MPs Probe NHS Response to Rising Negligence Costs

MPs have pressed NHS England and NHS Resolution on what concrete steps they are taking to tackle the rising cost of clinical negligence, warning that longstanding system failures — including poor complaints handling, maternity safety issues, and slow case progression — are driving avoidable spending.

Members of the Public Accounts Committee (PAC) said the focus must shift from describing the scale of the problem to delivering action. 

Future liabilities for clinical negligence claims are now estimated at £60 billion — a quadrupling in real terms of the 2006-2007 figure — but MPs said the more urgent issue is putting the clinical negligence bill on “a more sustainable path.”

The PAC inquiry comes as a report last month by the National Audit Office (NAO) showed that annual negligence costs had increased from £1.1 billion in 2006-2007 to £3.6 billion in 2024-2025. The NAO said that it had repeatedly warned governments about the growth, but that “so far, no government has succeeded in controlling the cost.”

PAC committee chair Sir Geoffrey Clifton-Brown said the £60 billion set aside for future liabilities was “astounding.” Current spending equates to “£350,000 pounds per hour, every single hour, 24 hours a day in the NHS,” he said. Costs are forecast to reach £4.1 billion within 5 years. 

Negligent Maternity Care Drives Record Claims Costs

NHS Resolution CEO Helen Vernon told MPs that claims of £1 million or more, which relate to the most seriously harmed individuals, were the major contributor. These are often brain injuries suffered in maternity care, involving around 120-130 children every year. 

“Those harmed children require care costs for their lifetime, going on for decades,” she said. This covers aids and equipment, accommodation and adaptations, and support for the family. Court rulings on access to innovative or novel treatments have also driven rising costs, she explained.

Clifton-Brown asked what new measures would be taken to halt cost escalation, noting that “we know all the drivers.”

Vernon said that that preventing avoidable harm remains the most important lever for reducing long-term costs. Learning gained from settled claims feeds back into the NHS, and the organisation is exploring the use of technology to mine its large dataset on causes of harm going back 30 years, she noted.

Legal Costs and Delays Add Pressure

Vernon said that the organisation now keeps 83% of cases out of court, noting that litigation drives up costs.

However, the NAO found that many patients pursue action to seek answers because the complaints system is confusing and slow to respond.

Dr Aidan Fowler, national director of patient safety at NHS England, said about half of litigants had used the complaints system first. “That of course means that half have not,” he said. People must be treated well locally, he added, so they are “not frustrated” into pursuing legal action.

MPs on the committee noted that legal costs make up 15% of total settled claim costs. Claimant legal fees had increased to a little over half a billion pounds in 2024-2025, up from £148 million in 2006-2007.

Claimant Costs ‘Inevitable,’ Lawyers Say

Suzanne Trask, executive committee member at the Association of Personal Injury Lawyers, said claimant costs will “always be higher than the NHS’s legal costs” because patients must prove their case from scratch, while the NHS holds key information. 

Average waiting time between notification and settlement has risen by 51% over the past decade. Longer cases increase costs. “Many of these delays are within the NHS Resolution’s power to resolve,” Trask said.

She added: “Legal costs are an inevitable consequence of ensuring injured victims of clinical negligence have access to justice.”

Private Care Costs Inflate Damages

During the session on 20 November, the committee also examined the use of private care costs in damages awards. Vernon said this reflects the legal requirement to place claimants in the position they would have been in had they not been injured. About 60% of very high-value settlements relate to future private care.

Conservative MP Dr Neil Shastri-Hurst, a doctor, barrister, and former member of Action Against Medical Accidents, said it seemed “somewhat perverse” that claimants could receive sums based on private care while still receiving NHS treatment. That is, in effect, “getting a double reward.” 

Vernon noted that other countries use caps or base compensation on top-ups to state care and suggested the UK could examine similar models.

‘Every Pound Is Because of Avoidable Harm’ 

Trask said most costs relate to essential social care for children with life-long catastrophic birth injuries — costs she described as “innately expensive.” She urged policymakers not to “focus on the wrong targets” when addressing rising clinical negligence spending.

“Every pound spent is because of avoidable harm and suffering,” she said. Reducing damages “would force injured people to return for their treatment and care to the same, already overstretched, NHS that caused them harm in the first place.”