Medical Negligence Claims UK: Bolam, Time Limits and Evidence

Breach of duty: the Bolam and Bolitho tests

Every UK clinician owes patients a duty of care. The standard is set by the 1957 case of Bolam: a doctor is not negligent if their actions are supported by a responsible body of medical opinion. The 1997 Bolitho case added that the supporting opinion must withstand logical analysis — a doctor cannot escape liability simply because some peers would have done the same thing if that practice itself is indefensible.

Proving breach therefore requires expert evidence from a clinician in the same speciality, willing to say the treatment fell below the standard a competent practitioner would have provided. Without that supporting expert report, a clinical negligence claim cannot proceed.

Causation: the harder hurdle

Even if breach of duty is proven, you also have to show that the breach caused the injury. The test is 'but for' — but for the negligence, would the harm have happened anyway? Many claims fail at causation rather than breach, particularly where the underlying condition was already serious.

For a missed cancer diagnosis, you must show that earlier diagnosis would have led to materially better outcomes — often a survival statistic difference at a particular stage. For surgical errors, you must show the error caused the specific injury rather than being an inherent risk that materialised. Causation typically needs its own expert separate from the breach expert.

Time limits and date of knowledge

The standard limitation period is three years from the date of the negligent act or, more often, from the 'date of knowledge' — when you first knew, or reasonably should have known, that the injury was significant and linked to medical care. This makes clinical negligence time limits more flexible than other personal injury claims, but only up to a point.

For children, time runs from age 18, giving until age 21 to issue. For people lacking mental capacity, time may not run at all. The court has discretion under section 33 of the Limitation Act 1980 to extend time, but discretion is not generosity — fading evidence and witness memory work against late claims.

How NHS Resolution handles claims

NHS clinical negligence claims are handled by NHS Resolution, the body that indemnifies hospital trusts. The pre-action protocol requires a Letter of Claim setting out allegations and supporting evidence, to which NHS Resolution must respond within four months. Most cases settle without trial — court is the exception, not the rule.

Private treatment claims work similarly but against the clinician's medical defence organisation (MDU, MPS or MDDUS). The substantive law is identical; the process can be more variable depending on the defendant.

What compensation typically covers

General damages (pain, suffering, loss of amenity) follow the Judicial College Guidelines: a missed fracture causing minor ongoing problems might be £8,000 to £20,000; a brain-damaged baby case can exceed £15 million when future care costs are added. Special damages cover lost earnings, care, treatment, equipment and home adaptations — these often vastly exceed the general damages.

Severe lifelong injuries from clinical negligence are often settled with periodic payment orders rather than lump sums, providing tax-free annual income for life-long care needs. This protects against the claimant outliving their settlement money.

Frequently asked questions