One of the most noticeable changes in medico-legal practice over the last 20 years has been the vast increase in the number of complaints from patients and their relatives. There may be a number of reasons for this, including:

• clinicians may be making more errors;

• patient expectations are higher;

• patients are more likely to sue clinicians;

• lawyers are more likely to pursue legal claims against clinicians;

• significant financial payouts act as incentives to pursue legal claims.

The cost to the National Health Service (NHS) of settled and outstanding negligence claims is enormous. Various estimates have been made. Fenn et al. estimated that the rate of closed claims rose by 7% per annum throughout the 1990s, and cost the NHS between £48 million and £130 million in 1998 alone. By extrapolation, the liability for claims that are yet to be settled amounts to £1.8 billion.

The gradual realisation of the cost of negligence claims to the NHS has prompted the formation of a number of bodies, in order to try and improve the safety and quality of healthcare.