The much-anticipated 10 Year Health Plan for England set out the position of the NHS in dramatic terms: the service "stands at an existential brink" where the only choice was to "reform or die".
The remedies were ambitious and largely welcome, especially the pivot towards preventative care in the community through Neighbourhood Health Centres. We hope this will be accompanied by much-needed investment in primary care services, including training and development for the expanding workforce.
The emphasis on innovation is also important for productivity, although the use of AI, robotics and the like, comes with medico-legal risks for clinicians. The MDU can of course support members if they are unfairly blamed for technology and system failures that harm patients under their care.
But while the 10 Year Plan set out a brighter vision for the NHS, a shadow was soon cast by news that clinical negligence payments cost the NHS £3.1 billion in 2024/25, compared to £2.8 billion in 2023/24. Overall provision for clinical negligence liabilities stood at £60.3 billion on 31 March 2025, up from £58.4 billion at the same point in 2024.
According to NHS Resolution's latest Annual Report and Accounts, the overall volume of clinical negligence claims and reported incidents was broadly stable at 14,428 (up 5% from 13,784 in 2023/24) but the cost of settling cases has actually risen by 10%.
Claimants' legal costs were a significant factor, even though 83% of clinical claims were resolved without the need for legal proceedings. In 2024/25, claimant costs rose by 14% year-on-year to £620.9 million, while the NHS' own legal costs rose by 7% to £181.3 million over the same period.
Overall provision for clinical negligence liabilities stood at £60.3 billion on 31 March 2025, up from £58,4 billion at the same point in 2024.
A patient who has been negligently harmed should of course be compensated. But I wonder how many are aware that their lawyers can bank so much more than the cost of their client's compensation, especially for lower value claims?
NHS Resolution reports that for claims where damages paid were below £25,000, average claimant legal fees were £27,380 - and this certainly echoes the MDU's experience.
To take just a couple of recent examples, in one case the claimant was awarded £1,400 while their legal fees came to £60,000 and in another, the claimant received £5,000 while their legal fees came to £155,000.
The spiralling cost of clinical negligence is a slow-motion crisis, but to use the government's own language, this is an area where the status quo presents an existential threat to the NHS.
After all, the eye-watering provision for future liabilities dwarfs the £29 billion real-terms increase awarded to the NHS in the last spending review, which was intended to, "get the NHS back on its feet and fit for the future."
The MDU hopes that the government's decision to ask David Lock KC for, "expert advice on the rising legal costs of clinical negligence claims," is a sign that it recognises it's time to act. Lock's advice will inform a review by the Department of Health and Social Care later this year, although there's no confirmation this will be published.
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We're also encouraged by the Public Accounts Committee's (PAC) announcement of an inquiry into clinical negligence costs, the second in less than a decade. As the PAC put it, "It is unacceptable that the Department is yet to develop a plan to deal with the cost of clinical negligence claims, and so much taxpayers' money is being spent on legal fees."
The MDU has repeatedly called for reform of the litigation system to make it fair and sustainable for all parties. The repeal of section 2(4) of the Law Reform (Personal Injuries) Act 1948 would be truly far-reaching, as this outdated legislation requires the courts to base compensation awards on the cost of private care, disregarding the NHS.
We also want to see the government implement existing plans to limit legal costs in clinical negligence claims valued up to £25,000, and extend that to claims valued up to £250,000.
These changes would be relatively simple to achieve, compared with some of the other reforms in the 10 Year Health Plan. But together, they will make huge difference to NHS finances and the public purse.
The case for urgent litigation reform is undeniable if the NHS is to have a secure future. It's time to seize the day.
Making the case for healthcare professionals
With so many items in the government's in-tray, including the 10 Year Health Plan, the abolition of NHS England and healthcare quangos, and industrial action by resident doctors, it's essential that healthcare professionals' voices are heard above the noise.
We're working alongside royal colleges and others to ensure politicians are fully informed about areas of concern through the All-Party Parliamentary Group (APPG) for healthcare workers - which we wrote about in our last issue.
For example, a recent discussion on the challenges within maternity care services heard perspectives from the Royal College of Obstetricians and Gynaecologists as well as the Royal College of Midwives and NHS Providers, along with the MDU's Dr Michael Devlin. APPG meetings scheduled for after the summer recess will include sessions on recruitment and retention, emergency medicine and mental health.
The MDU will continue to use every opportunity to speak up for members and highlight ways to improve their working lives.
From litigation reform to effective support for health and wellbeing to modernising the GMC's outdated and unfair fitness to practise system there's much to be done to make the health service better for those on the front line.
Dr Matthew Lee
Chief executive, the Medical Defence Union
Dr Matthew Lee
Chief executive, the Medical Defence Union
BM, MBA, FRCP, MRCPCH, FFFLM
Matthew has been chief executive of the MDU since September 2021.
He has worked at the MDU since 2000, initially as a medico-legal adviser assisting members facing complaints, disciplinary procedures and criminal investigations before becoming professional services director (with responsibility for claims handling, underwriting, legal services and the medical and dental advisory services) in 2009.
He joined the MDU from a background of working as a clinical fellow in paediatric intensive care in Southampton, having trained in both anaesthetics and paediatric medicine.
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