64th Report - Costs of clinical negligence

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 … Read more 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 Show less

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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 … Read more 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 Show less

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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% … Read more 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 Show less

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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 … Read more 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 Show less

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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 … Read more 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 Show less

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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 … Read more 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 Show less

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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, … Read more 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 Show less

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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 … Read more 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. Show less

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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 … Read more 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 Show less

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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 …

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