title: Learning from lawsuits: Ten-years of NHS litigation authority claims against 11 surgical specialities in England.
abstract: BACKGROUND
  Medico-legal claims are a drain on NHS resources and promote defencive practice. The litigious burden of surgery in England has not been previously described. This paper describes trends over ten years of claims made against the NHS across 11 surgical specialities.
  
  
  METHODS
  Data were requested for all claims received by the NHS Litigation Authority (NHSLA) from 2004 to 2014. Surgical specialities included cardiothoracic, general, neurosurgery, obstetric, oral and maxillofacial (OMFS), orthopaedic, otorhinolaryngology, paediatric, plastic, urology and vascular surgery. A literature review of peer-reviewed publications was performed with search terms 'NHSLA' and 'Surgery'.
  
  
  RESULTS
  The NHS paid out approximately £1.5 billion across 11 surgical specialities from 2004 to 2014. Orthopaedic, obstetric and general surgery received the largest number of claims per year, and paediatric surgery the least. The mean time from registration of claim with the NHSLA to settlement was 25.5 months (range 17.8 months-35 months). Neurosurgery was responsible for the highest average amount paid per claim, and OMFS the lowest. Failure/delay in treatment and/or diagnosis and failure to warn/adequately consent were the three leading types of claim. 806 never events were successfully claimed for during the ten-year period.
  
  
  CONCLUSIONS
  Sharing information and good practice should be a priority for surgical professionals. Lessons learnt from medico-legal claims are transferrable in strategic planning. This pan-speciality report has demonstrated considerable burden on the NHS and should promote improvement in practice on an individual level in addition to providing systems based recommendations to NHS and international organisations.
authors.affiliation: King's College Hospital, SE5 9RS, UK. Electronic address: Kathryn.Ford1@nhs.net.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Ford
authors.affiliation: Queen Victoria Hospital, RH19 3DZ, UK. Electronic address: lillicooper@doctors.org.uk.
authors.forename: Lilli R L
authors.initials: LRL
authors.lastname: Cooper
mesh_terms: D006801:Humans; D007603:Jurisprudence; D013043:Specialties, Surgical / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D013222:State Medicine / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology
keywords: Claim; Financial management; Legislation; Surgery