Cauda Equina Syndrome pathways – Can the NHS deliver given its lack of resources?
The Getting it Right First Time (GIRFT: National Suspected Cauda Equina Syndrome Pathway was introduced in February 2023. It was designed to be used by clinicians as a guide to ensure the correct process and procedures are implemented for patients with Cauda Equina Syndrome (CES), from initial presentation through until postoperative care and subsequent discharge.
The GIRFT Pathway for Spinal Services outlines when and how to conduct stages of the Pathway – including referrals, imaging, surgical techniques, pain control, and other postoperative support. NHS England has said that GIRFT is now widely consulted by clinical teams to ensure that CES is diagnosed and treated without delay, thus improving patient outcomes.
CES is a rare and devastating spinal condition affecting 1 to 3 in 100,000 people in England. There are around 8,000 suspected cases per year. If not treated promptly CES can lead to impaired lower limb function and mobility, loss of bladder and bowel function, impaired sexual sensation, and neuropathic pain. It is widely recognised that time is of the essence when a patient presents with suspected CES.
Perhaps it is too early to tell whether the GIRFT Pathway has substantially improved patients’ CES outcomes but it is undoubtedly a step in the right direction. There is significant potential for it to make a positive impact on patients being treated for CES. However, whether the NHS will have the resources to fully embrace the GIRFT Pathway will be the “make or break”. As medical negligence lawyers we have observed how the NHS is unable to deliver the care that it aspires to provide, given the lack of resources it has. This, regrettably, leads to avoidable illness and harm.
The GIRFT Report showed that more than 20% of litigation claims for spinal surgery in England relate to CES (based on claims 2013/14 to 2015/16). It will be interesting to compare the data from subsequent statistics. One would consider whether, if the number CES litigation claims are reduced, is this due to the GIRFT Pathway? Conversely, if the number of CES litigation claims remain the same or even increase, can it be said that the GIRFT Pathway has been successfully implemented?
Anecdotal evidence points to a lack of resources to, for example, conduct an MRI scan 24/7 where there should be a low threshold for investigation for CES.
It is likely too early to add further comment on the success of the GIRFT Pathway without falling into speculation but it is something to keep a close eye on over the coming years.
The Cauda Equina Champions Charity
The Cauda Equina Champions Charity is one of the many collaborating professional bodies behind the GIRFT Pathway. In addition to campaigning for medical policy and raising awareness about CES, the Cauda Equina Champions Charity provides much-needed support to those living with CES, as well as their families. The charity has reported that family members, who double as carers for those affected by CES, have found it enormously difficult to cope with feelings of frustration, isolation, and being torn between their loved one and themselves.
It is truly uplifting to see how the Cauda Equina Champions Charity has gone above and beyond to deliver vital support to those affected by CES, through funded clinical psychology, psychosexual therapy and CBT sessions; as well as a new “Friends and Family” online support group led by Consultant Psychologists. The aims of the support group are to engage friends, families, and carers to share their experiences and support each other in a private setting, and to offer ideas for improving their own wellbeing and quality of life whilst living with someone who has been impacted by CES.
How Moore Barlow Can Help
Moore Barlow support Cauda Equina Awareness Day on 1 October 2024. Our broader determination is always to support the NHS and other healthcare providers to actively improve patient care and safety, and to minimise the chances of similar avoidable injuries occurring again to someone else. When things do go wrong, we do all we can to help our clients secure a better future by accessing the therapies etc. that will help to improve their quality of life.
Our experienced Medical negligence team includes lawyers dual-qualified as nurses and doctors with many years’ experience of working in the NHS and in bringing sight loss claims whether against hospitals, GP’s or other healthcare providers. We have a consistently strong track record and are regarded as leaders in the field.
