Specialist legal advice for avoidable pressure ulcers, bed sores and pressure injuries
In many cases, pressure sores are preventable with proper assessment, regular skin checks, appropriate pressure-relieving equipment, repositioning, good nutrition, hydration and careful nursing care. Where these steps are not taken, a pressure sore may be evidence of negligent care.
Scott Harding-Lister (Solicitor and ex-senior nurse) advises patients and families in pressure sore negligence claims involving hospitals, care homes, district nursing, rehabilitation units and community care providers.
If you or a loved one developed a pressure sore during a hospital admission, in a care home or while receiving care at home, we can advise whether the injury may have been avoidable and whether a claim can be brought.
What is a pressure sore?
A pressure sore is an area of damage to the skin and the tissue underneath. It usually develops where pressure has been placed on one area of the body for too long. Common areas include the heels, sacrum, hips, buttocks, ankles, elbows and back.
NICE describes a pressure ulcer as localised damage to the skin or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear. NICE guidance covers prevention and management for people at risk of, or with, a pressure ulcer, across hospital, care home and community settings.
Pressure sores can range from early skin discolouration to deep wounds involving muscle, tendon or bone. Serious pressure ulcers can be extremely painful and may lead to infection, sepsis, prolonged hospital admission, surgery, permanent scarring or a significant loss of independence. The NHS explains that pressure sores are damage to the skin and underlying tissue and can become serious if not properly prevented or treated.
Are pressure sores always negligent?
No. Not every pressure sore is caused by negligence but most of them are preventable and should not occur!
A pressure sore may give rise to a negligence claim where there were avoidable failures in care. The important question is not simply whether a pressure sore occurred. The question is whether the care provider recognised the risk and took reasonable steps to prevent, reduce, monitor and treat that risk.
A claim may arise where there was a failure to:
- carry out a proper pressure sore risk assessment
- recognise that the patient was at increased risk
- inspect vulnerable skin areas regularly
- provide a suitable pressure-relieving mattress or cushion
- reposition the patient at appropriate intervals
- respond to early signs of skin damage
- manage continence, moisture, nutrition and hydration properly
- refer to tissue viability nurses or wound care specialists when required
- document care properly
- communicate risk between staff, wards, care homes or community teams
- review and update the care plan when the patient’s condition changed
A pressure sore claim often turns on the records. Nursing notes, skin inspection charts, repositioning charts, Waterlow or Braden assessments, wound photographs, care plans, nutrition charts, continence records and tissue viability notes can be central to proving what happened.
How should pressure sores be prevented?
Good pressure area care starts with early recognition of risk. NICE guidance says adults should have pressure ulcer risk assessed and documented when they are admitted to secondary care or care homes where NHS care is provided, or when they receive NHS care in other settings if they have risk factors such as limited mobility, loss of sensation, a current or previous pressure ulcer, nutritional deficiency, inability to reposition themselves or significant cognitive impairment.
A proper care plan should usually include the following:
Risk assessments
Patients at risk should be assessed promptly. This may involve clinical judgement and a recognised tool such as Waterlow, Braden, Norton or PURPOSE T. The assessment should consider mobility, skin condition, continence, nutrition, hydration, cognition, sensation, acute illness and any previous pressure damage.
A risk assessment must be accurate. It must also be repeated when the patient’s condition changes. A person who was mobile on admission may become high risk after surgery, infection, sedation, deterioration, a fall or a prolonged stay in bed.
Skin inspections
Patients at risk should have regular skin checks by trained staff. NICE quality standards refer to skin assessment for people identified as high risk of developing pressure ulcers. The purpose is to identify early signs of skin damage before the injury progresses.
Early signs may include redness, discolouration, heat, swelling, pain, hardness, blistering or broken skin. Staff should be particularly alert to the heels, sacrum, buttocks, hips and other bony areas.
Robust Repositioning Regime
Patients who cannot move themselves may need help to change position. Repositioning reduces prolonged pressure on vulnerable parts of the body.
A repositioning plan must be robust, realistic, documented and followed. It is not enough for a care plan to say that a patient should be turned regularly if the care records show that this did not happen.
Pressure-relieving equipment
Patients at risk may need a suitable mattress, cushion, heel protection or other pressure-relieving equipment. Delay in providing appropriate equipment can be significant, particularly where a patient is immobile, frail, incontinent or already showing signs of skin damage.
Nutrition and hydration
Poor nutrition and dehydration can increase the risk of skin breakdown and delay healing. Clinical staff should consider nutrition screening, dietetic referral, fluid intake, weight loss and whether the patient needs additional support with eating and drinking.
Continence and moisture management
Moisture from incontinence, sweating or wound leakage can increase the risk of skin breakdown. Patients may need a continence plan, regular cleansing, barrier products and careful monitoring.
Treatment and escalation
Once a pressure sore develops, care should be escalated. This may involve tissue viability nurses, wound care plans, dressings, infection monitoring, antibiotics, surgical review, pain relief and more intensive pressure relief.
A common problem in pressure sore cases is that early warning signs are missed or ignored. A small area of redness can deteriorate into a serious wound if action is not taken promptly.
Common examples of pressure sore negligence
Pressure sore negligence can occur in hospitals, care homes, nursing homes, rehabilitation units and the community. Examples include:
- a patient admitted to hospital with limited mobility but no pressure sore risk assessment was completed
- a patient was assessed as high risk but no pressure-relieving mattress was provided
- a patient was left in bed or in a chair for long periods without repositioning
- heel pressure damage developed because no heel protection was used
- skin redness was recorded but no effective action was taken
- a care home failed to inspect the skin of a resident who was known to be immobile
- district nursing staff failed to escalate a deteriorating wound
- a patient was discharged from hospital with a pressure sore but without a proper wound care plan
- poor handover meant that pressure area risks were not communicated
- records suggested that repositioning was required, but the turning charts were incomplete or inconsistent
- a Grade 1 or Grade 2 pressure sore progressed to a Grade 3 or Grade 4 wound because of inadequate care
These cases are often distressing for families because the injury may only become obvious once the wound has already become serious.
Pressure sores in hospital
Hospital patients may be at risk because of surgery, infection, sedation, immobility, reduced consciousness, serious illness, poor nutrition or prolonged time on trolleys and wards.
Hospital pressure sore claims may involve:
- failure to assess risk on admission
- failure to reassess after surgery or deterioration
- inadequate nursing observations
- delay in providing a pressure-relieving mattress
- failure to turn or reposition the patient
- failure to protect the heels
- poor wound care
- failure to involve tissue viability nurses
- unsafe discharge planning
If a patient entered hospital without pressure damage but was discharged with a significant pressure sore, the records should be carefully reviewed.
Pressure sores in care homes
Care homes and nursing homes must identify residents who are at risk of pressure damage and put suitable plans in place. Many residents are vulnerable because of age, dementia, frailty, reduced mobility, poor nutrition, incontinence or existing health conditions.
A care home pressure sore claim may arise where:
- risk assessments were not completed or reviewed
- staff failed to inspect the resident’s skin
- a resident was left in bed or in a chair for too long
- equipment was not provided or was not used properly
- staff failed to respond to redness or early skin breakdown
- nutrition, hydration or continence needs were not managed
- medical help was not requested quickly enough
- records were poor, inconsistent or missing
Families often feel guilty when they discover that a loved one has developed a pressure sore in a care setting. It is important to remember that the responsibility for pressure area care rests with the care provider.
Pressure sores in community care
Pressure sore claims can also arise where care is provided at home. This may involve district nurses, carers, occupational therapists, GPs, community hospitals or rehabilitation services.
Problems may include delays in arranging equipment, inadequate wound reviews, failure to escalate deterioration, poor communication between services or a lack of a proper care plan.
What evidence is needed for a pressure sore claim?
The evidence will usually include:
- hospital records
- GP records
- care home records
- district nursing notes
- risk assessments
- Waterlow, Braden or other scoring documents
- skin inspection charts
- turning and repositioning charts
- wound care plans
- tissue viability records
- photographs of the wound
- nutrition and fluid charts
- continence records
- safeguarding records, if relevant
- witness evidence from family members
- expert evidence from an independent nursing or wound care expert
The records may show whether appropriate care was planned and whether that care was actually delivered.
How is a pressure sore negligence claim proved?
To bring a successful clinical negligence claim, it is usually necessary to prove three things.
First, that the care fell below a reasonable standard. This is known as breach of duty.
Second, that the negligent care caused injury or made the injury worse. This is known as causation.
Third, that the injury caused loss. This may include pain, suffering, care needs, treatment costs, equipment, loss of earnings or other financial consequences.
In pressure sore cases, causation can be very important. The issue may be whether the pressure sore would have been avoided with proper care, or whether it would have been less severe and healed more quickly.
For example, a patient may have developed early pressure damage because they were very unwell, but the claim may still succeed if negligent delay allowed that wound to progress to a much more serious injury.
What compensation can include
Compensation in a pressure sore claim may include damages for:
- pain and suffering
- loss of amenity and reduced quality of life
- scarring
- infection or sepsis
- delayed recovery
- additional hospital admission
- private treatment or wound care
- care and assistance provided by family members
- professional care costs
- pressure-relieving equipment
- travel expenses
- loss of earnings
- future care needs
- adaptations or aids, where required
In fatal cases, there may also be a claim on behalf of the estate or dependants. This requires specialist advice.
How long do I have to bring a pressure sore claim?
In most clinical negligence cases, the usual time limit is three years from the date of the negligence or from the date when you first knew, or ought reasonably to have known, that the injury may have been caused by negligent care.
Different rules may apply for children and for people who lack mental capacity.
It is important to seek advice as soon as possible. Pressure sore claims depend heavily on medical and care records, and early investigation can make a significant difference.
Can I bring a claim on behalf of a relative?
Yes, in some circumstances.
You may be able to seek advice on behalf of a loved one if they are too unwell to do so themselves, if they lack capacity, or if they have died. The appropriate legal route will depend on the circumstances.
Families often raise concerns because they noticed deterioration, poor hygiene, inadequate repositioning, distress, pain, or a wound that was not properly explained. Those concerns should be taken seriously.
Why choose us?
Pressure sore claims require careful analysis of both clinical care and legal causation. They are not simply paperwork exercises. The records need to be reviewed in detail, the chronology needs to be understood and the right expert evidence needs to be obtained.
Scott Harding-Lister is a clinical negligence solicitor with a nursing background. That experience is particularly valuable in pressure sore cases because these claims often involve detailed nursing records, care planning, wound management, risk assessment, repositioning, nutrition, continence and escalation.
We can help you understand:
- whether the pressure sore may have been avoidable
- whether the care provider followed appropriate guidance
- whether the records support a claim
- what expert evidence may be needed
- what compensation may be recoverable
- how the legal process works
- whether a conditional fee agreement or another funding route may be appropriate
Speak to a pressure sore negligence solicitor
If you or a loved one developed a pressure sore in hospital, a care home or while receiving community care, there may be a basis to investigate a claim.
These injuries can be painful, distressing and life-changing. They should not be dismissed as inevitable without proper investigation.
Scott Harding-Lister
Specialist Clinical Negligence Solicitor
Scott Harding-Lister is a dual-qualified solicitor and registered nurse with hands-on experience in both clinical practice and legal advocacy. His unique background enables him to understand the realities of healthcare delivery and to identify when standards have fallen short. Supported by a skilled team of clinical negligence specialists and connected to leading UK medical experts, Scott offers clients clear guidance, expert case preparation, and a depth of insight that ensures every claim is built on strong medical and legal foundations.