The Public Accounts Committee (PAC) says that the government has failed to tackle the issue of clinical negligence – despite repeated warnings for over two decades.
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 further highlights 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.
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.
"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."
Responding to the report, Thomas Reynolds, Director of Policy and Communications at the Medical Defence Union (MDU), said: “It’s clear that Parliament has run out of patience with the failure of successive governments to take control of soaring clinical negligence costs. The MDU’s patience is equally, if not more, exhausted. MPs have now set a six-month deadline for action and we’ll be holding the Government to account to make sure they meet it. We need concrete action to end this huge financial drain on the NHS and the public purse.
“The MDU has been sounding the alarm bell for years about two issues the report highlights. We strongly support the recommendation to repeal outdated legislation which risks the NHS paying twice for claimants’ care. We are particularly pleased that the Committee is supporting our call for data from government on the cost to the taxpayer of the current approach. Currently, there’s none – and that’s not good enough."
Dr Pallavi Bradshaw, Medical Director at Medical Protection Society, said: “The Public Accounts Committee is right to highlight the eye-watering cost of NHS clinical negligence claims, the staggering amount of public money being spent on legal fees, and the inaction of successive governments on this issue.
“At a time when NHS finances are under strain, and there is much to be done to transform patient care and services, the Government simply cannot afford to do nothing. A comprehensive strategy - which balances fair compensation for patients and affordability for the NHS - is urgently needed following David Lock KC’s review.
“This strategy must iron out the many inequities and flaws in the system - not least disproportionate legal fees in lower-value claims, and the 80-year-old legislation which sets out that claims are settled based on how much a patient’s care would cost in the private sector, rather than in the NHS.”
