By Sammy Jones-
Successive governments have been warned that clinical negligence represents one of the gravest threats to patient safety and the long-term sustainability of the National Health Service. Those warnings, repeatedly issued by parliamentary committees, regulators and medical professionals, have largely gone unheeded.
According to a January 2026 report from Parliament’s Public Accounts Committee, the Department of Health and Social Care “cannot provide reassurance that it has taken any meaningful action to address clinical negligence to date,” and the NHS “has not done enough to tackle the underlying causes of harm to patients,” despite rising liabilities of £60 billion and annual settlement costs of £3.6 billion.
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The committee’s findings expose a health system trapped in a cycle of preventable error, reactive compensation and institutional inertia. According to the PAC, the total liability for clinical negligence has now reached approximately £60 billion, having quadrupled over the past 20 years.
This makes it one of the largest obligations on the government’s balance sheet, surpassed only by nuclear decommissioning. The full findings are available on the UK Parliament website, which details how annual spending on settling claims has risen to £3.6 billion, drawing resources away from patient care and frontline services.
Sir Geoffrey Clifton-Brown, chair of the PAC, described the situation as a “swelling accounting of profound suffering,” arguing that the government’s inability to translate warnings into reform has left patients exposed to repeated harm.
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He stressed that the scale of negligence claims reflects not an increase in frivolous litigation, but a failure to prevent avoidable injury within the health system itself.
His comments underline a central theme of the report: that clinical negligence is not an unfortunate by-product of modern medicine, but a symptom of deeper structural and cultural failings.
The PAC’s criticism is particularly striking because it is not new. Similar recommendations were made as early as 2002, yet the committee found no evidence that the Department of Health and Social Care has implemented a coordinated national strategy to reduce patient harm.
Instead, responsibility for patient safety has been fragmented across multiple bodies, with no clear accountability for outcomes. The result, MPs argue, is a system that repeatedly identifies problems but fails to fix them.
The financial consequences of this failure are severe, but the PAC is clear that the figures tell only part of the story. Behind every negligence claim lies a patient who has suffered harm that could, in many cases, have been prevented.
The report highlights how legal costs alone have ballooned, with claimant legal fees rising from the equivalent of £148 million in 2006–07 to more than £538 million in 2024–25. Legal analysts writing in Legal Futures have described these costs as “unacceptable,” particularly in lower-value cases where fees often exceed the compensation awarded.
MPs argue that this pattern reflects a system focused on managing the consequences of harm rather than preventing it. They point out that every pound spent on litigation is a pound not spent on staff, equipment or patient care.
Despite this, the PAC found that the government has delayed decisive action, citing an ongoing review into negligence costs with no clear timetable for completion. This, the committee warned, risks perpetuating a status quo that benefits no one except legal processes.
The report also exposes deep flaws in how the NHS collects and uses patient safety data. Although trusts record vast quantities of information on adverse incidents, near misses and complaints, the PAC concluded that this data is not effectively shared or analysed at a national level.
With a result, the same mistakes recur across different hospitals, sometimes with devastating consequences. The committee described this as a failure to “learn lessons at scale,” a criticism that has been echoed repeatedly by healthcare watchdogs.
Maternity and neonatal care stand out as areas of particular concern. Birth-related injuries account for a disproportionately large share of negligence costs, with settled paediatric claims reaching £325 million in a single year. Many of these cases involve children who will require lifelong care due to brain injuries sustained during birth.
The PAC urged the government to publish and act on the long-awaited Amos Review into maternity services, warning that continued delays risk further tragedy.
Medical professionals have added their voices to these concerns. The British Medical Association has published testimony from doctors describing serious patient safety risks linked to staffing shortages, workload pressures and blurred lines of clinical responsibility.
In particular, the BMA has warned that the rapid expansion of physician associates and anaesthesia associates, without adequate regulation or supervision, may be increasing the risk of error rather than reducing it. The association has called for urgent interim safeguards while wider workforce reforms are developed.
The human cost of negligence is perhaps most clearly illustrated in the stories of families affected by systemic failures. Investigations into underperforming maternity units have revealed repeated patterns of ignored warnings, poor communication and defensive institutional cultures.
A recent report from Wales detailed harrowing accounts from parents whose babies were harmed or died due to failures in care, reinforcing the PAC’s conclusion that negligence is not an abstract policy issue but a lived reality for thousands of families.
Editorial voices have increasingly argued that the current approach to negligence is fundamentally flawed. Writing in The Independent, commentators have warned that focusing on compensation without addressing root causes merely treats the symptoms of a broken system.
In response to its findings, the PAC has issued a set of clear and time-limited recommendations. These include the creation of a national patient safety framework with measurable annual targets, a robust system for sharing safety data between trusts, and a published operational plan for reducing negligence. The committee has given the government just two months to respond, signalling that patience has run out.
The government has acknowledged the report but has yet to outline specific measures it will take. Health policy experts warn that further delay risks entrenching a culture of complacency, where harm is accepted as inevitable rather than preventable.
They argue that meaningful reform will require political will, sustained investment and a willingness to confront uncomfortable truths about how the NHS operates.
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