The annual cost of settling clinical negligence claims against the NHS in England reached £3.6 billion in 2024-25, according to the National Audit Office, more than three times the £1.1 billion recorded in 2006-07. NHS Resolution, the body that manages claims on behalf of the health service, separately reported payouts of £3.1 billion for the same year, a rise of 10.7 per cent on the £2.8 billion paid out the year before. Whichever figure is used, the trajectory is the same, and it has left the government's total liability for future claims standing at £60 billion, the second largest provision on the Treasury's balance sheet after nuclear decommissioning.
NHS Resolution received 14,428 new claims and incidents during the year, and resolved 83 per cent of them without formal legal proceedings, the highest proportion on record. That figure is often presented as evidence that the system is becoming less adversarial. It sits awkwardly beside a separate finding from the same reporting cycle: legal costs for low-value claims, those settled for £25,000 or less, were 3.7 times higher than the damages awarded to the patients involved.
The asymmetry runs deeper than individual case types. Claimant legal costs on successful claims rose from £148 million in 2006-07 to £538 million in 2024-25. NHS defence legal costs rose too, but far more slowly, from £76 million to £159 million over the same period. The gap between what lawyers recover and what patients receive has become one of the more uncomfortable features of a system built to compensate for harm.
Most of the money, in cash terms, still goes toward a small number of very large awards. Damages of £1 million or more accounted for 68 per cent of all costs in 2024-25 despite representing just 2 per cent of claims by volume, with an average award of £11.2 million. Maternity care remains the largest single contributor, accounting for £1.3 billion, 42 per cent of the total, and brain injury at birth alone accounted for £1,554 million in settled claims. NHS Resolution settles around 120 to 130 children's brain injury cases each year, but each takes an average of 11 to 12 years to resolve, since damages must cover a lifetime of care, lost earnings and adapted housing.
The Public Accounts Committee, reporting in January, was blunt about what sits behind these numbers. It found a system "overwhelmed by safety recommendations that it cannot action," with data on patient harm too fragmented to identify the underlying causes of repeated failure. Inadequate training and poor workforce planning, the committee said, had "created the conditions for clinical negligence claims to occur" in the first place. The NHS records around 2.4 million patient safety incidents a year; roughly 30 per cent result in some harm, and around 0.5 per cent, close to 12,000 events, in severe harm or death.
Reform proposals are not new. The British Medical Association has argued for a gradual shift toward a no-fault compensation model loosely based on New Zealand's system, beginning with a single specialty as a pilot before wider rollout. The government commissioned David Lock KC to review the rising legal costs of clinical negligence claims, with a report originally expected in autumn 2025. There is still no confirmed date for its publication.
Sir Geoffrey Clifton-Brown, who chairs the Public Accounts Committee, described government inaction on the issue as "unacceptable stasis" that had persisted for most of his political life, and called for movement "at pace" toward a system that is less adversarial and faster for the families involved. The figures published this year make clear why that pressure has not gone away. Every year the reform is delayed, the gap between legal cost and patient compensation widens, and the £60 billion already set aside for future claims serves as a standing reminder of how expensive inaction has become.
