As medical negligence solicitors, we often support clients whose lives have been profoundly affected by surgical errors. One area of concern is the impact of negligent appendix surgery on female fertility. While appendectomies are common and generally safe procedures, when things go wrong the consequences can be life-altering – particularly for women of childbearing age.

In this article, we explore how negligent appendix surgery can affect fertility, the types of errors that can occur and what compensation may be available. We also share two anonymised case studies to illustrate the real-world impact of such negligence.

How can appendix surgery affect fertility?

The appendix is located near the reproductive organs, particularly the fallopian tubes and ovaries. When surgery is performed negligently, whether due to delays, incomplete removal or post-operative complications, it can lead to infections, scarring (adhesions) or damage to surrounding structures. These complications can, in turn, impair fertility.

Some of the ways that negligent appendix surgery can affect fertility include:

• Pelvic inflammatory disease (PID): Infection spreading from a perforated appendix can cause PID, which may damage the fallopian tubes.
• Adhesions: Internal scarring can distort pelvic anatomy, making natural conception more difficult.
• Tubal blockage: Inflammation or infection can block the fallopian tubes, preventing the egg from reaching the sperm.
• Need for IVF: In some cases, natural conception becomes impossible and assisted reproductive techniques like IVF are required.

We have seen a number of cases where negligent care has been provided to patients with appendicitis. In one case, our client attended A&E with severe abdominal pain, nausea and fever, all signs of appendicitis. Despite this, there were delays in arranging appropriate imaging and surgical review. Her appendix perforated while she waited, leading to a widespread infection in her abdominal cavity.

She underwent emergency surgery and suffered a severe infection that prolonged her recovery period and may have affected her fertility. Our evidence confirmed that, had she been operated on sooner, the appendix would not have ruptured and the infection would not have spread. However, we were able to settle the claim.

In another case, our client underwent surgery to remove her appendix after presenting with the classic symptoms of appendicitis. Initially, she was told the operation had gone well. However, she continued to suffer from abdominal pain, fever and fatigue in the following weeks. Eventually, it was discovered that a portion of her appendix known as the “appendix stump” had been left behind and the retained tissue had become infected. She required several further investigations and procedures.

Unfortunately, the infection had spread to her pelvic region, causing adhesions and damage between the uterus and rectum. She was advised that she would likely require IVF to conceive in the future.

What can you claim for?

The emotional toll that surgical negligence can take – especially when it affects something as personal and life-changing as fertility – is, of course, impossible to fully compensate. However, a successful medical negligence claim can cover general damages for pain, suffering and loss of amenity, as well as special damages for financial losses caused by the negligent treatment.

These include:

• Cost of fertility treatment such as IVF
• Loss of earnings
• Travel and care expenses
• Future losses such as reduced earning capacity or ongoing medical costs.

Each case is assessed individually and compensation will depend on the severity of the injury and its impact on the patient’s life.

Changes are on the horizon for businesses that rely on flexible labour arrangements, so employment businesses and companies engaging with casual or self-employed workers will need to take note.

HMRC has long been concerned with the widespread use of umbrella companies given their reputation as tax avoidance schemes. Draft legislation seeking to address this may, however, have significant hidden consequences for all companies – including small companies who engage self-employed individuals through their own personal service limited companies (PSCs) by potentially extending tax liability beyond the scope of the current IR35 tax regime.

‘Umbrella company’ is the term used to refer to a business that acts as the employer of workers supplied to end user clients. They take care of the payroll and employment administration allowing a flexible and ‘risk free’ supply of casual labour. They are frequently used by employment businesses to outsource payroll services and/or for the supply of ‘self-employed’ consultants or contractors to reduce the risk of the end user being caught by IR35. However, a number of umbrella companies have been found by the courts to operate unlawful tax avoidance schemes, often to the detriment of the workers they employ.

This is why it is no surprise that HMRC has recently announced a change to the tax regime targeted at the use of umbrella companies and due to come into force in April 2026 under the Finance Bill 2026. The draft legislation introduces a new Chapter 11 into the Income Tax (Earnings and Pensions) Act 2003 (ITEPA) (‘the umbrella rules’).

What will change?

The new legislation will make liability for PAYE deductions ‘joint and several’ between the umbrella company and either the employment agency who has hired them or the end client if there is no employment agency or if the party the client contracts with is outside the UK. This means that if an employment agency or client hires an umbrella company which does not properly account for PAYE, HMRC can seek to recover any shortfall from either the agency or the client as well as from the umbrella company.

While this may be a welcome step to address misuse of umbrella companies, a closer eye on the detail reveals significant hidden risks, particularly for businesses sourcing workers either through another company such as an employment agency or directly through a PSC. This is owing to the new concept of a ‘purported umbrella company’ which is widely defined and covers a situation where a company supplies the services of an individual who has a material interest in that company which would include a PSC.

If a company is classed as a purported umbrella company, a tax liability will arise on either the agency contracting with them or the end client if there is no agency. The liability would arise if it could be reasonably presumed that one or more parties in the chain believe that the majority of the payments made to the company in respect of the individual’s services would be taxed as the individual’s employment income but that is not in fact the case.

Of particular note is that the IR35 rules and the off-payroll rules under chapter 10 ITEPA (the ‘off-payroll rules’) are disapplied so the umbrella rules will take precedence and apply automatically. This means the question of whether the individual is genuinely self-employed or operating ‘outside’ of IR35 becomes irrelevant and will not be a defence.

What does this mean in practice?

Currently, when a small company – as defined by the IR35 legislation – hires a consultant via the consultant’s PSC either directly or through an agency, the off-payroll rules do not apply. As a result, the company is not required to carry out an employment status test nor is it or the agency required to make any tax deductions. Instead, chapter 8 ITEPA (the ‘old IR35 rules’) applies which means that any tax liability – and therefore risk – under IR35 sits with the consultant’s PSC and not the end client or the agency.

Under the government’s current proposals, from April 2026, this will change. If the consultant receives the majority of their pay through dividend payments (which is common) or does not otherwise take the contract ‘profits’ out of the PSC as a salary, HMRC could determine that there has been a shortfall of income tax and national insurance contributions and, under the new umbrella rules, the company (as the ‘client’ of the PSC) or the agency that hires them could be liable for that shortfall.

It is not just small companies at risk. Medium to large companies and employment agencies engaging contractors through PSCs will also face the same issue if it is ‘reasonable to suppose that they would assume a substantial amount of the payments made to the PSC will be treated as earnings’, and will be taxed accordingly.

What can companies and agencies do to protect themselves?

It is not clear what is meant by ‘reasonable to suppose that [one of the other companies] would assume a substantial amount of the payments made to the [PSC] will be treated as earnings’ and it is hoped that further guidance on this point will be published before the change comes into effect.

However, it may be considered a reasonable supposition if one of the other companies believed that the consultant (engaged via a PSC) was operating inside IR35, as if they were ’employed’ by the end client or, alternatively, where the client or agency just simply had not turned their mind to the issue.

This should be less of a problem for medium or large companies as they are already required to issue a Status Determination Statement (SDS) when engaging a contractor via a PSC under the off-payroll rules. If an individual is found to be inside IR35, their earnings will be taxed at source and there should be no shortfall provided, of course, this has been done correctly. If an individual is found to be outside IR35, the SDS serves as evidence that there was no assumption that the majority of the payments would be treated as income.

What about small companies engaging with PSCs?

As small companies are not required to comply with IR35, most do not apply their minds to the tax or employment position of contractors they engage via a PSC. However, this will need to change and they (or the agencies they engage) will need to carry out due diligence to satisfy themselves that either the contractor is genuinely self-employed or that the majority of the payments made to them are taxed as income. Companies should also ensure that appropriately-worded warranties and indemnities are included in commercial terms with any agencies or contractors they engage.

The legislation is currently in draft format and is subject to change. Further, HMRC’s likely intention is to tackle rogue umbrella companies and not small companies engaging with contractors via limited companies. However, this consequence – even if unintended – will be a welcome one for HMRC. Whether this legislation stays as drafted remains to be seen but prudent businesses should start taking action now by looking closely at their policies and procedures for off-payroll and labour supply chain compliance to ensure these are robust and well documented.

If you would like further information on your IR35, labour supply chain or employment status compliance issues, please contact Kathy Potter, Katie Harris or your usual Penningtons Manches Cooper contact. h of knowledge.

Penningtons Manches Cooper has once again been recognised for its outstanding performance in the latest legal directories, with the Legal 500 and Chambers UK both commending the firm’s excellence across a wide range of practice areas. The firm has also been featured in The Times Best Law Firms 2026 and ranked in The Lawyer’s Litigation 50 Report, reaffirming its position as a leading legal practice in England and Wales.

The independent analyses provided by these directories and reports are widely regarded as the most authoritative sources on the UK legal market. Their thorough research methodologies draw on both qualitative and quantitative analysis, covering a range of criteria from legal technical ability to commercial awareness and client service, and with client testimonials, endorsements from fellow lawyers, and feedback from industry experts playing a key role. The Times’ list is compiled by international market research agency Statista, while The Lawyer’s Litigation 50 Report highlights the UK’s most prominent disputes practices based on headcount and revenue.

In the Legal 500, Penningtons Manches Cooper has been ranked as a top tier firm in 12 practice areas, with recommendations in a further 75. Among the standout performers was the family law department, which was described as ‘the best in the country’. The commercial dispute resolution team was noted for providing ‘an exceptionally high level of service’ and being ‘a very safe pair of hands’, with one client highlighting its position as ‘a market leader in technology and AI’. The commercial property team meanwhile was lauded for its ‘superbly sharp minds giving fast, effective and reliable advice’ and for combining ‘great communication skills’, ‘modern technology’ and ‘the personal touch’. The medical negligence team was described as ‘engaging, caring and highly professional’ and praised for being ‘professional and forceful when required, yet always good-humoured and caring’. Similarly, the personal injury team was commended for going ‘above and beyond to help… in any way they can’ and for being ‘always kind, respectful and compassionate’.

Elsewhere, the intellectual property team stood out for its ‘combination of deep sector expertise, international reach, and client-focused innovation’, while the IT and telecoms practice was praised for ‘a rare blend of technical excellence, commercial acumen, and emotional intelligence’. The private client team was recognised for offering ‘a more sophisticated service addressing the more complex needs of higher net worth individuals’, and, finally, the social housing team was commended for being ‘responsive’, ‘proactive’ and ‘collaborative’. Individual recognition across the firm was equally impressive, with 97 rankings for individual lawyers, including seven in the prestigious ‘Hall of Fame’, 46 ‘leading partners’, 19 ‘next generation partners’, and 25 ‘leading associates’.

In Chambers UK, the firm achieved 46 department rankings, including eight in band 1, with glowing feedback across its top-ranked teams. The family law team was described as ‘a major player in family finance’, praised for its ‘strategic thinking’, and noted for a ‘client-focused’ culture where ‘every single lawyer from paralegals to senior partners is ten out of ten’. The commercial property team was commended for its ‘excellent breadth of knowledge and acumen on real estate and development’, while the intellectual property team impressed with its ‘deep bench of experience’ and ‘business-minded… client-ready advice’. The ‘highly skilled’ real estate litigation team was described as having ‘real expertise in any matter thrown at them’. Clients spoke of the medical negligence team as being, ‘during… an exceptionally difficult time… outstanding’ and ‘relentless’ in pursuit of the case, while the IT team was praised for its ‘hands-on approach and a huge pool of experience combined with good project management’. In total, 98 individual rankings were also achieved, with 20 in band 1.

Adding to these successes, the firm was also featured in The Lawyer’s Litigation 50 Report, with its dispute resolution teams collectively recognised as ‘heavyweight’ in terms of headcount and revenue, reflecting the breadth and depth of the firm’s contentious offering.

Finally, the firm has also been recognised in The Times Best Law Firms list for 2026, with commendation for its expertise in commercial dispute resolution, employment, family law, private client and tax, real estate litigation, personal injury and medical negligence.

For full details of Penningtons Manches Cooper’s directory rankings, please click here for the Legal 500, here for Chambers UK, here for The Times Best Law Firms list, and here for The Lawyer’s Litigation 50 Report.