§ GUIDE · WARD CARE

Nobody was watching,
and something happened

A fall, a pressure sore, a patient who went missing from a ward. These are the failures families most often describe to us, and they are the hardest to take to court. Three of the six judgments here succeeded. Coroners see far more of these cases than the courts do, which tells you something about how they usually end.

Judgments read

6

Claimant succeeded

3 of 6

Coroner reports read

72

Usual loss reason

Reasonable care

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§ BEFORE YOU GO FURTHER

For a claim about basic care on the ward, these things usually need to be true

  • There was a recorded risk: a falls assessment, a pressure-sore score, a note that the patient was confused or at risk of wandering.
  • The step that risk called for was not taken: repositioning, supervision, a safe bed, a locked door, an escalation to a doctor.
  • A lasting injury followed, not only distress or poor treatment.
  • It happened within the last three years, or you only recently found out.

Courts accept that hospitals cannot prevent every fall and that some measures carry their own risks. Claims succeed where a specific recorded risk was ignored, not simply because something went wrong.

§ 01

Pressure sores

Reaney v University Hospital of North Staffordshire is the reference case. A woman already paralysed from a spinal condition developed grade 4 pressure sores during a long admission, with bone infection and contractures; the Trust admitted negligence. The High Court assessed damages at over £2.8 million, but the Court of Appeal sent the assessment back, holding the hospital was only responsible for the extra needs its negligence had caused, not for all her care.

That is the pattern in pressure-sore claims for patients who were already very unwell. Liability is often the easier part. The argument is about how much of the care she would have needed anyway.

§ 02

Falls in hospital

Doubell v King's College Hospital shows how hard these are. A confused 65-year-old fell out of bed at night and argued bed rails should have been fitted. Damages had been agreed at £7,500, but the claim was dismissed and the appeal failed: rails had not been recommended, would have been removed anyway, and carry their own risk for a mobile patient.

Spearman v Royal United Bath is the contrast, and it succeeded. A man brought to A&E after a hypoglycaemic attack left the department, climbed five flights of stairs through unsecured doors to a flat roof, and fell. The court found the Trust liable because it had never risk-assessed the roof, where furniture made the barrier easy to climb. The duty to a confused patient covers the building and the supervision, not only the treatment.

§ 03

Observations and escalation

Failes v Oxford University Hospitals is the caution on nursing charts. After surgery to remove a spinal tumour the charts appeared to show deterioration and the surgeon was not alerted; four days later the patient was permanently paralysed. The claim failed because the court accepted the clinicians' own examinations showed no real change until the final day. Charts alone are not proof that a patient was getting worse.

§ 04

Being sent home without the basics

Rajatheepan v Barking, Havering and Redbridge succeeded: a newborn was discharged after his mother, who spoke very little English, was given feeding advice she could not understand and without an interpreter, and the family's concerns were not acted on. He suffered permanent brain injury from low blood sugar. Callaghan v South Tees failed on the same territory: a single limited breach over discharge advice was found, but the court was not persuaded the mother would have returned in time.

Advice only counts if the patient or parent can understand it. That is a real and winnable allegation, but it still has to be shown to have changed what happened.

§ 05

What the coroners see

We also read the most recent 72 coroners' Prevention of Future Death reports on hospital deaths. Inpatient falls, malnutrition, pressure sores, choking and unanswered monitor alarms come up repeatedly, far more often than they appear in the courts. Several involve patients who fell while on blood thinners and did not get a prompt head scan. Coroners' reports are about preventing deaths rather than compensation, but they are useful evidence that a failure is a known and recognised one.

§ THE JUDGMENTS BEHIND THIS GUIDE

The six judgments behind this guide.

Every one a published decision of the courts of England and Wales, linked to its source. Three losses and three wins.

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.

Claim failed

Doubell v Kings College Hospital NHS Trust

[2020] EWHC 359 (QB)·2020·Appeal decision

A 65-year-old inpatient who became confused at night fell out of bed and hurt her knees, and she argued that bed rails should have been fitted. The trial judge found that rails had not been recommended and would have been removed anyway, and the High Court refused to disturb those findings.

Bed rails are not automatically the safe option, because they can create their own risks for a confused and mobile patient. An appeal court will rarely overturn a trial judge's findings about what nursing staff decided or would have decided.

Claimant succeeded

Spearman v Royal United Bath Hospitals NHS Foundation Trust

[2017] EWHC 3027 (QB)·2017·Liability decided at trial

A man with type 1 diabetes was brought to A&E after a hypoglycaemic attack, left the department within about 15 minutes, climbed five flights of stairs through unsecured doors to a flat roof, and fell into a courtyard. The judge found the Trust liable because it had not risk-assessed or restricted access to the roof, where furniture made the safety barrier easy to climb.

A hospital's duty to a confused or vulnerable patient covers the safety of the building and how patients are supervised, not just medical treatment. A patient who cannot appreciate the danger because of his condition is not treated as partly to blame.

Claim failed

Failes v Oxford University Hospitals NHS Trust

[2020] EWHC 3333 (QB)·2020·Liability decided at trial

After removal of a spinal cord tumour, nursing charts appeared to show neurological deterioration two days post-op, but the surgeon was not alerted; four days later the patient suffered sudden permanent paralysis. The court accepted the clinicians' assessments that there was no real deterioration until the final day, so earlier escalation would not have changed the outcome.

Nursing observation charts alone may not prove deterioration if contemporaneous clinical examinations showed improvement. Even a failure to escalate must be shown to have changed the outcome.

Claimant succeeded

Rajatheepan v Barking, Havering And Redbridge NHS Foundation Trust

[2018] EWHC 716 (QB)·2018·Liability decided at trial

A newborn baby was discharged after his mother, who spoke very little English, was given feeding advice she could not understand and without an interpreter, and the family's concerns about his crying were not acted on. He was found pale and lethargic the next day with dangerously low blood sugar that caused permanent brain injury.

Discharge advice only counts if it is given in a way the parent can actually understand, using an interpreter where needed. Concerns raised by a family before discharge should be recorded and looked into rather than brushed aside with reassurance.

Claim failed

Callaghan v South Tees Hospitals NHS Foundation Trust

[2023] EWHC 1199 (KB)·2023·Liability decided at trial

A baby born at James Cook University Hospital was discharged two days after birth and died of GBS meningitis and sepsis. The judge found only one limited breach (a missing piece of discharge advice) and that it did not cause the death because the mother would not have returned to hospital in time.

Even where a hospital gets something wrong, the claim fails unless the mistake is shown to have changed what happened. Record-keeping failings alone did not establish causation here.

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

My relative fell in hospital and broke a hip. Is that a claim?

It can be, but a fall alone is not enough. Doubell failed even though the patient was confused, because the measures suggested carried their own risks. Ask for the falls risk assessment and the care plan; if a recorded risk was ignored, the claim is stronger.

My relative developed pressure sores as an inpatient.

Reaney shows liability is often accepted for sores that develop in hospital. The harder question is how much of the later care need the sores actually caused, especially for someone already seriously unwell.

A confused patient walked out of the ward and was hurt.

Spearman succeeded on exactly that. A hospital's duty to a confused patient includes the safety of the premises and proper supervision, and the patient is not usually blamed for what their condition prevented them understanding.

The observation charts show my relative was deteriorating and nobody came.

That is the right document to start with, but Failes is a warning: the court accepted the doctors' examinations over the charts. The claim needs expert evidence that earlier escalation would have changed the outcome.

We were sent home without being told what to watch for.

Rajatheepan succeeded where feeding advice was given to a mother who could not understand it and no interpreter was used. Whether the advice was adequate, and whether better advice would have brought you back in time, decide the claim.

§ MORE GUIDES

Plain answers to the other questions people ask.

Newborn brain injury →

How brain injury claims arise from the first days of life and from delays in labour: blood sugar monitoring, fetal heart monitoring, and delivery timed in minutes.

Deterioration on the ward →

Nine published judgments on patients who deteriorated in hospital: leaks after surgery, sepsis, compartment syndrome and observations not escalated. Six succeeded.

Child sent home →

Six published judgments on children discharged or reassured with meningitis, sepsis, asthma or infection. Four succeeded, one at £9.3 million.

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.