The human misery caused to patients who are the victims of avoidable NHS harm has been laid bare in the House of Commons Public Accounts Committee (PAC) report on clinical negligence spending.

It was published on Friday and pulls no punches as it declares that the NHS has simply not done enough to tackle the underlying causes of patient harm. Lessons are not being learned, putting more patients at risk of harm. It is obvious that negligence is at the root of every penny spent on redress. It is refreshing that the PAC has doubled down on this fact, as investigations into clinical negligence spending will often sidestep the bigger picture on patient safety, focusing instead on the cost of putting things right.

So, it was disappointing to see a disparaging turn of phrase to describe patient representatives in one national newspaper’s online headline when the report was published.

Claimant legal costs have, naturally, been scrutinised as part of the PAC’s review, which found that they have increased above inflation. There are reasons behind those increases and some are within the NHS’s own control. But this is not the key message from the PAC. 

The main driver behind the increase in claimant legal costs is delays in settling cases. These are often caused by uncooperative NHS bodies dragging their heels, which is completely out of the claimant lawyer’s control. This causes further frustration and difficulty for the injured patient, and increases costs. APIL’s analysis shows that delays to clinical negligence settlements have continued to increase, reaching another record high in 2024/25.

These delays play a pivotal role in determining claimant legal costs, with NHSR itself acknowledging that ‘the longer cases run for, the higher the costs’.

Analysis of NHS Resolution (NHSR) data shows that a victim of NHS negligence now has to wait, on average, ten months longer for their claim to settle when compared to 2013/14. This is an increase of 58 per cent.

During the last year alone, the average time between claim notification and settlement increased by more than a month.

APIL members often report frustrating delays to cases caused by the defendant and their lawyers. All the time a claimant is in limbo, suffering the effects of their injuries and waiting for their case to settle so they can move on with their lives.

The NHS is supposed to abide by the statutory duty of candour which requires it to be open and transparent with patients when something goes wrong. APIL members report this frequently does not happen. NHS trusts all too often seem to close ranks when clinical negligence has occurred, which makes getting the answers that patients need difficult and time consuming. Meanwhile, opportunities to learn valuable lessons which would improve patient safety and reduce incidents of harm are being missed.

The bulk of the NHS clinical negligence bill is not legal costs, but damages paid to the injured patients. This is some 82 per cent of the increase, as highlighted by the National Audit Office (NAO) report published at the end of last year.

Damages for a small number of the most serious cases account for the bulk of the bill. In 2024/25, damages for claims valued at over £1 million represented 68 per cent of total costs, despite accounting for just two per cent of all claims.

This increase is because the cost of being injured has become more expensive, through all sorts of economic factors. The cost of social care has outstripped inflation. This care is essential to people who have life-changing injuries, particularly in the two per cent of claims above. To cut it would leave people existing rather than living, and turning to the State to pay for their support.

The new upcoming film for APIL’s Rebuilding Shattered Lives campaign focusses on a young boy who suffered with cerebral palsy as a result of brain damage when he was born. His mother has sacrificed so much to care for him for the rest of her life. She describes her grief over the life he has lost because of the negligence in their medical treatment. She brought a claim against the NHS trust for redress so that she could get the accommodation, therapies, and support for her son that he needs throughout his life.

It is not fair, justified, or accurate to accuse legal representatives, who fight for families and support them through their darkest days, of being 'ambulance chasers'.

Injuring people is expensive, and it is this that must be tackled – the PAC has hit the nail on the head. The financial and human cost is enormous. The key is improving patient safety. 

Slashing delays in claims would quickly cut legal costs. But the cost of settling claims is as an inevitable consequence of ensuring injured victims of clinical negligence have access to justice.