Soaring NHS medical negligence bill quadruples to £60billion, with nuclear decommissioning the only larger liability on the government's balance sheet

Published: | Updated:
The NHS medical negligence bill has hit £60billion after quadrupling since 2006/7, the UK spending watchdog has revealed.
The National Audit Office said the cost is the second largest liability on the Government’s budget sheet, after nuclear decommissioning.
A rising number of claims, larger payouts and spiralling legal fees have all fuelled the rise, its report adds.
In many cases the legal fees far outweigh the compensation, meaning lawyers receive more money than the harmed patient.
£60billion is an official estimate of what would be needed to settle all NHS clinical negligence claims as of the end of March this year, including any claims not yet received for the period before then.
The NAO said legal costs for claimants on successful claims have increased ‘much more’ than those incurred by the NHS when defending itself.
Claimant legal costs increased from £148million to £538million in real terms between 2006/07 and 2024/25, representing 15 per cent of the total cost of settled claims.
NHS defence costs also increased over the same period from £76million to £159million but reduced from 7 per cent to 4 per cent of settled claim costs.
Gareth Davies, head of the NAO
The NAO report said legal costs for low-value claims now vastly exceed the damages paid to claimants.
About three-quarters of clinical negligence claims settle for £25,000 or less, but the costs of these are almost four times the total damages awarded.
In 2024/25, £143million of the £183million cost to settle low-value claims was for legal costs, while £39million (21 per cent) was for damages.
Overall, damages on very-high value cases (with awards of £1million or more) account for 68 per cent of all costs, despite only constituting 2 per cent of claims by volume.
The highest-value claims are usually for brain injury caused by poor maternity care.
Between 2006/07 and 2024/25, the total cost for obstetrics claims involving cerebral palsy or brain damage increased by over £1billion in real terms.
The report also said that, although forecasts remain uncertain, it is likely that the cost to the Government of clinical negligence ‘will continue to grow substantially’.
When looking at annual figures, the yearly cost of settling clinical negligence claims has more than tripled over the past two decades, from £1.1billion in 2006/07 to £3.6billion in 2024/25.
The report said improving how the NHS responds to complaints of harm could reduce the number of claims and the cost of clinical negligence.
The NAO said plans made by the previous government to cap the legal costs in low-value cases have not been implemented.
And it points out the Government may be paying twice in some cases - first by settling a claim, and then again when patients choose NHS or social care, despite an assumption their settlement will be used for private care.
The NAO acknowledged that NHS Resolution has worked hard to resolve claims faster and without litigation wherever possible, but said more needs to be done.
Gareth Davies, head of the NAO, reducing harm to patients is clearly the best way of containing rising costs.
‘Alongside this, DHSC should consider whether the existing approach to legal costs remains proportionate for all claims, including whether alternative methods to compensate for negligent treatment could provide better outcomes for patients, with less cost overall,’ he said.
A Department of Health and Social Care spokesperson said: ‘The broken state of the NHS has led to an unacceptable rise in the cost of clinical negligence claims – billions that should have been spent on front line services.
‘From overhauling our broken safety landscape, to grasping the serious problems in maternity care – this government is taking the decisive action patients and taxpayers deserve.
‘Our 10-year health plan makes clear that patient safety is the bedrock of a healthy NHS and we are working to ensure we reduce the incidents that lead to claims.
‘However, a large portion of these costs occur through the legal system and we have appointed legal expert David Lock KC to advise us on how we can improve the claims process for patients.’
The number of written complaints submitted to the NHS increased by 6.1 per cent last year to a record 256,777, new figures reveal.
NHS England said there were 113,780 complaints about hospital and community health services, of which a quarter were fully upheld.
There were also 142,997 complaints about primary care, such as GPs and dentistry, of which almost a third were fully upheld.
Reacting to the figures, Rebecca Curtayne, external affairs manager at patient watchdog Healthwatch England, said: ‘Fewer than one in 10 people who experienced poor care in the past year told us they made a formal NHS complaint.
'The most common reason was a lack of confidence that the NHS would take meaningful action to prevent similar issues for future patients.
'Many also feared that speaking up could negatively affect their ongoing care.
‘Even when people do make the effort to complain, they’re often met with delays and defensiveness from services – adding frustration to an already difficult experience.’
Rebecca Curtayne, external affairs manager at patient watchdog Healthwatch Englan
Daily Mail