Recommendations & Conclusions
27 items
2
Recommendation
64th Report - Costs of clinical neglige…
Accepted
The NHS has not done enough to tackle the underlying causes of harm to patients. The Department and NHS England’s approach to patient safety lacks coordination. Patients often pursue legal action to get answers and accountability due to a confusing and unresponsive complaints system. Neither the Department nor NHS England …
Government response. The government states it has already implemented a national patient safety framework (2a) and reviewed the complaints system (2b) through the NHS Patient Safety Strategy (2019). For estimating costs of avoidable harm (2c), it explains that comprehensive tracking is not …
HM Treasury
3
Recommendation
64th Report - Costs of clinical neglige…
Accepted in Part
We are concerned there is far too little data on the factors behind clinical negligence, given its huge impact on people’s lives and NHS finances. Behind every clinical negligence claim is a tragic incident of patient harm. We were disappointed that neither the Department nor NHS England could adequately explain …
Government response. The government rejects establishing a new national data sharing system, citing existing arrangements. However, it agrees to explore using artificial intelligence to analyse live data, with NHS England assessing machine learning algorithms for patient safety events and the Federated Data …
HM Treasury
4
Recommendation
64th Report - Costs of clinical neglige…
Accepted in Part
The Department’s failure to address problems with maternity care in England has led to avoidable harm and unnecessary costs. Over the last 20 years the cost of settling claims involving infants and children has increased significantly. In 2024–25, costs for claims involving brain injury at birth were £1,554 million, with …
Government response. The government agrees and has established a National Maternity and Neonatal Taskforce to develop a national action plan based on the Amos Review's recommendations, which will serve as its full response. A timeline for delivering this action plan will be …
HM Treasury
5
Recommendation
64th Report - Costs of clinical neglige…
Deferred
Legal costs in clinical negligence claims are disproportionate for medium and low volume claims. Legal costs in clinical negligence claims have risen sharply, with claimant legal fees increasing in real terms from £148 million in 2006–07 (in 2024–25 prices) to £538 million in 2024–25. At 19% of total settled claim …
Government response. The government states the recommendation is under consideration and it is exploring international examples and policy proposals for reducing legal costs in clinical negligence. It will write to the Committee by Autumn 2026 to provide further information on its intentions, …
HM Treasury
6
Recommendation
64th Report - Costs of clinical neglige…
Deferred
Clinical negligence claims are settled on the basis of costs of care in the private sector and yet there is nothing to stop the claimant using the NHS or publicly funded social care in the future, potentially inflating the costs of claims. It is not clear the extent to which …
Government response. The government acknowledges the concern of 'Double Recovery' and states it is under consideration. However, due to limited data, it cannot commit to providing estimates within the six-month timeframe and will provide further information on its intentions by Autumn 2026.
HM Treasury
1
Conclusion
64th Report - Costs of clinical neglige…
Not Addressed
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department), NHS England and NHS Resolution on the costs of clinical negligence.1 Our predecessor committees reported on clinical negligence in 2002 and 2017, and both this …
Government response. The government's response broadly addresses the wider issue of rising clinical negligence costs and mentions David Lock KC's ongoing advisory role. However, it explicitly states it has no plans to publish a separate report of David Lock KC's work, and …
HM Treasury
7
Conclusion
64th Report - Costs of clinical neglige…
Acknowledged
Clinical negligence is the second largest provision on the government balance sheet after nuclear decommissioning. Over the period 2006–07 to 2024–25, the total provision for clinical negligence increased by £45.6 billion in real terms, from £14.4 billion at 31 March 2007 to £60.0 billion at 31 March 2025. Since 2006–07, …
Government response. The government acknowledges the rising cost of clinical negligence and its impact on NHS finances, and will write to the Committee by Autumn 2026 to set out the case for change and its workplan.
HM Treasury
8
Conclusion
64th Report - Costs of clinical neglige…
Acknowledged
NHS Resolution told us that clinical negligence is putting pressure on NHS budgets and is a significant cost to the public purse. The Department told us the reasons for the rising costs were complex. NHS Resolution explained that the increasing costs of compensation for claims of £1 million in damages …
Government response. The government will write to the Committee by Autumn 2026 to set out the case for change regarding rising clinical negligence costs and its workplan, including key milestones and likely areas of focus for reform.
HM Treasury
9
Recommendation
64th Report - Costs of clinical neglige…
Deferred
On multiple occasions the Department told us that it was unable to comment on many aspects of current policy as a recent review into clinical negligence by David Lock KC was still being considered by ministers.9 5 C&AG’s Report, paras 6, 7, 1.18 6 C&AG’s Report, para 14 7 Q …
Government response. The government will write to the Committee by Autumn 2026 to set out the case for change, its workplan including to describe key milestones, and the likely areas of focus for reform in clinical negligence.
HM Treasury
10
Recommendation
64th Report - Costs of clinical neglige…
Accepted
The NHS reports around 2.4 million patient safety incidents annually, most of which (70%) cause no harm to patients, but around 0.5% of patient safety incidents result in severe harm or death. The 2025 Dash review identified considerable overlap and duplication in the current patient safety landscape with relatively little …
Government response. The government states that the NHS Patient Safety Strategy (2019) already provides a national framework. They will update this strategy in 2026.
HM Treasury
11
Recommendation
64th Report - Costs of clinical neglige…
Accepted
The cost to health services of treating cases involving clinical negligence specifically or cases of avoidable harm to patients is unknown. The Organisation for Economic Co-operation and Development estimates that treating cases where harm was avoidable costs developed countries 8.7% of their health expenditure each year, on which basis the …
Government response. The government agrees to set a national framework for improving patient safety, but claims the NHS Patient Safety Strategy (2019) already sets such a framework and is achieving significant impact.
HM Treasury
12
Recommendation
64th Report - Costs of clinical neglige…
Accepted
The 2025 Dash review of patient safety found that the current system for raising complaints and concerns is confusing, with issues often poorly handled and patients subject to delays and poor-quality responses. Research commissioned by NHS Resolution found that improving the NHS’s initial response to harmful incidents could reduce the …
Government response. The government agrees to review the NHS complaints system and improve the number of cases resolved without litigation, aiming for implementation by Summer 2028, including updating complaints regulations and increasing use of AI.
HM Treasury
13
Recommendation
64th Report - Costs of clinical neglige…
Accepted
In 2024, the Health Services Safety Investigations Body reported that the broader health system was drowning in patient safety recommendations rather than taking affirmative actions to improve it.26 NHS England told us that there are over 1,500 recommendations in the system and that managing those centrally is a huge task. …
Government response. NHS England is required to collect information about what goes wrong in the health service and use this to provide advice and guidance and has introduced the Patient Safety Incident Response Framework (PSIRF) which is a contractual obligation for all …
HM Treasury
14
Recommendation
64th Report - Costs of clinical neglige…
Rejected
It is generally accepted that learning from past incidents is fundamental to improving patient safety, but the 2025 Dash review found that insufficient use is made of the NHS’s data resources to generate insights and support improvement.28 NHS England told us that although it aims to learn from litigation and …
Government response. The government disagrees with establishing a national system for sharing data, stating that existing data sharing arrangements and patient safety data are already in place.
HM Treasury
15
Recommendation
64th Report - Costs of clinical neglige…
Rejected
Written evidence submitted to us raised concerns about a lack of centralised learning leading to incidents being repeated across multiple trusts.31 When asked what it was doing to improve systemic learning from patient safety incidents, NHS England told us it had a “variety of mechanisms” but did not provide any …
Government response. The government disagrees with establishing a national system for sharing data, stating that existing data sharing arrangements and patient safety data are already in place.
HM Treasury
16
Recommendation
64th Report - Costs of clinical neglige…
Accepted
Some clinical negligence firms are reportedly using artificial intelligence to triage claims more efficiently and effectively. NHS Resolution holds almost 30 years of experience and data concerning compensation claims.33 NHS Resolution told us it is starting to explore how technology can mine its database to learn more about how claims …
Government response. NHS England is developing and evaluating AI models on Learn from Patient Safety Events (LFPSE) data to identify discrepancies and emerging themes and is assessing the feasibility of enabling secure, real-time analytics via the Federated Data Platform (FDP) to underpin …
HM Treasury
17
Recommendation
64th Report - Costs of clinical neglige…
Accepted
Over the last 20 years the cost of settling claims involving infants and children has increased significantly. The highest-value claims are typically those associated with brain injuries suffered in maternity care. In 2024–25, costs for these claims were £1,554 million, and costs for paediatric claims were £325 million.36
Government response. The government agrees to learn lessons from failures in maternity care and address systemic failings, aiming for implementation by Winter 2026-27, including a national investigation, the National Maternity and Neonatal Planning Framework, best practice resources, and the Maternity Outcomes Signal …
HM Treasury
18
Recommendation
64th Report - Costs of clinical neglige…
Accepted
NHS Resolution told us that harmed children require care costs for decades into the future.37 Damages can include compensation for pain and suffering, care costs, future lost earnings, educational support and accommodation adaptations. They are calculated based on a claimant’s specific circumstances and to reflect differing needs throughout their remaining …
Government response. The Secretary of State announced a rapid, national, independent investigation into NHS maternity and neonatal care to help understand the systemic issues behind why so many women, babies and families experience unacceptable care and will bring together the findings of …
HM Treasury
19
Recommendation
64th Report - Costs of clinical neglige…
Accepted
NHS Resolution told us it settles around 120 to 130 brain injury cases involving children every year, but historically it has taken an average of 11 or 12 years to settle each claim.43 We asked NHS Resolution what action it was taking to try to manage the cost of maternity …
Government response. The Secretary of State announced a rapid, national, independent investigation into NHS maternity and neonatal care to help understand the systemic issues behind why so many women, babies and families experience unacceptable care and will bring together the findings of …
HM Treasury
20
Conclusion
64th Report - Costs of clinical neglige…
Accepted
Evidence from the Royal College of Obstetricians and Gynaecologists suggested that the maternity workforce is struggling under the pressure of delivering increasingly complex care, with more than half of births involving medical intervention, such as a caesarean section or the use of instruments such as forceps.47 Similarly, evidence from Sands …
Government response. The government agrees to learn lessons from failures in maternity care and address systemic failings, aiming for implementation by Winter 2026-27, including a national investigation, the National Maternity and Neonatal Planning Framework, best practice resources, and the Maternity Outcomes Signal …
HM Treasury
21
Conclusion
64th Report - Costs of clinical neglige…
Deferred
Claimant legal fees have increased in real terms from £148 million in 2006–07 (in 2024–25 prices) to £538 million in 2024–25 and now represent 15% of all settled costs. During the same period, NHS’s legal costs increased in real terms from £76 million to £159 million, but fell as a …
Government response. The government is considering alternative dispute resolution mechanisms to reduce legal costs, and will provide additional information by Autumn 2026.
HM Treasury
22
Conclusion
64th Report - Costs of clinical neglige…
Deferred
Over the last 10 years, NHS Resolution has introduced several new approaches to help keep claims out of court. These alternative dispute resolution initiatives are typically less adversarial and more collaborative than conventional litigation and provide greater opportunities for claimants seeking non-monetary redress such as an explanation or apology. The …
Government response. DHSC, working with David Lock KC, is considering alternative dispute resolution mechanisms. The government will write to the Committee by Autumn 2026 to set out the case for change.
HM Treasury
23
Recommendation
64th Report - Costs of clinical neglige…
Deferred
Around three-quarters of clinical negligence claims settle for £25,000 or less, but the legal costs for these claims vastly exceed the damages payable to claimants. In 2024–25, there was a 3.7:1 ratio of claimant and NHS legal costs compared with damages payable for low-value claims.58 NHS Resolution agreed that legal …
Government response. The government is considering alternative dispute resolution mechanisms to speed up decisions and reduce costs for less complex cases, but specific policy proposals remain under consideration and will be addressed in a letter by Autumn 2026.
HM Treasury
24
Recommendation
64th Report - Costs of clinical neglige…
Deferred
The previous government announced plans to place limits on how much lawyers receive from lower damages clinical negligence claims of under £25,000 where 85% of cases fall within this category from April 2024, but 51 Q 50 52 C&AG’s Report, paras 2.12-2.13 53 Q 64 54 Q 67 55 C&AG’s …
Government response. The government will write to the Committee by Autumn 2026 to set out the case for change and provide additional information on the department’s intentions, including Fixed Recoverable Costs for lower-value clinical negligence cases.
HM Treasury
25
Conclusion
64th Report - Costs of clinical neglige…
Deferred
The government may effectively be paying twice in some instances of clinical negligence, once through the compensation given to claimants and once again through providing NHS treatment and publicly funded social care. Section 2(4) of the Law Reform (Personal Injuries) Act 1948 provides that defendants who pay for the future …
Government response. The government is keeping the issue of double recovery under consideration and will write to the Committee by Autumn 2026 on the case for change, after David Lock KC has focused on this in his work.
HM Treasury
26
Conclusion
64th Report - Costs of clinical neglige…
Deferred
There is no estimate of the extent to which successful clinical negligence claimants then go on to use publicly funded health or social care services for their conditions.67 We asked NHS Resolution why there is no clear data on the number of people who are paid compensation and go on …
Government response. The government is keeping under consideration the issue of clinical negligence claimants using publicly funded services and will write to the Committee by Autumn 2026.
HM Treasury
27
Conclusion
64th Report - Costs of clinical neglige…
Deferred
Written evidence from the Medical Defence Union told us that Section 2(4) of the Law Reform (Personal Injuries) Act 1948 is based on a recommendation made in 1946, two years before the establishment of the NHS, which was caveated that it “might need to be radically altered if a comprehensive …
Government response. The government is keeping the matter of double recovery under consideration and will write to the Committee by Autumn 2026 on the case for change and provide additional information on the department’s intentions, including Double Recovery.
HM Treasury