Views & Reviews Personal View

Rising litigation does not mean falling standards

BMJ 2012; 345 doi: (Published 28 August 2012) Cite this as: BMJ 2012;345:e5760
  1. Paul Nisselle, senior consultant, Educational Services, Medical Protection Society, 33 Cavendish Square, London W1G 0PS, UK
  1. paul.nisselle{at}

The number of claims for compensation reported to the UK NHS Litigation Authority increased from 5426 in 2006-7 to 8665 in 2010-1, an astonishing increase of more than 60%.1 Complaints in the United Kingdom and elsewhere have also risen. What’s happened? Have standards of care fallen as a result, in part, of resource rationing? Have first world consumers simply become more assertive? Are rapacious lawyers creating an expanding litigation market?

Well, perhaps none of these conjectures are correct.

A recent review article in the New England Journal of Medicine said, “Health care’s share of the GDP [gross domestic product] quadrupled from 4.6% in 1950 to more than 17% in 2009; in most peer countries, the share is 9 to 11%.”2 The article also notes an expansion in health insurance; more federal government funding; fewer hospital inpatients; more outpatient services; a rise in female, specialist, and hospital based doctors; and the 6000 drugs and 4000 procedures that clinicians now have in their armoury.

These …

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