§ GUIDE · SETTLEMENT APPROVAL

Why a judge has to approve
a child's settlement.

When the injured person is a child or lacks mental capacity, the parties cannot simply agree a settlement. A judge must approve it under Part 21 of the Civil Procedure Rules. Those approval hearings are public, which is why they are one of the few places you can see what serious claims actually settle for.

Rule

CPR 21.10

Largest approval here

£9.3M + PPO

Approvals in this guide

6

Who brings the claim

Litigation friend

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§ WHO NEEDS APPROVAL

Children, and adults who cannot manage their own affairs.

A child under 18 claims through a litigation friend, usually a parent. An adult who lacks capacity to conduct the litigation, often because of the very brain injury the claim is about, is a protected party and also claims through a litigation friend. In both cases no settlement is valid until the court approves it. In CTQ v King's College Hospital [2023] EWHC 2975 (KB) the court used its inherent jurisdiction to approve a settlement for a mother with cognitive impairment even though she had not formally been found to lack capacity.

§ WHAT THE JUDGE CHECKS

Is this deal in the claimant's best interests?

The judge reads the advice of the claimant's counsel, the medical evidence and the schedule of loss, and asks whether the settlement sits within the range a court would have awarded, allowing for the risk of losing at trial. In AXA v Airedale [2024] EWHC 2499 (KB) the judge agreed the settlement level and structure were sensible and well within a reasonable range. In ERE v East Suffolk and North Essex [2024] EWHC 2569 (KB) the judge weighed the litigation risks and the issues still in dispute about prognosis and future care before approving.

The judge also considers how the money is held and paid: a deputy appointed by the Court of Protection for a protected party, and periodical payments for care so the funds cannot run out.

§ THE APPROVALS

Six public approval judgments.

MGS v University Hospitals Bristol and Weston [2023] EWHC 1547 (KB)

Neonatal hypoglycaemia causing permanent brain injury. A gross lump sum of £9.3 million plus periodical payments from £190,000 a year. The settlement came from the Trust's late acceptance of a Part 36 offer, and the court held extra interest was owed for the delay.

XX v Barts Health NHS Trust [2023] EWHC 963 (KB)

Severe cerebral palsy after uterine rupture. A £6.5 million lump sum plus periodical payments, capitalised value £17,185,985, approved without any admission of liability.

MHE v Wye Valley NHS Trust [2024] EWHC 25 (KB)

Shoulder dystocia causing cerebral palsy. £5,557,500 gross plus stepped periodical payments for life.

AXA v Airedale NHS Foundation Trust [2024] EWHC 2499 (KB)

Dystonic cerebral palsy after a bradycardia in induced labour. £5,750,000 plus stepped periodical payments; total value £16,707,835.

ERE v East Suffolk and North Essex [2024] EWHC 2569 (KB)

A mother's cardiac arrest two weeks after birth. £3,850,000 plus periodical payments, settled on the day the quantum trial was due to start.

CTQ v King's College Hospital [2023] EWHC 2975 (KB)

A mother's brain injury after a cardiac arrest under spinal anaesthesia. £2,500,000 plus periodical payments, capitalised at about £5.56 million.

§ INTERIM PAYMENTS AND PART 36

Money before the end, and pressure to settle.

Once liability is admitted, interim payments fund care and housing while the claim is valued. MHE's settlement was net of £650,000 of interims; MGS's of £1.9 million; XX's of £250,000. Part 36 offers put the other side at risk on costs and interest if they refuse and do worse later. MGS shows the flip side: a defendant that accepts late can owe interest for the delay.

§ THE JUDGMENTS BEHIND THIS GUIDE

The six approval judgments.

Each is a public judgment approving a settlement for a child or protected party, linked to Find Case Law.

Settlement approved£9.3M

MGS v University Hospitals Bristol and Weston NHS Foundation Trust

[2023] EWHC 1547 (KB)·2023·Settlement approved by the court

A low-birth-weight baby was not fed adequately overnight and his blood sugar was not checked early enough, causing hypoglycaemic brain damage; the Trust admitted liability in 2018. The court approved a £9.3m lump sum plus periodical payments and held the Trust also owed interest for accepting the offer late.

Negligence in the first days of a newborn's life, not just during labour, can produce some of the largest clinical negligence awards. If a defendant accepts a Part 36 offer late, interest for the delay can be claimed on top.

Settlement approved£6.5M

XX v Barts Health NHS Trust

[2023] EWHC 963 (KB)·2023·Settlement approved by the court

A 19-year-old with severe cerebral palsy from a brain injury at his 2004 birth settled his claim without any admission of liability. The judge approved a package of a £6.5m lump sum plus lifelong periodical payments for care, with a total capitalised value of about £17.2m.

Settlements for people who lack capacity must be approved by the court, and the judge weighs litigation risk against the offer. Combining a lump sum with periodical payments is often preferred because it guarantees care funding for life.

Settlement approved£5.56M

MHE v Wye Valley NHS Trust

[2024] EWHC 25 (KB)·2024·Settlement approved by the court

The baby's shoulders became stuck during delivery and manoeuvres failed, so she was deprived of oxygen and left with cerebral palsy; the Trust admitted in 2012 that it failed to deliver her with sufficient or safe speed. The court approved a settlement of about £5.56m plus lifelong periodical payments.

Shoulder dystocia claims are not only about arm injuries; a prolonged delay in freeing the baby can cause brain injury, and damages then reflect lifelong care needs. Approval judgments like this are one of the few public sources showing what such settlements are worth.

Settlement approved£5.75M

AXA (a child, by her father and litigation friend MXA) v Airedale NHS Foundation Trust

[2024] EWHC 2499 (KB)·2024·Settlement approved by the court

A child born in April 2019 after an induced labour suffered fetal bradycardia and a brain injury; the Trust admitted the clinical failures by letter in April 2021. The court approved a settlement of a £5.75m lump sum plus lifelong index-linked periodical payments, worth about £16.7m in total.

Serious cerebral palsy claims are usually settled as a lump sum plus annual periodical payments for care, so the headline total depends on how long the child lives. Before approving a deal for a child the judge checks it sits within the range a court would have awarded.

Settlement approved£3.85M

ERE v East Suffolk and North Essex NHS Foundation Trust

[2024] EWHC 2569 (KB)·2024·Settlement approved by the court

A 23-year-old mother was discharged after giving birth in July 2015, developed breathlessness and palpitations, and suffered a cardiac arrest after being readmitted, leaving her with severe hypoxic brain damage. The claim settled on the day the quantum trial was due to start and the court approved the package for her as a protected party.

Maternal claims are not limited to injuries during labour itself; a failure in care in the weeks after birth that causes brain injury can lead to a multi-million-pound settlement. Where the injured person lacks capacity, a judge must approve any settlement.

Settlement approved£2.5M

CTQ v King's College Hospital NHS Foundation Trust

[2023] EWHC 2975 (KB)·2023·Settlement approved by the court

A 37-year-old mother suffered a cardiac arrest because intravenous fluids were not given during spinal anaesthesia just after her daughter's birth, leaving her with a brain injury; the hospital admitted liability. The court used its inherent jurisdiction to approve a settlement worth roughly £5.56m including periodical payments.

Anaesthetic errors around delivery can found a maternal negligence claim even when the baby is unharmed. Courts can approve settlements for adults with cognitive impairment even where they have not formally been found to lack capacity.

Browse the whole case library →

Contains information licensed under the Open Justice - Licence v2.0. Judgments from Find Case Law, The National Archives. Summaries are ours; amounts only where printed in the judgment.

§ QUESTIONS

Common questions

Why can't parents just accept the offer?

Because the child cannot consent for themselves and the law protects them from settlements that are too low or badly structured. The judge checks the deal is in the child's best interests before it becomes binding.

Does approval mean the hospital admitted fault?

Not necessarily. XX v Barts Health was approved without any admission of liability. The judge weighs the risk of losing at trial when deciding whether the offer is reasonable.

Who looks after the money afterwards?

For a protected party, usually a professional deputy appointed by the Court of Protection, whose costs are often included in the award; AXA's settlement included £13,500 a year for deputy costs. Periodical payments for care go direct, year by year.

Are the sums always made public?

Usually the judgment states them, which is why these hearings are such a useful source. Occasionally the figures are kept confidential at the parties' request.

How long do approvals take?

The hearing itself is short. The years before it are spent establishing liability and, above all, waiting until the child's long-term needs are clear enough to value. See our guide on how long claims take.

This guide is general information about the law in England and Wales, not legal advice about your case. ClaimGavel is run by Costart Projects Ltd on behalf of Tomlin & Partners, a specialist medical negligence firm regulated by the SRA. The free assessment on this page is an AI overview to show you roughly where you stand; a solicitor confirms the position in a free, no-obligation conversation.