The NHS is facing claims totalling £3.9bn in England for negligence by hospital doctors and other staff, according to a report today from the national audit office, the official watchdog on public spending.
The 23,000 claims outstanding total £2.6bn, with another £1.3bn estimated as the likely cost of claims not yet received for mishaps which have already occurred.
Sums paid in damages and costs to settle negligence claims have spiralled from £50m in 1997-98, through £107m in 1998-99, to £386m in 1999-00.
The study, which excludes claims against GPs, is the first survey to look at all negligence claims in every NHS trust in England. It paints a picture of a slow, expensive and inefficient system in which claims settled in 1999-00 had taken an average of 5 years and costs often exceeded the damages received.
Eight per cent of cases took 10 years or more. The report highlights a huge backlog of old cases, with claims which are still open averaging more than eight years on the books and 22% of open claims dating back more than 10 years.
For nearly half the claims settled in 1999-00, legal and other costs were higher than the damages. For settlements up to £50,000, the costs were higher than the damages in two out of three cases.
The rising bills are partly down to increased numbers of patients suing: the rate of clinical negligence claims went up by 72% from 1990 to 1998. The size of settlements has also risen following a court ruling covering a number of test cases which changed the way awards are calculated.
The report recommends new ways of dealing with claims, for instance by mediation rather than litigation, or by claims managers who can offer a range of remedies tailored to patients' wants.
A "package" approach recommended by the report could include a reasonable settlement offer at an early stage, an explanation, meetings with medical staff to explore what went wrong, an apology, and action to prevent a recurrence.
A spokesman for the Department of Health said: "The NAO is absolutely right to highlight the issue of rising claims, but the fact is that the total £3.9bn is an estimated figure for potential costs spread over future years."
In 1999-00 the NHS in England paid out under £400m in clinical negligence costs, while the total NHS budget in England was just over £40bn.
"There are two ways to reduce clinical negligence costs. We are working on reducing clinical errors in the first place by introducing an independent patients safety agency to record errors, mistakes and near misses, and to speed up the process of sorting them out", said the spokesman. "But we also need to ensure that money spent on claims is going to patients who deserve it - not on spiralling legal costs."
