Key learnings from LXLP -v- St George’s University Hospitals NHS Foundation Trust

LXLP is a helpful case in understanding how the Court might approach differing national and local guidance documents when determining whether there has been a breach of duty. The Judgment also indicates that evidence of a statistical trend does not show whether a particular claimant would have conformed to trend and further evidence will be needed to establish causation.

In the recent case of LXLP v St George’s University Hospitals NHS Foundation Trust [2026] EWHC 560 (KB), it was admitted by the Trust that the failure to prescribe erythromycin was a breach of duty; however it was alleged that LXLP’s mother should have been given additional antibiotic treatment in labour and that the failure to provide it caused an adverse outcome.

National guidance v local guidance

It was said that oral penicillin ought to have been offered in the context of pre-term pre-labour rupture of membranes, in the presence of Group B Streptococcus colonisation. Local Trust guidance indicated penicillin should be offered in this clinical scenario, whereas national guidance did not.

The Judge accepted that national guidance is held in high regard and is often the basis for local protocols but recognised that all guidance documents are “evidence” not rules and the weight to be given to each is case-specific and sensitive to context.

Speaking of national and local guidelines generally, the Judge said, “Such documents may capture, in summary form, the best available evidence. They incorporate a balancing of relevant factors, articulate the preferred courses of action, and indicate where caution is needed.”

The Court treated all guidance documents as just one part of the evidential picture and focussed on whether practice was reasonable, logically defensible and properly risk balanced.

In this particular case, aided by medical experts, the Court preferred the national position as the ’best available evidence’ and held that acting in line with national guidance rather than local policy was not a breach of duty.

We think there are some important messages here for healthcare providers:

• While not determinative of negligence on their own, Courts may treat compliance with national guidance as highly persuasive when assessing breach of duty and it is likely to be a powerful reference point. Local policies should be regularly reviewed and kept up to date and in line with national guidance, with any divergence clearly explained and justified.

• If local guidelines do not align to national recommendations (without clear rationale) and/ or are outdated, this can create the impression of weak governance.

• Local policies should be easily accessible and embedded into best practice with training. An unexplained gap between “what we say” and “what we do” can invite adverse inferences around training, supervision and organisational learning.

Causation cannot be established from statistical trends alone

It was alleged that the absence of prophylactic antibiotics led to LXLP’s mother developing chorioamnionitis which caused LXLP’s severe brain damage.

The causation experts for the claimant relied on risk reduction statistics apparent from medical literature (Cochrane review data), in support of the contention that antibiotic treatment would have been expected to bring about a favourable outcome.

The Judge accepted that the risk ratios were pertinent to causation, but he considered that these were ’a tool and not an answer’ and that, although a trend might be apparent from the statistics, they did not show whether this claimant would have conformed to trend.

The Judge went on to conclude that there was insufficient evidence to prove that antibiotic treatment would probably have changed the outcome for this particular Claimant. Accordingly, the claim failed on causation.

Whilst the statistical trend favouring the claimant’s case was well attested by medical literature, the Judge’s decision in LXLP makes clear that the Courts will have regard to case-specific factors.

The LXLP judgment has already been used by our Health Litigation team in another case to highlight that literature addressing how a majority of patients might react is insufficient to establish causation. This assisted in achieving a sensible and cost-effective resolution in that case.

If you require any further information or advice concerning the issues addressed in this article, please do not hesitate to contact our Health and Social Care team and we will do all we can to assist.

This article was co-authored by Paralegal, Maria Chowdhury.