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DUBLIN–(BUSINESS WIRE)–The “UK Clinical Negligence Market Report 2020” report has been added to’s offering.

In 2019/20, the publisher estimates law firms earned revenue of around 1 billion GBP from CN cases. In 2019/20, law firm revenues rose by around 8.8%. However, once the cost of running cases where no damages were awarded on a no-win, no fee bases are factored in, net revenue to law firms drops some way below 1 billion.

Across the four nations of the UK, the publisher estimates that over 2 billion GBP was paid out in CN cases in 2019/20, covering damages, payment of claimant legal costs and payment of defence costs. This is little changed on the amount spent in 2018/19. One factor behind the slowdown in annual spending is the growing trend to settle high-value cases, where ongoing care is a feature, with a periodical payment order (PPO) rather than a lump sum payment. New CN case numbers have declined sharply in 2020 compared with previous years, however, this reflects the impact of COVID-19 and case numbers are likely to recover if the impacts of the pandemic end.

Even with a slowdown in annual expenditure, there is likely to be continued high levels of spending on CN cases in the future. Collectively, the UK indemnity organisations hold provisions of around 91 billion GBP to meet future CN claims, so sustained and substantial case numbers and payments are likely in the years to come. The future, however, could see a reduced number of CN cases below the value of 25,000 if fixed recoverable costs are introduced for these cases. Law firms are likely to only take on those cases where there is a significant chance of damages being paid.

The future may also bring other changes, with a twin-track system for cases below the value of 25,000 likely to be introduced and with medical defence indemnity organisations possibly subject to FCA regulation.

These findings come from the Clinical Negligence 2020 Market Report, which provides a review of the Clinical Negligence legal market, looking at the legislative background, market size and trends, the key players and future market developments.

Key Topics Covered:


  • Around 2.5 billion GBP spent annually on CN cases
  • But case numbers collapse in 2020
  • But a substantial caseload going forward
  • Law firms earn around 1b GBP annually from CN cases
  • Four key participants for a market in two halves
  • Key recent developments and market drivers


  • Abbreviations


  • Four main market participants
  • It’s a market in two halves
  • Clinical negligence indemnity/insurance cover
  • The Clinical Negligence protocol


  • Coronavirus
  • COVID-19 may increase future risks
  • COVID-19 leads to changes in how CN cases are investigated
  • Average awards are increasing
  • With Obstetrics the main cause of claims inflation
  • Civil Liability Act – 2019 review of the personal injury discount rate
  • Proceedings only started in less than 30% of cases
  • NHS Resolution’s claims mediation service


  • Overview
  • Indemnity Organisations
  • Claimant and defendant legal advice – two separate market segments
  • Selected Law Firms – Profiles
  • A small selection of law firms involved in CN cases are profiled below.


  • Steady decline in case numbers
  • Regional Spending by State-Backed Indemnity Schemes (SBIS) and State bodies
  • Legal costs as a percentage of NHS payments has declined recently
  • Medical indemnity organisations
  • Clinical negligence legal revenue


  • Potential changes to procedures in lower value CN cases
  • Could indemnity cover fall under the regulation of the FCA?
  • A market where expenditures are coming under control
  • But huge potential expenditures in the pipeline


List of Figures

Figure 1 The current protocol in CN cases

Figure 2 The number of NHS Resolution CN claims* cases received by damage range, 2013/14-2019/20

Figure 3 Breakdown of CN claims or payments in England, Northern Ireland, and Scotland

Figure 4 Examples of the impact of different PIDRs on CN awards

Figure 5 The breakdown of NHSR cases (CN and non-CN) by stage and damages, 2016/17 – 2019/20

Figure 6 Breakdown of WRP Open CN cases (no of claims and value m)

Figure 7 Welsh Risk Pool Expenditure Payments and Budget

Figure 8 Total Active membership of MDDUS

Figure 9 No. of Claims and Costs (m) for Top 10 Claimant Solicitor Firms on CNST, 2017/18/ 2018/19

Figure 10 Leading claimant/appellant solicitors – number of judgements on BAILLI database

Figure 11 Examples of leading defendant/respondent solicitors – no. of judgements on BAILLI database

Figure 12 Trends in clinical negligence cases, settlements by the CRU, 2011/12-2020/21

Figure 13 Trends in clinical negligence case recoveries by the CRU, 2011/12-2020/21

Figure 14 NHS Resolution Clinical claims reported and all claims closed, 2009/10-2019/20

Figure 15 The number and amount of clinical negligence payments of CNORIS

Figure 16 The number and amount of clinical negligence payments in Wales

Figure 17 CN payments and cases in Northern Ireland 2014/15-2019/20

Figure 18 The amount spent on CN cases across the UK by SBIS and State bodies, 2015/16 to 2019/20

Figure 19 Clinical negligence expenditure by NHSR and in NI Health Boards, 2015/16-2019/20

Figure 20 Estimated gross legal revenue earned by clinical negligence cases, 2016/17-2019/20

Figure 21 The final summary positions as to possible fixed costs in low value CN cases.

Figure 22 Movement in NHSR provisions for claims

For more information about this report visit


Laura Wood, Senior Press Manager

[email protected]

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