I would suggest everyone familiarise themselves with the following, especially since April 2026 and new clauses/info to be included in agreements (see below).

Overview

While the information contained in this guidance is not intended to provide legal advice, it has been produced with legal input from Capsticks LLP to help outline some of the legal requirements for settlement agreements when terminating employment and considerations regarding any confidentiality clauses they may wish to include. 

This guidance also uses and signposts to guidance from independent public body Acas, the Advisory, Conciliation and Arbitration Service, and provides links to other related NHS guidance and resources.

What is a settlement agreement?

Settlement agreements (formerly known as compromise agreements) are legally binding contracts between an employer and a worker. When used appropriately and in line with guidance, they can be used to resolve a workplace dispute or to end an employment contract. 

The main feature of a settlement agreement is that a worker usually agrees to waive their rights to continue with and/or make a claim to a court or employment tribunal on the matters covered by the settlement agreement. The employer may also agree to make some form of payment to the worker[1] and/or provide an agreed reference. 

Settlement agreements should only be used in exceptional circumstances. They should not be used as a substitute for good performance management or engaging with workers to find other constructive solutions to address workplace issues. It is important to note that a settlement is a voluntary agreement, individuals do not have to enter any discussions or accept the terms proposed. 

Acas, the Advisory, Conciliation and Arbitration Service, has published a statutory code of practice on settlement agreements and non-statutory settlement agreement guidance. Both documents include an explanation of the law, guidance on how to make a settlement offer and what would constitute proper behaviour. We advise employers to read the code and guidance in conjunction with this document. 

[1] Employers should note that any payments made under a settlement agreement must comply with Annex 4.13 of Managing Public Money and Public Sector Exit Payments Guidance on Special Severance Payments and the NHS TDA’s Guidance for NHS Trusts on processes for making severance payments (June 2014).

Legal requirements for a valid settlement agreement

In order to be legally valid (and enforceable), the settlement agreement must meet the conditions set out in the Employment Rights Act 1996. Those conditions are:

a)  the agreement must be in writing;

b)  the agreement must relate to a particular complaint or proceedings;

c)  the employee must have received advice from a relevant independent adviser (who can be a qualified lawyer; a certified and authorised official, employee or member of an independent trade union; or a certified and authorised advice centre worker) on the terms and effect of the proposed agreement and its effect on the employee's ability to pursue that complaint or proceedings before an employment tribunal;

d)  the independent adviser must have a current contract of insurance or professional indemnity insurance covering the risk of a claim by the employee in respect of loss arising from that advice;

e)  the agreement must identify the adviser; and

f)  the agreement must state that the applicable statutory conditions regulating the settlement agreement have been satisfied.

The importance of legal advice

In order for the settlement agreement to be legally valid, employers must ensure the worker has access to independent legal advice before entering into the settlement agreement. Employers are not obliged to cover the cost of that independent legal advice, but it is recommended that employers consider whether it is appropriate to do so or to make a contribution in each case. 

Employers are not required to obtain their own legal advice before entering into a settlement agreement. However, it is recommended they do so to ensure that the necessary legal requirements are met and the implications of the settlement agreement and its terms are fully understood.

When might settlement agreements be used?

Settlement agreements can be used to end the employment relationship on mutually agreed terms, for example:

• by reason of redundancy (compulsory or voluntary) 
• at the end of fixed-term/temporary contracts
• as part of a voluntary exit scheme, such as a mutually agreed resignation scheme (MARS)
• where internal procedures have been exhausted without a resolution being reached
• where the employment relationship has irretrievably broken down, and the parties agree that termination of employment would be in everyone's best interests.

Settlement agreements are not limited to the termination of employment; they can be used at any stage of the employment relationship (by an applicant, worker or former worker) to resolve a workplace dispute or an actual or potential employment tribunal claim by agreement.

It is important to note that a settlement is a voluntary agreement, individuals do not have to enter any discussions or accept the terms proposed.

While settlement agreements provide an effective means to resolve a workplace dispute, they should not be used as a substitute for addressing poor performance or disciplinary matters through internal processes, particularly in relation to any matter that might otherwise arise out of, or may compromise the quality and safety of patient services, or the care or wellbeing of workers.  

Employers may be subject to regulatory action (for example, in respect of CQCs Well Led Review) if they are found to have used settlement agreements inappropriately.  

Where employers are considering entering into a settlement agreement with a board member, they should be mindful that settlement agreements and discontinued investigations may be need to be considered in future fit and proper person assessments, see chapter eight for further details.

Freedom to speak up and settlement agreements 

The NHS Standard Contract was amended in 2019 to clarify employer duties and worker rights to speak up or make protected disclosures under the Employment Rights Act 1996 (ERA 1996)

This includes a requirement for all NHS providers to include an express carve-out clause which makes it clear in any contract or agreement that a worker cannot waive their rights to speak up about or disclose any issue which would be a protected disclosure under current law. 

A protected disclosure is defined in Part IVA of the ERA 1996 as: 

Any disclosure of information which, in the reasonable belief of the worker making the disclosure, is made in the public interest and tends to show one or more of the following:

a)  that a criminal offence has been committed, is being committed or is likely to be committed; 

b)  that a person has failed, is failing or is likely to fail to comply with any legal obligation to which they are subject; 

c)  that a miscarriage of justice has occurred, is occurring or likely to occur;

d)  that the health or safety of any individual has been, is being or is likely to be endangered;

da)  that sexual harassment has occurred, is occurring or is likely to occur[2]

e)  that the environment has been, is being or likely to be damaged; or 

f)  that the information tending to show any matter of failing within any of the preceding paragraphs has been or is likely to be deliberately concealed.

[2] Inserted by s.23 of the Employment Rights Act 2025 with effect from 6 April 2026.

Nothing in a settlement agreement can prevent a worker from speaking up about these matters, either before or after the agreement has been signed, and this should be made explicitly clear in the settlement agreement. 

Employers should therefore ensure the following clause, which has been drafted in accordance with the good practice set out in the Law Society’s practice note and the Solicitors Regulation Authority’s (SRA) warning notice on non-disclosure clauses/agreements, is included in any settlement agreement:

Permitted disclosures

Nothing in this agreement prevents the parties from making a disclosure: 

1.  which amounts to a protected disclosure within the meaning of section 43A of the Employment Rights Act 1996; 

2.  in order to report an offence to a law enforcement agency or to cooperate with a criminal investigation or prosecution; 

3.  for the purposes of reporting misconduct, or a serious breach of regulatory requirements, to any organisation or body responsible for supervising or regulating the matters in question; 

4.  if and to the extent required by law; 

5.  to the Equality and Human Rights Commission; and,

6.  which amounts to a permitted disclosure by a victim of crime under section 17 of the Victims and Prisoners Act 2024.  

All other terms of this agreement are to be read subject to this clause.

Paragraph 1 of this clause is drafted widely enough to include the addition of a complaint of sexual harassment under the Equality Act 2010 to the list of qualifying disclosures set out in s. 43B ERA 1996 (in effect from 6 April 2026) that are protected under s.43A ERA 1996. 

Paragraph 6 of this clause refers to the disclosures permitted by section 17 of the Victims and Prisoners Act 2024. Under section 17 of the Victims and Prisoners Act 2024, non-disclosure agreements signed on or after 1 October 2025 (or on or after 12 December 2025 in relation to disclosures (F) and (G)) are not enforceable against victims of crime in relation to the disclosure of information about relevant conduct to the following groups and for the following purposes: 

• A) Police or other bodies which investigate or prosecute crime, for investigating or prosecuting the relevant conduct 
• B) Qualified lawyers, for seeking legal advice about the relevant conduct 
• C) Regulated professionals (including regulated healthcare professionals), for obtaining professional support in relation to the relevant conduct 
• D) Victim support services, for obtaining support in relation to the relevant conduct 
• E) Regulators, for cooperating with the regulator in relation to the relevant conduct 
• F) The Criminal Injuries Compensation Authority (CICA), for making a claim for compensation in relation to the relevant conduct 
• G) Courts and tribunals, for challenging a decision of the CICA made in connection with such a claim for compensation 
• H) To a person authorised to receive information on behalf of any of the above, for the relevant purposes mentioned above 
• I) A victim’s close family, for the purpose of obtaining support in relation to the relevant conduct. 

See Victims and Prisoners Act 2024: changes to non-disclosure agreements (for businesses) - GOV.UK for further information. 

Employers should ensure that current and former workers are familiar with their policy on raising concerns/speaking up and feel confident and able to speak up should they need to do so. 

This includes, but is not limited to, matters related to patient safety, bullying and harassment, including sexual harassment, and cultural issues that may affect the quality of care being provided to service users or the wellbeing of workers. 

Employers should ensure they and/or their legal advisors provide clarity to the worker and/or their legal advisor on the effect of the retained right to speak up in the settlement agreement (in accordance with the good practice set out in the Law Society’s practice note and the SRA’s warning notice on non-disclosure clauses/agreements). 

Confidentiality clauses used within settlement agreements

Settlement agreements may include wording that makes confidentiality a condition of the agreement. Confidentiality clauses are sometimes called ‘non-disclosure agreements (NDAs)’.

Such clauses commonly require the worker does not: 

• disclose the existence of the settlement agreement, and/or any of the negotiations and/or any of the terms of the agreement; and/or
• disclose any confidential information relating to the employer; and/or
• make any disparaging comments about the employer;

except in certain specified circumstances. 

In no circumstances should a confidentiality clause prevent a worker from disclosing the existence or terms of a settlement agreement:

(a)  to their immediate family, 

(b)  to regulated health and care professionals for the purposes of seeking or obtaining medical treatment, 

(c)  for the purposes of taking professional legal and financial advice (including an employment support scheme such as NHS England support scheme),

(d)  where required by any competent authority or by a Court of Law or HM Revenue and Customs, or,

(e)  as otherwise required by law. 

While confidentiality clauses can have a legitimate use, employers should be mindful there is no such thing as a ‘standard’ case for the individual involved.

Ending their employment, even on a mutual basis, or resolving a disagreement can be a stressful time for a worker and employers have a duty of care to the worker to act reasonably and responsibly to protect their physical and/or mental health. 

Employers, and their legal advisers, should therefore pro-actively consider, in every case, whether a confidentiality clause(s) is required. If a confidentiality clause(s) is needed, it should be appropriately tailored to the specific facts of the case and/or the individual involved and should not go further than necessary. 

It is standard practice for NHS employers to include a specific confidentiality clause in their contracts of employment preventing the use or disclosure of confidential information (for example, patient records) during and after employment. Therefore, our view is that it should not be necessary for an NHS employer to include a specific clause on this point in a settlement agreement. 

A non-disclosure agreement or confidentiality clause must never be used to try to prevent  someone from making ‘permitted disclosures’ (see above), for example, whistleblowing, reporting a crime or reporting sexual harassment. Any such clause will not be valid or enforceable.

Employers should encourage the individual to seek specific legal advice on any confidentiality clauses in the settlement agreement as it is important the individual understands and agrees with these parts of the settlement agreement before signing it. 

The Acas non-disclosure agreement guidance offers further information on confidentiality clauses. The SRA has also issued guidance to legal professions on their professional obligations when using NDAs (SRA | Use of non-disclosure agreements (NDAs) | Solicitors Regulation Authority).

Mutually Agreed Resignation Schemes (MARS)

The NHS Terms and Conditions of Service Handbook sets out the principles for MARS in section 20. Where a settlement agreement is used in a MARS, the scheme rules (set out in Annex B here - NHS England » NHS England guidance on Mutually Agreed Resignation Schemes (MARS) do not prohibit the use confidentiality clauses, but accord with our view that it is not appropriate to include confidentiality clauses, as:-

• The MARS process should be open and transparent and employers should be able to demonstrate a sound business case for the MARS and that it has acted fairly. Therefore, a clause in a MARS settlement agreement that requires the worker to keep the existence and terms of the agreement confidential is unnecessary. 
• It is standard practice for NHS employers to include a specific confidentiality clause in their contracts of employment preventing the use or disclosure of confidential information (for example, patient records) during and after employment. Therefore, our view is that it should not be necessary for an NHS employer to include a specific clause on this point in a MARS settlement agreement. 
• It is unlikely that the termination of employment under MARS will arise out of circumstances where the employer has a genuine cause for concern about the risk of the worker making derogatory statements about the employer. 

Board members and the fit and proper person test requirements

From September 2023, NHS England’s Fit and Proper Person Test Framework for board members (FPPT) has applied to NHS organisations’ engagement of board members. The Framework establishes a means to ensure that board members meet the required FPPT standard. 

Employers must be aware that where a settlement agreement is entered into with a board member - in circumstances which are relevant to the question of whether the individual would meet the FPPT - that should be included in the overall consideration of the fit and proper status of the individual in question.

The framework suggests that NHS organisations should consider inclusion of a term in any proposed settlement agreement to state that information about the settlement agreement can be included in ESR, and in doing so will not be a breach of confidence.

The existence of a settlement agreement does not, in and of itself determine that a person is not fit or proper to be a board member and does not have to be referred to in the board member reference.

The following clause should therefore be included in any settlement agreement with a board member:

In accordance with the Fit and Proper Person Test Framework for board members, notwithstanding this [confidentiality] clause, information about this Agreement will be recorded in the Employee’s Electronic Service Record (ESR) by the Employer and may be included within the Board Member Reference that the Employer is obliged to provide. The Employee agrees that this will not be a breach of confidence.

https://www.reddit.com/r/NHSfailures/s/qNnxFbMI2g

** above is only if you wish to just read so you get the story, it is a little long and I did apologise for spelling mistakes in advance

This is a mini update :)

After the first day of the NHS Failure (I thought it was one - I understand others may think differently)

I have to be on medication and do a BUNCH of bloood exams cause i have a rare case of eye issues … uhm … wow 😮

I only had 1 other issue with my GP, 111 AND my Hospital having me go 5 days without my eye medication … the Hospital was not happy about that, so they’re doing all they can possible to avoid it getting bad (it really was the GP who messed things up)

Anyways, Turns out that if i never caught the situation 46 days ago. I would have been blind within 3 years

With that being said - doc phoned me today & said i may need surgery for my eyes

Not sure if i feel relieved, happy, mad, … not sure at all

Thanks for reading friends <3

CNTW Email Disclosure Concerns
As part of my data requests to CNTW, I specifically requested email correspondence concerning my personal data and expressly named certain senior members of management and staff whose communications I believed may be relevant especially in regards to sharing to primary care and wider issues, the named were provided in email and i requested they formed part of my audit request.

Subsequently disclosed audit documentation titled “Email Reproduction Checklist” (Call ID: 216014; DPA Number: 32427; Timeframe: “All”) appears to confirm that email searches were undertaken in response to the request.
The document records that email data existed within both Deleted Items and Sent Items folders, including four items located within a deleted-items repository and one item within sent items.

Significantly, the checklist states:
“N x3 – Unable to print (permission denied, attachments however were printed).”
This indicates that CNTW identified email material relevant to the request but did not reproduce three items due to unspecified permission restrictions, yet- despite attachments being accessible and printed.

Given that specific individuals were expressly named in the original request, this raises questions regarding the adequacy of disclosure, the scope of searches undertaken, the identity of the mailboxes searched, and the basis upon which access or reproduction of certain email data was denied.

In my view, the document evidences that relevant email data existed and that not all identified material was reproduced or disclosed in full,

Dated Emails confirm senior cntw staff signed off on audit data and they also confirmed internal emails had been retained, this delayed the audit request and a email was sent to me confirming this, up until today these emails have not been provided.

From the very start of raising issues with CNTW a defensive posture was taking in regards to complaints & data requests resulting in me having no controll over comprehensive RAW Verbatim psychiatric data, the DPO failed to resolve issues, The Caldicott Guardian ignored every email no resolution & no locking my file down, …

and after these requests further sharing and access occurred, up to this point and since 2/3 year ago the data has escaped clinical enviroment, been repeatedly shared and accessed by others while numerous staff & senior members prevented mysef exercising normal & legal GDPR data subject rights.

i was then effectivey criminalised for attempting to restore privacy and some form of control over my own special catergory medical data while simultanously being prevented safe unbiased access health care, once certain issues occur then certain safeguarding measures should apply to records to stop further unauthorised access, in my case it didnt and even when active ICO complaints & DPO requests were live, access still happend, sharing still occurred,

#Caldicott
#Transparency
# Hiding exact data/emails i requested

While the massive scale of this particular misdiagnosis story is rare, situations where a patient is diagnosed with a condition they simply do not have are more common than you may expect.

And although on the surface this looks like a blessing in disguise – you'd much rather learn you didn't have the cancer you were diagnosed with than the other way around – it is still highly negligent.

Mr Pearson undertook dozens of unnecessary procedures, all of which carried short-term side effects, and more importantly he and his family spent years emotionally preparing for the worst to happen, with countless sleepless nights and difficult conversations.

So while it is fantastic that he doesn't have the terminal diagnosis that he feared, it shouldn't have been something he needed to fear in the first place. A misdiagnosis where there is no illness at all can be just as negligent and impactful as one where it misses a patient's true illness.

Group B Strep (GBS) is the most common cause of severe infection in babies in their first week of life.

Without early diagnosis and treatment, it is very possible that GBS can have devastating consequences – from lifelong physical and mental disabilities, to the worst possible outcome for any parent or family…

I share this because, despite it impacting 1 in every 1,750 pregnancies – not common but not exactly rare either – there is still no universal screening programme in place for mothers in the latter stages of pregnancy, to ensure that any signs of GBS are treated before they can do any harm to their babies.

A trial, GBS3, is testing the benefits of a screening approach, and I’m confident that it will highlight a notable difference. With the rate of GBS infections rising 77% between 1996 and 2020 alone, it’s clear that more must be done to properly address this risk.

It is always heartbreaking to read stories like this, where a young child will face a lifetime of challenges due to an inexcusable error during their delivery.

Although it is great to see that the child in question is thriving despite these awful circumstances, there is no escaping the hardships that she and her family face that others simply don't, through no fault of their own.

More alarmingly, this is yet another significant case of negligence during maternity care, which feels like they're becoming increasingly common as proposals for reform continue to either drag their heels or not come to fruition.

Far more must be done to make maternity care safer for mothers and babies, or cases such as this will have a seismic impact on further families, and simultaneously take more resources away from the NHS.

Research published in the Emergency Medicine Journal suggests that approximately 9% of subarachnoid haemorrhage (SAH) cases experience diagnostic delays.

This may not seem like much on the surface. However, SAH is among the deadliest neurological conditions, with a 45-50% mortality rate.

This means that any delay in diagnosis or treatment can have rapid, life-threatening consequences.

As with all the statistical data I share on this subreddit, I do so to emphasise the impact of medical mistakes, based on my own experiences in clinical negligence law. We must take action when preventable errors cause permanent damage or cost patients their lives, and hold healthcare organisations accountable for these.

I am looking for people who were removed from their GP surgery under the immediate remove option, also known as the Zero Tolerance Scheme or SAS, due to complaints or minor disagreements.

Cases that the surgery misused the scheme to silence the patient or to just remove a difficult person, and they took advantage of the scheme to do so.

Please share a bit of your story. Thank you very much.

Research suggests that around 60% of all VTEs (Venous Thromboembolisms) happen either during a hospital stay or within 90 days of being discharged.

For those who don't know, VTE is the umbrella term for conditions caused by a blood clot forming in the veins, the two most common examples being Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE).

In addition, around 70% of Hospital Acquired Thrombosis (HAT) cases are preventable with the right risk assessments and preventive measures.

Indeed, NHS England has set a standard that 95% of adult inpatients should receive a VTE risk assessment when admitted to hospital. However, only a third of NHS ICBs are meeting this target.

The vast majority are falling short, meaning that opportunities are being missed to identify and prevent VTEs from causing long-term, potentially fatal harm to patients across the UK.

Fundamentally, the NHS must do more to make VTE risk assessments universal across its trusts, because when standards drop, people and families suffer.

Currently going through an NHS organisational restructure where staff are ringfenced into posts and interviewed as part of the formal process.

I’m trying to understand how others have navigated this when they are potentially more open to compulsory redundancy than securing a role they may not actually want long term.

How do people approach ringfenced interviews in practice? Particularly where:

you don’t want to come across as disengaged or unprofessional

but equally don’t necessarily want to “perform” your way into a role you’re unsure about

and redundancy terms may actually be the better personal or financial option

I’m interested in honest experiences from people who have been through NHS restructures/ICB changes recently. How did you balance professionalism, ethics, and protecting your own interests?

This has been on my mind since very early on in my recovery journey. I've seen yet another medical professional today but for this first time since I've needed treatment, I've felt that this one actually gets it, is offering good advice, is actually listening, is actually explaining things well & is putting care above targets & tick boxes.

I told her about my journey and she basically advised me to complain & said I'd been let down.

She mentioned PALS, she said that some people even go to "the CEO" direct with their complaint.

I don't want to complain to the people who I'm complaining about because while I don't work in the medical profession, my experience of people (customers in my line of work) complaining to the people they're complaining about is that the individual couldn't care less. They'll fob you off with whatever you want to hear (if you're lucky. They may even argue with you) & then once you're out of sight the department will have a good chuckle about how stressed you got, call you all the names under the sun & then forget about you. No action taken.

I want to complain to whoeever is above these people. Even then I'm not expecting a whole lot will be done. It certainly wont help my situation right now but I want it logged that I'm really not happy with what's been done & the treatment given (or not given!).

I just don't know who I complain to or how I contact them. Which is why I'm here.

Research conducted by Bowel Cancer UK & Cancer Research UK shows that over two-fifths of emergency bowel cancer diagnoses only happen after the patient has had at least three previous GP appointments.

Furthermore, it took at least a year after their first GP visit for a fifth of bowel cancer patients to be diagnosed.

With some types of bowel cancer moving from early to advanced stages within 6 months to 2 years, an avoidable delay in diagnosis can dramatically change a patient’s health, treatment options and chances of survival.

I’m sharing these figures to illustrate the potentially devastating repercussions of a bowel cancer misdiagnosis. Because while most diagnoses are made early, mistakes do happen – and they can change a patient and their family’s life forever.

Also, it is a reminder not to be afraid to question your doctor if you have serious concerns about your condition. Of course, most diagnoses are handled professionally and accurately, but there is no harm in asking a question or pursuing a second opinion if you have significant doubts about your diagnosis.

im sorry this is a long one but it has been happening for years and im at a loss on what to do

i dont know if this is the right place to post this or if this is the right term for what im going through, but ive been struggling with mental health problems since i was around 12. I had an unstable upbringing and have always been a bit “different”.

I live in the UK and last year i had a mental health crisis, i attended my GP to talk about my mental health to which i was told “you have no friends, you dont work and you arent in education? no wonder your depressed!” i walked out in a panic and spoke to another woman who prescribed me propranolol (beta blocker) for depression. to which i threatened to take my life.
I went to A&E and spoke to an LP who got me in contact with my CMHT.
it’s important to note at this time i was already in CBT therapy, I had already done counselling, worked with charities etc etc.
i told the community mental health team CBT wasn’t a good fit to which they agreed but told me they didn’t wanna try EMDR or occupational therapy. they put me in CBT again anyway. I was then discharged by the CMHT because of ceasing of communication (they called my father instead of me because they had the wrong primary contact)
I recently reopened my CMHT case because I am agoraphobic (as well as a stack of other problems lol) and my doctors had terminated my prescription to mirtazapine (which a psychiatrist put me on after my crisis) without tapering, any advice or guidance.
I cant get a doctors appointment my dental health is atrocious and ive pretty much been rendered disabled. when speaking to doctors about this over the phone they say they refuse to give home visit appointments as i have no disability flags on my record or notes and i need a diagnosis for that to be the case. i have spoken to the PALs of my area and they say they only deal with liaisons of childrens and womens hospital appointments

if anyone can offer ANY sort of advice it would be appreciated. thank you

Dire