Source · Select Committees · Public Accounts Committee
Recommendation 23
23
Deferred
Legal costs for low-value clinical negligence claims are disproportionately high compared to damages.
Recommendation
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
Government Response 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.
Government Response
Deferred
HM Government
Deferred
5. PAC conclusion: Legal costs in clinical negligence claims are disproportionate for medium and low volume claims. 5a. PAC recommendation: The Department should: • 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 … 5.1 The Committee’s recommendation is under consideration by the government. Target implementation date: to be advised 5.2 DHSC, working with David Lock KC, is considering alternative dispute resolution mechanisms and ways to reduce costs for less complex cases and speed up resolution. Disproportionate legal costs for low value claims is a key concern in this area of work. For the smallest/lowest value claims, payments to lawyers for processing claims can be over 10 times the compensation for the patient. For claims with a damages value under £50,000, a total of £184 million is spent on lawyers’ fees each year and only £70 million goes to patients as compensation. DHSC is also taking account of international examples to see what lessons can be learned about resolving claims outside litigation, but it remains important to note that other countries’ healthcare and legal systems are not directly analogous to the NHS in England and the English legal system. 5.3 The government will write to the Committee by this Autumn 2026 to set out the case for change and provide additional information on the department’s intentions. However, specific policy proposals, like alternative dispute mechanisms, remain under consideration within government at this time.