The NHS faces unprecedented financial and operational pressures linked to the cost of avoidable harm. The government’s liability for medical negligence now stands at £58.2 billion, second only to the cost of decommissioning the UK’s ageing nuclear power stations. In 2023/24 alone, the NHS in England paid out a record £2.8 billion in compensation for clinical errors, with £536 million directed to legal fees for claimants’ representatives.
The Westminster Health Forum provided an important opportunity to explore strategies for tackling the growing burden of litigation while maintaining a sharp focus on patient safety. Stakeholders from across healthcare, legal and policy examined the wider implications of clinical negligence on staff morale and public trust. Among the many conditions prompting claims, aortic dissection remains a stark example of the consequences when early diagnosis and timely treatment fall short.
Lived Experience and System Change
Catherine Fowler, Trustee of the Aortic Dissection Charitable Trust, delivered a moving and powerful account of the human consequences of avoidable harm. Her father, Tim Fleming, died in 2015 after an aortic dissection was misdiagnosed, a tragedy that encapsulates the systemic issues repeatedly highlighted throughout the forum. Tim’s story is not an isolated one, but emblematic of failures in diagnosis, pathways and learning culture across the NHS for aortic dissection.
Citing the 2022 NHS Resolution review of emergency care fatalities, Catherine noted that misdiagnosed aortic dissections were a recurrent theme, with 86 fatality claims alone costing £8.6 million. Her father’s case reflected each failure listed in the report, from inadequate decision-making tools and fragmented pathways to resource pressures and a weak safety culture. But Catherine was clear that this is not about blame. Patients, families and clinicians ultimately share the same goal – the delivery of safe, effective care. She acknowledged the emotional burden that clinicians carry when patients are harmed and called for a shift away from individual fault-finding towards systemic learning and improvement.
Catherine shared the success of a partnership with Hull Royal Infirmary, which implemented a structured approach to aortic dissection diagnosis that mirrored successful models used in sepsis care. The project not only improved clinical outcomes but was recognised with the 2024 HSJ Patient Safety Award, offering a template for change that is both practical and scalable.
In response to questions from Dr Neil Shastri-Hurst MP, Catherine discussed the results of a 2022 FOI request, showing stark inconsistencies in how NHS trusts manage aortic dissection. While most trusts had policies in place, the vast majority were localised, and only a small fraction aligned with national guidelines. The issue is not a lack of knowledge but a failure to implement existing best practice across the system. The charity is calling for a national approach to learning and a responsive culture that does not depend on complaints or inquests, to drive change.
Catherine concluded with a clear vision for the future. One where patients and families are actively engaged in co-producing solutions, and where system-wide action replaces reactive, piecemeal responses. Her family’s work with the hospital following her father’s inquest ultimately helped shape a national guideline in Ireland. This collaboration stands as a model for how lived experience and clinical expertise, when brought together, can produce meaningful and lasting improvement.
GIRFT in Driving Systemic Change
Professor Tim Briggs, Chair of NHS England’s Getting It Right First Time (GIRFT) programme, presented a compelling case for how a data-driven approach can reduce avoidable harm and financial waste across the NHS. GIRFT emerged from the recognition that variation in clinical practice was leading to poor outcomes and increasing legal action. By systematically collecting and analysing data across NHS trusts the programme demonstrated measurable improvements in patient outcomes, such as shorter hospital stays and fewer revision surgeries.
Now spanning 43 clinical specialities, GIRFT’s remit has grown significantly. Hospitals now receive regular productivity packs and service reviews, with a particular emphasis on urgent care and outpatient efficiency. Integral to this is the partnership with NHS Resolution, which provides trusts with annual data packs comparing claims volumes and costs. These insights help to identify underperforming NHS trusts and direct targeted support, transforming claims data into a tool for clinical learning and prevention.
Professor Briggs stressed that while data and tools can help align practice, it is the clinician–patient relationship that ultimately determines the safety and quality of care. GIRFT’s success lies in reducing variation and supporting frontline staff as well as embedding a culture of learning across the system. This is particularly vital in high-risk, time-sensitive conditions such as aortic dissection, where early recognition and consistent care pathways are essential to avoiding tragic outcomes.
A Legal Perspective on Reducing Harm
Lisa Jordan, Managing Partner and senior clinical negligence solicitor at Irwin Mitchell, gave a valuable legal perspective on the drivers behind rising litigation costs and the need for a balanced, collaborative approach. Speaking from the claimant side, she challenged the assumptions about the motivations behind legal action, suggesting that many families pursue claims not for compensation alone but in search of answers, accountability and system change following life-altering harm or bereavement.
The presentation highlighted that the most effective way to reduce costs is to reduce the harm that leads to claims. Lisa also pointed to broader systemic issues, including the NHS complaints process, which many families find protracted and dismissive. She welcomed NHS Resolution’s efforts to settle claims more swiftly and reduce adversarial approaches.
Supporting Clinicians While Pursuing Safer Care
Dr Matthew Lee, Chief Executive of the Medical Defence Union (MDU), brought attention to the often overlooked dimension of clinical negligence: the profound impact on individual clinicians. While the conversation often centres on financial cost and patient compensation, Dr Lee highlighted the psychological toll experienced by healthcare professionals facing allegations of negligence. More than 80% of MDU’s cases, no negligence is found, suggesting that many claims could be better addressed through non-legal routes. The current litigation system, he argued, exacerbates mistrust between patients and clinicians, prolongs distress and undermines confidence in the relationship. He also pointed to a growing number of patients attempting to submit claims without legal representation, often using artificial intelligence tools, which rarely succeed and can lead to further frustration and disappointment. In high-risk scenarios such as aortic dissection, where clinicians are under significant pressure to make rapid and life-saving decisions, an overly punishing legal environment may hinder openness and learning rather than encourage it. Reform, Dr Lee insisted, must protect both patients and professionals if lasting improvements in care and safety are to be achieved.
Embedding Safety
Clare Wade, Director of Patient Safety Learning, focused on the pressing need for a coordinated, system-wide approach to patient safety. Despite years of initiatives, unsafe care continues to affect patients across all areas of the health service. The failure often lies in the gap between strategic intent and implementation. Healthcare systems suffer from a disconnect between “work as imagined” and “work as done”, where resource constraints, human factors and complexity create barriers to consistent delivery.
Clare stressed that patient safety must not be treated as a secondary objective but integrated into the core purpose of healthcare delivery. She advocated for the adoption of Safety Management Systems (SMS), successfully used in other high-risk industries such as aviation, to support proactive risk identification and response. Clare called for better system-level learning, not only from incidents but also from examples of success. Patient Safety Learning’s report, Mind the Implementation Gap (2022), drew attention to the NHS’s struggle to translate patient safety policy into practice. Closing this gap is essential to reducing harm and restoring public confidence. In conditions like aortic dissection, where delays and missed diagnoses often result in fatal outcomes, the need for a coherent and embedded safety culture is particularly urgent.
