Clinical Negligence Practice in 2026: Reform, Resilience, and a Changing Market
Guest Article by Ian Cohen, Director, The Cohen Consultancy Limited.
As clinical negligence practitioners prepare to gather at AvMA’s conference in Leeds this week, the sector finds itself at an important moment of transition. A series of major reports, legal developments and market changes over the past 12 months point clearly towards reform, while at the same time confirming the continued importance and resilience of clinical negligence practice.
Taken together, these developments provide valuable insight into the future direction of the sector, and the practical realities firms will need to navigate.
Government Scrutiny and the Clear Direction of Reform
Two major public reports have brought the clinical negligence system under unprecedented scrutiny.
The National Audit Office’s October 2025 report confirmed that clinical negligence liabilities now stand at approximately £60 billion, with annual payments of £3.6 billion.1
While the report acknowledged that the largest proportion of damages relates to birth related injury, it placed particular emphasis on the legal costs associated with lower-value claims.
This theme was reinforced in January 2026 by the Public Accounts Committee, which expressed concern about the overall cost of the system and the lack of progress in controlling expenditure, with the proposed fixed recoverable costs scheme for lower value cases coming in for criticism and requiring clarification at the earliest opportunity. 2
The PAC was also critical that the NHS had not done enough to tackle the underlying causes of harm to patients, with key recommendations relating to establishing a clear system for accountability for patient safety as well as a review of the current NHS complaints system.These reports are significant, not simply for their analysis, but because they provide a clear signal of political intent. The recoverability and proportionality of legal costs are firmly at the centre of policy discussion.
The David Locke KC Review
Alongside these developments, the sector awaits the outcome of the independent review being conducted by David Locke KC on behalf of the Department of Health and Social Care3
This review is expected to consider whether structural reform is required to the way clinical negligence claims are managed and whether changes to recoverable costs — including fixed recoverable costs — should be implemented.
Its conclusions will be pivotal in shaping the future operating environment for claimant practitioners.
David Locke KC was due to report in Autumn 2025, but further to a recently published Ministerial answer to a written question from January, there is no clear indication as to when the review will be completed. It remains to be seen whether the full review is ever published or how long it will take the Government to act on the review.
Never Events
NHS England has published a provisional data set for the period April and November 2025 across 120 NHS Trusts, detailing the number of Patient Safety Incidents, commonly referred to as ‘Never Events.’
A Never Event is a serious, and sometimes catastrophic, patient safety incident that has either caused serious harm or had the clear potential to do so. These are incidents that are considered entirely preventable when appropriate safety measures are in place.
For the period April 2025 – November 2025, 274 never events were reported, 116 wrong and 73 relating to a retainer foreign object post procedure.
Clinical Negligence Volumes Remain Strong
Compensation Recovery Unit data shows that the number of clinical negligence claims notified has held up comparatively well, particularly when contrasted with other areas of personal injury practice.4
This resilience reflects the fundamentally different nature of clinical negligence work, compared to the overall decline of the PI market.
Legal Developments Continue to Shape the Value and Complexity of Claims
Recent case law has reinforced the importance and value of clinical negligence litigation, such as the Supreme Court’s decision in CCC v Sheffield Teaching Hospitals NHS Foundation Trust clarified the recoverability of lost years earnings in catastrophic birth injury cases.5
Market Consolidation Reflects Changing Commercial Realities
Structural changes are continuing to take place within the legal market itself.
The acquisition of Shoosmiths’ clinical negligence practice by Fletchers Group provides a clear example of ongoing consolidation.6
Scale, efficiency and operational discipline are becoming increasingly important in sustaining successful clinical negligence practices.
Conclusion: A Profession in Transition
Taken together, these developments point to a profession that remains strong but is entering a period of uncertainty and potential change.
Government scrutiny, anticipated reform, and market consolidation are reshaping the landscape.
The outcome of the David Locke KC review will be particularly important in determining how clinical negligence claims — and recoverable costs — are managed in the future.
As practitioners gather in Leeds, there is a clear sense that clinical negligence practice is entering its next phase.
Firms that understand these changes and adapt to them will be best placed to continue providing access to justice for injured patients in the years ahead.
Footnotes
1. National Audit Office, Costs of Clinical Negligence in England, October 2025. https://www.nao.org.uk/reports/costs-of-clinical-negligence/
2. House of Commons Public Accounts Committee, Clinical Negligence in the NHS, January 2026.https://committees.parliament.uk/committee/127/public-accounts-committee/
3. Department of Health and Social Care, Independent Review led by David Locke KC.
4. Ministry of Justice, Compensation Recovery Unit Statistics.
5. CCC v Sheffield Teaching Hospitals NHS Foundation Trust [2026] UKSC 5.
6. Fletchers Group acquisition of Shoosmiths Clinical Negligence Practice.
