The cost of the NHS’s clinical negligence bill is never far away from scrutiny. As my APIL presidency gets underway, we await the Government’s plan of action following the latest report and recommendations, this time from the Public Account Committee, which is due in the autumn.

I want to take every opportunity to ensure policymakers have the full picture. It would be a mistake to look at the possibility to reform clinical negligence claims though the lens of public sector resources, rather than the needs of those patients who suffer harm which could and should have been avoided.

The root of spending on clinical negligence is the failure to prevent harm from happening in the first place. And if the NHS was better at responding to negligence when it happens, outcomes for injured patients would improve and so would patient safety. Bringing down the NHS’s compensation bill always boils down to better patient safety.

In the 20-plus years that I’ve specialised in clinical negligence cases, frustratingly all too often I see the same patient safety issues come up time and again. In turn, there can often be a repeated pattern of denial, evasiveness, and failure to put injured patients and bereaved families at the centre of the process. Despite a succession of inquiries into failures in healthcare, and their reports and recommendations, it is clear to see the problems are deep-rooted and to tackle them it will require fundamental, cultural and system change within the NHS.

There must be transparency and openness with patients and their families. All trusts need to abide by the statutory duty of candour. At the moment that is not the case. It is sporadic. Candour needs to be the benchmark when clinical negligence has occurred. Families are all too often left in the dark about what happened.

Many of those affected by a patient safety incident would benefit from the support of an independent advocate who can understand their needs and offer detailed advice and guidance about their rights and options.

The Harmed Patients Alliance in its report, Signpost to Nowhere, proposed funded independent advocacy, advice, and information for patients and families after patient safety incidents. It says that even if an incident does not result in legal action, empowering patients and their families through independent advocacy makes it more likely that the NHS will recognise it was at fault earlier and save the high legal costs of prolonged litigation.

Some will go on to seek advice from a lawyer, but most patient safety incidents will not be actionable as a claim. Families in these cases would benefit from independent support, advice and guidance in ensuring that the statutory duty of candour is complied with and that they are able to engage meaningfully in discussions. The emotional and psychological support provided to patients and families as part of the duty of candour requirements should be improved.

There have been some steps forward over the years in the way patient safety incidents are investigated. The independent Maternity and Newborn Safety Investigations (MNSI) programme and the Health Services Safety Investigations Body (HSSIB) in England, and more recently the Patient Safety Incident Response Framework (PSIRF), for example.

But the fact remains that the NHS is a behemoth organisation and it is hugely fragmented. If care and investigations are improved by an initiative in one particular trust or region, it is not a given that this best practice runs through the entire NHS. The health service is desperate for an overarching patient safety strategy, implemented and adhered to throughout, which is driven by strong and cohesive leadership.

Consistency and transparency allow for lessons to be learned to prevent those repeated failures in care.

Consistency and transparency also allow for patients and their families to get the answers they need. And when people also need redress, the process is less contentious, lengthy, and costly when all the cards are on the table.