Total NHS liabilities for medical negligence hit £60 billion
The NHS’s total liability for medical negligence has reached £60bn, the National Audit Office (NAO) has said.
This amount was associated with the increasing number of claims, more payouts per claim and ever-increasing legal fees.
The estimated fee is the total amount required to resolve all NHS clinical negligence claims as of the end of March this year; This includes requests not yet received for the period prior to that date.
According to the NAO, clinical negligence is the second largest liability on the government balance sheet after nuclear weapons decommissioning, and the figure is now four times what it was in 2006-07.
The NAO has raised the added legal costs for claimants following successful claims to be “far greater” than the costs the NHS incurs defending itself.
Claimant legal costs rise from £148 million (in real terms) in 2006-07 to £538 million in 2024-25; this represents 15 percent of the total cost of resolved claims.
Meanwhile, NHS defense costs have also risen from £76 million (in real terms) in 2006-07 to £159 million in 2024-25, but have fallen from 7 per cent to 4 per cent of claims costs paid over the same period.
The NAO report noted that legal costs for low-value claims now greatly exceed compensation paid to claimants.
Nearly three-quarters of clinical negligence claims result in £25,000 or less, but their cost is almost four times the total compensation awarded.
In 2024-25, of the £183 million costs of resolving low value claims, £143 million was towards legal costs and £39 million (21%) was towards damages.
Looking at settled claims, the report noted that the largest percentage increases were seen in mental health and radiology.
Meanwhile, obstetric cases involving cerebral palsy or brain injury (£599 million) and paediatrics (£137 million) saw the biggest increase in annual fixed costs.
Overall, damages in very high value cases (cases requiring compensation of £1 million or more) accounted for 68 per cent of all costs, despite accounting for only 2 per cent of claims by volume.
The highest value claims often relate to brain damage caused by inadequate maternity care.
Between 2006-07 and 2024-25, the total cost of obstetrics claims for cerebral palsy or brain injury has increased by over £1bn in real terms.
The report also said the cost of clinical negligence to government was likely to “continue to increase significantly”, although estimates remain uncertain.
Looking at annual figures, we see that the annual cost of resolving clinical negligence claims has more than tripled over the last two decades, from £1.1bn in 2006-07 to £3.6bn in 2024-25.
Improving the NHS’s response to complaints of harm could reduce the number of claims and the cost of clinical negligence, the report said.
“Stakeholders have expressed concerns about how well individual healthcare providers are enforcing the duty of candor, the legal obligation of honesty and transparency when care goes wrong,” the statement said.
The NAO also said the previous government’s plans to limit legal costs in low-value cases had not been implemented.
It also highlights how the government can pay twice in some cases: first by settling a claim, and then when patients choose the NHS or social care despite the assumption that their payments will be used for private care.
The NAO acknowledged that NHS Solution was working hard to resolve claims more quickly and without litigation wherever possible, but said more needed to be done.
NAO chief executive Gareth Davies said reducing harm to patients was the best way to contain rising costs.
“Alongside this, the DHSC should consider whether the current approach to legal costs remains proportionate for all claims, including whether alternative methods of compensating for negligent treatment could provide better outcomes for patients at less cost overall,” he said.
A Department of Health and Social Care spokesman said: “There has been an unacceptable increase in the cost of clinical negligence claims – billions of dollars that should be spent on frontline services.
“From overhauling our broken security environment to solving serious problems in maternity care, this government is tackling this problem and taking the decisive action that patients and taxpayers deserve.
“Our 10-year health plan makes clear that patient safety is the foundation of a healthy NHS and we are working to reduce incidents that lead to claims.
“However, the majority of these costs are incurred through the legal system and we have appointed legal expert David Lock KC to advise us on how we can meet rising legal costs and improve the claims process for patients.”
