Expert evidence about a patient’s death or serious harm

Reference: INV-5c

Last Updated 06/04/2018


When we investigate after a patient has died or suffered serious harm, we will always need to think about the kind of evidence we will need. If patients suffer harm, we take it extremely seriously, but we balance this with our need to help keep patients safe by avoiding a culture of blame or cover up. This means we do not punish nurses and midwives for making genuine clinical mistakes.

So, applying our guidance on what caused the death or serious harm of a patient, if the nurse or midwife chose to take a risk with patient safety, or did something truly exceptionally bad as part of the patient’s care, we will need expert evidence. We will need evidence that shows clearly how the fault on the part of the nurse or midwife led to the patient suffering harm, or dying, made those outcomes more likely, or cost them a chance of survival. An expert will usually be the best source of this kind of evidence.

When things go wrong and patients suffer harm, there will usually be investigations by employers, the police, other regulators, or the coroner. If an independent expert gave evidence to an investigation like this, we’ll usually start by thinking about asking that expert to help with our investigation.

In cases where the nurse or midwife made a genuine clinical mistake, and following our guidance we are not investigating whether their mistake caused the harm, we will not need to gather independent expert evidence. We would want to refer to the outcome as part of the background to the case, but we would make clear that we were not looking to hold the nurse or midwife responsible. This means we would not need the specialist knowledge of an independent expert witness.