The public accounts committee’s review into clinical negligence: a claimant solicitor’s perspective

The House of Commons’ Committee of Public Accounts (PAC) published its Review into the costs of clinical negligence on 30 January 2026. Much has since been written about the Review because it is rightly critical of the government’s lack of action in addressing the issue of clinical negligence. Recommendations include establishing a clear operational plan, reforming the NHS complaints system, tracking the cost of tackling avoidable harm, improving data sharing and analysis, introducing a mechanism for resolving low value claims and urgent clarification of the position on fixed recoverable costs.

From a Claimant solicitor’s perspective, though, I think it is something of a mixed bag.

The opening statement in the Summary at the beginning starts with: “The rising cost of clinical negligence in England continues to divert vital resources away from our frontline health services”. This is no doubt a correct statement but it seems rather one-sided. It might have been appropriate early on to spare a thought for the poor victims of the medical accidents to whom a large proportion of these ‘rising costs’ are paid to compensate them for their avoidable injuries, injuries that will have profoundly affected many of their lives. The fact that the impact of harm on patients is not mentioned until late on in the Summary perhaps belies the focus the PAC has on the issue.

With respect to these ‘rising costs’, the Summary further states that, “Settlement costs for clinical negligence have tripled since 2006-07 and the government has a staggering £60 billion of liabilities on the balance sheet”. It repeats this figure of £60 billion on a number of occasions throughout the Review. The use of the word “staggering” seems unnecessarily hyperbolic. Use of the £60 billion figure is also rather misleading and needs to be qualified and properly contextualised. As all who work in the field know, the figure is not the actual cost of clinical negligence. This is because it represents the estimated costs of all claims that have been notified to NHS Resolution (NHSR), which includes all potential claims that NHSR anticipates will be reported in the future. As NHSR readily accepts in its own formal Accounts, the figure represents only the “provision” that NHSR estimates for future potential claims, with NHSR describing it as “... the value of liabilities arising from incidents that occurred before 31 March 2025, both in relation to claims received and our estimate of claims that we are likely to receive in the future but have yet to be reported as claims (incurred but not reported, IBNR)” [my emphasis].

Further, not only is this figure merely an estimate but many, if not most, of these potential claims will be abandoned and will never proceed to the payment of compensation. The figure that should be quoted and relied upon is the actual cost of clinical negligence, taking into account compensatory damages and legal costs. As the PAC Review report notes, this actual annual cost of clinical negligence claims was £3.6 billion in 2024-25, a far cry from the £60 billion “provision”. Whilst I recognise that this is nevertheless still not a small figure, it is less than 2% of the NHS’s annual budget and less than the NHS’s annual IT spend. In fact, would this be less than the cost of insurance for such claims: if such insurance was possible, of course? I understand that the use by the PAC Review report of the figure of £60 billion was to emphasise the potentially high level of costs that government needs to address, but nevertheless it remains an unnecessarily misleading figure.

The Summary then identifies two particular factors that the PAC considers are responsible for these rising clinical negligence costs.

First, it asserts that legal costs are disproportionate to the compensatory damages in “far too many cases”, particularly those where the value is less than £25,000 and where legal costs will often significantly exceed the value of the claim. Of course, the perennially delayed introduction of fixed recoverable costs in low value clinical negligence claims has been a material factor in this. Whilst I acknowledge that there needs to be a mechanism to manage low value clinical negligence claims appropriately, it also needs to be recognised that value does not equate to complexity and it is important to ensure claimants in low value claims are not deprived of either access to justice or proper recompense.

Secondly, the PAC criticises the principle that claimants can recover compensation for the costs of future care and treatment on a privately paying basis when they may, in fact, nevertheless then subsequently use NHS provision, thereby obtaining a windfall or ‘double recovery’. However, in my view, this argument has flaws. First, the PAC Review recognises that there is no data to support the concern that claimants are using state provision having recovered compensation for private provision, albeit NHSR apparently asserts it is a major contributory factor. Secondly, a claimant can be required to undertake to the Court that they will not avail themselves of NHS provision to avoid double recovery. The fact that such undertakings are rare is a question that should be asked of NHSR’s legal strategy. Thirdly, the Review fails to recognise that the purpose of monetary compensation is to place the injured claimant back in the position they would have been in but for the negligence, insofar as financial recompense is able to do so. The reality is that in many cases the NHS is unable to provide the future care and/or treatment at all – or there are manifestly unreasonable delays in it being able to do so even when the care/treatment is available – such that the claimant has little option but to use private provision; claiming for the cost of that provision would obviously then be justifiable. Until genuine data is provided that demonstrates that claimants are, as a fact, significantly benefiting from this ‘double recovery,’ the argument should really be just academic.

The Summary praises NHS Resolution (NHSR) for demonstrating “the range of steps it has taken so far, such as resolving more claims than ever without costly Court proceedings”. However, it perhaps surprisingly fails to mention the inordinate delays that NHSR and its panel solicitors frequently oversee in many claims, and at varying stages of a claim including during the investigation, court proceedings and settlement. I speak to this from a position of having experienced it in many – if not most – of my own cases. Such delays are a genuine issue, as they not only significantly contribute to the increased costs of claims but they often antagonise the injured claimant, enhancing ill-feeling and further polarising the parties, reducing the prospect of early settlement, increasing costs. Whilst praising NHSR, the Summary does go on to point out that the issue of clinical negligence costs has been examined by the PAC many times but, nevertheless, the Department of Health and Social Care (DHSC) and NHS England “… have so far failed to take any meaningful steps to tackling the rising costs”. This is a correct statement and the PAC is rightly critical of the DHSC for failing to take meaningful action to address clinical negligence to date and for its failure to address disproportionate low value clinical negligence claims.

Notwithstanding the points raised regarding how best to reduce costs by reducing compensation and legal fees, in the last paragraph in the Summary the Review – eventually – acknowledges the more fundamental point that “Preventing harm from happening in the first place is clearly the most effective was to protect patients and reduce the widespread impacts of clinical negligence”.

The body of the Review notes that there are c.2.4 million patient safety incidents in the NHS annually and, whilst 70% of those fortunately cause no harm, 0.5% of those cause serious injury or death: this is a figure of about 12,000 patients per annum. NHSR’s own data shows that the number of reported claims and incidents continues to rise year-on-year, to 14,428 in 2024/25, a rise of nearly 4.7% on the previous year. However, the PAC Review notes that there is an absence of data on the reasons for patient harm and the underlying causes for clinical negligence claims, despite the NHS’s very extensive data collection. It notes that the NHS has a “plethora of data and no information”. The PAC is rightly also critical of the DHSC and NHS England for a lack of coordination in patient safety, recognising that patients pursue legal action to obtain answers and accountability, which the complaints process is ill-equipped to do. The Review further rightly highlights the need for timely apologies and explanations, which it asserts could reduce claims. It notes that the NHS is “drowning in recommendations” on patient safety.

It goes without saying that patient safety and reducing harm caused by clinical negligence will reduce claims made and, in turn, this will reduce costs. I find it odd that it is not until the last paragraph in the Summary that the most important way of reducing the clinical negligence ‘bill’ is referenced by the PAC Review. This is in truth the only meaningful way of reducing clinical negligence costs, which the Review tacitly seems to accept. Without wanting to bang a very tired and rather worn out drum, the point that ‘prevention is better than cure’ has been one that claimant stakeholders have been making for all of the nearly 30 years that I have been working in this field; and yet, in reality, little truly of note has changed when it comes to attempts to reduce the number of adverse medical incidents.

As said at the beginning, from my perspective the PAC Review is a mixed bag.

I welcome criticism of the government for its lack of action in addressing patient safety and reducing harm caused by adverse medical incidents, but prevention should be the primary topic of conversation, not clever legal ways to reduce the value of compensation once an accident has occurred. I do not welcome attempts to divert needed compensation away from deserving claimants, nor do I welcome the failure to recognise delays created by the NHS and/or its lawyers to the swift resolution of claims, which increases costs on both sides of the fence.

Maternity-related claims are, of course, a key area, representing 42% of NHSR’s total clinical negligence payment outlay, and rightly there should be focus on preventing these specific incidents, but there are many other areas that need consideration and investigation, too. Sepsis is a prime example. I see the same types of errors being made over and over again. This suggests both culture and education are material factors in relation to why medical accidents and harm continue to occur. There are many other factors. Ultimately, there needs to be a far better understanding of the ‘why’, so appropriate steps can be taken to prevention.

It is right that the cost of clinical negligence claims diverts funds away from care, but claimants with good claims should not suffer because of government’s recognised longstanding failures in addressing the root causes of such claims and in increasing patient safety; as has always been the case, whilst the incidence of adverse medical accidents and resulting claims continues to rise, the prevention of harm in the first place still has to be the issue of paramount importance. The Review is a reasonably helpful step forward but, in my personal view, there nevertheless needed to be a greater emphasis and focus on patient safety, the prevention of medical accidents and resulting harm, and the importance of the response to adverse incidents when they do occur: for me, these are the things that really matter.