DOI: 10.1093/bjs/znad241.482 ISSN:

342 The NHS in crisis; assessment of the impact of litigation trends over 20 years in general surgery

Sabina Wallace-King, Aya Musbahi, Rachael Coates, Reza Mofidi
  • Surgery



A rising proportion of the NHS annual budget is being spent on medico-legal costs, with over 1.6% of total UK healthcare spending on litigation in the year 2018/19. This is a risk to both patient care and public opinion of the NHS. Despite this, surgical litigation is a relatively understudied subject. This paper aims to assess the scale of the litigation crisis to fuel further work into mitigating it and improve value for patients and staff alike.


Data was obtained via a Freedom of Information request from NHS resolution for all claims relating to General Surgery between January 2000 and December 2020.


17,542 claims were made against General Surgical units in England with a gradual increase in claims per year. The successfully closed claims cost £1.3 billion. This was out of proportion to both inflation and case volume. The three most common causes for claims were intra-operative problems, failure/delay of treatment and failure/delay of diagnosis.


The NHS is threatened by a litigation crisis, with case volume and cost rising out of proportion to surgical workload and inflation. The most common causes for claims against surgical units are known complications discussed as part of a standard consenting process, indicating that current practice may fail to achieve adequate patient understanding of surgical risk. More research is required to design methods to improve the current consenting process, and to identify specific demographics that may increase an individual’s propensity to make a claim and establish modifiable risk factors.

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