A lack of ‘any meaningful action’ on clinical negligence has allowed its cost to the government to soar to £3.6 billion, according to a new report by the Public Accounts Committee (PAC).
Released today (30 January), the report criticises the Department of Health and Social Care (DHSC) and NHS England for failure to act on 24 years of warnings. This is despite four PAC reports on the rising impact of clinical negligence which have been released since 2002.
The report estimated that the government’s liability for clinical negligence has quadrupled in real terms since 2006/7.
The PAC called for the following measures to be implemented within two months of the report’s release:
- A national system for sharing data between NHS trusts
- An operational plan from the government to tackle clinical negligence
- A national framework for improving patient safety with clear annual improvement targets.
‘Profound suffering’
PAC chair Sir Geoffrey Clifton-Brown 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.’
He concluded: ‘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.’
Key dental organisations shared their thoughts on the report below.
Thomas Reynolds, director of policy and communications at the Medical Defence Union (MDU)
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.
Secondly, capping legal fees for lower value clinical negligence cases can’t come soon enough to control spiralling claimant legal fees. We urge the government to get on with it and finally introduce fixed recoverable costs for lower value claims, which has been continuously delayed since the change of government in 2024.
‘Decades of inaction on clinical negligence’
We join the Public Accounts Committee (PAC) in calling for publication of the long-awaited Lock review into the current clinical negligence regime. This review was commissioned as part of the NHS Year 10 Year Plan and is intended to outline to ministers how to fix the broken system. Given the public interest in this issue, that review’s findings and recommendations must see the light of day as quickly as possible. This is all about transparency.
Decades of inaction on clinical negligence have allowed costs to balloon, so we are pleased to see that MPs are putting pressure on government to act. This is a chance to put an end to the millions of pounds being unnecessarily diverted from frontline patient care. We‘ll be following next steps closely to ensure the Government sticks to the timetable that’s been set out and finally shifts the dial on this issue.
Chris Kenny, chief executive at Medical & Dental Defence Union of Scotland (MDDUS)
This report underlines the urgent need for the government to tackle the scale of clinical negligence costs in England and Wales. We welcome the Public Accounts Committee’s call for faster action, including the rapid publication of the Lock review, which we understand has been with ministers for several weeks and, crucially, a specific and deliverable action plan.
That plan needs to be as focused on improving patient safety as it is on driving excessive costs and unfounded claims out of the system. Without progress in both these areas, costs will continue to rise for the NHS without delivering better outcomes for patients or healthcare professionals.
It’s vital that the Government begins with clear legislative reform, including repeal of Section 2(4) of the Law Reform (Personal Injuries) Act 1948 and the introduction of a Fixed Recoverable Costs regime.
We’re now approaching 10 years since a Fixed Recoverable Costs regime was first proposed. At a minimum, the £25,000 threshold should be raised for inflation over that period, with an automatic inflation ratchet built in to control these rising costs. As the report shows, claims with damages of £25,000 or less in 2024-25 cost far more in fees than victims received.
Without decisive action from the government now, the clinical negligence system will remain unsustainable for everyone it’s meant to protect.
Raj Rattan, dental director at Dental Protection
The Public Accounts Committee report provides yet more evidence about the need to tackle the rising cost of clinical negligence claims.
A particular concern in dentistry is the impact of high legal costs. Dental claims usually involve much lower compensation payments than those made against the NHS or doctors in private practice, yet the associated legal fees can be disproportionately high – often exceeding the compensation patients receive.
In our submission to the Public Accounts Committee, we argued that the government should take a two-step approach. It should without delay implement the long-awaited policy on Fixed Recoverable Costs for claims valued up to £25,000. It should then take a phased expansion of this regime to encompass claims valued up to £100,000.
While the Public Accounts Committee’s role is to scrutinise government spending – in this case, the cost of claims against NHS trusts and GP practices – we were keen to ensure it also heard about the impact of claims on dentists. We hope its strongly worded report will now prompt the government to act.
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