Pressure Sore (Bedsore) Negligence Claims: What You Need to Know

You can bring a clinical negligence claim for pressure sores, also known as bedsores or pressure ulcers, where they developed or worsened because of a failure in care that fell below the standard a hospital, care home, or other healthcare provider was legally required to meet. Pressure ulcers are largely preventable, and where they occur as a result of inadequate risk assessment, repositioning, skin care, or wound management, a claim may be available against the responsible organisation.

This guide explains the clinical standards that apply, the types of failure that most commonly give rise to claims, who can be held liable, what compensation covers, and how the process of pursuing a claim works.

What Are Pressure Ulcers and Why Do They Matter Legally?

A pressure ulcer is an area of localised damage to the skin and underlying tissue, caused by sustained pressure, friction, or shear. They develop when blood supply to an area of skin is restricted for a prolonged period, most commonly over bony prominences such as the sacrum, heels, hips, and elbows. People who are immobile, critically ill, malnourished, or incontinent are at greatest risk.

Pressure ulcers are classified in four categories of increasing severity:

• Category 1: Non-blanchable redness of intact skin. The area may be painful, firm, or warmer than surrounding tissue.
• Category 2: Partial thickness loss of skin, presenting as an open shallow ulcer or intact blister.
• Category 3: Full thickness skin loss. Subcutaneous tissue may be visible but bone, tendon, and muscle are not exposed.
• Category 4: Full thickness tissue loss with exposed bone, tendon, or muscle. Category 4 ulcers can be life-threatening, particularly where infection leads to sepsis or osteomyelitis.

Approximately 700,000 patients are affected by pressure ulcers in England each year, with over 186,000 developing a new ulcer in acute care alone, according to NHS Safety Thermometer data. NICE and NHS England both recognise that the majority of pressure ulcers are avoidable with proper care, and it is this preventability that is central to the legal framework.

What Is the Standard of Care?

The primary clinical standard governing the prevention and management of pressure ulcers is NICE guideline CG179, Pressure Ulcers: Prevention and Management, first published in 2014 and kept under review since. NICE Quality Standard QS89 supplements this with specific measurable statements of quality care. Together, these documents define what any hospital, community health provider, or care home is required to do.

The core obligations under NICE CG179 include the following.

Risk assessment must be carried out on admission and whenever there is a relevant change in the patient’s condition, such as after surgery, a deterioration in their underlying condition, or a change in their mobility. NICE recommends using a validated risk assessment tool to support clinical judgment. The tools recommended include the Waterlow score, the Braden scale, and the Norton risk-assessment scale, each of which generates a risk score based on factors including mobility, skin condition, nutrition, continence, and age. A failure to carry out any risk assessment on admission, or to reassess after a change in condition, is a clear departure from the standard of care.

Skin assessment must be offered to patients assessed as being at high risk, checking for colour changes, variations in temperature, firmness, and moisture, and any pain or discomfort the patient reports.

Repositioning must be offered to patients at risk, with the frequency tailored to the individual’s needs and documented in their care plan. Repositioning plans must be recorded, and adherence to them must be monitored and documented in the nursing records.

Pressure-relieving equipment including specialist mattresses, cushions, and heel protection devices must be provided to patients at risk. A failure to use appropriate equipment, or to replace equipment that has become ineffective, is a failure of a basic preventive standard.

Wound care and management for patients who develop a pressure ulcer must follow the appropriate clinical pathway, including regular dressing changes, wound measurement and documentation, and referral to a tissue viability nurse where the ulcer is grade 3 or above.

A departure from any of these requirements, without documented clinical justification, is significant evidence that the care fell below the standard required by NICE CG179 and QS89.

Who Can Be Held Liable?

Pressure ulcer negligence claims can be brought against several types of organisation depending on where the ulcer developed or worsened.

NHS trusts are responsible for the care provided in their hospitals. Where a patient develops a pressure ulcer during an inpatient admission, or where an existing ulcer worsens because of inadequate management during that admission, the trust is vicariously liable for the failures of its nursing and medical staff.

Care homes are responsible for the care provided to residents. Both residential care homes and nursing homes are regulated by the Care Quality Commission under the Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The fundamental standards imposed by these regulations include a requirement to provide safe care and treatment and to ensure that residents receive appropriate nutrition, repositioning, and skin care. A care home that allows a resident to develop avoidable pressure ulcers through inadequate care may be in breach of both the fundamental standards and its common law duty of care.

Community health providers including district nursing teams and community care providers may be liable where pressure ulcers develop or worsen in a community setting because of inadequate assessment, wound management, or support for carers.

How Is Liability Established?

A pressure ulcer negligence claim follows the same legal framework as any clinical negligence case. The claimant must establish that the defendant owed them a duty of care, that the duty was breached, and that the breach caused or materially contributed to the harm suffered.

The duty of care is not in dispute in any case involving a caring relationship between a patient or resident and a healthcare or care provider.

Breach of duty is assessed using the Bolam test from Bolam v Friern Hospital Management Committee [1957] 1 WLR 582. A clinician or care provider is not negligent if their conduct accords with a practice accepted as proper by a responsible body of opinion in the relevant field. In pressure ulcer cases, this is assessed against the NICE CG179 standards and the professional standards applicable to nursing care. The Bolitho qualification from Bolitho v City and Hackney Health Authority [1998] AC 232 means that a body of opinion relied upon by a defendant must be capable of withstanding logical analysis. A failure to assess risk, to reposition a patient, or to use pressure-relieving equipment is very difficult to defend on Bolam grounds where the failure is clearly documented in the nursing records and no clinical justification is recorded.

Causation requires the claimant to show on the balance of probabilities that the breach of duty caused or materially contributed to the development or worsening of the pressure ulcer and the harm that resulted from it. In many pressure ulcer cases, this is more straightforward than in other clinical negligence claims, because the records will often show a patient with documented risk factors who was not repositioned at the required intervals, was not provided with appropriate pressure-relieving equipment, or whose deteriorating skin was not escalated to a tissue viability nurse in accordance with the applicable standard.

The Evidential Picture: What the Nursing Records Reveal

Nursing records are central to any pressure ulcer negligence claim. Where care has been provided appropriately, the records should show a documented risk assessment on admission and at each subsequent change in condition, a care plan specifying the repositioning frequency and the equipment provided, regular entries confirming that repositioning was carried out, wound assessment charts recording the size, grade, and condition of any ulcer, and referral records where specialist input was sought.

Where the records show gaps in repositioning entries, an absence of risk assessment documentation, a failure to provide or document the provision of appropriate equipment, or a deteriorating wound that was not escalated appropriately, these gaps are significant and well-recognised evidence of a failure in care. An independent nursing expert will review the records and provide a detailed opinion on whether the care met the standard required at each stage of the relevant period.

What Can You Claim Compensation For?

Compensation in a pressure ulcer negligence claim covers both the physical and financial consequences of the harm.

General damages compensate for the pain, suffering, and loss of amenity caused by the pressure ulcer and its consequences. Category 3 and 4 ulcers are extremely painful, often require extended hospital treatment, and in the most serious cases result in sepsis, osteomyelitis, or death. The Judicial College Guidelines provide indicative figures for a range of wound injuries and their sequelae, and the award will reflect the individual claimant’s specific circumstances, the severity of the ulcer, the treatment required, and the prognosis.

Special damages cover financial losses already incurred, including the cost of private wound care or specialist dressings, lost earnings during any period of incapacity attributable to the negligence, travel expenses connected to treatment, and the value of care provided by family members. Future losses are relevant where the consequences of the pressure ulcer are long-lasting or permanent.

Where a pressure ulcer has resulted in the death of a patient, the estate may bring a claim under the Law Reform (Miscellaneous Provisions) Act 1934 for the losses suffered up to the date of death, and dependants may bring a claim under the Fatal Accidents Act 1976 for bereavement and dependency.

Time Limits

The standard three-year limitation period under the Limitation Act 1980 applies. The period runs from the date of the negligent care or, where the claimant did not immediately appreciate that the pressure ulcer resulted from negligent care rather than their underlying condition, from the date of knowledge under section 14 of the Act. Children have until their 21st birthday to bring a claim. Adults who lack mental capacity are protected from the limitation period running while incapacity continues. Legal advice should be sought promptly, since the time required to obtain records and commission expert evidence means that delay in instructing a solicitor can put unnecessary pressure on the investigation process.

What to Do Next: Starting a Claim

If you or a family member developed a pressure ulcer during a period of inpatient care, a care home stay, or community nursing, the practical steps are as follows:

1. Seek specialist legal advice. A clinical negligence solicitor with experience in pressure ulcer claims will assess the circumstances and advise on the strength of a potential claim.
2. Medical and care records are obtained. Your solicitor will request the full nursing records, care plans, wound assessment charts, risk assessment documentation, and any incident reports connected to the pressure ulcer.
3. Independent nursing expert evidence is commissioned. An independent tissue viability or nursing expert will review the records and provide a detailed opinion on whether the care met the NICE CG179 standard and whether any failures caused or contributed to the harm.
4. A letter of claim is sent. Once the evidence base supports the claim, a formal letter is sent to the relevant defendant under the Pre-Action Protocol for the Resolution of Clinical Disputes, giving the defendant the opportunity to investigate and respond before proceedings are issued.

Most pressure ulcer negligence claims are resolved through negotiated settlement rather than court proceedings, particularly where the nursing records clearly document the failures in care.

Talk to Satchell Moran Solicitors

Pressure ulcers are painful, distressing, and in many cases entirely preventable. Where they result from a failure to meet the standards that hospitals and care homes are legally required to follow, you have the right to seek compensation and a formal account of what went wrong. At Satchell Moran Solicitors, our specialist clinical negligence team handles pressure ulcer claims against both NHS trusts and care homes, and we act on a no win, no fee basis so there is no financial barrier to finding out where you stand. As a dual Lexcel accredited firm, we are committed to the highest standards of client care throughout.

If you or a family member has suffered from a pressure ulcer that you believe resulted from negligent care, contact us today for an initial, confidential and no obligation conversation.