A guide to mediation for NHS Trusts, Legal Teams and Local Authorities

We work with NHS trusts, care providers, local authorities and their legal teams on disputes involving patients, families and the professionals supporting them — including where a case has reached, or risks reaching, a formal complaint, safeguarding referral or Court of Protection application.

What we mediate

• Treatment and care disputes — disagreements between families and clinical or care teams about treatment decisions, discharge planning, or ongoing care
• Court of Protection and mental capacity matters — disputes over the welfare, residence or finances of a person who may lack capacity, including between family members holding a Lasting Power of Attorney or Deputyship, and disputes that sit alongside or precede formal proceedings
• Paediatric and critical care — disagreements between parents and clinical teams over the care of a seriously or critically ill child, including in intensive or palliative settings
• End-of-life care — conversations between families and clinical teams about palliative care decisions
• Family and organisational conflict — disputes involving charities, trustees or family-run care arrangements that intersect with a person’s health or care needs

A note on scope: we mediate disputes about care, treatment and capacity decisions, including where legal proceedings are being considered or have already been issued to resolve the disagreement — for example, Court of Protection or judicial review proceedings. We do not mediate clinical negligence, personal injury or other compensation claims.

Why commission mediation

Mediation is a proportionate step to offer alongside, or ahead of, formal routes such as a complaints process, safeguarding review or Court of Protection application. It typically helps because it:

• gives everyone a structured, confidential space to be heard, which can de-escalate a dispute before it hardens into a formal complaint or litigation
• is usually faster and less costly than formal proceedings, and can run alongside them without prejudice to any party’s position
• protects the working relationship between families and clinical or care teams, which matters when care is ongoing
• supports a culture of openness and candour, and can reduce the number of disputes that escalate to a serious incident review, ombudsman referral or court

It doesn’t replace your statutory duties, safeguarding processes or clinical governance — it sits alongside them, and we’re careful to work within those boundaries.

Our approach and credentials

Mediation is led by Arabella Tresilian, founder of Health and Care Mediation. Arabella is a CEDR-accredited mediator (accredited 2017) and CEDR-accredited trainer, registered with the Civil Mediation Council and the International Mediation Institute, and a qualified Mental Health First Aid Instructor. She works substantively with the Mental Capacity Act 2005, Lasting Powers of Attorney and Office of the Public Guardian processes, and has mediated cases up to board, CEO and trustee level. Professional indemnity insurance is held and confirmed on request.

Every mediation is confidential, and we’re happy to work within your organisation’s information governance requirements.

How and when to refer

Mediation only works with everyone’s willing participation, so it’s usually best considered early — before positions harden, but it can also help later, including alongside a live complaint or legal process.

Cases typically come to us via:

• Legal teams, where legal proceedings are being considered or have been issued to resolve the dispute (for example, Court of Protection or judicial review proceedings) — this doesn’t extend to clinical negligence or other compensation claims, which fall outside our scope
• Complaints teams (PALS or equivalent), where a family dispute has not resolved through the standard complaints process
• Safeguarding leads or Court of Protection teams, where a capacity or best-interests disagreement needs a structured conversation before or alongside proceedings

You’re welcome to refer or commission a case directly — this is our preferred route, since it lets us agree scope, confidentiality and timelines with you from the outset. A family member or patient may also approach us having been signposted by you, in which case we’ll confirm your organisation’s willingness to take part before proceeding.

To start, contact us for a confidential scoping conversation. We’ll talk through the situation, who needs to be involved, and whether mediation is the right fit before any commitment is made.

Costs

Fees are agreed case-by-case, depending on the complexity of the dispute, the number of parties, and whether the case needs a single mediator or co-mediation. In most cases the commissioning organisation covers the cost, though costs are sometimes shared between the parties, and in certain Court of Protection matters a family’s solicitor may be able to draw on legal aid to help fund their client’s participation. We’ll agree and confirm the funding arrangement with you before mediation begins.

Contact us below to discuss a referral