The House of Commons public accounts committee is "appalled" that the NHS has at least 15 000 cases of clinical negligence on its books, and the total could be much more, according to its report last week on NHS financial management.
The report on the 1997-1998 NHS expenditure for England revealed that £79 million ($126 million) had been paid out that year on negligence cases, with outstanding liabilities estimated at £2.8 billion.
The MPs' watchdog on public spending said that such cases represented a "tragedy" for the people involved and the figure for outstanding liabilities was "a significant drain on stretched health care resources."
In evidence to the committee, Alan Langlands, head of the NHS Executive, had estimated that the total of current cases was somewhere between the 15 000 allowed for under its accounting provisions and the 80 000 suggested by the charity Action for Victims of Medical Accidents.
The committee noted a range of initiatives designed to improve clinical standards, including clinical governance, the National Institute of Clinical Excellence, the Commission for Health Improvement and proposals for all doctors to undergo revalidation. The success of these initiatives was "crucial in stemming this enormous drain on scarce NHS resources," it said.
Where clinical negligence occurred, "the aim must be to ensure that the system for dealing with those involved is cost-effective, quick, efficient, fair and humane," said the report.
It noted recent measures designed to speed up the handling of claims and settlements, including Lord Woolf's reforms to civil litigation, which came into force last April, and quicker settlements by the NHS litigation authority.
The Medical Defence Union, which covers general practitioners and specialists in private practice against negligence claims, said that recent proposals on damages awards could increase the cost to the NHS substantially. Christine Tomkins, professional services director, said: "The impact on the MDU will also be significant, and we are already starting to see this effect."
In 1998 the House of Lords ruled that successful claimants' awards for future care and loss of earnings should be calculated on the assumption that they would invest the payouts in risk free, index linked gilts and not in equities, which give a higher return but carry a higher risk.
The result was to increase awards by up to 30% in catastrophic injury cases. Claimants' lawyers are now pressing for even larger awards because the return on gilts has dropped further.
Next month the Court of Appeal will convene an unprecedented, five judge court to decide whether to implement Law Commission proposals that awards for pain, suffering, and loss of amenity—currently a maximum of £150 000 in the most serious cases—should go up by 50-100%.