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Spotlight on: Respiratory Conditions

One of the benefits of shielding during the COVID-19 pandemic, for those with lung and respiratory conditions, was to protect an already vulnerable group from exposure to a virus that creates further complications and in some cases fatalities.

There is no doubt that shielding has protected so many lives however those suffering with respiratory conditions and the clinicians caring for them are now rebuilding treatment plans to address secondary complications.

Our associate expert witnesses working on quantum and liability reports are seeing a number of complications in their clinical patients and managing the challenge of the necessary changes in NHS investigations and management.

Respiratory nurses and respiratory physiotherapists have a strong clinical background in managing a variety of lung conditions and diseases, can evaluate appropriate investigation & treatment pathways and can provide objective comment on the management of respiratory conditions in line with NICE guidance and local protocols.

The impact of shielding on respiratory conditions

Over a third of people with lung conditions felt pressure to avoid or delay seeking treatment during lockdown. Patients avoided care as they did not want to 'burden' the NHS or did not feel safe going to A&E or their GP" (

Jane Scullion, Respiratory Nurse Consultant at Leicester Hospital, recounts the impact of essential shielding in response to COVID-19 on her client base:

"Patients who suffer with chronic obstructive pulmonary disease (COPD) frequently suffer from exercise intolerance, leading to a reduced ability to participate in activities of daily life & therefore to a reduced health-related quality of life. An important determinant of exercise tolerance is muscle mass. The loss of muscle function is known to be multifactorial but deconditioning appears to play a primary role which Jane says has increased patients' frailty and breathlessness which has been life-altering for some people."

Managing the necessary changes in NHS investigations, treatments and subsequent management due to the limitations of virtual assessments & cessation of diagnostics Jane says has been a challenge.

"Respiratory services are now mindful in the wake of COVID-19 of potential undiagnosed cancers and a variety of lung diseases which will have sustained a life-altering reduction in lung function as a result of the emergency response to the pandemic."

Providing expert opinion on respiratory conditions

At Bush & Co, we are starting to see an increase in the number of respiratory related cases requiring an expert witness report for both quantum and liability. This increase is not a claim against COVID-19 but as the UK begins to open up and patients will seek to get back to a place prior to the pandemic in the management of their condition or rehabilitation. Across the sector missed cancers, a lack of access to services and treatments such as oxygen therapy and medication and a failed duty of care will increase.

Our nurse and respiratory physiotherapy expert witnesses working in multi-disciplinary teams on the front line, caring for patients who have developed conditions such as industrial lung disease, reduced functional capacity and fatigue where liability is to be sought.

They are also trained to examine and assess quantum loss in a variety of infection control, lung conditions/diseases.

Our expert witness nurses have a strong clinical background in managing a variety of lung conditions and diseases as well as evaluating appropriate investigation and treatment pathways and commenting on the management of respiratory conditions in line with NICE guidance and local protocols. Our expert witness respiratory physiotherapist is also able to provide expert opinion and ultrasound diagnostics.

When communities shut down

Our liability experts working in community nursing report that due to lack of access to GP and hospital specialist services that they have been managing a wide range of respiratory conditions as nurse specialists in the community such as bronchial diseases (including COPD), lung cancers, asthma complications and long COVID where conditions have been miss-managed and not addressed at the point of need.

Because of the increase in IV therapy, oxygen therapy and lung function monitoring within the community we expect that from a medico-legal standpoint we will start to see arising complaints regarding disease burden including cancers, COPD and reduced functional capacity and long term COVID sequalae.

Meet our respiratory expert witnesses


Jane Scullion | Consultant Respiratory Nurse

Jane is an experienced consultant respiratory nurse with over 30 years' experience working with individuals with respiratory disease. She is enthusiastic, passionate and compassionate; with an interest in symptomatology and health psychology across a range of respiratory diseases. Jane also has a keen interest in the issues around palliation.

For the past 20 years Jane has been a Consultant Respiratory Nurse and more recently Service Lead for Interstitial Lung Disease (ILD) at University Hospitals of Leicester. In her clinical role, in the respiratory unit, Jane runs her own clinics diagnosing, prescribing treatment pathways and medications; she also receives direct referrals for a range of individuals presenting with respiratory symptoms. Jane also has a teaching, service development and research elements to her role; she undertakes peer support and staff development as one of the senior nurses at the hospital. View full profile.


Holly Spencer | Respiratory Physiotherapist

Holly is a specialist respiratory physiotherapist with over 16 years' experience working within the NHS and educational settings. She currently works within education and private practice and her experience and expert knowledge includes the management of people with respiratory disorder or disease.

As a clinical specialist respiratory physiotherapist Holly has worked for Cardiff and Vale NHS Health Board managing a case load of clients from birth to adult with complex respiratory needs in acute, outpatients and community settings, including emergency on-call with particular expertise in paediatric populations. She is experienced in long-term ventilation, cough augmentation and respiratory care planning and has worked with patients in intensive care, post-surgery and with those living with chronic respiratory conditions. Holly has additional experience in thoracic medicine cardiac and thoracic surgery, intensive care and high dependency, A&E settings and working with clients living with cystic fibrosis. View full profile.


Alison Smith (nee Conway) | Registered General Nurse

Alison is well liked and respected amongst the medico-legal sector and is regularly instructed to provide expert opinion on catastrophic injury including spinal cord injury as well as mesothelioma, respiratory disease, ventilation, tracheostomy, thoracic surgery and occupational lung disease.

She is an advanced practitioner and nurse prescriber and her experience as an expert witness is wide ranging and covers nursing negligence, loss of service and care reports for disabilities and injuries including paraplegia, tetraplegia, cerebral palsy and neuromuscular disease. View full profile.


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