Intended for healthcare professionals


Current cost of medical negligence in NHS hospitals: analysis of claims database

BMJ 2000; 320 doi: (Published 10 June 2000) Cite this as: BMJ 2000;320:1567
  1. Paul Fenn, economist (paul.fenn{at},
  2. Stephen Diacon, director of centre for risk and insurance studiesa,
  3. Alastair Gray, directorb,
  4. Ron Hodges, accountanta,
  5. Neil Rickman, economistc
  1. a University of Nottingham Business School, Nottingham NG7 2RD
  2. b Health Economics Research Centre, Department of Public Health, University of Oxford, Institute of Health Sciences, Headington, Oxford OX3 7LF
  3. c Department of Economics, University of Surrey, Guildford, Surrey GU2 5XH
  1. Correspondence to: P Fenn
  • Accepted 22 February 2000


Objectives: To identify trends in the incidence and cost of clinical negligence claims. To determine the current annual cost to the NHS as a whole in terms of cash paid out to patients and their solicitors and the defence costs incurred.

Design: Analysis of records on database.

Setting: A well defined group of hospitals within one health authority which collected information on a consistent basis over many years.

Main outcome measures: Data on individual claims. Trends in incidence of claims and costs identified independently from organisational reforms and changes in accounting practices.

Results: The rate of litigation increased from 0.46 to 0.81 closed claims per 1000 finished consultant episodes between 1990 and 1998. Overall expenditure on clinical negligence by the NHS in England in 1998 was estimated at £84 million (95% confidenceinterval £48 million to £130 million).

Conclusions: After adjustment for hospital activity, the rate of closed claims increased during the 1990s by about 7% per annum, a substantial rate of growth but not the uncontrolled explosion sometimes alluded to in the wider media. More coordinationand openness are needed in data collection.


  • Funding None.

  • Competing interests None declared.

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