Committee publication · Report · 30 January 2026 · HC 1234
64th Report - Costs of clinical negligence
From: Public Accounts Committee
Inquiry: Costs of clinical negligence
Government response deadline: 30 March 2026
Summary
The Public Accounts Committee reports that clinical negligence costs in England have quadrupled since 2006–07 to £60 billion, with annual settlement costs reaching £3.6 billion in 2024–25. Despite repeated warnings from predecessor committees and the current committee, the Department of Health and Social Care has taken no meaningful action to address rising costs. The report identifies maternity care failures, disproportionate legal costs in low-value cases, outdated legislation assuming private care provision, and insufficient data-driven learning as primary drivers of unsustainable expenditure.
Key findings
- Clinical negligence liability has reached £60 billion in 2024–25, with annual settlement costs forecast to exceed £4 billion by 2029–30, driven largely by high-value maternity claims averaging £11.2 million per case.
- The Department has failed to commit to meaningful action pending completion of David Lock KC's review of clinical negligence policy, with no expected completion date provided.
- Legal costs are disproportionately high: claimant legal fees totalled £538 million in 2024–25 (19% of settled costs), and low-value claims (under £25,000) show a 3.7:1 ratio of legal costs to damages awarded.
- Outdated 1948 legislation mandates damages be calculated on the presumption of private sector care provision, potentially causing double-payment where claimants later access NHS services; no data exists on the true extent of this.
- NHS England and the Department lack a coordinated patient safety system, comprehensive data analysis of harm causes, and adequate complaints mechanisms, contributing to litigation that could otherwise be avoided through early resolution and transparency.
Recommendations
- Department must submit an operational plan for tackling clinical negligence with key milestones for cost and volume reduction, and publish David Lock KC's review within six months of completion alongside the Department's response.
- Department must establish a national patient safety framework with clear annual improvement targets, review the NHS complaints system to improve resolution without litigation, and track costs of treating avoidable harm.
- Department should establish a national system for sharing anonymised data between trusts to identify trends and early warning signals, and explore artificial intelligence for analysing live data and detecting outliers.
- Department and NHS England must publish the Amos Review within two months and set out systemic failures in maternity care and plans to reduce harm and claim costs.
- Department should develop alternative dispute mechanisms (examining non-adversarial models from New Zealand and Sweden) and clarify its position on fixed recoverable costs for lower-value clinical negligence cases.
- Within six months, Department should estimate the impact of assuming private sector care provision for clinical negligence victims and propose legislative measures to prevent double-payment, with implementation timeline.
Tone
CriticalTopics
Key actors
Department of Health and Social Care, NHS England, NHS Resolution, Public Accounts Committee, David Lock KC, Sir Geoffrey Clifton-Brown, Comptroller and Auditor General
Notable line
“The Department has failed to tackle the rising costs of clinical negligence despite repeated warnings. The government's liability for clinical negligence has quadrupled in real terms since 2006–07, reaching £60 billion in 2024–25.”
Key Quotes
“The rising cost of clinical negligence in England continues to divert vital resources away from our frontline health services.”
“… it is unacceptable that so much taxpayers' money continues to be spent on legal fees. NHS Resolution has worked hard to increase the number of claims resolved without litigation”
“… we are extremely concerned that low-value clinical negligence claims (damages of £25,000 or less) cost far more in legal fees than victims receive in damages, with a 3.7:1 cost-to-damages ratio.”
“… the Department could not provide us with any reassurance as to the meaningful action it has taken to address the fundamental issues of clinical negligence.”
“It is not clear the extent to which the taxpayer is paying twice for clinical negligence – once through compensation for injury 7 and then again by providing subsequent health and social care.”
“Preventing harm from happening in the first place is clearly the most effective way to protect patients and reduce the widespread impacts of clinical negligence.”
Source · parliament.uk record ↗