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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.