Select Committee · Public Accounts Committee

Costs of clinical negligence

Status: Open Opened: 10 Jul 2025 18 recommendations 9 conclusions 1 report

The PAC in its 2025 scrutiny the Department of Health and Social Care’s (DHSC) annual report and accounts 2023-24 called on government to reduce tragic incidences of patient harm. The PAC found it unacceptable that DHSC had yet to develop a plan to deal with the cost of clinical negligence claims, with so much taxpayers’ …

Clear

Reports

1 report
Title HC No. Published Items Response
64th Report - Costs of clinical negligence HC 1234 30 Jan 2026 27 Responded

Recommendations & Conclusions

10 items
5 Recommendation 64th Report - Costs of clinical neglige… Deferred

Develop alternative dispute mechanisms to speed up decisions and reduce costs for less complex claims.

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

Develop estimates and set out measures to prevent double payment for negligence care.

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
9 Recommendation 64th Report - Costs of clinical neglige… Deferred

Department unable to discuss policy due to ongoing clinical negligence review.

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
21 Conclusion 64th Report - Costs of clinical neglige… Deferred

Claimant legal fees for clinical negligence have significantly increased as a proportion of total.

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

Alternative dispute resolution successfully increases claims resolved without litigation, saving significant legal costs.

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

Legal costs for low-value clinical negligence claims are disproportionately high compared to damages.

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

Plans to limit lawyer fees for low-value clinical negligence claims are stalled.

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

Presumption of private care in clinical negligence awards leads to double public payments.

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

No clear data on clinical negligence claimants accessing public services post-compensation.

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

Debate over 1948 Act's private care presumption requires dedicated inquiry into double recovery.

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

Oral evidence sessions

1 session
Date Witnesses
20 Nov 2025 Elizabeth O'Mahony · Department of Health and Social Care, Helen Vernon · NHS Resolution, Professor Aidan Fowler · NHS England, Samantha Jones · Department of Health and Social Care View ↗

Correspondence

4 letters
DateDirectionTitle
21 May 2026 From cttee Letter to the Permanent Secretary at the Department for Health and Social Care …
12 Jan 2026 To cttee Letter from the Chief Financial Officer at NHS England relating to the Committe…
15 Dec 2025 To cttee Letter from the Permanent Secretary at the Department for Health and Social Car…
15 Dec 2025 To cttee Letter from the Permanent Secretary at the Department for Health and Social Car…