I’m a nurse but not as most people know it!
“So you used to be a nurse?” I am often asked by colleagues who work in mainstream health or social care services. “I am still a nurse!” I respond! “Just a different sort of nurse!”
My career spans over 40 years. As a registered General Nurse and Mental Health Nurse, I have always worked with older people. My focus has been the health and social care interface, mental health, the community and care homes.
For 10 years, before I left the NHS in 2013, I was the Consultant Nurse for safeguarding adults at risk and was the health lead for many safeguarding investigations. I developed specialist knowledge of institutional abuse and neglect of frail older people. Alongside this, my knowledge and skills in the Mental Capacity Act developed and enabled me to undertake complex capacity assessments.
Alongside my clinical practice, in 1993 I began undertaking occasional Expert Witness reports. I equipped myself by undertaking two qualifications of Certificate in Expert Witness practice in criminal and civil law.
The nature and amount of work increased and in 2013 I left the NHS to work as an independent Consultant Nurse. My clinical practice as an educator and professional adviser to care companies supported my Expert Witness practice, focussing on reports for litigation, the Police and CPS, Coroners, Health & Safety Executive and the Court of Protection.
An Expert Witness can be anyone, in any field of work with knowledge or experience of a particular field or discipline beyond that expected of a layperson, which includes AHPs, doctors and nurses. The duty of an Expert Witness is to help the court to achieve the overriding objective by giving opinion which is objective and unbiased, in relation to matters within their expertise. This is a duty that is owed to the court and overrides any obligation to the party from whom the expert is receiving instructions.
The role of the expert is not only to have knowledge and expertise in the specific issues, but also to be able to forensically examine records, video footage or information provided through assessment, and write an evidence-based report, written in language that can be understood by laypeople. An Expert Witness must also be impartial and objective. A vital skill for a caring professional who is loyal to their profession is to be objective and understand the difference between justification and mitigation.
The nature of my work is varied. It is always confidential but may at some point become public.
- one report that initially concerned possible negligence by a care home where I identified that a woman had been subject to false imprisonment by Kings College Hospital when the DOLs process was not followed. (Esegbona v Kings College).
- a criminal case where the owner and nurse manager were convicted of neglect and went to prison for a year (Bentley and Simpson)
- a Court of Protection assessment where there was a dispute about what was in the person’s best interests. I was instructed to carry out an independent assessment and give recommendations about what was in the man’s best interests. However, I also observed significant safeguarding concerns and acted on them. (MK v JK & Ors)
The work can be distressing. For example, watching CCTV footage of deliberate abuse, as seen in the criminal case of care worker Mavis Offei.
Although the abuse may be obvious to many, my role was to dissect and articulate not only what was happening but also why it was abusive. An expert must not assume that what is obvious to the professional is understood by the lay person. For this and subsequent cases of a similar nature I use the Kitwood malignant social psychology framework to dissect and articulate what is happening.
There are not enough nurses or AHPs who specialise in the care of older people undertaking Expert Witness work. I have seen nurses and even doctors who have had a limited exposure to our specialty undertake nursing reports, which introduces significant risks to the quality and accuracy of the report and undermines the expertise within our nursing sector.
As I start to plan my retirement, succession planning is important to me and I am keen to support nurses and AHPs who want to develop the skills to be an Older People Nurse/AHP Expert Witness, to ensure the highest quality reporting is provided, for the benefit of justice for all those involved.
There will be a workshop on this subject at the BGS Autumn Meeting on Wednesday 24th November at 11.30am. Please join us!