Part 2 —continued

Clinical Timeline (1993–2026)

A 33‑year record of continuity, stability, and the point at which the system failed

This section provides a 33‑year clinical timeline showing the stability of the young person’s neurological visual impairment, the consistency of specialist findings, and the point at which continuity collapsed. It sets out the evidence base that makes the 2026 assessment clinically inappropriate and explains how contradictory information entered the record.

The following timeline provides a clear, chronological overview of the young person’s clinical history from the time of their traumatic brain injury to the events of 2026. It demonstrates the stability of the neurological visual impairment, the consistency of specialist findings, the loss of continuity following the retirement of the long‑term clinician, and the introduction of contradictory information into the clinical record.

This timeline is essential for understanding why the 2026 assessment was not clinically appropriate.

1993 — Traumatic Brain Injury

At eight years old, the young person sustained catastrophic head injuries after being struck by an unlicensed, uninsured driver operating an unroadworthy vehicle. The injuries included:

• skull fractures with bone fragments penetrating the brain
• occipital lobe damage
• cerebral oedema
• right‑sided depressed skull fracture
• severe neurological deficit
• grossly reduced vision

These injuries resulted in permanent neurological impairment affecting multiple visual pathways.

1994–1996 — Early Specialist Neuro‑Visual Assessments

The young person was placed under long‑term specialist care. Across multiple assessments, the specialist documented:

• divergent strabismus with variable angle
• severely impaired eye‑movement control
• jerky pursuits and overshooting saccades
• intractable double vision
• alternating fixation (RE for distance, LE for near)
• reduced contrast sensitivity
• vertical nystagmus
• poor spatial awareness and mis‑location of objects
• significant fatigue during visual tasks

These findings established the clinical baseline that remained stable for decades.

1998 — Confirmation of Permanence

The specialist confirmed that the visual impairment was:

• permanent
• non‑recovering
• neurological in origin
• functionally disabling

This became a key anchor for all future assessments.

2000–2001 — Medico‑Legal and Functional Reports

Detailed reports prepared for legal and professional audiences reiterated:

• absence of binocular function
• unstable fixation
• impaired hazard detection
• severe spatial‑awareness deficits
• predictable fatigue‑related deterioration

Findings remained unchanged from earlier assessments.

2006–2012 — Continued Specialist Oversight

Regular neuro‑visual reviews confirmed:

• no improvement
• no fluctuation
• no restoration of binocular function
• ongoing functional risks

The impairment remained stable and permanent.

2015–2017 — Ongoing Monitoring

The specialist continued to provide consistent oversight. Findings remained aligned with the established baseline.

2018 — Specialist Appointment (Report Missing From SAR)

Evidence confirms:

• the young person attended a specialist appointment in late 2018
• a full neuro‑visual report was written and provided directly to the family
• the service’s complaint response acknowledges this document as a “report rather than a summary letter”

However:

• the 2018 report is absent from the SAR
• it is not indexed
• it is not stored in the clinical file
• it was not available to the 2026 clinician

This marks the first major break in continuity and a significant governance concern

2020 — Routine Optometry Notes

A non‑specialist appointment recorded:

• alternating fixation
• high refractive error
• no evidence of improvement

Findings remained consistent with the neurological baseline.

2021 — GP Information Form

The GP form noted:

• vision “similar to previous occasions”
• no ocular cause for symptoms
• ongoing functional difficulties

Again, no improvement was recorded.

2023 — Final Specialist Assessment Before Retirement

The young person was seen by the long‑term specialist for the final time. Findings included:

• alternating exotropia
• RE for distance, LE for near
• difficulty with night vision
• no binocular function
• functional challenges consistent with all previous reports

This was the last accurate specialist record before the collapse of continuity.

2024–2025 — Loss of Specialist Oversight

Following the specialist’s retirement:

• no successor was appointed
• no transition plan was implemented
• no safeguarding considerations were made
• no communication was provided to the young person or their carer
• the neuro‑visual pathway effectively ended

This created the conditions for misinterpretation.

2026 — Routine WGOS 1 Assessment

A general optometrist conducted a standard ocular assessment without:

• access to the specialist’s longitudinal records
• awareness of the neurological baseline
• knowledge of the missing 2018 report
• understanding of the functional‑vision profile

The resulting summary letter contradicted:

• 30 years of specialist findings
• the permanent nature of the impairment
• the absence of binocular function
• the documented spatial‑awareness deficits
• the established clinical baseline

This appointment introduced inaccurate information into the clinical record.

April 2026 — Formal Complaint Response

The service’s response asserted that:

• the 2026 findings were “accurate and clinically safe”
• the Special Assessment Clinic “has never been a specialist neuro‑visual service”
• “all records were available and reviewed”
• “there has been no change in care provision”

These statements conflict with:

• the historical record
• the clinic’s own academic output
• the missing 2018 report
• the 2023 specialist findings
• the nature of neurological visual impairment

This response closed the complaint administratively but did not resolve the clinical or governance concerns.

This timeline makes clear that the young person’s impairment has been stable for more than three decades. The next section examines the missing 2018 specialist report — a critical document whose absence broke continuity, misled the 2026 clinician, and created the conditions for clinical and governance failure.

Next

2.3B — The Missing 2018 Report

&

Its Governance Significance

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