§ GUIDE · PERIODICAL PAYMENTS

A lump sum now,
and care paid for every year of life.

The biggest medical negligence settlements are rarely one number. They pair a lump sum with periodical payments: an index-linked amount paid every year for life to fund care. Here is how they work, why they are used, and what the seven judgments below show about their scale.

AXA v Airedale lump sum

£5,750,000

AXA total capitalised value

£16,707,835

XX v Barts capitalised

£17,185,985

Index used for care

ASHE 6115

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§ WHAT THEY ARE

A guaranteed yearly sum, for as long as the person lives.

Under the Damages Act 1996 a court can order that part of an award for future loss is paid as periodical payments rather than a lump sum. The claimant receives a fixed sum every year, usually for life, which rises each year with an index. For care the index is normally ASHE 6115, which tracks the earnings of care workers, so the payments keep pace with the real cost of carers.

The lump sum covers everything else: the injury itself, past losses, housing, equipment, therapies and lost earnings.

§ WHY THEY ARE USED

Nobody knows how long the money has to last.

A lump sum for lifelong care has to guess at life expectancy. Live longer than predicted and the money runs out; die sooner and the estate keeps a windfall. Periodical payments remove both risks: they stop when the person dies and continue as long as they live. That is why judges approving settlements for children and protected parties favour them. In MHE v Wye Valley NHS Trust [2024] EWHC 25 (KB) the judge found the structure was in the claimant's best interests and approved it under CPR 21.10.

§ STEPPED PAYMENTS

Payments that rise as care needs grow.

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

A £5,750,000 lump sum plus periodical payments for care and case management stepped at £147,500, £305,000 and £350,000 a year, with a further £13,500 a year for deputy costs. Total capitalised value £16,707,835.

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

A gross lump sum of £5,557,500 plus periodical payments of £57,500 a year from December 2024, £110,000 from December 2028 and £144,000 a year for life from December 2039, indexed to ASHE 6115.

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

A £3,850,000 lump sum plus £86,544 a year to 2060, £157,500 a year from 2061 to 2070 and £180,000 a year for life from 2071. The steps track the point at which family carers can no longer provide care.

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

A gross lump sum of £9.3 million plus periodical payments starting at £190,000 a year from December 2022 and rising to £238,000 a year from December 2028.

§ WHY HEADLINE TOTALS DIFFER

Lump sum, gross, net, capitalised: the same settlement has several numbers.

The lump sum is the cash paid now. Gross means before interim payments already received are deducted; MHE's £5,557,500 gross was £4,907,500 net after £650,000 of interims. The capitalised value adds the periodical payments over the expected lifetime: XX v Barts Health NHS Trust [2023] EWHC 963 (KB) was a £6.5 million lump sum with a capitalised value of £17,185,985 on a life expectancy of 63. CTQ v King's College Hospital [2023] EWHC 2975 (KB) paired a £2,500,000 lump sum with periodical payments and a conservative capitalised value of about £5,560,000.

So when you read that a case settled for £6.5 million, the family may in fact receive well over twice that across a lifetime.

§ PAYMENTS CAN CHANGE STEP

Even settlements without a court approval use the structure.

Chocken v Oxford University Hospitals [2020] EWHC 3269 (QB) records a compartment syndrome claim settling 70 days before trial for a £2,850,000 lump sum plus periodical payments of £48,000 a year rising to £85,000 a year. The judgment itself is about the lawyers' success fee, but it shows the same lump-sum-plus-payments shape in an adult claim.

§ THE JUDGMENTS BEHIND THIS GUIDE

Seven judgments with periodical payments.

Court approvals and one costs judgment, each printing the lump sum and the yearly payments. Every one links to its source.

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£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£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£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£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.

Claimant succeeded£2.85M

Chocken v Oxford University Hospitals NHS Foundation Trust

[2020] EWHC 3269 (QB)·2020·Appeal decision

After a 10-hour facial reconstruction the claimant developed compartment syndrome in both legs in intensive care and was left with permanent damage; the trust settled 70 days before trial for a £2.85 million lump sum plus annual payments of £48,000 rising to £85,000. This later judgment dealt only with the lawyers' success fee and dismissed the claimant's appeal on that point.

Compartment syndrome arising from post-operative monitoring failures can attract multi-million-pound settlements with periodical payments for lifelong care, although this figure comes from a costs judgment rather than a damages judgment.

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

Can I choose a lump sum instead of periodical payments?

For an adult with capacity, the form of the award is usually agreed between the parties, and the court considers the claimant's needs. For children and protected parties the court decides what is in their best interests, and periodical payments for care are commonly preferred because they cannot run out.

What happens to periodical payments if the person dies early?

They stop. That is the point of them: the defendant pays for care for exactly as long as it is needed, no more and no less.

What is ASHE 6115?

A category in the Office for National Statistics' Annual Survey of Hours and Earnings covering care workers. Indexing care payments to it means they rise with carers' wages rather than general inflation.

Why do the payments step up at future dates?

Because care needs change. A child's parents often provide much of the care while they can; the payments step up when professional carers are expected to take over, as the ERE and MHE settlements show.

Are periodical payments secure?

Payments from NHS bodies are treated as secure under the Damages Act framework, which is one reason courts are willing to approve them for lifelong care.

§ MORE GUIDES

Plain answers to the other questions people ask.

How big awards are built →

How a multi-million medical negligence award is assembled: general damages, care, accommodation, prosthetics, lost earnings and lost years. Real judgments.

Settlement approval →

Why a settlement for a child or protected party must be approved by a judge, what the judge checks, and what public approval judgments reveal about real sums.

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.

Time limits →

The 3-year time limit for medical negligence claims, the date-of-knowledge rule, and the exceptions for children, mental capacity and fatal claims.

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.

A lump sum now,and care paid for every year of life.