High Court Addresses Settlement Approval and Anonymity in CTQ v King’s College Hospital NHS Foundation Trust

Citation: [2023] EWHC 2975 (KB)
Judgment on


In the case of CTQ v King’s College Hospital NHS Foundation Trust, the High Court addressed two significant legal issues within the context of a clinical negligence claim. First, it considered the application for court approval of a settlement pursuant to the court’s inherent jurisdiction in light of the claimant’s cognitive capacity following brain injury. Second, the Court deliberated on issuing an anonymity order to protect the claimant’s identity. This case analysis aims to dissect the court’s approach in dealing with these particular issues and the legal principles invoked.

Key Facts

CTQ, the claimant, brought a claim against King’s College Hospital NHS Foundation Trust following a cardiac arrest caused by a failure to administer intravenous fluids after giving birth, resulting in sustained brain damage. Consequently, CTQ suffered from substantial disabilities and cognitive deficits, prompting a claim for clinical negligence. The defendant admitted liability, though not the extent of the neurological injuries, thus focusing the dispute on quantum.

The central considerations were whether the claimant should be treated as a protected party due to her cognitive capacity and whether court approval was necessary for the settlement, despite no formal finding of incapacity. Additionally, the Court explored whether an anonymity order should be granted concerning the claimant and her daughter.

The Court applied several legal principles which underpin the administration of justice in cases involving vulnerable claimants:

Anonymity Orders

Pursuant to CPR rules 39.2(4), 5.4C, and 5.4D, and the Contempt of Court Act 1981, anonymity orders can be granted to serve the interests of protected parties, such as children or those with diminished capacity. The Court invoked the principles of open justice and recognized the tension between Articles 8 and 10 of the ECHR, highlighting the necessity test as the benchmark for departure from open justice.

Inherent Jurisdiction for Settlement Approval

Referencing the Coles and Grimshaw judgments, Deputy Judge Dexter Dias KC affirmed the inherent jurisdiction of the court could be invoked when there is a “real and credible doubt” about a claimant’s capacity to manage a settlement. CPR 21.10 stipulates that settlements involving children or protected parties require court approval. The court outlined the need for careful scrutiny by the legal representatives on the merits of the proposed settlement to ensure it aligns with the claimant’s best interests.

Best Interests and the Overriding Objective

The Court underscored its role in upholding the interests of justice and the best interests of the claimant, guided by the overriding objective. The approved settlement is considered in light of this principle and with reference to the White Book (2023 edition), suggesting court approval is wise where there is doubt about capacity.

Periodical Payments and Financial Advice

CPR 41.7 was considered relevant in assessing the structure of the awarded settlement, particularly concerning periodical payments which aimed to meet the long-term needs of the claimant.


The Court granted an anonymity order to protect the claimant, designated as CTQ, and her daughter, finding that it met the necessity test. Examining the settlement, the Court found it sensible and in the best interests of the claimant. Despite the absence of a litigation friend, the settlement was approved under CPR 21.10 based on the Court’s use of its inherent jurisdiction to treat the claimant as though she were a protected party. The Court promoted a “valid, final and binding settlement” without the need for a capacity trial, endorsing the approach reflected in Grimshaw and Coles.


In CTQ v King’s College Hospital NHS Foundation Trust, the High Court carefully navigated the complexities surrounding the approval of a clinical negligence settlement for a claimant with cognitive challenges. The Court balanced the principles of open justice with the claimant’s right to privacy while ensuring that the settlement was in her best interests and not compromised by any incapacity. The judgment reflects the nuanced application of legal principles to protect vulnerable individuals within the UK’s civil justice system. Through inherent jurisdiction, the Court underscored its protective function and demonstrated accountability in finalizing settlements under the CPR, emphasizing the importance of certainty and finality in litigation outcomes.

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