Horrifying, but not sufficiently horrifying: when is an event shocking enough to enable a secondary victim to recover damages for psychiatric injury?

June 24, 2021

Alice Dobbie

Alice Dobbie considers King v Royal United Hospitals Bath NHS Foundation Trust [2021] EWHC 1576

The Alcock principles

To succeed in a claim for psychiatric injury as a secondary victim, a claimant must satisfy the control mechanisms derived from Alcock v South Yorkshire Police [1992] 1 AC 310.

Those requirements are:

  1. A close tie of love and affection with the person killed, injured or imperilled.
  2. A proximity to the incident in time and space.
  3. Direct perception of the incident rather than, for example, hearing about it from a third party.
  4. The illness must have been induced by the shocking or horrifying event.

The Court of Appeal described these requirements as “both arbitrary and pragmatic” in Ronayne [2015] EWCA Civ 588.

This week, the High Court considered the fourth requirement in detail in King v Royal United Hospitals Bath NHS Foundation Trust [2021] EWHC 1576.

The King facts

The claimant’s son died 5 days after he had been born from complications arising from a negligent delivery. The claimant’s wife had settled a claim as a primary victim against the hospital. The claimant made a claim for PTSD as a secondary victim. This injury arose from seeing his critically ill son on his first visit to NICU after his son’s birth.

It was agreed that the claimant had developed PTSD, and that this had arisen in the manner alleged. The issue was whether the first visit to NICU was sufficiently shocking to pass the Alcock test.

The court found that at the first visit the claimant’s son was surrounded by wires and machines, but had been sedated and appeared to be sleeping peacefully.

The definition of ‘shocking event’

The court described Alcock horror as something exceptional, outside normal human experience in the context in which it occurred. Seeing a sedated and severely ill baby in NICU was horrifying, but not sufficiently horrifying to satisfy the Alcock criterion, even if it did lead to PTSD.


There is no appetite yet for a softening of the Alcock criteria. The Court of Appeal has continued to affirm it (albeit with reservation) and so the High Court has followed suit. Importantly, the fact that a shocking event led to a psychiatric injury is not evidence that the event itself satisfies Alcock’s test.

Alice Dobbie is a member of the Personal Injury: Defence team at Exchange Chambers. She acts exclusively for Defendants. She is a specialist in civil fraud, negligence and costs.