Public Accounts Committee publishes report on clinical negligence

A new report by the House of Commons Public Accounts Committee (PAC) on clinical negligence claims in England has acknowledged that NHS Resolution has taken positive steps to address rising clinical negligence costs.

The report, called Costs of Clinical Negligence and published today, says NHS Resolution, the scheme administrator for clinical negligence claims in England, has “demonstrated the range of steps it has taken so far, such as resolving more claims than ever without costly court proceedings” and also set out the future actions it will take to address rising clinical negligence costs, including “improving its understanding of factors influencing claim costs by making better use of the extensive claims database it has amassed over the last 30 years.”

NHS Resolution has also developed an innovative early notification scheme for obstetric cerebral palsy cases to provide more timely support to families and ensure patient safety lessons are learned swiftly.

The PAC report states “the rising cost of clinical negligence in England continues to divert vital resources away from our frontline health services” and that “patients often pursue legal action to get answers and accountability due to a confusing and unresponsive complaints system.”

The report highlights the following further issues:

• Clinical negligence is diverting £3.6 billion cost of away from frontline NHS care.
• Settled claims involving infants and children have increased significantly, costing £325 million in claims for paediatric failings in 2024/25, including settlement of 120 to 130 high value paediatric brain injury cases every year.
• Recent increases in settlement costs (which have tripled to £3.6 billionn in 2024/25) are likely to rise significantly to over £4 billion a year by the end of the decade.
• Claims are being settled on the basis of how much care would cost in the private sector, rather than in the NHS, in accordance with the Law Reform (Personal Injuries) Act 1948.
• Disproportionate legal costs in clinical negligence claims. Claimant legal fees more than tripled to £538 million in 2024/25, whilst claims with damages of £25,000 or less cost far more in fees than patients receive, with a cost-to-damages ratio of 3.7:1.
• The government’s previous plans to limit the amount paid to lawyers in lower-value cases have not been implemented as planned two years ago and the Department of Health and Social Care (DHSC) should develop an alternative mechanism to speed up decisions and reduce costs for these cases.

The Royal College of Obstetricians and Gynaecologists (RCOG) told the PAC that the pressure of delivering increasingly complex care is challenging for the maternity workforce, more than half of births involving medical intervention, such as a caesarean section or instrumental delivery.

The Sands and Tommy’s Joint Policy Unit raised concerns with the PAC that inadequate training, poor workforce planning and failure to adhere to staffing requirements have created the conditions for clinical negligence claims to occur.

To reduce the incidence of clinical negligence in England and associated costs, the PAC is calling for within two months of publication of its report:

• an operational plan from government to tackle clinical negligence.
• a national framework for improving patient safety with clear annual improvement targets.
• DHSC to learn lessons from its failure to improve maternity care in England set out plans to reduce to the incidence of harm and the cost of claims in this area.
• publication of the final report of the National Maternity and Neonatal Investigation, led by Baroness Amis, within two months alongside its response to the PAC report.
• a national system for sharing data between NHS trusts.

The PAC has also recommended that DHSC develop alternative dispute mechanisms “to speed up decisions and reduce costs for less complex cases” and, with NHS England and NHS Resolution, that it “explore the use of artificial intelligence to analyse live data, detect discrepancies and outliers quickly, and improve the speed of early warning systems.”

In response to the PAC report, DHSC said:

“This government inherited an NHS that was failing too many people. We have taken rapid action to strengthen patient safety – overhauling the Care Quality Commission, rolling out Martha’s rule and Jess’s rule so patients can get a fresh clinical review, and introducing hospital league tables to drive improvement.

“We have also brought in new maternity safety measures, are conducting an urgent investigation of failings and are establishing a taskforce, so every mother can have confidence in NHS care once again.

“We know there is much more to do but we are determined to make sure the NHS is the safest in the world.”

The need to curb the cost of clinical negligence claims was highlighted by the National Audit Office’s recent report Costs of clinical negligence. Ministers are also currently considering the wide-ranging review of clinical negligence by David Lock KC, which includes the options for dispute resolution, policy on legal costs and international comparisons, and whose recommendations are eagerly awaited given the impact on patients and cost to the public purse.