Government and NHS Fail to Curb Negligence Costs

cross-party parliamentary watchdog has warned that spiralling legal costs and systemic failures in how patient harm is addressed are compounding the NHS’s clinical negligence crisis. It urged the government to set out concrete plans — with deadlines — to tackle these problems. 

In a new report, the House of Commons Public Accounts Committee (PAC) said the Department of Health and Social Care (DHSC) could not demonstrate that it had taken “any meaningful action” to address clinical negligence, despite warnings spanning more than 20 years. The NHS, it added, had “not done enough to tackle the underlying causes of patient harm.”

The committee said government liability for clinical negligence had quadrupled over two decades, reaching £60 billion in 2024-2025, but that repeated reviews and commitments to improve patient safety had failed to translate into sustained change.

It builds on findings from the National Audit Office, which showed annual negligence settlement costs rose to £3.6 billion in 2024-2025, up from £2.6 billion in 2022-2023 and £1.1 billion in 2006-2007. By July last year, NHS Resolution had set aside £60 billion for future claims.

Avoidable Harms From Obstetric Care

The PAC said forecasts suggested the cost of clinical negligence would “continue to rise significantly in coming years”, driven mainly by rising damages rather than an increase in the number of claims.

A small number of very high-value obstetrics cases accounted for the bulk of costs. These represented 2% of claims by volume but 68% of total damages paid in 2024-2025, with an average award of £11.2 million per claim.

The committee said the DHSC’s failure to address problems in maternity care had resulted in “avoidable harm.” Evidence from the Royal College of Obstetricians and Gynaecologists showed that maternity services were “struggling” to cope with increasingly complex care, with interventions such as caesarean section or forceps delivery now used in more than half of all births.

Inadequate training, poor workforce planning, and failures to meet staffing requirements had “created the conditions for clinical negligence claims to occur,” the PAC said.

Paediatric Damages Must Cover Lifelong Care

In 2024-2025, claims involving brain injury at birth accounted for £1554 million, while settled claims involving paediatric failings reached £325 million.

NHS Resolution settles around 120-130 children’s brain injury cases each year, but each case takes an average of 11-12 years to resolve.

Damages in these cases are typically higher than for other clinical negligence claims because they cover lifelong health and social care, future loss of earnings, and adaptations to housing. Court rulings on eligibility for innovative or novel treatments had also increased the value of awards in recent years.

System Overwhelmed by Safety Recommendations it Cannot Action

The NHS estimates that around 30% of the 2.4 million patient safety incidents reported each year result in some harm, while 0.5% — around 12,000 events — lead to severe harm or death.

However, the PAC said the evidence pointed to “a system overwhelmed by safety recommendations that it cannot action.” While NHS England collects extensive data on patient harm, the report said its “fragmented nature does not amount to good information which could identify and address clinical negligence’s underlying causes.”

The committee said similar concerns had been raised by its predecessor bodies in reports published in 2002 and 2017, and again in its own reviews of DHSC accounts in 2024 and 2025.

“Despite these repeated warnings, the department cannot provide reassurance that it has taken any meaningful action to address clinical negligence to date,” the report concluded.

The PAC said the DHSC had not committed to any new improvement activity until the completion of an ongoing review of clinical negligence by David Lock KC.

Dr Pallavi Bradshaw, medical director at Medical Protection Society, said the committee was right to highlight the “eye-watering cost” of clinical negligence claims, the “staggering” sums spent on legal fees, and the failure of successive governments to act.

The government “simply cannot afford to do nothing,” she said.

A comprehensive strategy was urgently needed following the Lock review to balance “fair compensation for patients and affordability for the NHS.”

Legal Costs More Than Triple Damages

PAC Chair Sir Geoffrey Clifton-Brown said clinical negligence was now the second-largest financial liability across government, diverting resources away from frontline care.

“Patients often pursue such costly legal action due to the lack of a complaints system worthy of the name,” Clifton-Brown said. “Disgracefully, for lower-value claims, the legal costs can be over 3.5 times what victims can expect to receive in damages.”

Bradshaw said reform must also address “disproportionate legal fees in lower-value claims,” as well as long-standing flaws in how damages are calculated. She highlighted legislation dating back more than 80 years, under which compensation is based on the cost of private care rather than NHS provision.

Clifton-Brown said government had been in “unacceptable stasis” on clinical negligence for most of his political life, as claim numbers and costs had continued to rise. Ministers must move “at pace” towards a less adversarial system that reduced costs and delivered faster settlements for families, he said.

“This is a swelling accounting of profound suffering,” Sir Geoffrey said. “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.”