Healthcare delivery
complaints standards into future inspection and oversight regimes as patients report finding the current processes confusing and frustrating.
“Despite progress in containing the number of clinical negligence claims in some specialties, the increasing cost of the small number of very high value claims is driving higher costs for taxpayers. Reducing harm to patients is clearly the best way of containing this cost. Alongside this, DHSC should consider whether the existing approach to legal costs remains proportionate for all claims, including whether alternative methods to compensate for negligent treatment could provide better outcomes for patients, with less cost overall,” commented Gareth Davies, head of the NAO.
Response to the report Responding to the report, Thomas Reynolds, Director of Policy & Communications at the Medical Defence Union, said: “This report needs to be a wake-up
call...This report from the National Audit Office (NAO) shines a spotlight on the huge burden borne by the British taxpayer because of an outdated clinical negligence
Approach Claims mediation scheme Description
Independent accredited mediators facilitate confidential discussions between patients and NHS representatives, focussed on openness and learning. Of 138 claims mediated in 2024-25, 73% settled within 28 days of mediation.
Stocktake meetings
Scheduled pre-litigation discussions between parties to consider evidence and options. Of 40 stocktake meetings held in 2024-25, 39 were subsequently resolved without formal proceedings.
Grouped claims
A consistent approach is used across similar claims to create efficiencies, for example using the same expert witnesses or agreeing protocols with claimant lawyers.
Early neutral evaluators
Independent legal experts provide non-binding, neutral assessments to help parties realistically assess their positions. NHS Resolution piloted the scheme between 2023 and 2025 and is currently evaluating the outcomes.
Early Notification Scheme Introduced in 2017, the scheme aims to facilitate improvements in the safety of maternity care and to better meet the needs of affected families, including through the early admission of liability where appropriate. It trials innovative ways of managing maternity incidents to ensure NHSR reaches decisions on liability as early as possible. This includes convening experts to review evidence for multiple cases in one sitting, and working with families to put in place immediate support packages pending final settlement. NHSR expects the scheme will deliver savings in the longer term because early settlement will reduce the impact of claims inflation and legal costs.
Table 1: Approaches to help keep claims out of court 70
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system. This should be a lightning-rod for change. The MDU has campaigned on this for decades. Now, more than ever, is time for the Government to act. We welcome this report by the NAO and were pleased to be a key contributor to this work, as set out in the report.
We have long argued that clinical negligence costs in the UK are unsustainable and diverting millions of pounds from frontline NHS services and patient care. “The NAO’s findings are stark, but sadly
they come as no surprise. From a ratio approaching 4:1 in relation to legal costs versus compensation in claims of £25,000 or less; to the NHS almost certainly ‘double-paying’ on a vast scale because of an outdated law that requires courts to disregard the existence of a national health service when determining compensation; to the fact that by the end of this Parliament, the Government estimates that £4.1 billion will be needed for annual payments of compensation and legal costs. This simply cannot go on. “The MDU is calling on the Government to
introduce the long promised fixed recoverable costs scheme for claims valued at less than £25,000, to begin to arrest these spiralling costs. However, as the NAO report lays bare, both the Chancellor and the Secretary of State for Health & Social Care need to be even more ambitious and the MDU urges the Government to introduce such a scheme for the upper limit of £250,000. “If the Chancellor is looking for a ‘rabbit out of the hat’ moment to end rising clinical negligence costs, the Government should end the decades long absurdity that is Section 2(4) of the Law Reform (Personal Injuries) Act 1948 - which requires courts to disregard the existence of the NHS when paying clinical negligence compensation, and instead do so on the basis of the cost of private healthcare. “Change is there for the taking. We hope the Government seizes it.”
Download the report at:
https://www.nao.org. uk/reports/costs-of-clinical-negligence/
CSJ
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