There has hardly been a week over the past six months when there has not been media comment on the high cost of clinical negligence claims and the burden that these create for the NHS.

This has resulted in calls for less litigation and a cheaper method of resolving disputes.

Examples have included mediation, better self-regulation and latterly no-fault compensation.So what are the real problems with clinical negligence claims? Traditionally such claims have taken a long time and been very costly.

However, since the Woolf reforms and the emphasis on openness, early exchange of evidence and offers to settle, the situation has changed.

Mediation, meetings of experts and settlement meetings are becoming increasingly common.

All of these initiatives can speed the resolution of clinical disputes.But the cry continues for a cheaper way of dealing wit h disputes about medical treatment.

The government, for financial reasons, has been calling for a no-fault compensation scheme for the victims of medical accidents.

And, perhaps understandably, the British Medical Association is campaigning hard for such a system.The proposal is that there should be a 'non-adversarial dispute resolution with a tariff that would pay fixed amounts for different injuries regardless of blame'.

The perceived advantages are that it would cost less, the amount spent could be more easily fixed and controlled, and -- much of the time -- effort and money spent on establishing negligence would be saved.

Doctors' reputations would not be tarnished by judgments and they would avoid being called to task for negligent error causing injury to patients.However, there are a number of serious disadvantages which need to be considered.

Causation would still have to be proved-often more difficult and costly than proving negligence.

It would still be necessary to obtain medical records and involve analysis of those records by one or more medical experts.

Lawyers would be needed to represent claimants and defendant health professionals, so legal time and costs would still be significant.There would still be disputes about the level of compensation.

A similar scheme exists for victims of criminal injury, the Criminal Injuries Compensation Board (CICB).

There are many appeals about the financial awards in those cases, but there is no doubt that establishing causation and quantum and compensation in clinical negligence claims is much more difficult; hence the tariff that works (or arguably does not) in the CICB scheme is not appropriate.Currently, trusts and individual doctors are insured, but under a no-fault compensation scheme it is not clear whether insurers would pay, or whether the costs would be passed to the whole community as opposed to those suspected of negligence.

Money for the scheme would have to come out of NHS resources and possibly directly from patient care.And most importantly, a no-fault culture could lead to less clinical accountability.

There is no doubt that outside scrutiny and financial payments have raised standards of clinical care and accountability.

Surgeries and NHS trusts nationwide have introduced clinical audits, risk assessments and staff training to avoid negligent errors occurring or being repeated.

Protocols have been drawn up and guidance given to health professionals.A no-fault compensation scheme could mean less accountability and more autonomy for health professionals.

This would in turn mean poor reporting and ultimately repetition of errors.If a new system is introduced, it needs to be one that is fair and just to the injured party, allows proper explanation and compensation, while at the same time encouraging better practice and more accountability within the NHS and the private health sector.