Background to the report

Clinical negligence is a breach of a legal duty of care which directly caused harm to the patient. If clinical negligence has occurred, a patient or their representative may claim for damages against the clinicians or their employers. NHS services are legally liable for any clinical negligence and must pay compensation to the claimant and cover their legal fees if the claim is proven. The vast majority of patient safety incidents are not associated with a clinical negligence claim.

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NHS Resolution (NHSR) is responsible for administering seven clinical negligence indemnity schemes for general practice and secondary healthcare services in England. Members of NHSR’s indemnity schemes include NHS trusts, foundation trusts and general practitioners. Private contractors, such as dental practitioners, are generally legally liable for their own clinical negligence claims. The Department of Health & Social Care (DHSC) oversees NHSR and develops policy to manage the costs of clinical negligence cases.

We last reported on the cost of clinical negligence in our 2017 report, Managing the costs of clinical negligence in trusts. We concluded that clinical negligence costs in trusts were significant and rising fast. While DHSC had proposed measures to reduce existing costs at the time, these were small and incremental compared with predicted rises in liabilities. In May 2025, the Committee of Public Accounts concluded that it was unacceptable that DHSC had yet to develop a plan to deal with the cost of clinical negligence claims.

Scope of the report

With the cost of clinical negligence continuing to rise, and in response to PAC’s concerns, this investigation sets out:

  • long-term changes in the government’s liability for clinical negligence and the amounts needed to settle claims (Part One);
  • the drivers of claims volume and costs (Part Two); and
  • the factors that could affect the future cost of clinical negligence, including systemic pressures (Part Three).

This report only considers the cost of clinical negligence in England. We have not set out to evaluate the performance of the public bodies involved, nor reviewed NHS patient safety, which is the subject of other inquiries and reviews. We consider only the compensation schemes administered by NHSR, and not those administered separately, such as compensation for infected blood. The figures in this report are presented in 2024-25 values (referred to as real terms) unless otherwise stated.

Conclusions

We have reported several times over consecutive decades that the costs of clinical negligence are increasing but so far, no government has succeeded in controlling the cost. Even though recent claim numbers have plateaued in many areas the cost of claims has continued to increase, particularly for very high-value cases (£1 million or more).

Although rising damages have been a key driver of cost increases, little is known about the extent to which the government may be paying twice by providing care for claimants who have already received compensation.

Over the last 10 years, NHSR has worked hard to reduce the financial and emotional cost of clinical negligence by resolving claims faster and without litigation wherever possible. Although these efforts have been well received by the legal sector, claimant legal costs continue to rise with legal costs for low value claims (£25,000 or less) greatly exceeding the level of damages.

There is also a lack of transparency around claimant compensation being used to settle additional legal fees and how far this may inflate claim costs. While measures across these areas might reduce the rate at which costs increase, by far the most important issue is reducing the incidence of clinical negligence and the harm caused to patients.

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Publication details

Press release

View press release (17 Oct 2025)

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