Recommendations & Conclusions
10 items
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
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
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