Healthcare delivery
is confusing and may lack responsiveness. Patients, users, and their representative groups describe a confusing landscape where it is unclear how to complain, with concerns often poorly handled and characterised by delays and poor-quality responses. In 2022, the Parliamentary and Health
Service Ombudsman (PHSO) issued an updated complaints standard for all organisations delivering NHS care. PHSO is working with regulators to explore how the complaints standards could be incorporated into NHS inspection regimes. Research commissioned by NHSR suggests that improving the NHS’s initial response to harm could reduce the number of patients who pursue clinical negligence claims. This research noted common motivations for making a claim included wanting to prevent similar events happening to others, to receive an apology or explanation, or to trigger a more detailed investigation. Most of the research participants reported dissatisfaction with the existing NHS complaint handling process due to poor communication and lack of meaningful outcomes. Since 2014, the statutory Duty of Candour
has required all providers to be open and transparent with patients and their families when harm occurs. Stakeholders raised
concerns about how well this is understood by patients and applied in practice. Lord Darzi’s review in 2024 found that the NHS “still appears to struggle with the Duty of Candour” more than a decade after its introduction. DHSC launched a call for evidence to review the Duty of Candour in November 2024, but it has yet to publish its findings. NHSR’s guidance to health workers
encourages them to apologise to patients as soon as possible after an incident occurs as delayed or poor communication increases the likelihood a patient will seek answers in a different way. Other countries, such as Japan and the US, have reported reduced lawsuits and legal cases following changes to how harm is responded to in health settings.
Seeking alternative resolutions Over the last 10 years, NHSR has introduced several new approaches to help keep claims out of court. (See Table 1) Average claimant legal costs were £96,000 more for litigated claims than unlitigated ones between 2018-19 and 2023- 24 (for claims resolved with damages). 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. These new approaches have been well received by the legal sector. In 2024-25, the vast majority (99.8%) of clinical negligence cases did not proceed to trial. The proportion of claims resolved without litigation has also increased from 66% in 2016-17 to a record high of 83% in 2024-25. NHSR attributes this success to its strategic priority of achieving fair resolution while keeping patients and healthcare staff out of formal processes.
Managing future risk The NAO has recommended the following steps to help DHSC and NHSR manage future risk: l Build on NHSR’s existing use of analytics and AI to help provide a more comprehensive analysis of damages awarded.
l Consider whether the current approach to legal costs remains proportional given the high relative costs of low-value claims.
l Explore possibilities for greater transparency on the fees agreed between claimants and their lawyers.
l Assess whether the requirement to calculate damages based on privately funded care packages remains aligned with DHSC’s vision of a modern NHS.
l Consider incorporating performance against
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