Unofficial prototype web edition of APIL's report, made by Ideate Partners to show what the report could be online. Not produced or endorsed by APIL. APIL's clinical negligence page
The reality behind the myths
Too much of the current debate about clinical negligence compensation is informed by misunderstanding and myth. These myths pose a risk not just to victims of negligence, but to the NHS and wider society too.
Spending on clinical negligence claims accounts for just 1.6% of NHS England's total budget
Under a no-fault system, there would be an eighteen-fold increase in spending on compensation claims
Of those harmed by NHS negligence say that compensation was crucial in allowing them to recover and rebuild their life
Of the real-terms increase in clinical negligence costs is accounted for by the compensation received by victims (2015/16 to 2025/26)
In the average time victims of clinical negligence have to wait for their claim to settle (2013/14 to 2024/25)
The amount saved if the NHS prevented ten negligent incidents that cause a brain injury or cerebral palsy to a baby
The costs of clinical negligence compensation can only be properly understood when set against the size of the NHS and the scale of the patient safety crisis.
Each year, the English NHS engages in around 600 million interactions with patients and spends about £200 billion
In 2025, 2.9 million people said they had been harmed by the NHS in the last year
Last year, NHS England recorded 1.1 million patient safety incidents which resulted in harm
Of those harmed in these incidents go on to claim compensation from the NHS
Total clinical negligence spending as a percentage of NHS England's annual budget in 2025/26, down from 1.9% in 2019/20. This includes the cost of legal support for victims and NHS legal costs.
Clinical negligence costs are just one symptom of the patient safety crisis. In comparison to the scale of this crisis, the amount spent on compensating victims of NHS negligence is relatively small.
The NHS faces far more significant financial challenges. These include dealing with the consequences of an ageing society, filling the gaps left by a broken social care system, and addressing the patient safety crisis which gives rise to negligence claims.
This context shows that the provision of compensation to victims of negligence is not one of the key challenges that threatens the financial sustainability of the NHS.
This is not money which has been 'set aside', as is sometimes claimed. It is just a forecast or estimate of what future or unresolved claims might cost.
As a result, this 'provision' captures costs that will be incurred over many future years, even decades.
New APIL-commissioned opinion polling, undertaken by Opinium, shows the vital importance of compensation to victims of clinical negligence.
If these victims had not received compensation…
For victims of negligence, compensation is not a luxury. It is something they simply cannot afford to be without.
Legal support helps victims get the answers and accountability they desperately need, and supports them to deal with the consequences of the harm they have suffered. It can also play an important role in improving patient safety.
of these victims would recommend that others who are harmed by NHS negligence should approach a clinical negligence lawyer for help.
An overwhelming majority of the public believe the NHS should provide compensation to those it harms. Only a tiny minority would support exempting the NHS from providing it.
The costs of clinical negligence ultimately stem from serious failures in patient safety that could and should have been avoided.
Over the past ten years, the compensation which injured victims receive accounted for almost all of the real-terms increase in clinical negligence spending.
Real-terms increase in clinical negligence spending, 2015/16 to 2025/26
During the past decade, less than 2% of the real-terms increase in clinical negligence spending was the result of victims' legal costs. This 'legal' spending covers the wide range of costs victims may face in pursuing their case: solicitors' fees, and also court fees and medical expert reports, which form a significant proportion of it.
Those harmed must establish that their care was negligent if they are to receive compensation. That high threshold applies in every case, including claims under £25,000, and it protects the NHS from a much higher number of claims.
Claimant legal costs in claims where compensation is less than £25,000 represent just 3% of all clinical negligence spending.
Each year, this small amount of spending allows around 3,500 victims of negligence, half of all those who ultimately receive compensation, to access justice and vital support. Over the past ten years it has fallen in real terms.
Social care can be incredibly expensive and is not available on the NHS. Just over half of what victims receive in compensation covers these costs. It is the key element of compensation.
The care crisis is key to explaining rising clinical negligence costs
Increase in wider inflation
Increase in social care costs
Inflation associated with care costs is rising at almost twice the rate of wider inflation. If they are just to keep up with these costs and pay for their care, injured victims require much higher compensation.
Care is only one area. The costs of the mobility aids and equipment many victims rely on have soared in recent years, with disabled people reporting that these items have seen larger price increases than other products. Victims of negligence are among those hardest hit by the cost-of-living crisis.
Such support is the difference between an injured person or a disabled child merely existing in a bed, or being able to have a life which is worth living.
Negligence in maternity care is by far the largest contributor to these costs. Maternity cases account for over half of the total cost of clinical negligence claims received last year.
It is sometimes claimed that spending on compensation for maternity failures is nearly as high as the cost of running the maternity care system. Data highlighted by the Department of Health and Social Care shows that this is a myth: running the system costs four times more.
Previous proposals to reduce the legal costs victims can recover in claims under £25,000 were only expected to save less than half this amount, around £50 million a year. Preventing harm in the first place is the key to avoiding costs, and would spare families huge emotional trauma.
Victims of clinical negligence are waiting a record-breaking amount of time to receive justice. On average, it currently takes NHS Resolution over two years to settle a claim.
Since 2013/14, there has been a 58% increase in the time it takes NHS Resolution to settle clinical negligence claims
The average time a victim of clinical negligence has to wait for their claim to settle
Victims now wait, on average, ten months longer for their claim to settle than in 2013/14
The average wait for victims with the highest value claims, almost two years longer than in 2013/14
Delays also push up legal costs unnecessarily. NHS Resolution itself acknowledges that "the longer cases run for, the higher the costs".
Several proposals to reduce the cost of claims treat the symptoms rather than the cause. They would further harm victims of negligence and pose a significant risk to the NHS.
Repeal of Section 2(4) would reduce costs, and victims of negligence could just rely on the NHS for treatment.
Only a tiny fraction of compensation spending is affected by Section 2(4), so repeal would fail to deliver significant savings. Forcing victims to return to the institution that harmed them would cause further trauma, or leave them unable to access treatment that is difficult to obtain through the NHS.
A no-fault compensation system would decrease costs, improve patient safety, and reduce stress for those seeking compensation.
Such a system would pose a significant financial risk to the NHS, while injured victims' experiences of no-fault schemes show it would not pave the way for a less stressful process. International examples show it is not the answer to the patient safety crisis.
Removing or reducing access to legal support would tackle costs, with no adverse impacts on victims of negligence.
Without legal support, victims would not get the answers they need about what went wrong with their care, and existing 'lawyer-free' schemes show those harmed would struggle to access justice. The impact on spending would be minimal, as costs have been driven by the compensation victims require.
Under Section 2(4) of the Law Reform (Personal Injuries) Act 1948, victims can claim compensation for private healthcare costs, and the availability of NHS treatment is disregarded. Repeal would force them to rely on the institution that harmed them for all their treatment.
of those harmed by NHS negligence would feel anxious, scared, distressed, unhappy or angry if they had to return to the NHS for treatment.
Only 17% of those harmed say they would be happy about returning to the NHS for treatment.
Only 4% of damages spending is impacted by the existence of Section 2(4)
Only 4% of compensation spending covers therapy and treatment costs. Most of it covers support such as social care, which is not available on the NHS and would be unaffected by repeal.
Some argue that Section 2(4) creates the potential for 'double recovery'. In reality, government papers show there is no evidence that injured claimants go on to use the NHS for treatments covered by their compensation.
New Zealand, which has long run a no-fault scheme for treatment injuries, is pointed to as an exemplar. APIL's research shows the cost of that scheme is spiralling, growing four times faster than clinical negligence spending in England.
The current system requires negligence to be established, a very high bar. A no-fault system would remove it.
APIL's analysis of New Zealand's system found that, if there were no cuts to compensation, a similar no-fault scheme in England would cost eighteen times more than the current system.
The only way to make a no-fault system affordable would be to slash the compensation provided to victims of negligence.
Successful claimants in New Zealand's no-fault system receive, on average, 96% less compensation than a victim of negligence in England.
Under the current system, compensation is carefully calculated so that just enough is provided to meet each person's needs. A system that slashes it would leave many unable to pay for care or afford everyday essentials.
APIL has found no evidence of a link between a country's compensation system and its patient safety record. Analysis of Imperial College London figures shows the ten countries ranked highest for patient safety use a wide range of systems, including some extremely similar to England's.
Ireland: 4th
Ireland's system for compensating injured patients is similar to England's, and Ireland ranks fourth internationally for patient safety, ahead of countries with alternative systems, including New Zealand, Denmark and Sweden. Its improvements have come from openness and transparency, not major changes to the compensation system.
New Zealand
The leading example of a no-fault system ranks below several countries with systems similar to England's, including Ireland, Australia and Canada. In recent years, New Zealand has also fallen in international patient safety rankings.
Injured people who have used New Zealand's no-fault system describe the application process as traumatic, intimidating and complex. Independent reviews and university research back this up.
The process was intimidating and impossible to navigate
I felt I wasn't listened to. I felt that I keep saying this is traumatising. You've already got the information. Why am I having to repeat myself. It was like I didn't have a voice.
I felt like they were hoping we'd quit
I had to fight to get the back payment … It was absolutely soul-destroying
[The compensation system is] a wall designed to look like a door
People who have used Britain's no-fault and administrative schemes, covering injured veterans and victims of crime, report similar problems. Those without legal support struggle to navigate them, and can receive tens of thousands of pounds less than they are entitled to.
The key focus for reform must be on preventing harm and, where avoidable harm does occur, improving the response to it. The government can and must meet its objectives without compromising patient protection or reducing access to justice.
Damages are carefully calculated to put the injured person back, as closely as possible, to their life before the injury, and are only paid when negligence has been proven. A priority must be preventing this harm in the first place. That comes from cultural change within the NHS, not changes to the compensation system.
When things go wrong, families are often kept in the dark and feel the only way to find out what happened is a clinical negligence claim. There must be consistent and effective implementation of the statutory duty of candour, and the Public Office (Accountability) Bill must be brought into force without delay.
APIL's full plan is at apil.org.uk/clinicalnegligence.
The findings in this report are drawn from these key sources.
Clinical negligence arrangements vary throughout different parts of the UK. This report focuses on the clinical negligence system in England. All data is correct at the time of publication. For a full list of the research, or the most up-to-date figures, contact APIL's research team.
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