SPIRE HEALTHCARE LTD V ROYAL & SUN ALLIANCE INSURANCE LTD

[2022] EWCA Civ 17, Court of Appeal, Lord Justice Underhill, Lord Justice Bean and Lady Justice Andrews, 11 January 2022

Insurance (liability) – Aggregation – Indemnity limited to all losses arising from one original cause – Two groups of patients subjected to misconduct by one surgeon – Whether one or two original causes

IP was a consultant breast surgeon employed by the Heart of England NHS Foundation Trust. He had developed the practice of performing sub-total mastectomies (STM) which involved leaving some breast tissue behind without obtaining informed consent. The practice was admittedly negligent. IP had also been employed to carry out surgery on private patients at two hospitals operated by Spire.