Lambeth and Southwark are two of the most deprived areas of London.
The health needs of the two boroughs - with a combined population of about 650,000 - are looked after by the staff of King's College Hospital.But who looks after the doctors? It takes an in-house team of six women to care for the hospital's legal needs.
And the lawyers claim that they make up the only in- house legal team working at a hospital.Last year, King's had a budget of £190 million and treated 415,000 patients.
The four million residents of the south west of England are referred to King's as their local regional specialist for cardiology, neurology, neurosurgery, renal care and foetal medicine.
King's is also a training hospital for doctors, nurses and dentists.Although bashful about her involvement, Judith Seddon, the corporate and legal services manager, admits that she was instrumental in developing the in-house team, which has been in existence since 1993, when King's became a trust hospital.
Without an in-house team, most hospital trusts rely far more heavily on external firms of solicitors.
Some refer matters out-of-house as soon as a complaint is received.
Others deal with complaints but when it becomes a claim, solicitors have to be involved.
King's in-house team manage to retain control of most matters through to resolution.She says the team now deals with 60% of clinical negligence claims in-house, which is reflected in costs savings to the hospital trust.
More importantly, she says, the team provides valuable assistance and advice to staff on legal, ethical and sometimes practical problems.As an example of the diversity of questions which can arise, Caroline Featherstone, legal services manager, and a qualified nurse, says the team has been asked to advise on the ownership of a bullet removed from a patient who was shot by the police, after the police asked for it back.
She said the team negotiated with high-profile publicist Max Clifford when he was handling public relations for Mandy Allwood - who was treated at King's during her in vitro fertilization octuplet pregnancy - and advised the hospital on its rights to exclude journalists from the premises.
Mr Featherstone adds that she still nurses once every six weeks or so 'to keep up-to-date and in touch'.Ms Seddon explains that the team is made up entirely of women because they were the best candidates.
The individuals all bring something to the unit besides a legal qualification, she adds, pointing out that the lawyers in the department are also variously qualified as a nurse, physiotherapist and medical ethics expert.The ethos of the department and the hospital, they say, is now one of 'transparency' when handling complaints and claims.
However, the lawyers admits this has not always been the case.
The team has been moving its organisation towards a change in culture in which doctors are less defensive about complaints from patients.
This ultimately enables problems to be resolved before outside lawyers are involved.In order to achieve this change in culture, the in-house team has worked hard to gain the trust of the doctors and nurses.When high-profile cases like the negligent operations on babies with heart conditions at Bristol arise, it can be a rude awakening for the medical profession,' says Ms Featherstone.
She says: 'However, such cases help open the clinicians' minds to seeking advice from the legal department to pre-empt problems arising'.She adds that being near the doctors and nurses, and creating a rapport with them, helps develop trust.
She says they can talk directly to the doctors and immediately start investigations when a difficult situation or a potential problem arises.The number of clinical negligence claims has risen significantly, year on year.
'Patients' expectations are much higher now and they seem to think it's their duty to complain,' says Ms Featherstone.
'Sometimes they can go off the scale.'Ms Seddon adds: 'Pe ople are more informed about hospitals and procedures now, but if they think it's like ER, and that thousands of pounds worth of tests will be done on arrival, it's just not like that'.Although the team handles a large number of claims in-house, the balance is dealt with externally by a panel of 18 law firms.
Claims usually go to external firms because a particular area of specialist knowledge is required or, more often, because they exceed the department's financial limit imposed by insurers, says Ms Featherstone.
She adds: 'The department looks at cost but, more importantly, we consider the firm's expertise in the particular field and our working relationship with it'.Ms Featherstone explains: 'When a mistake happens at the hospital we want to retain ownership of that problem.
We want to get the right conclusion for all the parties, which includes the doctors and the hospital trust.
Maintaining the reputation of the hospital and the staff is paramount, and claims are defended on merit and not settled on costs.'We frequently deal with outside solicitors and we have a good relationship with them, but there is no room for complacency on their part.
As we are dealing with public money, the department is very aware of costs and the quality of work.' Ms Featherstone adds that remaining involved and informed is of vital importance to the team when claims go out of house.With a smile, Ms Featherstone recalls: 'When you work here you have to be ready for anything.
A woman arrived at reception recently in labour and gave birth there - with the help of a passing accident and emergency consultant - to a healthy baby within a few minutes of arriving.
The next day we received a claim from the family for allowing the birth to take place in insanitary conditions and for invasion of the mother's privacy'.CASE STUDY 1 - CAROLINE FEATHERSTONE, 35, LEGAL SERVICES MANAGERQualified as a nurse in 1985 and worked in accident and emergency before becoming a ward manager in 1988.
Decided on career change and started a full-time law degree in 1991.
Did articles at City firm Jennings Son & Ash after finishing the legal practice course (LPC) in 1995.
Qualified in 1997 and stayed at Jennings until joining the legal team at King's College Hospital in September 1998.She says: 'Although I did plaintiff personal injury cases in private practice, I wanted to do defendant clinical negligence because of my nursing background.
I moved to King's to get back into the hospital environment which, although it has its stresses, is a more enjoyable environment than private practice.'The majority of my case load is clinical negligence but I, and the team, also deal with all kinds of queries from staff on legal and ethical questions.
We handle inquests for the hospital trust and support staff through that process.
I also manage the team, supervise case handling and give talks to the hospital staff to help their understanding of the law and how it affects their work.'CASE STUDY 2 - CAROLINE GORDON, 40, CLINICAL RISK MANAGERQualified as a physiotherapist in 1982.
Considered various options when looking at a career change but settled on law.
Started the common professional examination part-time by distance learning in 1994, and took the exams during the next two years while working full-time.
Did the LPC at the College of Law at Lancaster Gate before starting articles at Bevan Ashford in 1996.
Qualified in 1998, having done mostly clinical negligence work, and started at King's as the clinical risk manager the same year.She says: 'When I qualified I wanted to get back into the NHS environment.
I could not reconcile myself to working at a law firm for a health trust client, as there seemed better ways to spend NHS money.
I wanted to make a difference and I feel I make good use of my dual professions in this role.'My job is reviewing hospital practices and specific events and making changes or creating systems to forestall problems, complaints and ultimately claims against the trust.
For example, I have reviewed patient consent forms.
We now have a system which ensures not only that patients have all the information presented to them clearly before giving their consent to a procedure, but that the process is fully recorded by the staff.'CASE STUDY 3 - LINDSAY FIELD, 26, LEGAL SERVICES ADVISORGraduated from the University of Kent in Canterbury in 1994 in English law and French law.
Did the LPC at the College of Law in Guildford in 1995 and her training contract at Bond Pearce, a medium-sized commercial firm in Southampton, where she qualified in 1997.She says: 'Throughout my training contract I kept up an interest in medical ethics.
On qualification I decided to pursue this interest and took a master's degree in medical law and medical ethics at King's.
I found myself well placed to apply for the job of legal services adviser here when I finished my MA in 1998.
The job is both varied and intellectually stimulating because of all the queries which come to us from the staff.'I am currently involved with a specific project with the medical director, looking at the issues surrounding withdrawal of treatment from patients.
My legal background provides useful input for the clinicians when looking at a patient's capacity to request that treatment be withdrawn.
I was able to point out to the team the specific three-stage test which the Court of Appeal has already laid down as a framework for them to work around.'CASE STUDY 4 - RACHEL MARGETTS, 27, LEGAL SERVICES ADVISORGraduated from Kingston University, London with a law degree in 1993.
Tried for Bar School but was unable to secure a place.
After two years of doing various administrative jobs while still trying to get into the law, started on a temporary contract at King's in 1995.
She was taken on in a permanent role as an adviser later in 1995 and starts the LPC part-time in September, which she will complete in 2000.She says: 'I have not worked in private practice so I cannot make comparisons with working in-house at King's.
The reason I enjoy my job is because it is such a dynamic and multi-faceted world which we, the legal team, inhabit.
As well as being here for the staff to refer questions to, the hospital serves such a diverse community that raises lots of interesting problems which can affect the staff and the trust.There is a real sense of team work here, but within that there is autonomy when handling claims.
Doing inquest work is part and parcel of the job which, perhaps surprisingly is seasonal, although we all handle about four or five inquests a month on average.'