had observed the deceased's driving prior to the accident, and provided estimates of his speed ranging from 60mph to 80mph. There were two accident reconstruction reports, one prepared as part of the police investigation, and another produced by a retired police officer who had served as a senior forensic collision investigator. Neither report was able to provide a reliable estimate of the motorbike's speed pre-collision, as there was insufficient physical evidence. There were no marks on the road prior to the collision site, no calculations could be made from the throwing distance of the deceased because he was arrested by a metal fence within a hedgerow, and the damage to the vehicles did not enable calculations because of the disparity in mass between the vehicles and because the motorbike had not travelled through the centre of mass of the car. The retired police officer also provided some alternative scenarios in relation to the deceased's distance from the point of collision at 80mph and 50mph, and his ability to take evasive action.
At a CMC, the Defendants made an application for permission to rely on evidence from an A&E consultant and a freshly instructed accident reconstruction expert. Master Davison refused permission for the A&E consultant. The application for accident reconstruction evidence was unopposed and was granted. The report was to be served unilaterally, and the Claimant was granted like permission, if on considering the report she wished to rely on her own expert.
Having reflected on the application overnight, Master Davison revoked permission and listed the matter for a further hearing. The Defendants argued that the additional accident reconstruction evidence would enable the trial judge to reach a properly informed view as to how long it would have taken the First Defendant to complete the turn; how far the deceased would have been from the point of impact when the First Defendant started his turn, if he had been travelling at the speed limit; how long it would have taken the deceased to cover that distance if he had been travelling within the speed limit; whether the First Defendant could have cleared the southbound lane within this time. The expert could also form their own opinion as to the speed of the motorbike.
Master Davison found that the test set out in CPR Part 35, for the expert evidence to be reasonably required to resolve the proceedings, was "nowhere near made out". The court is not bound to grant permission for expert evidence merely because the parties have agreed to it. Accordingly, it was incumbent on the parties to furnish the court with sufficient material to enable the court to determine the need for the evidence. The parties had failed to provide the two existing accident reconstruction reports in the case until after the CMC and had also failed to provide costs estimates for the proposed evidence. At the second hearing, the Claimant's counsel provided an estimated overall cost for both sides' reconstruction evidence of £24,000. Master Davison considered that this sum appeared realistic. He also noted that the involvement of the experts would impact on the time required for the trial.
Master Davison's main objections to the evidence were as follows:
1. Given that two experts had unequivocally stated that they were unable to offer a reliable opinion as to the motorbike's speed, there was no realistic prospect that a third expert could do better. This was a case where the court will have to makes findings as to speed on the basis of lay witness evidence. There was "nothing unusual or untoward about that".
2. It would be very unusual to have expert accident reconstruction evidence in circumstances where the experts cannot reconstruct the single most important feature of the case, i.e. speed. Where there is insufficient forensic material from which experts can draw conclusion, the experts are redundant. The interpretation of witness evidence is a matter for the judge.
3. Whilst the accident reconstruction expert would be able to provide alternative scenarios, there are difficulties with admitting such evidence:
a. As the dynamics of this accident were not known, the evidence of elaborate alternative scenarios proposed would be "highly speculative, indeed absurdly so".
b. It was difficult to see how the trial judge would be assisted by the evidence in determining contributory negligence. "The assessment of contribution requires an evaluation of the culpability and causative potency of the negligence found against each motorist. That is an essentially impressionistic decision, involving the weighing and balancing of a range of different factors." The authorities discourage "prolonged or intensive enquiry" into the "fine degrees of contributory negligence" (Stanton v Collinson [2010] EWCA Civ 81).
Accordingly, permission was refused. Master Davison tested this decision by asking whether, if he were the trial judge, he would want expert evidence of the kind proposed. He found that the answer was "emphatically that I would not". If admitted, the evidence would have added little to the trial but expense.
Olivia Rosenstrom
Temple Garden Chambers
Image ©iStockphoto.com/spxChrome








