Litigation trends within rheumatology: a retrospective analysis of claims data from England for the Getting It Right First Time programme

Objectives To examine rheumatology-related litigation claims over a 5-year period to describe trends and identify learning opportunities.

Methods Data were extracted from NHS Resolution for all claims within rheumatology or claims referencing ‘giant cell arteritis (GCA)’ or ‘vasculitis’ within any specialty over 5 years (2018/19–2022/23). Variables for each claim included cause, injury, costs and claim status.

Results We identified 152 rheumatology claims (total cost £28.2 million). The most frequent injuries were unnecessary pain [n = 70 (46%)], fatality [n = 14 (9%)] and psychiatric/psychological damage [n = 13 (9%)]. Where specified, 37 claims (24%) involved inflammatory arthritis and 22 (14%) related to rare autoimmune rheumatic diseases (RAIRDs), such as vasculitis. Only 23 of the 152 claims were closed by the end of the study period, with just 4 being settled in favour of the claimant. Of these four, three involved soft tissue steroid injections. All 14 fatality cases with specified underlying conditions were RAIRDs. Diagnostic issues accounted for 38% of claims and treatment issues for 30%. Six claims exceeded £1 million. Forty-four GCA-related claims (total cost £13.1 million) were identified, mostly in ophthalmology or emergency medicine rather than rheumatology, representing a doubling compared with the previous 5-year period. Sixteen vasculitis-related claims (£3.4 million) were identified.

Conclusions High-cost, high-harm claims persist in rheumatology, with most remaining open for several years, creating personal, financial and professional strain. GCA-related claims are increasing and occur mostly outside rheumatology, highlighting the need for pan-speciality awareness agreed-upon care pathways. RAIRD-related claims seemed overrepresented in cases of fatality, highlighting the importance of timely suspicion, close monitoring and careful management.