The High Court’s decision in LXLP v St George’s University Hospitals NHS Foundation Trust [2026] EWHC 560 (KB) provides a clear illustration of the central importance of causation in clinical negligence claims, even where elements of substandard care are admitted.

The claim arose from antenatal care provided in April and May 2016 following a diagnosis of pre-term pre-labour rupture of membranes (PPROM). It was accepted that the Trust failed to prescribe erythromycin in accordance with national guidance, amounting to an admitted breach of duty. Subsequent vaginal swabs revealed Group B Streptococcus (GBS) that was resistant to erythromycin but sensitive to penicillin. While the Trust’s local guidance recommended penicillin in those circumstances, no antibiotics were administered until labour commenced. Tragically, the claimant was born prematurely and suffered a severe brain injury, ultimately resulting in cerebral palsy.

Despite the admitted breach of duty, the claim failed. Mrs Justice Kimblin held that the claimant had not established, on the balance of probabilities, that the earlier administration of antibiotics would have prevented the development of chorioamnionitis or the resulting injury. On the expert evidence, the court accepted that the infection developed only shortly before delivery and that earlier antibiotic treatment (with erythromycin or penicillin) would probably not have altered the outcome. Accordingly, the conventional ‘but for’ test in causation was not satisfied.

Material Contribution

The claimant advanced a fallback case based on material contribution, contending that even if earlier treatment would not probably have prevented the infection altogether, it would have reduced its severity and thereby materially contributed to the brain injury. The court rejected that argument. Mrs Justice Kimblin reaffirmed that material contribution does not dispense with the need to prove a causal link of legal significance; it applies only where an injury is indivisible (which she said this injury was not) and where each factor is shown to have made more than a negligible contribution. On the evidence, the court was not persuaded that the admitted failures made any material contribution to the development or severity of the chorioamnionitis, which was found to have arisen independently and acutely in the hours before delivery. The case provides helpful guidance on the complicated area of material contribution arguments in infection cases.

The judgment also contains important guidance on the status of clinical guidelines. National RCOG guidance did not mandate antenatal penicillin for GBS colonisation, and the court rejected the suggestion that failure to follow more prescriptive local guidance necessarily amounted to a breach of duty. Applying orthodox Bolam principles, the court held that reasonable clinicians were entitled to follow national guidance in preference to local protocols.

Overall, LXLP is a powerful reminder that admitted breach of duty does not mean that a claim will succeed, and that causation, particularly in complex obstetric and infection-related claims, remains the decisive battleground.

 

For legal guidance and advice regarding clinical negligence , please contact Alistair Wilson or any member of our Healthcare team.

While great care has been taken in the preparation of the content of this article, it does not purport to be a comprehensive statement of the relevant law and full professional advice should be taken before any action is taken in reliance on any item covered.