Exploring the Cauda Equina Syndrome pathway

Get It Right First Time (GIRFT) is a national programme designed to improve patient care in the NHS by reducing variations in service to improve patient outcomes. It began as an orthopaedic pilot in 2016 as a partnership between the NHS Royal National Orthopaedic Hospital Trust and NHS Improvement and is now being rolled out across 35 clinical and medical services in acute hospital specialties including spinal surgery and Cauda Equina Syndrome (CES).

The pathway is led by a spinal surgeon who collaborated with many professional bodies including the Cauda Equina Champions Charity.

From our grass roots organisation, we have campaigned hard to make sure the NHS addressed the lack of pathways for cauda equina patients. They had been left to struggle on alone, unsupported and with lack of referrals to appropriate services and care for too long. We are extremely proud to have contributed to the MSK Collaborative, giving CES patients a voice in the development of this pathway. We believe the pathway once implemented nationally with improve diagnosis and outcomes for CES patients nationally, standardising management across the NHS.

Champions Charity

Why has the CES pathway been developed?

One of the reasons for the development of the pathway was the realisation that people with suspected CES were not being transferred for care in line with agreed treatment protocols. The Healthcare Safety Investigation Branch (HSIB) produced a report in 2021 to support improvements in the timely identification and management of CES making five safety recommendations, four safety observations and two safety actions.

The report recommended access to 24-hour MRI scanning facilities, safety netting leaflets explaining red flag symptoms in clear and concise language, the development of a national CES pathway and updating guidelines. This particular report was one of the drivers for the GIRFT pilot.

Medical negligence in Cauda Equina Syndrome cases

As well as being a devastating condition for the individuals who sadly suffer from Cauda Equina Syndrome, CES cases account for a reasonably high proportion of medical negligence cases against the NHS of significant value in terms of compensation paid out. The usual failure is a delay in both diagnosis and treatment of CES.

The GIRFT assessment of litigated CES cases in 2013-2016 stated that CES cases accounted for around 23% of total litigated cases. It is not easy to obtain specific data about the number of CES cases from the NHSR as these cases are often labelled as a ‘spinal injury’ case without a CES sub-category.

How impactful could the CES pathway be?

For anyone who has ever conducted CES litigation on behalf of individuals, if one were to be cynical, all these reports and initiatives can feel a bit like “been there, done that, got the T-shirt…” in terms of the issues we see and have seen repeatedly in our own CES cases.

It has always been known that CES is a medical emergency that requires urgent clinical and imaging assessment followed often by rapid surgical intervention. That is not to say that investigations like the HSIB one does not have merit, of course it does as does the GIRFT initiative.

It is hoped that this pathway is fully embraced by the NHS in its wider context. CES is a condition that is not only missed by those within the acute hospital setting, but also those outside of that including ambulance staff, NHS 111 providers, GPs, nursing practitioners, osteopaths, chiropractors and physiotherapists to name a few specialities.

I sincerely hope that this does bring about real changes that are so desperately needed.

How Moore Barlow can help

Moore Barlow have a dedicated team of highly experienced solicitors who have worked on many cases related to Cauda Equina Syndrome previously, which makes us ideally placed to offer truly specialist support on every level.

We understand that making a Cauda Equina claim isn’t just about compensation; it’s also about finding a sense of justice for what has happened and can be a foundation on which to rebuild your life and start moving forwards from your injury.

Get in touch with our Cauda Equina negligence team for more information on how we can help with your claim.