Negligence settlements in England increase sevenfold in five years

BMJ 2002; 324 doi: (Published 15 June 2002) Cite this as: BMJ 2002;324:1411
  1. Susan Mayor
  1. London

    The total annual cost to the NHS of settling clinical negligence claims rose sevenfold between 1995 and 2000, warned a report from the Public Accounts Committee published this week.

    The report estimated that the cost at 31 March 2000 of providing for up to 23000 outstanding claims was £2.6bn ($3.8bn; €4bn). A further £1.3m was thought to be required to meet settlements for claims expected to arise from incidents that have occurred but have not yet been reported.

    The inefficiency of the system was clear from the fact that legal and other costs of settling claims below £50000 exceeded damages awarded in 65% of settlements.

    Edward Leigh, MP, chairman of the Committee of Public Accounts, warned: “The present system for dealing with claims against the NHS is inefficient and astronomically expensive. Patients suffer delay and an almost systematic lack of compassion. Often they are effectively cornered into pursuing litigation, and in many smaller value cases the legal costs outweigh compensation. Patients and the taxpayer are crying out for a more intelligent approach.”

    The committee proposed that alternative ways of handling claims for less than £50000 should be explored, to speed them up and cut costs. They suggested developing the equivalent of a small claims court, based on fixed fees and a guaranteed timetable. They also asked the Department of Health to explore ways of improving the initial handling of patients' complaints, with the aim of reducing the need for subsequent legal action.

    The recommendations were made in the face of a growing number of claims, with about 10000 new claims made in 1999-2000. Cases of cerebral palsy and brain damaged babies accounted for 80% of outstanding claims by value and 26% of claims by number. The Public Accounts Committee said a need remained to reduce the incidence of negligence in the first place.

    Initiatives are under way, but the report found that by March 2000, almost a quarter of NHS trusts had not achieved the basic risk management standards set by the clinical negligence scheme for trusts.


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