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Dr Bashir Qureshi

FRCGP, FRCPCH, AFOM-RCP, Hon FFSRH-RCOG,

Hon MAPHA – USA, Hon FRSPH

• Expert Witness in Cultural, Religious & Ethnic issues in Litigation.

• Expert Witness in GP Clinical Negligence.

• Author, Transcultural Medicine; Dealing with patients from different Cultures, Religions & Ethnicities.

• Former GP & Paediatrics Clinical Public Health Medical Officer, London, UK.



According to the theory of “double doctrine” in philosophy, it is justified to do a bad thing to achieve good results; for example, to kill four hijackers to save 40 hostages. It is also possible to do a good thing to achieve bad results; which may be intended, for example, to close an expensive service or agency. In Britain, most things are achieved by evolution than by revolution. The aims and objectives to get results are usually planned one year, five years or 20 years ahead. The British politicians are clever and often trained in Oxford, Cambridge, Edinburgh and London Universities. They are mostly of real British origins and very loyal to the British flag. Money makes the world go round. Today, Britain is facing shortage of money and austerity measures, in good faith, are essential. Let us look at five actions which look very good for patients and General Practitioners (GPs) but are amicably reducing the number of GPs, their services, cost of medications and referral to hospitals, as intended, while making patients feel powerful, happy and supportive.

Patient Power and Patient Associations

A patient can complain against a doctor but a doctor cannot complain against a patient. Every doctor is believed to have taken “Hippocrates Oath” but no one has ever done so because it involves a student to give money to the teacher’s family for lifetime. Similarly, a diagnosis is mostly based on symptoms and signs which suggest a number of different diagnoses and the doctor chooses one that is most possible. Medicine is a science but a diagnosis is an informed guess, except in a few cases such as a fracture of a bone. No diagnosis can always be right but the patients are encouraged to expect it to be always right. This expectation is the basis of increasing complaints against doctors, who indeed experience stress which if repeated makes them leave the practice or licence to practice.
Patients Associations are being used by the Government to monitor GPs performances and General Practice facilities. They are also being used by Doctors’ Royal Colleges and Trade Unions as an umbrella. Patients are making demands and complaints to Employing Authorities, General Medical Council and Courts. It is now an irreversible and manmade situation

Care Quality Commission visits General Practices

The patients’ feedback, often less complements and more complaints, is a compulsory requirement by the Care Quality Commission of the NHS. Every GP Practice is forced display a poster in their waiting room, for patients, how to complain and to whom. Surprised and planned visits take place by trained medical and non-medical inspectors skilled in finding faults in every surgery where possible. They question every member of the Practice staff rigorously. Practice instruments and oxygen cylinders are checked. The premises must be very clean all the time. These adjustments need more staff, time and funding. There is no extra funding or manpower given by the CQC or Employer Authorities to these Practices. The findings of good and bad grades, after inspections, are displayed on the internet for the whole world to see and assess the competency of GPs.

Annual Appraisal and five yearly Revalidation of every GP

No one but no one can pass examinations or appraisals for Revalidation at all times. There are instinctive personal reservations as well, based on factors such as age, gender, social class, culture, religion, ethnicity, university or medical college. If an examiner likes an appraisee for any reason, he/she may move goal post towards the candidate but if there is a dislike, the appraiser would move the goal post away from the appraisee and keep moving. For example; patients’ feedback survey and patients’ audits were not essential for self-employed Locum GPs as they were not employed by any practice which can let them access patients’ notes after consultations were over. Now, it has been made compulsory for Locum GPs who have to leave practice or licence to practice, as a result. The agencies who support them have limited influences. These GPs cannot help themselves. Even God helps those who help themselves.

The current situation is similar to what happens to overseas doctors who wish to practice in the UK. In 1960s, when junior doctors were needed to look after war wounded survivors, about 18000 South Asian Doctors were trained abroad by the British and they were all given work permits, by the Ministry of Labour, to work in the NHS hospitals. They were given Certificates of Acquired Rights to practice in the NHs as General Medical Practitioners. The MRCGP became compulsory only when they were all over 70 years of age. When there was no further need, the PLAB test by the General Medical Council was introduced. I am not sure whether the pass rate depends on the posts available in the NHS but I feel that it may be a possibility. We can be proud of our politicians for their skills.

Computer control of Prescribing by GPs

If a GP decides to prescribe a medication, a statement appears on the computer to either change the prescription to a cheaper drug or to give NICE (National Institute of Clinical Excellence) guidelines to forbid prescribing. For example; no prescribing of bonjela; oromucosal gel, for mouth ulcers. No more any prescriptions for Ibuprofen tablets or gel allowed for osteoarthritis pain. No antibiotics prescriptions unless a condition of infection gets worse; sometimes, it may be too late. Some patients, especially with pain or infection, become very angry with the GP as they have waited a long time to get an appointment and now no pain or infection reliever given. Patients’ feedback survey, which is mandatory for a GP’s Annual Appraisal and five yearly Revalidation, becomes very negative. Patients may use the information, provided on the Practice Notice Board, about how and whom to complain against the GP and the Practice. Patients put negative comments on the Practice page on the internet. The GP remains helpless and distressed.

Control of GPs referral of patients to hospitals

A Locum GP saw and examined a woman patient with pain and tenderness in right lower abdomen and gastric region for 3 days, getting worse, and suspected “acute appendicitis”. He rang a surgical registrar of the local hospital. It was usual that such an emergency was investigated and treated at hospital, where investigation staff, time, skills and admission facilities were available. This was particularly relevant when an operation was needed. The surgical registrar advised the Locum GP firmly that he should do an ECG and a pregnancy test, and then ring him. It was an evening surgery with 10 minute per patient appointments. Only one receptionist was helping patients. There was no ECG machine and no pregnancy test kit was available and it would have taken a long time. The waiting room was full of patients waiting anxiously for their turn. The locum GP had to write a letter and send the patient to A&E Department to save the patient’s life. I hope that it happened. Currently, these hospital doctors on call are advised to insist that GPs should manage emergencies in their GPs surgeries. This is a Pandora’s Box opened to risk patients’ lives and litigation against GPs.

Moreover, GPs’ non-emergency referrals are firmly scrutinised by a team of referral controlling trained doctors in local CCGs. Many referrals are sent back to the GP. This reduces referrals to hospitals which can remain open only to treat patients referred by local GPs. These austerity measures would reduce the number GPs and increase risks to patients’ lives. There is a case for the Private NHS today. The patient power and British politicians would soon decrease doctors’ orders or disorders in a NICE way to save money.

It is quite difficult writing about a subject in which one has been immersed for 40 years but here I am offered an opportunity to advertise my skills. They relate to aerial photography, not taking photos from the air, which many people are involved in, but analysing what was going on the ground using vertically taken airphotos taken from’ the back list’ which stretches to 1944. And doing this in the most surprising detail. For surprising perhaps read incredible!

It is something I grew up with, working on airphoto analysis for the Government, detail mapping of whole territories – the Bahama Islands all 10 of them was one such. Later I worked in matters to do with planning. I left that behind as many 40 year olds do – there comes a time in life when getting into the country and away from the London 7am/pm commute routine is magically appealing. That is when I focussed on the use of airphotos as evidence. [And alongside of this, on precise urban mapping for a number of London and other Local Authorities].

My first case was in 1983 and involved a heavily wooded residential area in Surrey. There was a house with poorly defined bounding fences. It worked, I got paid and I was on my way. I have since then done perhaps 150 cases. Some of these were really interesting, some rather routine but nevertheless satisfying – satisfying for the outcomes. That said we nowadays have the Internet, we have aerial photography on Google Maps and Google Earth and can look back to some extent on the photography of yesteryear. I feel that some of my potential clients are using their undoubted intelligence to sort out their boundary and land use problems in that way. Some of the photography on offer, free, is very good. But all is monoscopic. Is the Judge going to be impressed by ‘their expert credentials’?

What then is the need for an airphoto specialist, a real expert? How does it help the situation, your client’s long contested case, to employ one? Settle back here and I will tell you. Stifle your yawn.

First off, is that I use airphotos to create a 3D model of the ground. It is an idea going back to Victorian stereoscopes made of mahogany, and 3D photos of the American Civil War, but now pursued using high quality optically based instruments. Computers come into it as well in the preparation of the most advantageous images, digitally sourced. I am aware as many of you are that 3D images can be produced on screen (gorgeous) but this requires expensive software and achieves no more, at single target level, than a pair of overlapping airphotos.

The advantage of consecutively taken overlapping airphotos (a standard method in survey) is that they offer that 3D model – they also gives two views of the same piece of land (ie from different angles) and detect any movements. Two views, one for each eye, reinforces the readability of the image. Think how well (NOT) you would drive with one eye blanked off.

A second advantage is that I routinely scale photography and therefore produce measurements accurate to 10 cms ground distance. This brings to mind that, using an additional instrument (a stereometer) and 3D photos which allows me to measure the heights of trees, walls and buildings to a similar 10cm height accuracy.

That is all detail. The most important advantage that I offer is many years of experience in recognition of how people use land, gardens, shift boundaries, take advantage of unclaimed areas; ground conditions portrayed in a series of dated photos. The whole business of secure inference. This answers the critical question that my clients come with ‘It used to be like that and then it changed (often when a new neighbour came on the scene). Now it is like this. Can you tell me if this account of things is verifiable’?

There have been some notable cases for example of the discharge of effluent into a tidal river from a ‘ginormous’ industrial plant. Where and when and to what extent? Photos going back to 1947. A second case, to precise the position and accurate height of trees (which had been cleared at groundwork stage) on a development site where some of the houses began to develop foundation problems. That was a job where ‘cheap and cheerful’ automated heighting had already proved less than satisfactory. Imagine measuring the height and spread of 250 trees and setting this out in a coherent map based report accurately related to numbered houses.

Another case, one of the most complex, involved placing the physical position of a wall and gateway to an old furniture works when the entire area to the north had been cleared of similar factories and put down to housing. Added to this that the adjacent railway cutting had been filled in and most all previous landmarks were lost. One hundred thousand pounds rode on that decision and again it depended on a series of dated airphotos viewed in 3D. Critically it was the sharpness of the some of the photos that made accurate measurement possible.

I particularly remember the case of access to the rear of an old building – one of those in a complex townscape. The claim was that the other side had always driven into a back yard; the reality as found in one dated photo was that they could not have done this as the way was blocked by a small outbuilding long since removed but clear to see on a photo taken within the legal time limit. I recall speaking about this in an interview for Radio London. Hang on!! Was it Radio London – fortunately I have the cassette tape as solid evidence – but where did I put it! The uncertainty of memory is fundamental to land disputes.

I half recall the 14 year dates of Railtrack land near Liverpool Station.

Many disputes arise out of the width of access, sometimes on farm tracks, sometimes access widths critical to backland development. Other cases are about the use or non-use of paths and bridle ways and is such cases one is looking for gate widths, unrecorded obstacles and track wear.

A most attractive kind of case is the so called Village Green claim in which 20 or 30 local residents recall their use of a piece of land. ‘We always went … we used to play … when my son was a child we picked blackberries … there used to be a bridge …there were no fences … we held village fetes on land next to Number 21 … there was never any form of notice telling us it was private …it was never farmed.’ Many of these claims can be investigated using airphotos, some cannot. But often it is what is not claimed that indicates that those who filled in forms were not familiar with the land. And that emerges in cross examination. I recall people dog walking straight through thick (now vanished) hedges.

And there was the case of the rooftop dormer window in Kensington; the planning start in sand dunes in South Wales; the amazing case of an advertising sign on a building in North London – it actually showed up on a vertical photo that had been taken (as the plane progressed) not from directly above but slightly from the side; the incident of the Cockle Fishers in the Wash.

And the sea serpent seven miles long. But I mock!

Bud Young www.airphotointerpretation.com
This email address is being protected from spambots. You need JavaScript enabled to view it.

Memory of places

How well do you remember places you feel you know, your home ground perhaps for twenty years? Airphotos give an eyewitness account for year dates that have long since faded from memory. In land claim cases, if you are a witness you might have filled out a claimants’ questionnaire. Horror and embarrassment in court when you are put on the spot. This is cross examination. The barrister is merciless, withering. You are discredited. You flounder and you mis-remember, you start to lie to cover lies.

And you will not necessarily remember places and that is because your memory is:
• Limited by your age at the time

• Limited by your range of travel and frequency of visit (it was some way away, we only went there once a year) • Limited by your understanding of what you see (frame of reference)

• Limited by your indifference to what you see (‘mind on other things’)

• Limited by your access to a site, I never went beyond the gate

• Biased to what you thought was important

• Effaced by the onward accumulation of other information (particularly about a changing site)

• Dishonestly biased in pursuit of a property suit or strongly held notion

• Honestly mistaken for an adjoining place. • Dishonestly transposed from another place

• Non existent because of bad memory!

Bud Young is a partner at “Airphoto Interpretation”. A two person partnership established 1983.
He is experienced in detailed urban mapping, forest survey, river corridor and greenspace surveys.

He has over 32 years litigation experience based on the notion “Airphotos make Good Evidence.” He is also the professional editor of Landscape Research Extra, now in its 28th year.

Mr Young is experienced in expert witness work Contact: Mr. Bud Young 26 Cross Street, Moretonhampstead Devon TQ1 8NL Area of work Nationwide

Tel: 01647 440 904

Email: This email address is being protected from spambots. You need JavaScript enabled to view it. Website: www.airphotointerpretation.com

by Martin Burns



Chartered surveyors are the ultimate experts in matters relating to land, property and construction. RICS qualifications signal the fact that someone is highly competent, routinely keeps up to date on his/her specialist subject, and is robustly regulated to make sure s/he maintains high levels of professional competence.

Many surveyors spend a lot of their professional time helping clients who are involved in disputes, and many of these end up getting appointed to act as expert witnesses. The appointments may see surveyors giving written and/or oral evidence to courts of law, and other tribunals, such as: arbitrators, construction adjudicators, rent assessment committees, leasehold valuation tribunals and planning inspectors.

Surveyors, who take on instructions to act as expert witnesses, must be genuine subject matter experts. That is, they must have considerable knowledge and experience in the precise issue(s) on which expert evidence is required by the relevant tribunal.

Whilst chartered surveyors will have exceptional and varied skills in built environment matters, those who act as expert witnesses will often need to complement their knowledge by adding another “string to their bow”.

Most will already understand requirements around professional integrity and impartiality. These matters are at the heart of RICS ethics and will be reinforced throughout every surveyors’ professional lifetime through ongoing training and development, and also through published statements on professional practice, which are mandatory for all chartered surveyors.

Surveyor experts know and accept they must be, and be seen to be, independent and unbiased. They understand they must only deal with matters that fall within their personal expertise, experience and knowledge, and that they must be truthful at all times.

But acting as an expert witness requires surveyors to obtain additional knowledge about law and practice, and a real understanding of what is expected of them. Experts must be exceptionally good at communicating what they know about their specialist subject in a way that ensures the tribunal understands it. Surveyor experts must bear in mind, at all times, that the job is to help the tribunal understand a particular issue enough so that it can make an informed decision on the substantive dispute before it.

Surveyor experts must remember that, regardless of who is paying them to prepare their written reports and present oral evidence, their overriding duty is always to the tribunal. They are not to perform as advocates for their clients when they are acting as expert witnesses.

In recent years, instructing lawyers have become increasingly careful to ensure their expert witnesses are suitably qualified and capable of providing written and oral evidence to a high standard and in accordance with established legal requirements.

When assessing the suitability of experts, instructing parties and lawyers are likely to favour surveyors who have been trained and assessed by recognised training organisations. Formal qualifications provide assurance that those who hold themselves out as an expert witnesses are able to demonstrate real understanding of their primary roles and duties as experts. Those who instruct experts also need to be reassured that the expert is able to meet deadlines, produce court compliant reports, be credible in the witness box and have a thorough understanding of the relevant court procedures and rules.

In my experience, more and more surveyors are actively undertaking training and assessment in the role and duties of expert witness. It seems to me that the beginning of a genuine trend for surveyors to obtain formal qualifications as expert witnesses can perhaps be traced to the Supreme Court’s decision in March 2011 in Jones v Kaney.

The removal by the Court of experts’ immunity from being sued in negligence has not, at least in my experience, resulted in a plethora of cases being brought against surveyor experts. Even so, it seems the decision brought into sharp focus the requirements for surveyors to be as professional and detached in discharging the role of expert witness as they are when undertaking their day-to-day professional work as surveyors.

Clients naturally expect expert witnesses to perform to best practice legal standards in their role, and it seems surveyors are responding by getting themselves equipped to discharge the role to higher standards by undertaking formal training, and submitting to assessments and interviews which test their abilities.

There is greater realisation amongst surveyors today, that when acting as expert witnesses they really must possess essential legal knowledge and practical skills, and be confident in the witness box. And all this is in addition to their skills and experience in surveying matters.
Going forward, the demands on surveyor experts may ultimately lead to formal qualifications being requisite. Whilst this is not currently the case, it is apparent that surveyor experts who are trained and accredited have an advantage over those who are not when it comes to obtaining instructions.
Martin Burns

by William Bates


It is not easy being an architect these days. In the past, architects were protected by mandatory (later, ‘recommended’) fee scales, and obtaining planning permission for a building and then successfully getting it built was somehow much simpler than it is now. Today, everyone considers themselves to be experts in the field of architecture, by virtue of having watched a few episodes of Grand Designs and other aspirational television programmes. As with most professionals, architects are bombarded with information overload. Apart from basic construction skills, contemporary architects are expected to possess an adequate working and up to date knowledge of Planning Regulations, the Building Regulations, Building Contracts and Construction Law, hundreds of British Standards and Codes of Practice, Party Wall legislation, Rights of Light, Health and Safety, energy performance and sustainability, building economics, and a host of other complex issues. Architects are expected to be masters of all aspects of their craft and it is not altogether surprising that they sometimes fail to meet one or more of the obligations placed upon them.

The architect is an easy target. He or she is still perceived to be the leader of the building team and, when things go wrong, the architect will invariably find himself in the firing line. He will often be joined in a claim by other professionals, such as the structural engineer or the quantity surveyor, and/or by the building contractor.

In my role as an architect expert witness, I have come across numerous examples of my fellow professionals who have failed to meet the appropriate standards. But what are these standards? As with all professional persons, architects are expected to exercise reasonable skill and care in the performance of their duties. In judging if an architect has complied with this standard, the courts will assess whether the architect has met the standard of the average competent architect and whether his actions are likely to be supported by a significant body of opinion within the architectural profession, i.e. whether his peers are likely to have acted in a similar manner. If not, the architect may well be found to be negligent.

I have dealt with claims from architects for unpaid fees and for alleged copyright infringement, but the majority of building disputes involving architects are generally initiated by the client. The common thread of these disputes is that, rightly or wrongly, the client considers that he has been let down by the architect. The client’s aspirations have not been met in some way. Sometimes the reason for this is obvious – perhaps the building leaks and the client sees the architect as being responsible for the defect, either because the design and/or specification is seen to be faulty or it is alleged that the architect has failed to carry out his inspection duties with due diligence. But occasionally, the client will make more obscure claims. In the early part of my career as an architect, I had to respond to a threatened claim from a client after a project had been completed that it was not as large as he had been expecting. Since this was a loft conversion and thus an existing structure and it had been constructed fully in accordance with my design drawings (that the client had approved), this was not an easy claim to sustain and, fortunately, it soon dissipated and my fees were paid.

Another common feature of the cases that I have been involved with is confusion regarding the terms of engagement and the roles that the various parties involved considered that they were performing. Despite the fact that it is a code requirement of both the Architects Registration Board (ARB) and the Royal Institute of British Architects (RIBA) that the terms of any appointment are clearly set out in writing and agreed by both parties, it is astonishing how many of the disputes I have been involved with have imprecise or ambiguous terms of engagement (or none at all) at the core of the dispute. Unless the appointment is precise and the roles and responsibilities are clearly defined at the outset of a project, misunderstandings are likely to occur. This is particularly prevalent in small projects where the architect does not wish to frighten the client with reams of legalistic conditions and where the overall finances available are such that the client is often reluctant to engage specialist consultants. In an effort to please the client and move the project forward, many architects will take on roles for which they are not properly qualified. Thus I have seen examples of architects thinking that they were structural engineers or quantity surveyors or party wall surveyors and making major errors as a consequence.

Many building disputes are concerned with building defects. Building design is an increasingly complex skill and it is becoming more and more specialised. The individual elements that make up a construction have to satisfy a plethora of performance criteria and possess the ability of working effectively in combination. Depending on the particular context, a construction detail may have to be structurally sound, adequately fixed, thermally efficient, sound and fire resistant, secure and vandal resistant, water and draught resistant, durable, maintenance friendly, economic and, of course, aesthetically pleasing. Increasingly, the individual components also have to have been obtained from a sustainable source. Often, it is the interface between materials and components that causes a failure. Despite the advent of 3D CAD design and Building Information Modelling (BIM), the junctions between components are frequently ill considered and left to be ‘sorted out on site’.

With so many often conflicting criteria to satisfy, architects occasionally get it wrong. What enables them to sleep at night in the face of all this is the professional indemnity insurance that all architects are required to maintain. This has actually become cheaper to obtain in recent years due to competition. However, the very presence of their PI insurance means that they represent tempting targets for clients and their solicitors.

A Hertfordshire-based home improvement company has been fined after the unsafe removal of asbestos material from a domestic property.

St Albans Magistrates’ Court heard how Ace of Hearts Home Improvement Limited (AOH) removed asbestos containing materials (ACM) from a domestic property in St Albans.

Asbestos damage
The Asbestos Insulation Board (AIB) soffits surrounding the underside of the guttering around the front, gable end and back of the property had been dismantled in an unsafe manner creating the serious risk of respiratory exposure of asbestos fibres to the two workers and the residents of the property (family of four including two children).

An investigation by the Health and Safety Executive (HSE) into the incident which occurred on 25 Sept 2015 found that the company were not licensed to remove asbestos.

Unsafe removal of asbestos
Ace of Hearts Home Improvements Limited, of Alldicks Road, Hemel Hempstead, Hertfordshire, pleaded guilty to breaching Regulation 8(1) and Regulation 16 of the Control of Asbestos at Work Regulations 2012, and The Health & Safety at Work etc. Act 1974, Section 33 (1) (g) in that it failed to comply with an Improvement Notice, and was fined £100,000 and ordered to pay costs of £2,118.50.

The Health and Safety Executive (HSE) is Britain’s national regulator for workplace health and safety. It aims to reduce work-related death, injury and ill health. It does so through research, information and advice, promoting training; new or revised regulations and codes of practice, and working with local authority partners by inspection, investigation and enforcement. www.hse.gov.uk

by Mark Chester - Cedarwood Tree Care


Tree health has been in the headlines in recent years, as various species of trees common to the UK have come under attack from what seems to be an army of pathogens. In the late 1990s, Horse Chestnuts were suffering from the onslaught of Phytophtera, which can cause Bleeding Canker and killed many trees. The English Oak has suffered from Sudden Oak Decline, Larch are being wiped from forest plantations and there are fears for the future of the Ash with Ash Dieback caused by Chalara fraxinea. With some prophecying the pending loss of these trees from the British landscape, how can we help?

Readers of a certain vintage may remember the English Elm, which dominated the landscape and was a symbol of rural life until Dutch Elm Disease arrived in the 1960s and rapidly spread. Few trees were able to withstand the attack and little remains of the original population. Do Horse Chestnut, Oak and Larch have a better chance? There are a range of tools which we can use to assist the population, and some lessons to learn from tree management elsewhere.

One of the most comprehensive tools we can use, especially here in the UK and being an island nation, is quarantine. By ensuring that plant material is
checked before it passes through customs, the risk of pathogens being brought in is significantly reduced. Dutch Elm Disease was introduced in imported timber. There is evidence that Chalara fraxinea, if not introduced by humans, has certainly been spread towards the west coast and the north of the UK by infected plant material. This has been accentuated by transporting young saplings to woodland sites. In terms of economics, it is less costly to export one – year old ash trees (known as whips) and grow them on nurseries in Holland, and then bring them back to the UK for planting a year later!

Of course, what I am describing here in terms of quarantine is the panacea. It is an ideal which not only requires support from the UK Government but also global partners. At the time of writing, Britain is preparing to negotiate her exit from the European Union. Keith Sacre, Chair of the Drafting Committee for BS8545 ‘Young Trees From Nursery to Independence in the Landscape’(2014), faced the realities of the politics of the EU market and the Single Market. Recognising the importance and value of quarantine as a tool for biosecurity, he arranged for quarantine to be included as a recommendation in this new British Standard. However, this was thwarted by the principles of the Single Market and was vetoed by other members who were reluctant to see any restrictions on free trade between member states. The document could only be published if the reference was removed.

We seem to operate a policy here in the UK of shutting the stable door after the horse has bolted. Once a pathogen has established its presence here, further imports of infected material can be banned. In fact, there can be total bans of importing, whether material is infected, or not.

Clearly, this strong weapon of prevention is not currently available. However, there are other tools in the armoury. Diversity is important. When we have a population of trees of the same species, and even the same family, pathogens, whether pests or diseases, can spread more easily and become established if provided with a larger number of hosts. So often, trees and shrubs are selected for planting schemes based on their colour, leaf shape, availability or simply personal preference of the architect or landscape specifier. The suitability of the selected trees and shrubs to the new environment, and landscape, is often a factor overlooked.

Why does this matter? Some pathogens attach members of the Maple family, genus Aceracea. This is a large family including the Field Maple, Sugar Maple and Norway Maple. Diseases such as Anthracnose and Virticulum wilt can spread among different Maples. In parts of the United States, more than 30% of the trees planted in certain neighbourhoods are Maple, and the consequences of a pathogen attacking can be devastating, actually changing the appearance of the landscape. It may come as a surprise to consider that the humble Rowan, Sorbus aucuparia, is, alongside the domesticated rose and native Dog Rose (Rosa rugose), a member of the Rose family. As such, it is vulnerable to pathogens which attach roses.

The solution isn’t to necessarily stop planting Maples and Rowans, but to ensure species diversity within planting schemes. The recommendation is that no one species should exceed 10% of the planting list, by number. Those related by family should be limited to about 35%. This is a real challenge. So many tree enthusiasts have favourites, and in some situations, where, for example, tolerance to fluctuations in water supply, or drought, or coastal conditions, may be defining limitations, the species choice can be restricted.

There are design challenges. For example, if one is designing an avenue of trees as a landscape feature, it usually consists of a single species, or at the least, species from the same genera. If one were to select from the Tilia genera (Lime, it is possible to use several different species). However, with London Plane, an ideal street tree, there are two main species widely grown: the Oriental Plane, Platanus x orien-talis and the Spanish Plane (Platanus hispanica). The Plane tree is particularly vulnerable to Plane Tree Wilt (Ceratocystis fimbriata f. platini). The additional challenge is that the Oriental Plane propagates vegetatively so there is little genetic variation within the population. The London Plane is an important part of the tree population of the capital, and elsewhere. The consequences to the landscape if this disease became prevalent are ones many arborists are dreading.

I referred earlier to the situation in the US, where the disease control approach is to fell, even if this involves 100% of the population. This approach is not preferred here in the UK. It tends to drastically change the landscape. However, the management technique has been applied to controlling the spread of Phytophtera in Larch. This does relate primarily to forestry plantations with their monoculture cropping which enables the pathogen to spread more widely than in our urban landscapes. One of the main reasons for the total clearance approach with Larch is also about timber quality. The Larch plantations exist to provide timber, and its quality deteriorates as the disease spreads. By harvesting before the disease can spread, even if the trees have not yet attained maturity, the available timber can be saved.

I was working as a local authority tree officer when the consequences of Phytophtera, which causes Bleeding Canker in Horse Chestnut, became apparent. Part of my brief included managing the trees on several cemeteries, one of which had an avenue of Horse Chestnuts which sloped downhill. The disease is passed from tree to tree in soil water. I watched over the course of several years as the disease spread from those trees uphill to the lower ones. In the end, a number of trees had to be felled as their condition declined so much and branches were being shed.

At the time, I was pessimistic about the future of the Horse Chestnut. I wondered whether any would be left in ten to twenty years’ time. Then something began to happen. Or rather, it didn’t. Some Chestnuts didn’t succumb. It became apparent that there was a degree of resistance within the wider population. Genetic variation, it seems, can help the Chestnut.

It was this that got the plant pathologist Dr. Glynn Percival thinking. Why, he mused, did some trees succumb, and others not? Was it simply genetic variation? He began to explore the differences between trees which remained healthy and those which were unable to resist the advance of various pathogens.

One thing we have known for some time is that the ability of a tree to resist a disease attack can reduce with age (the ‘hard as nails’ London Plane, which can live for 300 years, stubbornly resists Innotus hispidus whereas the Common Ash, a veteran at 100 years, is more vulnerable). Glynn decided to stop thinking of the tree as a woody structure standing helplessly as a plethora of pathogens launch a barrage of assaults until finally it is overcome. He noted that trees suffering drought stress seemed to be more vulnerable. Stress can also come from the various operations associated with construction, including compaction of soil, the removal of soil and changes to both water and soil levels.

If we can help trees to avoid stress (through the application of best practice on construction sites) and equipping them to resist stress, they will then be better equipped to resist the pathogens. There are a range of tools which the modern arborist has access to. There has been recent press coverage about the potential of biochar to strengthen Ash trees. Trials which Glynn unexpectedly found himself supervising (biochar had been used to treat the trees as part of site management rather than in a formal experiment) indicated that it could be effective in the battle with Chalara.

One thing that I value with Glynn is that he is unwilling to be drawn prematurely on research. With these trials, interviewed on the BBC Countryfile programme, he was asked whether this was the solution for Ash. More research is needed, he cautioned. However, what delights me is that, through the work of Glynn and others, an array of tools is being identified which enables me, the arborist, to be better equipped in the battle. The skill is to know what to use, and when, and I feel better equipped than I did fifteen years ago. There are times
when I have to deliver the message which my client would rather not hear; the decline has progressed too far and it is unwise to invest further in resources aimed at helping a tree to recover. It is important to be proportionate in ones’ response.

I have been working closely with Kevin Martin, the Arboricultural Manager at Kew Gardens. He manages this internationally important collection which numbers some 14,000 trees. There can be a tendency, once a tree shows signs of decline, to fell and replace. Often, in pure economic terms, this is the preferred option especially when one has very finite resources. However, for Kevin, with many historically, botanically and biologically important trees felling is often the last option, only to be explored once others have been fully explored. Fortunately, Kevin has a naturally inquisitive mind; he likes to explore.

He recently shared with me about the journey to find out why a Japanese Pagoda tree was showing signs of stress. This particular tree was part of the original collection when the Botanic Gardens were founded in the 1760s. One might naturally conclude that time had taken its’ toll. In addition, due mainly to the historic significance of the specimen, it is the most popular member of the tree collection at Kew. One can only imagine the effects of the traffic from all of those visitors.

One of the key principles in arboriculture is that what happens below ground is as important as above ground. Kevin began to explore. The tree had a mulch of gravel. This is useful in the right place, but I find it is mainly suitable for footpaths and driveways. The absence of organic matter limits its value for trees. Kevin shared with me that he removed some four tonnes of gravel from the base of this tree! Below the gravel was a weed suppressant membrane which was not only really effective in stopping weeds growing upwards, but also water filtering downwards. The ground below the membrane was dry and had little organic matter, and needed Kevin’s expert touch to bring restoration. The tree is recovering well.

The application of chipped bark mulch can be an invaluable tool in helping a tree to thrive and equip it in the battle against pathogens. However, care is needed. Fresh mulch can drain the soil of nutrients whilst too can damage the trunk. Interestingly, the same applies to water: excess can be more damaging than too little.

I have looked so far at equipping the tree within the landscape for the challenges it will face. However, it is becoming increasing evident that the successful journey actually begins on the nursery, when the tree is growing and being prepared for ‘adulthood’ in the landscape. An over view of best practice for nursery production was published in 2014, the new BS8545: Young Trees – Achieving Longevity in the Landscape. Above ground elements such as the importance of a strong central leader are covered. However, the development of a good root system is also important. I recall, years ago, a friend was growing a young oak tree in their garden. They were delighted at how the tree was developing a strong and deep tap root, and wanted to know how they could transplant this tree to me without damaging the root. The reality is that actually, to develop a successful rooting system, the tap needs to be severed early in the life of the tree, to encourage lateral roots to form. We now have access to technology enabling us to assess the vigour of the tree both in the nursery and within the landscape. This is enabling monitoring from the earliest days. One element that surprised me is that, in part because trees are usually sent from the nursery to the landscape when they are dormant, is that some are dead when they are dispatched!

I have spoken about this technology before. It uses the response of chlorophyll fluorescence to sunlight. It is invaluable because the chlorophyll shows stress within the plant much sooner than it is revealed through physical symptoms. Glynn, who helped to develop the technology for arboriculture, has shared with me how, when assessing some nursery trees which had recently been planted in the landscape, he identified one batch to be suffering drought stress. The supplier was adamant that the stock was healthy. Glynn had to wait for three weeks for the physical symptoms to appear, and was relieved when his observations became evident and the trees began to decline.

Whether one considers climate change to be fact or fiction, one thing is apparent: drought conditions are becoming more common and widespread, especially in the urban environment. We know that some trees are better equipped to thrive in drought conditions. One of Glynn’s colleagues is focusing on this. He is exploring whether we can identify the characteristics of trees with drought tolerance. If we can, then we can be more informed in species selection.

There are a range of tools now available to equip the arborist in helping trees to resist pathogen attacks, ranging from variations in species selection to good plant health and biosecurity. We are better informed than ever before in understanding how trees resist attacks. The key element remains knowing what to use, when and how. As I continue on my journey to know more, I am able to help tree owners to look after their trees and enjoy this asset in to the future.

 

Smithers Rapra looks at the reasons for premature failure in plastics and rubber products and the importance of systematic failure analysis when preparing scientific and engineering evidence.


Expensive warranty claims, legal disputes and product recalls can result from the unexpected or premature failure of plastic and rubber products.

Smithers Rapra is one of the world’s largest independent failure investigators of failed plastic and rubber components and products. Th ecompany provides a comprehensive expert witness support service relating to polymer based failures, quality issues, disputes over design and manufacturing processes.

Reasons for Failure

Over 5000 plastic product failures have been undertaken by Smithers Rapra over the last 25 years. These have been classified below into root cause to highlight how and why failure occurs.

It has been found that although it is common for a combination of effects to contribute to failure there is often a human factor to its cause. The pie chart below (chart 2) shows 45% of the plastics failures investigated resulted from a poor material selection choice or a misunderstanding of the performance specification required for the product at its design stage.

Common factors that are often overlooked where products fail include:
➢ Long-term behaviour- rubber and plastics mechanical properties are both time and temperature dependent.

➢ Environmental effects - exposure to chemical environments and elevated temperature can reduce long term performance

Product manufacturing effects – errors in manufacturing polymer products can introduce complications that have a detrimental effect on the performance of the product.

Many polymer product manufacturers are often unaware of the consequences of their process on part performance.

Many applications for plastics are for metal replacement components and the design requirements are becoming more arduous with the operating environment having higher continuous operating temperatures and more aggressive chemicals.

The two main forms of mechanical failure are ductile and brittle failure. Ductile failure is, by definition, failure at high strain. It is relatively straightforward to design plastic components to avoid ductile failure. However, in practice, ductile materials often fail in a brittle manner, which becomes much more difficult to predict. Brittle fracture is a low energy process characterised by failure at low strain, with little or no deformation. Components can contain small, crack-like defects which can act as stress concentration features; these micro-cracks grow under load and may eventually lead to rapid failure.

Failure Investigation Process
In undertaking failure investigations at Smithers Rapra, a wide range of testing and polymer analysis tools can be called upon using its own UKAS accredited material testing, polymer chemical analysis and product testing laboratories in order to get a true picture of the reasons for failure.

A typical analysis on a failed product may require microscopic examination followed by chemical analysis to confirm material and additives type, examination of polymer molecular distribution to determine material degradation status and thermal analysis to understand temperature transition responses.

A manufacturing process audit may be appropriate to determine any influences on the failure. The product under load or its manufacturing process may be modelled using computer simulation.

Components or products are sometimes subjected to mechanical testing in creep or fatigue modes in specific operating environments to simulate in service conditions.

Best Practice Expert Witness for Polymer Products
In order to provide robust expert witness support in depth, experience combined with exposure to the preparation and presentation of evidence to court is vital.

The Smithers Rapra consultancy team comprises of plastics materials engineers, polymer chemists, rubber specialists and manufacturing consultants each with typically over 20 years’ experience in their field.

Expert witness services extend to a wide range of industry sectors including; pharmaceutical, transport, automotive, industrial and consumer.

Recent cases have included products such as medical devices, packaging materials, building components, toys and engineering plant.

Smithers Rapra has extensive experience testing materials and products manufactured from rubber and plastics. We are also highly skilled in the testing of engineered assemblies and products constructed from other materials that incorporate plastic and rubber components - including metal and composite structures.

Clients in a wide range of industries use our testing services from automotive, aerospace and industrial products to consumer, medical and pharmaceutical. We serve clients throughout the supply chain from material supply and processing to manufacturers and end users.

The laboratories at Smithers Rapra are UKAS accredited in accordance to ISO17025 and the majority of our projects are carried out to this quality standard.

Mr Gordon Miles, the chief executive officer of the Royal College of Emergency Medicine spent a significant part of his previous career with the NatWest Bank. It became obvious to us that some of the urgent care plans proposed by NHS agencies were already familiar to him in a different guise. Consequently, we asked him to write this piece……


As CEO of RCEM, I spend quite a bit of my time in meetings with the great and the good of UK healthcare discussing the challenges facing emergency medicine and, alongside our president and other officers of the College, advocating our STEP Campaign. We often find ourselves rehearsing arguments that I am very at home with because of my financial background, especially the strategy of channel management. This is the concept of delivering services to customers through specific “channels”, such as face to face, by telephone, via the internet etc.

As some of you may know, I spent many years working for NatWest, before I joined the world of healthcare. I started in the days when bankers were more popular than double glazing salesmen and fortunately, left just before it all went wrong! My time included being a corporate financier for small and large businesses as well as some years in the strategy team. “So what?” I hear you physicians saying! Well, I think that, in many ways, the dilemmas facing retail banking in the 1990s have echoes in the NHS of today. Let me explain…….

In the 1990s, it became clear that the retail banking network was over-supplied with branches. There were more than 1700 of them owned by NatWest alone. These branches were essential in the past as the places where the processing of financial transactions occurred, where deposits were kept and where business was done. However, the centralisation of back office procedures and phone calls (telephony) into “centres” gave economies of scale and improvements in processing consistency. This reduced the branches to cashiers with a small team whose primary task was to sell products and deal with customer enquiries.

The branches were a financial drain - expensive to maintain and run - and the staff there didn't generally generate much income by way of sales. Moreover, the buildings were often situated in the wrong part of town because the NatWest network had been created
by the merger of the Westminster Bank and the National Provincial Bank and often dated back over 50 years. So what was to be done?

The banking gurus of the time needed a way to discourage customers from coming in to the local branches. (Is this starting to sound familiar?) So they thought that telephone banking would be the answer. A one-stop phone service in call centres, using standard processes would be cheap to run and would stop the need for customers to visit long-established branches. Confidently, they launched the new service. What then happened was perhaps predictable. The new free telephone service was used but, when problems were encountered or the answer wasn't to the customer’s liking, they went to the branch just as before. Thus the impact on branch “foot flow” as it was called, was not what was expected or certainly what had been hoped for!

Still trying to reduce the ”foot flow”, the ever-optimistic gurus then saw the newly-emerging potential of the internet as the answer. Online banking would surely do the trick. Another free-to-use service was taken up but, unfortunately, just as before, customers phoned, went online and then visited the bank. Once again, the new channel was used, but the pull of the old traditional channels remained stubbornly high. Charging for branch use was also considered but the competitive market meant that it wouldn't be successful. (Bankers need customer loyalty and subsequent income.)

The next idea was to shut branches of the bank. That would surely force the customers to use the new channels. And indeed it did in part, but some customers left to join competitor banks whilst others found another NatWest branch nearby and used that.

The real breakthrough came when the main need for branches was almost removed. The debit card revolution meant that people rarely wrote or received cheques. Cash machines were installed all over the country as another very effective channel of delivery. These machines were cheap and, if other bank’s customers used them, then NatWest would charge that bank £1 each time! So the new channel actually made money. Consequently, it is no accident that many of the major railway stations still have a NatWest cash machine. The de-skilling and staff reductions in the branches meant that visiting them for advice became a largely futile exercise and, at last, NatWest succeeded in reducing its branch network. And this process in retail banking continues today. TSB is presently trimming its branch network drastically.

So back to the NHS and our STEP Campaign. The reason that RCEM is calling for primary care co-location is that the power of the A&E brand trumps all appeals to “only attend in an emergency”. I often find myself pointing out that encouraging the public not to attend the ED except in exceptional circumstances has a 25 year legacy of failure. There are a variety of reasons for this, not least the brand-pull argument above, but also the rational choices made by patients themselves. Their choice is influenced by where, in their perception, is the best place to go, the availability of other services, the impact of the visit on work life and indeed what other NHS service providers tell them to do - and many refer patients to the ED. Of course, whatever the choice, this is a free service (at least to the user)!

The other alternatives are bleak. In a world where patient numbers, acuity and demands are rising faster than supply, then queues are inevitable - a bit like my old bank branches where long queues used to form, particularly at lunchtime, consisting of angry, disgruntled people. The urgent care world is already experiencing this; the College receives report after report about the challenges of hospitals with fourhour and 12-hour waits.

Another option is closure and rationalisation of EDs. We can see this occurring at the present time with the consequent pressure that it puts on other local units. Unlike the bank customer, who was given a debit card and cash machines in many convenient locations or simply trotted off to a competitor’s outlet, closing an ED often offers a patient little alternative other than to simply travel further. Sometimes closure can be presented as centring demand on places with particular expertise but the patient doesn't start off with the perception that the closed unit delivered substandard care and so doesn't understand this argument easily. When the patient accepts the premise, it risks eroding trust in the NHS brand. A patient might ask: why would the NHS allow sub-optimal practices to persist? Or perhaps why was this not done years ago?

In my view, the channel management strategy of the NHS is in need of some resuscitation. A good place to start is with some sage advice. In their book “Developing Multi-Channel Strategy”, Dr Stan Maklan and Dr Hugh Wilson of Cranfield University offer just that. They state that: “Customers make channel choices alongside their product-service choices and expect suppliers to offer sales, marketing and service across multiple channels - online, telephone and physical presence. Offering all channel choices to all customers across all products and services is too costly for most companies. For many companies, channel strategy is now every bit as critical to their success, as are brand and product range policies. Companies must now determine how to service indifferent customers through a combination of channels that meets customer needs at competitive cost.” If we did a word search and replaced the word ”customer” with ”patient” and ”companies” with “NHS Trusts / commissioners”, this could well have lessons for us all.

So the STEP campaign, in my view, stands up well to a channel management strategy scrutiny. It is patientcentric and acknowledges the choices made by them. Additionally, it is potentially effective for the supply side too. One big challenge with co-location of services is space and estates, but often much can be achieved locally without the need for large infrastructure projects. The alternative is to try to reduce demand and we know how successful that strategy has been over the past few years! Growth rates of 2% per annum in ED patient attendance don't sound much but lead to an overwhelming demand on services over just a few years. And so next time you stand at a cashpoint with your plastic card, remember the banks and the lessons about patient flow that they can teach us!

By Gordon Miles, Chief Executive The Royal College of Emergency Medicine

Professor J Peter A Lodge MD FRCS FEBS Consultant Surgeon, Leeds Teaching Hospitals NHS Trust www.peterlodge.com

Surgical removal of the gallbladder by cholecystectomy is now one of the most commonly performed abdominal operations in the West, with rates approaching appendicectomy in the United Kingdom.

Asylum Aid is a national charity that has been providing legal representation to asylum seekers in the UK for 25 years. Our strap-line, protection from persecution, is at the heart of what we do: we take on the most complicated cases of people who face human rights abuses abroad, and secure protection in this country and the chance for them to start new lives.