§ GUIDE · BEING TOLD

They have to tell you.
It is the law.

When something goes wrong in NHS care, the hospital is not doing you a favour by explaining. There is a legal duty to tell you in person, give you a truthful account of the facts, apologise, and follow it up in writing. Failing to do it is a criminal offence. Most families have never been told any of this, so here is what you are owed and how far it goes.

The duty

Regulation 20

Threshold in NHS trusts

Moderate harm

Apology = admission?

No

Report response

56 days

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§ BEFORE YOU GO FURTHER

What you are entitled to when something goes wrong in NHS care

  • To be told in person, as soon as reasonably practicable, by someone from the organisation.
  • A truthful account of the facts known at the time, what further enquiries will happen, and an apology.
  • The same information again in writing, together with the results of those enquiries when they are done.
  • Reasonable support, and a written record kept of all of it.

This page covers England, with the Welsh differences noted as they arise. Scotland has its own duty of candour under separate legislation and is not covered here.

§ 01

What the law actually requires

The duty sits in regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and it binds every provider registered with the Care Quality Commission: NHS trusts, GP practices, independent hospitals, ambulance services and care homes alike.

When a notifiable safety incident happens, the provider must tell you as soon as reasonably practicable. That notification has to be given in person, provide an account of all the facts known at that date which to the best of their knowledge is true, say what further enquiries they think are appropriate, and include an apology. It must be recorded in writing and kept. A written notification must follow, repeating the account, setting out the enquiries and, when they are finished, giving you the results.

There is no fixed deadline in England, only as soon as reasonably practicable. In Wales, where a separate 2023 scheme applies to NHS-funded care, the first notification should come within 30 working days or the delay must be explained, and the written follow-up within five working days.

§ 02

The threshold, and why it is lower than you think

For NHS trusts the duty is triggered by an unintended or unexpected incident that, in the reasonable opinion of a healthcare professional, could result in or appears to have resulted in death, severe harm, moderate harm, or psychological harm lasting at least 28 days.

Moderate harm is defined, and it is a low bar: harm needing a moderate increase in treatment, and significant but not permanent harm. A moderate increase in treatment expressly includes an unplanned return to surgery, an unplanned readmission, a longer stay, cancelled treatment or a transfer to intensive care. If any of those happened to you because something went wrong, the duty was probably engaged.

The threshold is different for GP practices, dentists and independent providers, where it looks backwards at outcomes: an impairment lasting at least 28 days, changes to the structure of your body, prolonged pain, shortened life expectancy, or treatment needed to prevent death or serious injury. The same incident can cross the line in a hospital and not in a GP surgery.

One thing does not affect it at all. Whether anyone was at fault makes no difference to whether an incident is notifiable.

§ 03

An apology is not an admission, and everyone official says so

This is the misunderstanding that stops families getting answers and stops staff giving them. The Compensation Act says an apology or offer of treatment does not of itself amount to an admission of negligence. The Care Quality Commission says saying sorry is not admitting fault and you must apologise regardless of fault. NHS Resolution, which pays the claims, puts it most plainly: it has never refused cover on a claim because an apology was given.

Separately from the organisation's duty, every individual clinician has a professional duty of candour under joint guidance from the medical and nursing regulators. Its trigger is lower still: something that goes wrong and causes, or has the potential to cause, harm or distress. A clinician does not have to wait for an investigation to finish before speaking to you.

§ 04

The hospital's own investigation, and your part in it

Since 2022 the NHS in England has worked to the Patient Safety Incident Response Framework, which replaced the old serious incident system and abolished the serious incident category altogether. There is no longer a 60 working day rule. Responses are expected to take one to three months and no more than six.

What matters for you is the involvement. National guidance says those affected should be able to contribute to the terms of reference, including asking for questions that matter to them to be added, and that the draft report must be shared before it is finalised with a realistic opportunity to influence the content. The guidance also says in terms that lawyers should advise only on the legality of the report, and that a family deciding to make a claim should not change how they are engaged with.

The framework is explicit that it is not about blame or liability and forms no part of a clinical negligence process. That does not make it useless to you. It makes it a source of facts.

§ 05

One investigation you will not be able to use

If a case goes to the Health Services Safety Investigations Body, different rules apply. Material it holds is protected by a statutory safe space and generally cannot be disclosed, and its reports are not admissible in proceedings to determine civil liability, in an employment tribunal, or before a regulator. Only the High Court can let a report in, and only where the interests of justice outweigh the damage to future safety investigations.

Maternity is different again. The Maternity and Newborn Safety Investigations programme, hosted by the Care Quality Commission, investigates term babies who were stillborn during labour, died in the first week, or suffered severe brain injury, and maternal deaths within 42 days of pregnancy. No safe space applies to it, families receive the draft and the final report as of right, and its findings are routinely passed to NHS Resolution under the early notification scheme.

§ 06

Complaints, the Ombudsman, and the clock

You can complain to the provider or the commissioning body, normally within 12 months of the event or of realising something went wrong, and the body can extend that. If you are not satisfied you can go to the Parliamentary and Health Service Ombudsman, normally within a year, though the Ombudsman cannot usually investigate where you have or had a remedy through the courts.

Here is the warning, and it is the reason this page ends where it does. Nothing in the complaints rules changes the three-year time limit for a claim. A complaint can run six months before the body even has to explain a delay, and the Ombudsman adds more. Families who work through the complaint, then the Ombudsman, and only then see a solicitor can find the three years gone. In Wales a formal redress application does suspend the clock, but an ordinary complaint does not.

Complain if you want to. Just take legal advice at the same time, not afterwards.

§ THE JUDGMENTS BEHIND THIS GUIDE

Judgments where something was admitted.

Published decisions of the courts of England and Wales, linked to their source. They show what an admission is worth, which is not always what families expect.

Mixed outcome

MAN v St George's University Hospital NHS Foundation Trust

[2024] EWHC 1304 (KB)·2024·Liability decided at trial

A woman went to A&E with extreme lower-leg pain and was sent home by a nurse practitioner instead of being seen by a senior doctor or referred to surgeons; she developed a necrotising soft tissue infection and lost her leg. The Trust admitted negligence but tried to rely on the nurse's evidence disputing how much pain she reported; the Master ruled that evidence inadmissible because the defence had never properly pleaded that dispute.

An NHS trust cannot admit negligence and then quietly contest the facts at trial without pleading them. Severe, out-of-proportion pain in a limb is a recognised warning sign of necrotising infection that calls for senior review.

Mixed outcome

Pearce v East and North Hertfordshire NHS Trust

[2020] EWHC 1504 (QB)·2020·Liability decided at trial

A baby born breech by caesarean should have had a hip ultrasound within six weeks, but the appointment was not arranged until nine weeks and, after rescheduling, the scan at 17 weeks showed hip dysplasia in both hips, needing surgery. The Trust admitted breach but, shortly before trial, sought to blame the mother's missed appointment; the judge refused the late amendment.

Babies born breech need a timely hip scan, and a trust's failure to arrange one within its own protocol was admitted as negligent. Defendants cannot raise new causation arguments on the eve of trial without good reason.

Claimant succeeded£40,000

Leach v North East Ambulance Service NHS Foundation Trust

[2020] EWHC 2914 (QB)·2020·Liability and damages decided at trial

Ms Leach, alone at home with a brain haemorrhage, waited nearly two hours for an ambulance, of which the trust admitted 31 minutes was negligent delay; she went on to develop PTSD. The judge held that the negligent delay made a material contribution to her PTSD, that PTSD cannot be apportioned, and awarded the agreed £40,000.

Where a negligent ambulance delay materially contributes to a psychiatric injury like PTSD, the trust is liable for the whole injury and cannot reduce damages by arguing only part of the wait was its fault.

Claim failed

Dalchow v St George's University NHS Foundation Trust

[2022] EWHC 100 (QB)·2022·Liability decided at trial

After routine day-case removal of a scrotal cyst, the claimant returned in the early hours in severe pain; intravenous antibiotics were not started when they should have been and an ultrasound request was delayed, and he was later diagnosed with Fournier gangrene, needing repeated surgery and losing both testicles. The judge found breach of duty but held the claimant could not prove the delays changed the outcome.

Proving that care fell below standard is only half the case: the claimant must also show the negligence made a difference. Where surgery would have happened at the same time anyway, delayed antibiotics or scans may not be shown to have caused the injury.

Claim failed

Hakmi v East & North Hertfordshire NHS Trust & Anor

[2025] EWHC 2597 (KB)·2025·Liability decided at trial

An orthopaedic surgeon had a second stroke and the on-call stroke consultant, assessing by telephone because the video link was broken, decided against clot-busting treatment. The judge found documentation was poor but that thrombolysis would probably not have changed the outcome, and rejected the defendants' allegation that the claimant had faked his test results.

Poor record-keeping and a remote consultation do not win a case on their own; the claimant must show the missed treatment would have made a real difference. A defence of dishonesty needs solid evidence and failed here.

Claim failed

Watson v Lancashire Teaching Hospitals NHS Foundation Trust

[2022] EWHC 148 (QB)·2022·Liability decided at trial

A 29-year-old with sudden facial droop, speech problems and arm weakness was told by a junior A&E doctor she had migraine and was not referred to the TIA clinic, which the Trust admitted was a breach. Ritchie J found her March symptoms were in fact hemiplegic migraine, not mini-strokes, so the missed referral did not cause her later stroke.

Admitted breach of duty is not enough; the claimant must prove the correct pathway would have prevented the injury. Detailed findings about the exact sequence of symptoms decided this case.

Claim failed

Critchlow v University Hospitals of North Midlands NHS Trust

[2022] EWHC 949 (QB)·2022·Liability decided at trial

A former lorry driver with a history of pulmonary embolism attended A&E and clinics in 2015 with chest pain and calf symptoms; the Trust admitted it should have done a Wells score and imaging at the first visit. The judge found he did not actually have a clot on that date and that the later reduction of his apixaban was not negligent, so the claim failed.

An admitted failure to investigate only leads to compensation if the investigation would have found something. Normal D-dimer results were decisive evidence against a missed clot.

Claimant succeeded

Reaney v University Hospital of North Staffordshire NHS Trust & Anor

[2014] EWHC 3016 (QB)·2014·Damages assessed at trial

A woman who was already paralysed from a spinal condition developed severe pressure sores during a long hospital stay, and the Trust admitted that this was negligent. The judge decided how much the sores and their consequences had added to her care needs and assessed her damages.

Where a patient already has serious health needs, the hospital is only responsible for the extra needs its negligence causes. The Court of Appeal later sent the damages back to be worked out again on that narrower basis.

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

The hospital has not told us anything. Is that allowed?

If a notifiable safety incident happened, no. The provider must tell you in person as soon as reasonably practicable, give you the facts and an apology, and follow up in writing. Failing to do the notification is a criminal offence, and the Care Quality Commission regulates it.

They apologised. Does that mean they admit liability?

No, and that is settled. The Compensation Act says an apology is not of itself an admission of negligence, the regulator says apologise regardless of fault, and NHS Resolution says it has never refused cover because an apology was given.

Do we get a copy of the investigation report?

For a hospital patient safety investigation, national guidance says the draft must be shared with you and you must have a real chance to influence it, and you should be asked whether you want the final report. In maternity cases investigated nationally, the draft and final report come to you as of right.

Does making a complaint protect our time limit?

No. In England nothing in the complaints process changes the three-year limit, and a complaint plus an Ombudsman referral can easily take more than a year. Complain if you want answers, but get legal advice in parallel.

What counts as serious enough to trigger the duty?

In an NHS trust, moderate harm is enough, and that is defined to include an unplanned return to surgery, an unplanned readmission, a longer stay or a transfer to intensive care. The threshold is different for GP practices and independent providers.

Is it the same in Wales?

The duty is similar but sits in different legislation, applies to NHS-funded care rather than all registered providers, and has actual deadlines. Wales also has a redress scheme that can pay compensation without a court claim.

§ MORE GUIDES

Plain answers to the other questions people ask.

The evidence that decides →

Eleven judgments showing what wins and loses these cases: the notes, the charts, the missing letter and the expert. Read this before you ask for your records.

Inquests explained →

An inquest cannot find anyone negligent. The law forbids it. What it can do is establish facts on oath, and that is often where a claim begins.

Late claims →

Seven judgments on claims brought years after the deadline. Six were allowed to proceed, one from a birth 32 years earlier. What separated them from the one refused.

Payout examples →

UK medical negligence payout examples by claim type, typical compensation ranges, and what decides the amount. Then check your own claim free.

Fatal negligence payouts →

What compensation after a death caused by medical negligence can include: the bereavement award, dependency, funeral costs and the estate's claim.

NHS payout data →

Official NHS Resolution figures, band by band, for 2024/25.

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.