WIREDGOV

Government has failed to tackle the issue of clinical negligence – despite repeated warnings from the Public Accounts Committee (PAC) for over two decades.

• Read the report
• Read the report (PDF)
• Inquiry: Costs of clinical negligence
• Public Accounts Committee

In a new report, the PAC finds that, as government’s liability for clinical negligence quadrupled over 20 years (£60bn in ’24-’25), the DHSC is unable to show any meaningful action taken to address this, and that the NHS has not done enough to tackle the underlying causes of patient harm.

The report paints a picture of a system overwhelmed by safety recommendations that it cannot action, with evidence that, despite the NHS in England keeping a plethora of data on patient harm, its fragmented nature does not amount to good information which could identify and address clinical negligence’s underlying causes.

The PAC is further highlighting the problem of disproportionate legal costs in clinical negligence claims. Claimant legal fees more than tripled to £538m in 2024-25, while claims with damages of £25k or less cost far more in fees than victims receive, with a cost-to-damages ratio of 3.7 to 1.

Government’s previous plans to limit the amount paid to lawyers in lower-value cases were not implemented as planned two years ago, and the DHSC should develop an alternative mechanism to speed up decisions and reduce costs for these cases.

Recent increases in settlement costs (tripling to £3.6bn in ’24-’25) are likely to rise significantly to over £4bn/yr by the end of the decade, with these costs representing many tragic incidences of patient harm.

However, despite warnings from the PAC dating back to 2002, the DHSC would not commit to acting to make improvements to the fundamental issues of clinical negligence until the completion of a review announced last year, for which it did not have an expected date. The PAC is seeking, within two months of this report:

• an operational plan from government to tackle clinical negligence;
• a national framework for improving patient safety with clear annual improvement targets, and 
• a national system for sharing data between NHS trusts.

The report calls in particular for the DHSC to learn lessons from its failure to improve maternity care in England, and set out how it plans to reduce the incidence of harm and the costs of claims in this area.

The report shows settled claims involving infants and children increasing significantly, reaching £325m in claims for paediatric failings in 2024-25. The inquiry heard that 120-130 brain injury cases involving children are settled every year, but it can take an average of 11-12 years to resolve each claim, at a high cost both for the victim’s experience and financially.

Evidence to the PAC’s inquiry 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.

Further evidence raised concerns that inadequate training, poor workforce planning and failure to adhere to staffing requirements have created the conditions for clinical negligence claims to occur.

The PAC asks that DHSC and NHS find and fix systemic failings in care, and for the publication of the Amos review into maternity and neonatal care in England within two months alongside its response to the report.

Finally, the report notes that claims being settled on the basis of how much a victim’s care would cost in the private sector, rather than in the NHS, stem from a law from 1948.

The inquiry heard that this is a major contributory factor to the increasing cost of very high-value cases of £1m+. It is not clear how far the taxpayer is paying twice for clinical negligence – once when a victim is compensated, and then again if the victim uses the NHS for their subsequent care rather than the private sector.

The DHSC should set out how it will guard against the risk of paying twice for the care of those it has harmed.

Chair comment

Sir Geoffrey Clifton-Brown, Chair of the Public Accounts Committee, said:

“Clinical negligence is the second-largest financial liability across government, but represents to our Committee a different matter entirely from other large items like nuclear decommissioning or pensions.

This is a swelling accounting of profound suffering. Each case can represent unspeakable devastation for the victims involved, and the overall picture is of a system struggling to keep its patients safe from avoidable harm.

Indeed, the rising costs of such claims are diverting resources away from frontline care badly in need of them. That is why it feels impossible to accept that, despite two decades’ worth of warnings, we still appear to be worlds away from government or NHS engaging with the underlying causes of this issue. 

“Tragic failings in maternity care are one driver of this trend, and one of many problems within this system which we can see government has failed to address.

"Indeed, patients often pursue such costly legal action due to the lack of a complaints system worthy of the name, and disgracefully for lower-value claims, the legal costs can be over three-and-a-half times what victims can expect to receive in damages.

"Government must move at pace towards a less adversarial system, reducing costs and ensuring that claims are paid more quickly for the benefit of families involved.

"Whatever happens next, government has been in unacceptable stasis on the issue of clinical negligence for the majority of my political life, as numbers have continued to creep up.

"For those harmed by the outcomes of this system, the time for change has long since come and gone. We hope our recommendations, and those of other forthcoming reviews, help government and NHS carry out their duties to prevent future harm. 

“We would like to sincerely thank everyone who contributed evidence to our inquiry on this topic, in particular to those submitters who are victims of clinical negligence.”