Medicolegal claims in general surgery: a 10-year retrospective review of claims against the NHS in England

Abstract

Introduction Every year 12,000 medicolegal claims are brought against the NHS in England at a cost of £8 billion—6.7% of the NHS England budget. In 1,000 of these claims the primary speciality is General Surgery. The aims of this paper were to examine 10 years of claims against General Surgery Departments in NHS England, identify the common causes and injuries, review the associated cost and suggest strategies for improvement. Methods Data regarding medicolegal claims made against NHS General Surgical Departments in England from 2010 to 2020 were obtained from the Clinical Negligence Scheme for Trusts. A retrospective review was undertaken to examine the number of claims, cost of claims closed with and without damages, primary causes and primary injuries. Results A total of 10,027 claims were made between 2010 and 2020. Of these, 9,377 were closed in that time, with cost totalling £851,558,930. Of claims closed, an average of 608 per year were closed with damages and 329 without damages. Claims with damages resulted in more than forty-five times greater cost per claim compared with those closed without damages. Overall, cost increased by over 50% between 2010 and 2020. Common causes included ‘failure/delay in treatment’, ‘intraoperative problems’ and ‘failure/delay in diagnosis’. Common injuries included ‘additional/unnecessary operation(s)’, ‘unnecessary pain’, ‘fatality’ and ‘bowel damage/dysfunction’. Conclusion Medicolegal expenditure represents a serious concern for the NHS, worsening each year. This retrospective review highlights the rising cost along with the most common causes and primary injuries. Action is required at every level of the NHS to improve surgical care, consent and communication with our patients, and by doing so minimise poor outcomes and their resultant medicolegal consequences.