By Rachel Bowen, Legal Director
For more than two decades, successive governments, regulators and NHS leaders have been warned – repeatedly and in increasingly stark terms – that patient safety failures were becoming entrenched within the NHS. Yet a new report from the Public Accounts Committee (PAC) shows that, rather than improving, the consequences of unsafe care have escalated to crisis point.
Medical negligence costs now exceed £3.6 billion a year. That figure is not simply an accounting problem. It represents thousands of patients whose lives have been permanently altered, families grieving avoidable deaths, and an NHS system that continues to repeat the same mistakes despite 24 years of recommendations, inquiries and public assurances.
A failure decades in the making
The PAC’s findings echo concerns raised as far back as 2002, when early reviews warned that negligence claims were rising because patient harm was not being tackled at source. Since then, major inquiries – from Mid Staffordshire to Shrewsbury and Telford, Nottingham and East Kent – have exposed the same recurring themes: poor clinical leadership, inadequate staffing, defensive cultures, weak learning from errors, and a failure to listen to patients and families.
Despite this, the Department of Health and Social Care (DHSC) has been unable to demonstrate any meaningful, system-wide action capable of reducing harm. NHS England, meanwhile, is reactive instead of proactive – responding to scandals after the fact rather than preventing them.
The result, as the PAC makes clear, is that government liability for medical negligence has quadrupled over the last 20 years. That growth is not driven by opportunistic litigation; it reflects long-running, unresolved failures in patient safety.
Maternity care – the starkest example
Nowhere is this more evident than in maternity services. Since 2015 alone, multiple major scandals have revealed catastrophic failings in obstetric and neonatal care, many involving brain-injured babies and preventable deaths.
From a legal perspective, maternity claims are often the most complex and costly because the harm is so profound. A child with a severe brain injury may require round-the-clock care for the rest of their life. Claims regularly take a decade or more to resolve, not because families are seeking to prolong litigation, but because the NHS process for disclosure, investigation and admission of liability is slow, adversarial and fragmented.
The PAC rightly notes that these cases alone can absorb enormous sums of public money. Yet the focus on cost risks missing the deeper issue: these injuries should not be happening in the first place.
Why patients end up suing
As a lawyer, one of the most common things I hear from clients is not “we want compensation”, but “we want answers”.
The PAC found that some patients only pursue legal action because hospitals refuse to explain what went wrong or to offer a meaningful apology. This is a crucial point, because when openness is absent, litigation becomes the only route to uncover the truth.
The NHS has long claimed to support a “duty of candour”, but in practice this is inconsistently applied. Families often experience months, or years, of silence and defensive internal reviews by the time lawyers become involved, meaning trust has already been irreparably damaged.
Early disclosure, genuine apologies and timely investigations are not just morally right – they are proven to reduce litigation and costs. The failure to embed these principles across the NHS is a central theme of the PAC’s criticism.
Drowning in recommendations, failing to act
Another striking finding is that the NHS is overwhelmed by the sheer volume of patient-safety recommendations produced by regulators, watchdogs and public inquiries. Hundreds of recommendations exist on paper, yet many remain unimplemented or only partially adopted.
From a legal standpoint, this creates a dangerous feedback loop. Each new inquiry restates what previous reports have already said, while frontline practice remains largely unchanged. When harm occurs again, the existence of ignored recommendations strengthens the legal case that the risk was known and preventable.
The PAC’s call for a streamlined, transparent approach to patient safety is therefore long overdue. Without clear accountability for implementing recommendations, inquiries risk becoming performative exercises rather than engines of reform.
Government responses – familiar, but insufficient
The government has responded by pointing to new review rules, maternity safety initiatives and further investigations into failures. While these measures may be welcome, they follow a well-worn pattern: announce reform, commission a review, promise cultural change.
What is missing is decisive action to reduce harm at scale. That means properly resourcing services, tackling workforce pressures, embedding learning from adverse events, and transforming how the NHS responds when things go wrong.
An unsustainable status quo
The PAC’s report underlines a truth that medical negligence lawyers have seen for years: clinical negligence costs are a symptom, not the disease.
Unless patient harm is genuinely reduced, billions will continue to be diverted from frontline care into litigation and compensation. More importantly, patients will continue to suffer avoidable injury, and families will continue to be failed by a system that closes ranks rather than confronts its own shortcomings.
After 24 years of warnings, the question is no longer whether the NHS knows what needs to change. It is whether it has the will, the leadership and the funding to finally act.