DHSC has failed to tackle the rising costs of clinical negligence despite repeated warnings.

The report notes that the government’s liability for clinical negligence has quadrupled in real terms since 2006–07, reaching £60 billion in 2024–25. Annual settlement costs have tripled to £3.6 billion in 2024–25 with forecasts suggesting the cost of clinical negligence will continue to rise significantly in coming years.

It recommends that:

• Alongside its Treasury Minute response to this report DHSC should write to the Committee explain its operational plan to tackle clinical negligence, including key milestones for achieving reductions in claim costs and volumes.
• DHSC should also publish David Lock KC’s review of clinical negligence within six months of it being completed. This should include all supporting analysis and the Department’s response to any recommendations made by the review.

The NHS has not done enough to tackle the underlying causes of harm to patients.

The report states that DHSC and NHS England’s (NHSE) approach to patient safety lacks coordination and that patients often pursue legal action to get answers and accountability due to a confusing and unresponsive complaints system.

It recommends that:

• DHSC must set a national framework for improving patient safety with clear targets for annual improvement.
• DHSC must review the NHS complaints system and improve the number of cases that are resolved without recourse to litigation.
• DHSC should estimate and track the costs to the NHS of treating avoidable harm.
• DHSC should write to the Committee to set out progress in implementing the Dash Review and its assessment of the impact of abolishing the Health Services Safety Investigations Body (HSSIB) on patient safety.
• DHSC and NHSE should have a clear system of accountability for patient safety, learning from mistakes and sharing what works, implementing best practice across the NHS streamlining patient safety alerts and recommendations from national bodies.

We are concerned there is far too little data on the factors behind clinical negligence, given its huge impact on people’s lives and NHS finances.

The report states they are disappointed that neither the Department nor NHS England could adequately explain how the NHS uses its extensive data on patient harm to identify and address the underlying causes of clinical negligence.

It recommends that:

• DHSC should establish a national system for sharing data between trusts and analysing trends. If there are barriers to sharing protected data, it should develop analysis on an anonymised basis to pull out lessons and provide early warning alerts to trusts
• DHSC, NHSE and NHS Resolution should explore the use of artificial intelligence to analyse live data, detect discrepancies and outliers quickly, and improve the speed of early warning systems.

The Department’s failure to address problems with maternity care in England has led to avoidable harm and unnecessary costs.

It recommends that:

• DHSC and the organisations it funds need to learn lessons from its failure to improve maternity care in England. Where problems arise the Department and the wider NHS should look for systemic failings in care and tackle these problems at their cause.
• DHSC should publish the Amos Review within two months alongside its response and set out how it plans to reduce the incidence of harm and the costs of claims in maternity care.

Legal costs in clinical negligence claims are disproportionate for medium and low volume claims.

It recommends that:

• DHSC should develop alternative dispute mechanisms to speed up decisions and reduce costs for less complex cases. As part of this, the Department should look at international examples (such as in New Zealand and Sweden) of non-adversarial and ombudsman models and assess how our ombudsman system could be improved.
• DHSC should clarify its position on a fixed recoverable costs scheme for lower-value clinical negligence cases at the earliest opportunity.

Clinical negligence claims are settled on the basis of costs of care in the private sector and yet there is nothing to stop the claimant using the NHS or publicly funded social care in the future, potentially inflating the costs of claims.

It recommends that:

• DHSC should develop, within six months, proper estimates of the impact of assuming health and social care for clinical negligence victims will be provided exclusively by the private sector. It should by the same deadline set out additional measures—including any requiring changes to legislation—which it judges would effectively guard against the risk of paying twice for the care of those it has harmed and an indicative timeline for their potential implementation.

The report also shows how the injustice experienced by the bereaved and survivors following the Hillsborough disaster is still a painful reality today.

It is therefore critical, families told INQUEST, that a Hillsborough Law ensures a statutory duty of candour backed up by effective provisions to ensure compliance, and robust sanctions to ensure accountability. This would bring to an end the culture of denial and cover-ups following state failings which currently prevail.

Another key demand of families is for the law to provide for public funding for their legal representation following state failures to ensure equality of arms with public bodies. Under the current system, families are often left without public funding and forced to crowd fund to cover their legal costs, whilst state bodies have legions of lawyers.

Families see Hillsborough Law as a potential watershed moment, one that could redress the power of the state, fulfil the legacy project that Hillsborough families and survivors have fought for, and prevent future deaths and harm.

However, the report makes clear that families and victims fear the Government will change or amend the 2017 Bill and, as such, are demanding that Hillsborough Law be “all or nothing”.

Those involved in this report hope the Government heed their voices and resist attempts to dilute the bill, stressing that any compromise would undermine its vital purpose.

• Barking, Havering and Redbridge University Hospitals NHS Trust
• Black Country Healthcare NHS Foundation Trust
• Pennine Care NHS Foundation Trust
• Yorkshire Ambulance Service NHS Trust.

The guide has been developed to show health leaders actionable insights and practical interventions, ultimately giving them a roadmap to tackle racial discrimination and improve the experience for staff from diverse backgrounds.

Some of the most common themes across the report are ensuring staff learn from mistakes and see them as opportunities for growth, deploying anti-racism training, and the power of data analysis to identify inequalities.