Trends and causes of litigation in paediatric surgery within the National Health Service (NHS) England: a 19-year...

The aim of this study was to assess litigation patterns within paediatric surgery in the National Health Service (NHS) England by analysing long-term trends, financial costs and causes of successful claims over the past 19 years.

Litigation data were obtained from NHS Resolution via a Freedom of Information (FOI) Act 2000 request covering financial years 2006/2007 to 2024/2025. For paediatric surgery cases (patients <18 years), extracted variables included total claims, successful claims, damages paid and associated legal costs. Successful claims were categorised by primary cause and primary injury incurred.

Over the study period, 591 litigation claims were submitted in paediatric surgery, of which 332 (56.2%) were successful. Damages paid amounted to £48.05 million. Annual claims rose 5.1-fold, from 10 in 2006/2007 to 51 in 2024/2025. Damages increased 1.98-fold, from £1.47 million in 2006/2007 to £2.91 million in 2024/2025. The most frequent causes of successful claims were failure or delay in diagnosis (15.1%, 50/332), failure or delay in treatment (13.9%, 46/332), and intraoperative problems (10.8%, 36/332). Operative-related factors accounted for 27.4% (91/332), whereas non-operative causes comprised 57.2% (190/332). The most reported primary injuries were: additional or unnecessary procedures (15.7%, 52/332), unnecessary pain (15.1%, 50/332) and fatality (14.2%, 47/332).

Paediatric surgery litigation in NHS England has increased over 19 years, driven predominantly by diagnostic and treatment delays rather than operative error. Improvement of time-critical diagnostic pathways, enhanced follow-up systems and targeted claims resolution strategies represent the most impactful approaches to reducing litigation burden in this specialty.