CASE NOTE: Conway v Yeovil District Hospitals NHS Foundation Trust [2025] EWHC 2488 (KB) | 7 Oct 2025 | Hon. Mr Justice Turner

(This case note contains details of child abuse that some readers may find disturbing.)

 

Facts of the Case

Sidney Conway, the claimant, was born on 2 November 2014 – a healthy and thriving baby. On 31 December 2014, he suffered his first episode of abusive head trauma at the hands of his mother. No one else, including Sidney’s father, knew that any such abuse had taken place.

On 2 January 2015, Sidney was taken to his GP after several days of vomiting. The GP identified no urgent cause for concern and advised that his parents continue with community monitoring by the health visitor. Throughout this period, Sidney’s mother concealed her involvement through convincing displays of parental concern.

Sidney’s symptoms deteriorated, and he was taken to Yeovil Hospital on 6 January 2015. He continued to vomit, appeared drowsy, and his head circumference percentile had also increased (that is, the circumference in a proportionate comparison with other babies). While the primary suspicion was pyloric stenosis (a narrowing between the stomach and small intestine), one doctor noted the possibility of an intracranial cause and planned both an abdominal and, potentially, a head scan. In the event, only the abdominal scan was pursued.

Sidney was transferred to Bristol, where the abdominal scan on 9 January 2015 showed no evidence of pyloric stenosis. A doctor recorded that Sidney’s head circumference had been discussed with the Medical Registrar, and a plan was made for the health visitor to monitor his head growth and weight over the following one to two weeks. With his other symptoms resolved, Sidney was discharged home on 10 January 2015.

While at home, Sidney suffered further abusive head trauma from his mother, resulting in a cardiac arrest. He was taken to Southampton Children’s Hospital on 11 January 2015, where imaging revealed severe head injuries. Sidney survived but was left permanently disabled.

Issues

Although the particulars of claim alleged wide-ranging negligence, the case ultimately turned on a single question: whether the defendant breached its duty of care by failing to recommend an urgent head scan following the normal abdominal scan at Bristol.

The applicable legal test was the Bolam test, refined by Bolitho: whether the defendant acted in accordance with a responsible body of medical opinion that was itself logically defensible.

The claimant argued that the negative abdominal scan created a diagnostic gap. Given Sidney’s increased head circumference percentile, weight loss, and vomiting, it was said to be illogical not to pursue a head scan promptly.

The defendants maintained that the plan to monitor Sidney’s progress through community follow-up was reasonable, particularly as his symptoms had settled by the time of discharge. They further argued that, even if a scan should have been arranged “very soon” by 12 January, the subsequent abuse on 11 January would still have occurred. The claimant’s own expert accepted that the discharge itself was not negligent per se.

Decision

In most cases of clinical negligence, it is very common to observe the court consider whether there was a breach of duty and, if there was, whether that breach caused the harm sustained. In this case, however, the judge pointed to the Supreme Court decision in Meadows v Khan [2022] AC 852 which provides helpful guidance on analysing the different question of the scope of duty. Before examining breach and causation, the judge first considered what the risks of harm were to the claimant against which the law imposed on the defendant a duty to take care.

The answer to this question was that the scope of the hospital’s duty of care was “to take reasonable care (in the Bolam/Bolitho sense) to take reasonable steps (whether by way of testing, treatment or otherwise) to respond to the risk of any deterioration in or failure to recover from any ongoing condition from which Sidney may have been suffering.” There was, however, no duty to protect Sidney from all possible consequences of being discharged into his parents’ care. The fact that his mother was abusive was not, and could not have been, known to the hospital. Although the discharge gave Sidney’s mother the opportunity to inflict further harm, this was unrelated to the hospital’s duty of care. The claim was therefore outside of the hospital’s scope of duty and failed before breach or causation required consideration.

Despite this, the judge did address breach and preferred the evidence of the defendant’s expert, finding them to be more consistent, measured, and persuasive. The court concluded that the defendant’s conduct satisfied the Bolam standard.

This case provides helpful guidance on how foreseeability is a concept that can play a key role in establishing the scope of duty as well as where it more typically arises in assessments related to remoteness when assessing legal causation.

 

Analysis and review produced by Tomas McCabe Probationary Tenant of Farrar’s Building.  Tomas accepts instructions across Chambers’ core areas of expertise.  For further information, please contact his Clerking Team.

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