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 …
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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 know how 3 much cost the NHS incurs treating patients it has harmed each year, but research suggests it could be significant. There is also evidence to suggest that a better initial response to harm, such as timely apologies or explanations, could reduce both the number of claims and cost of clinical negligence. We were also told during our informal private roundtable that effective compassionate, local resolution is both ethically right and fiscally responsible. Recent reviews have found that the NHS is overwhelmed by safety recommendations that it cannot action and one person we spoke to as part of our roundtable referred to the NAO’s findings on this as the NHS drowning in recommendations. Despite the Department’s stated commitment to improve patient safety and reduce harm, it has yet to outline any of the specific measures it will take to achieve this. It is also not clear how the abolition of NHS England will impact future patient safety arrangements and the little progress made to date. recommendation a. The Department must set a national framework for improving patient safety with clear targets for annual improvement. b. The Department must review the NHS complaints system and improve the number of cases that are resolved without recourse to litigation. c. The Department should estimate and track the costs to the NHS of treating avoidable harm. d. The Department should write to the Committee to set out progress in implementing the Dash Review and its assessment of the impact of abolishing the Health Services Safety Investigations Body (HSSIB) on patient safety. e. The Department and NHS England should have a clear system of accountability fo
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Government response AI summary
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 feasible but can demonstrate costs …
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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 …
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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 how the NHS uses its extensive data on patient harm to identify and address the underlying causes of clinical negligence. Data is not routinely reviewed at a national level as NHS England claim there is no direct connection between data on patient harm 4 and clinical negligence claims. NHS Resolution has committed to making better use of its extensive claims database and to explore options to extract more detailed insight on the causes of harm to prevent the same things happening again. However, we remain concerned that poor investment in data analytics will leave the NHS lagging behind the private sector, where legal firms are now using artificial intelligence to triage clinical negligence claims on an industrial scale. One person we spoke to at our private roundtable described the English NHS having a plethora of data and no information, adding that we need more NHS data in one place. recommendation a. The Department should establish a national system for sharing data between trusts and analysing trends. If there are barriers to sharing protected data, it should develop analysis on an anonymised basis to pull out lessons and provide early warning alerts to trusts. b. The Department, NHS England and NHS Resolution should explore the use of artificial intelligence to analyse live data, detect discrepancies and outliers quickly, and improve the speed of early warning systems.
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Government response AI summary
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 Platform, and NHS Resolution exploring …
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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 …
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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 the total cost of claims for paediatric failings reaching £325 million. Damages awarded in these cases are higher than most clinical negligence claims as they typically include compensation for lifelong health and social care, future lost earnings and any necessary adaptations to accommodation. Court rulings on the eligibility of innovative or novel treatment options have also increased the value of damages awarded in recent years. NHS Resolution settles around 120 to 130 brain injury cases involving children every year but it can take an average of 11-12 years to resolve each claim. In response, NHS Resolution has developed an innovative early notification scheme to provide more timely support to families and improve the speed at which lessons are learned. NHS England told us that it expects the final part of the Amos Review into England’s maternity and neonatal services in 2026, but this does not mean it is waiting to act on its recommendations. 5 recommendation a. The Department and the organisations it funds need to learn lessons from its failure to improve maternity care in England. Where problems arise the Department and the wider NHS should look for systemic failings in care and tackle these problems at their cause. b. The Department should publish the Amos Review within two months alongside its response and set out how it plans to reduce the incidence of harm and the costs of claims in maternity care.
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Government response AI summary
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 announced once Baroness Amos’ recommendations …
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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 …
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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 costs it is unacceptable that so much taxpayers’ money continues to be spent on legal fees. NHS Resolution has worked hard to increase the number of claims resolved without litigation (83% in 2024–25, up from 66% in 2006–07). It has also expanded its use of alternative dispute resolution and mediation. There are considerable financial benefits to these approaches which have been well received by the legal sector. However, we are extremely concerned that low-value clinical negligence claims (damages of £25,000 or less) cost far more in legal fees than victims receive in damages, with a 3.7:1 cost-to-damages ratio. The Department’s previous plans to limit the amount paid to lawyers in lower-value cases were not implemented as planned in April 2024 and remain under review. recommendation The Department should a. develop alternative dispute mechanisms to speed up decisions and reduce costs for less complex cases. As part of this, the Department should look at international examples (such as in New Zealand and Sweden) of non-adversarial and ombudsman models and assess how our ombudsman system could be improved; and b. clarify its position on a fixed recoverable costs scheme for lower-value clinical negligence cases at the earliest opportunity.
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Government response AI summary
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, including a fixed recoverable costs …
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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 …
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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 the taxpayer is paying twice for clinical negligence – once through compensation for injury 6 and then again by providing subsequent health and social care. A law from 1948 states that damages must be calculated on the presumption that care will be provided by the private sector and not the NHS or local government. NHS Resolution identified this as a major contributory factor to the increasing cost of very high-value cases (£1 million or more), where about 60% of the damages relate to future care. Although claimants can be asked to declare in court if they plan to use the NHS for treatment, this rarely happens in practice and cannot be mandated. NHS Resolution is unable to ask successful claimants for information on how they spend their award or whether they subsequently access state funded services to manage their condition. Local authorities are also not able to consider clinical negligence compensation awards when assessing eligibility for publicly funded social care. recommendation The Department should develop, within six months, proper estimates of the impact of assuming health and social care for clinical negligence victims will be provided exclusively by the private sector. It should by the same deadline set out additional measures—including any requiring changes to legislation—which it judges would effectively guard against the risk of paying twice for the care of those it has harmed and an indicative timeline for their potential implementation. 7 1 The rising costs of clinical negligence Introduction
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Government response AI summary
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.
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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 …
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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 Committee and our immediate predecessor raised further concerns about progress in tackling the rising costs in its 2024 and 2025 reviews of the Department’s accounts.2
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Government response AI summary
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 does not directly address the …
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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, …
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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, the annual cost of settling claims has increased in real terms from £1.1 billion in 2006–07 to £3.6 billion in 2024–25.5 Forecasts suggest that the cost of clinical negligence will continue to rise substantially in coming years, with annual payments expected to exceed £4 billion by 2029–30.6
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Government response AI summary
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.
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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 …
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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 or more is a major contributing factor. Those claims relate to the most seriously harmed individuals and are often associated with brain injury suffered in maternity care.7 In 2024–25, these very-high-value claims represented 2% of all claims by volume, but the associated damages accounted for 68% of total costs. The average compensation for obstetrics claims involving cerebral palsy or brain damage in 2024–25 was £11.2 million (for claims settled with damages).8
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Government response AI summary
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.
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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 …
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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 35 8 C&AG’s Report, para 8 9 Qq 35, 47, 63, 97, 100 10 As a result it would also not comment on whether it thought the current steps being taken to reduce clinical negligence costs would make a difference.10 The Department repeatedly assured us that the review would cover all aspects of clinical negligence, including when we asked about policies on legal costs, international comparisons, options for alternative dispute resolution, the assumptions around provision of private health and social care and the overall causes of rising costs.11 Underlying causes of harm to patients
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Government response AI summary
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.
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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 …
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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 improvement over the last five to 10 years.12 The Department told us it had set out a new plan to oversee quality and safety as part of the 10-Year Health Plan,13 but did not outline any of the specific measures it will take to achieve this.14 In 2025 the Department announced the planned abolition of NHS England and the Health Services Safety Investigations Body.15 NHS England told us that there is a lot of change going on and it is working to rationalise the patient safety system but that it must take a cautious approach to ensure important functions are not lost.16 The NHS is being asked to find at least £1 billion in savings over the next three years. The ambition is to reduce central staff numbers by up to 50% across the Department, NHS England and Integrated Care Boards by March 2028 and is expected to cost between £1 billion and £1.3 billion.17
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Government response AI summary
The government states that the NHS Patient Safety Strategy (2019) already provides a national framework. They will update this strategy in 2026.
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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 …
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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 costs in England could run to tens of billions.18 Both the Department and NHS Resolution told us the most important thing is therefore to prevent 10 Q 97 11 Qq 61, 64, 75, 85, 100 12 C&AG’s Report, paras 1.2, 1.4 13 Fit for the future: 10 year health plan for England, July 2025 14 Q 97 15 C&AG’s Report, Figure 1 16 Q 94 17 Billions to be redirected back into patient care with NHS reform - GOV.UK; and Letter from DHSC, dated 11 December 2025 18 C&AG’s Report, para 13 11 harm from happening to patients in the first place.19 NHS England told us it is making considerable efforts around patient safety and that there is no evidence that the levels of harm are increasing.20
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Government response AI summary
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.
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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 …
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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 number of patients who pursue clinical negligence claims.21 However, in their written submissions to us, multiple organisations raised concerns about how inconsistently NHS trusts apply the statutory requirement to be open and transparent with patients, known as ‘duty of candour’.22 NHS Resolution told us that in its experience openness and transparency are the best way to prevent a claim in the first place.23 When questioned about inadequacies in the existing complaints system, NHS England told us it is very keen to do more to improve patient experience and is looking at alternative models for the NHS complaints system. When asked about how it is learning from complaints, NHS England told us that complaints are collected centrally in themes with around 200,000 to 250,000 reviewed each year nationally.24 NHS Resolution explained that it is also working across all areas locally with NHS trusts to identify complaint issues that might escalate into clinical negligence claims further down the line.25
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Government response AI summary
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.
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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. …
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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. NHS England told us that the new National Quality Board will look at how the NHS can access stronger, smarter recommendations.27 19 Qq 35-36 20 Q 38 21 C&AG’s Report, para 16 22 Switalskis Solicitors (CCN0014); Action against Medical Accidents (CCN0018); Slater & Gordon (CCN0023) 23 Q 83 24 Q 78 25 Q 99 26 C&AG’s Report, para 1.4 27 Q 80 12 Learning from available data
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Government response AI summary
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 Trusts.
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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 …
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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 wishes to see it reduced through the reduction of harm, there is no direct connection between patient safety incidents and clinical negligence claims.29 Where patient safety incidents increase with age, clinical negligence claims are skewed towards middle-aged claimants. The relative balance of specialties also differs, with claims weighted towards maternity and emergency care, compared with general medicine and secondary care for safety incidents.30
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Government response AI summary
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.
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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 …
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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 detail on what these were.32
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Government response AI summary
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.
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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 …
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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 are made up in terms of damages and the underlying causes of claims.34 It also explained how it has been working with the Getting It Right First Time programme, which is part of NHS England, to bring claims data together with other NHS metrics to better understand what causes claims in different clinical specialties.35 28 C&AG’s Report, para 3.24 29 Q 83 30 C&AG’s Report, para 3.27 31 Society of Clinical Injury Lawyers (CCN0005); Switalskis Solicitors (CCN0014) 32 Q 81 33 C&AG’s Report, paras 3.25, 3.28 34 Q 36 35 Q 53 13 2 Putting the costs of clinical negligence on a more sustainable path Problems with maternity care in England
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Government response AI summary
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 a scalable national infrastructure for …
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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
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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
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Government response AI summary
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 System.
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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 …
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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 life. Compensation awards for these claims have also increased due to new precedents set by the courts, for example around access to innovative or novel treatment options.38 NHS Resolution told us that these changing precedents have driven up costs over time.39 One participant in our roundtable questioned whether the current tort based legal system was fit for purpose and whether there should be changes. Others suggested possible lessons to be learned from the private sector and how commercial insurers go about assessing high value claims. It was also suggested that an amendment to the Pre-Action protocol to better reflect the complexities of clinical negligence claims by providing a more realistic framework than it currently does for the investigation of those claims.40 Secondly, adopting 36 C&AG’s Report, paras 8, 2.19-2.10 37 Q 35 38 C&AG’s Report, paras 1.11, 2.8 39 Q 35 40 Pre-Action Protocol for the Resolution of Clinical Disputes – Civil Procedure Rules – Justice UK, updated March 2024 14 a similar approach to rehabilitation, specifically the Rehabilitation code.41 Also, the cost of expert reports in clinical negligence average £3,100 and quite often two reports are needed. Significantly we heard about the case of Wiseman, currently before the Supreme Court relating to lost years.42 We await the outcome of this case to understand its implications.
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Government response AI summary
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 past reviews into one clear …
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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 …
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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 claims. In response, NHS Resolution told us it has introduced an innovative early notification scheme for obstetric cerebral palsy.44 The scheme trials ways of managing maternity incidents to ensure a decision on liability is reached as early as possible.45 NHS Resolution told us this means it can learn from incidents more quickly and, where appropriate, make early interim payments to better support affected families. NHS Resolution hopes that the scheme will make the experience better for the victims of clinical negligence and reduce the costs in the longer term.46
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Government response AI summary
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 past reviews into one clear …
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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 …
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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 and Tommy’s Joint Policy Unit raised concerns that inadequate training, poor workforce planning and failure to adhere to staffing requirements have created the conditions which result in clinical negligence claims being filed.48 NHS England told us it carefully monitored trusts with high levels of maternity related clinical negligence claims and around 30 trusts are taking part in its maternity support programme.49 However it accepted that it had struggled to reduce maternal mortality rates in recent years, pointing to increasing maternal risk factors such as obesity and age.50 NHS England told 41 The Rehabilitation Code is a voluntary framework offered by insurance companies in the context of personal injury claims: Rehabilitation Code (Code of Best Practice on Rehabilitation, Early Intervention and Medical Treatment in Personal Injury claims, 2015 42 CCC (by her mother and litigation friend MMM) (AP) (Appellant) v Sheffield Teaching Hospitals NHS Foundation Trust (Respondent) 43 Qq 46, 48 44 Qq 43, 48 45 C&AG’s Report, para 3.23 46 Q 48 47 Royal College of Obstetricians and Gynaecologists (CCN0021) 48 Sands and Tommy’s Joint Policy Unit (CCN0003) 49 Q 84 50 Q 51 15 us that it expects the final part of the Amos Review into England’s maternity and neonatal services in 2026 but this did not mean it was waiting to act in its recommendations.51 Disproportionate legal costs
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Government response AI summary
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 System.
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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 …
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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 share of total settled costs (from 7% to 4%).52 NHS Resolution told us it had broadly kept the increase in defence costs level with inflation by using fixed and capped rates for its external legal support.53 It also claimed to have saved over £138 million in 2024 by challenging the bills presented by claimant lawyers.54
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Government response AI summary
The government is considering alternative dispute resolution mechanisms to reduce legal costs, and will provide additional information by Autumn 2026.
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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 …
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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 proportion of claims resolved without litigation has also increased from 66% in 2016–17 to a record high of 83% in 2024–25.55 NHS Resolution told us keeping a case out of litigation saves on average £96,000 in claimant legal costs.56 The increased use of mediation and alternative dispute resolution has been praised and encouraged by legal stakeholders.57
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Government response AI summary
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.
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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 …
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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 costs were disproportionate for low-value cases.59
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Government response AI summary
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.
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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 …
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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 Report, paras 3.12, 3.13 56 Q 64 57 Fletchers Solicitors (CCN0013); Switalskis Solicitors (CCN0014) 58 C&AG’s Report, paras 12, 2.16 59 Q 60 16 the required legislation was not introduced.60 We understand the Civil Rules Committee has put all its work on hold and there is no ongoing work in this area. Critics of these plans have raised concerns that they would impact access to justice for legitimate victims of clinical negligence.61 NHS Resolution agreed that access to justice for people who are severely harmed but who may have a low-value claim is an important consideration that needs to be part of decision making.62 The Department told us options to reduce legal costs in low-value cases form part of the ongoing review by David Lock KC.63 Assumptions around private care
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Government response AI summary
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.
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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 …
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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 healthcare and treatment of damaged patients must do so on the presumption that such care will be provided by the private sector and not the NHS. Local authorities are also not able to consider clinical negligence compensation awards when assessing eligibility for state social care.64 NHS Resolution identified the assumption of private care as a major contributory factor to the increasing costs of very high-value cases (£1 million or more).65 It estimates that about 60% of very high-value settlements for damage related to the cost of providing future care.66
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Government response AI summary
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.
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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 …
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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 to receive ongoing health and social care services. NHS Resolution told us it is not able to ask claimants for information on either how they spend their award or whether they subsequently access publicly funded services to manage their condition.68 Although claimants can be asked to declare in court if they 60 Committee of Public Accounts, DHSC Annual Report and Accounts 2023–24, Twenty-fifth Report of Session 2024–25, HC 639, 14 May 2025 61 Society of Clinical Injury Lawyers (CCN0005); Action against Medical Accidents (CCN0018); Do No Harm (CN0024) 62 Q 74 63 Q 67 64 C&AG’s Report, para 2.20 65 Qq 35, 76 66 Q 44 67 C&AG’s Report, para 2.20 68 Q 76 17 plan to use the NHS for treatment, NHS Resolution told us the courts have explicitly said that these arrangements cannot be imposed on claimants without their permission.69
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Government response AI summary
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.
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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 …
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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 health service is introduced”.70 Evidence from The Medical Protection Society and the Medical and Dental Defence Union of Scotland suggested that repealing the Act would save the NHS money that could be reinvested into frontline care.71 However, the Association of Personal Injury Lawyers raised concerns that removing the presumption of private care would force patients to return to the NHS institution which injured them in the first place.72 Action against Medical Accidents suggested to us that the issue should be subject to its own dedicated inquiry or review.73 NHS Resolution recognised that it needs to do more to understand the true extent and cost of any double recovery by claimants.74 69 Q 76; C&AG’s Report, para 2.20 70 The Medical Defence Union (CCN0004) 71 The Medical and Dental Defence Union of Scotland (CCN0009); The Medical Protection Society (CCN0019) 72 The Association of Personal Injury Lawyers (CCN0017) 73 Action against Medical Accidents (CCN0018) 74 Q 43 18
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Government response AI summary
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.
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HM Treasury