Otolaryngology litigation in England: 727 clinical negligence cases
against the NHS
Abstract
Introduction: Litigation against the National Health Service (NHS) in
England is rising, costing £2.4 billion in 2018/19. The aim of this
study was to determine the incidence and characteristics of
otolaryngology clinical negligence claims in England. Methods: A
retrospective review was undertaken of all clinical negligence claims in
England held by NHS Resolution relating to otolaryngology between April
2013 and April 2018. Analysis was performed using information for cause,
patient injury and claim cost. Where claim information was adequately
detailed, the authors categorised claims by subspecialty, diagnosis and
operation. Results: A total of 727 claims were identified with an
estimated potential cost of £108 million. From these, 463 were closed
claims. Including open claim reserves, the mean cost of a claim was
£148,923. Head and neck surgery was the subspecialty with the highest
number of claims (n=313, 43%) and highest cost (£51.5 million) followed
by otology (n=171, £24.5 million) and rhinology (n=171, £13.6 million).
Over half of claims were associated with an operation (n=429, 59%)
where mastoid surgery (n=46) and endoscopic sinus surgery (n=46) were
equally associated with the greatest number of claims. The most frequent
reasons for litigation included failure or delay to diagnose (n=178,
25%) failure or delay to treat (n=136, 19%), intra-operative
complications (n=130, 18%) and failure of the consent process (n=107,
15%). Discussion: Clinical negligence claims in otolaryngology are
related to several different components of patient management and is not
limited to post-operative complications. This study highlights the
importance of robust pathways in outpatient diagnostics and the
consenting process, especially in the high-risk speciality of head and
neck surgery, in order to deliver better patient care and reduce the
impact of litigation.