High value clinical negligence cases continue to attract increasing scrutiny, not only in terms of liability and damages, but also the legal costs of clinical negligence claims. As damages awards grow and litigation becomes more complex, disputes over costs have become a central battleground in high value claims.

From our experience, the real challenge is not simply the cost of claims, but how those costs are justified, structured and ultimately assessed. In high value cases, even small percentage reductions can result in significant financial impact.

The Scale of Clinical Negligence Costs in England

The issue of clinical negligence in England has been widely reported by organisations such as the National Audit Office and through scrutiny of public accounts. Reports have highlighted that the total annual cost of clinical negligence liabilities and payments has reached billions, with figures often cited in the region of 3.6 billion per year.

This includes both damages and the legal costs of clinical negligence claims, which have continued to increase alongside rising complexity and evidential demands.

Bodies such as the Department of Health and those responsible for health and social care policy have acknowledged the need to better manage the costs associated with these claims. As litigation evolves, there is a clear focus on controlling expenditure without undermining access to justice or patient safety.

Rising Costs and Increasing Claim Complexity

One of the key drivers behind rising costs is the increasing complexity of high value claims. These cases often involve:

• Multiple expert disciplines
• Extensive medical evidence
• Long-term care and rehabilitation considerations
• Complex causation issues
• Significant financial losses

As a result, the legal work required is substantial. This is particularly true in catastrophic injury claims where damages may run into the millions.

Although claim numbers may fluctuate year on year, the value and complexity of claims continues to grow. This creates pressure across the system, including for organisations such as NHS Resolution, which handles claims on behalf of the NHS.

Costs Disputes in Settled Claims

A common misconception is that once a claim is resolved, costs issues fall away. In reality, settled claims often give rise to some of the most detailed and contested costs disputes.

In high value clinical negligence cases, the costs can be substantial. As a result, paying parties will carefully scrutinise every aspect of the claim for costs.

This includes:

• Time spent by fee earners
• The level of hourly rates
• The necessity of expert evidence
• The proportionality of the overall costs

In many cases, disputes proceed to detailed assessment where a costs judge determines the appropriate level of recovery.

High Value Claims and Proportionality

In high value claims, proportionality remains a key issue. Even where damages are significant, the court will still consider whether the level of costs claimed is reasonable in relation to the work required.

This is particularly relevant where:

• Multiple experts have been instructed
• There have been extensive interim applications
• The litigation has been prolonged

The court will look at whether the work undertaken was necessary and whether the cost of claims has been kept under control.

From our experience, proportionality is often one of the main areas of dispute in high value clinical negligence costs cases.

Managing Costs in High Value Clinical Negligence Cases

The increasing cost of clinical negligence litigation has drawn attention at a policy level. The Department of Health, which oversees aspects of health and social care, has recognised the need to address the financial impact of claims on public resources.

Government bodies have sought to develop policy to manage the cost of claims, including:

• Encouraging early resolution
• Promoting patient safety initiatives
• Reviewing litigation processes
• Exploring alternative dispute resolution

The link between patient safety and litigation costs is particularly important. Reducing avoidable harm reduces both the number and value of claims.

However, even with policy intervention, the cost of high value litigation is likely to continue to increase, particularly given the complexity of modern medical treatment and the long-term consequences of serious injury.

Given the scale of the issues involved, effective cost management is essential.

From our experience, firms handling high value clinical negligence litigation should focus on:

• Early and accurate costs budgeting
• Clear justification of expert evidence
• Appropriate delegation of work
• Careful monitoring of time recording
• Strategic preparation for costs disputes

Failing to manage these elements can leave costs vulnerable to challenge at a later stage.

In high value litigation, cost management is a necessity.

The Importance of Specialist Costs Expertise

High value clinical negligence costs disputes are highly technical. They require an understanding of both the legal framework and the practical realities of complex litigation.

A specialist costs team can:

• Prepare robust Bills of Costs
• Anticipate likely challenges from paying parties
• Defend costs claims effectively
• Advise on proportionality and recoverability
• Support cases through detailed assessment

This is particularly important where claims involve significant sums and complex evidential issues.

How ARC Costs Can Assist

ARC Costs has extensive experience dealing with high value clinical negligence cases and the complex disputes that arise from them. We work with solicitors and litigation teams to manage and protect the legal costs of clinical negligence claims from the outset through to final recovery.

Our services include:

• Preparation of Bills of Costs in high value claims
• Strategic advice on proportionality and cost management
• Support with costs disputes and negotiation
• Representation and preparation for detailed assessment
• Guidance on maximising recovery in complex litigation

We understand the pressures created by rising costs, scrutiny from organisations such as NHS Resolution, and the wider policy focus on controlling expenditure in clinical negligence in England.

We combine technical expertise with a practical, commercial approach to help ensure that costs are properly justified and recoverable.

High value clinical negligence litigation is unlikely to become less complex. As claims continue to evolve and the cost of claims continues to increase, costs disputes will remain a key part of the litigation landscape.

Firms that approach costs strategically, with the support of experienced specialists, are far better placed to protect recovery and achieve successful outcomes.

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