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Clinical negligence costs: the (almost hidden) threat to the sustainability of the NHS and what to do about it


Yau CWH, Leigh B, Liberati I, Punch D, Dixon-Woods M, Draycott T. Clinical negligence costs: the (almost hidden) threat to the sustainability of the NHS and what to do about it. BMJ 2020;368:m552;

Tackling the soaring cost of clinical negligence

Investment into improving patient safety is essential at all levels in the NHS to reduce avoidable harms and so that money spent on clinical negligence claims can be deployed for patient care.

Investment to improve patient safety in the NHS would help to reduce the human distress and escalating cost of clinical negligence claims, releasing money that could be used directly for patient care, according to a new analysis. The authors recommend four key principles to improve patient safety:

  • Address structural problems in the NHS – tackle under-staffing and problems with equipment, physical environments and information technology to improve safety directly and support staff morale.
  • Really commit to learning – develop the conditions, contexts, and underlying competencies for learning and improving rather than focusing on “tick-box” attitudes and don’t launch new improvement efforts without evaluating them.
  • Learn from high-performance – learn from best practice as well as from failures.
  • Enable and support system-wide safety improvements – by working at scale, while also supporting local improvements.

Why it matters

Litigation costs are reaching unsustainable levels. The NHS paid £2.4 billion for clinical negligence claims in 2018-1029 and has set aside £83.4 billion for expected future claims. This money would otherwise be spent on patient care. Maternity cases account for over 50% of total litigation costs although they represent only 10% of the number of cases, because injury sustained at birth may have lifelong consequences. While some influences on litigation are outside the control of the health system, implementing the steps outlined above will help to reduce avoidable harm.

Related content from our open-access series, Elements of Improving Quality and Safety in Healthcare

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