I am not a medical negligence lawyer. I do not work in health policy and I have no view or say on the structure of legal costs, the design of ADR frameworks or the mechanics of how claims should be processed.
I am a scientist. My work involves going back to the original research that underpins expert opinions in medico-legal and insurance cases, and looking at something quite specific: does the original study – its design, population and limitations – align with the specific question the case needs it to answer?
This is not the same job as the expert witness. Expert witnesses provide clinical opinions drawn from training, experience and their understanding of the literature. That is skilled, essential work, and nothing in this article is intended to question it. What I do sits underneath that: examining the research itself, in its full methodological detail, to see whether it is capable of bearing the evidential weight being placed on it. It is a different discipline, not a competing one. And that is the only perspective from which this article is written.
It was a conversation with a medical negligence solicitor that started me thinking about this. Over coffee, he mentioned the Lock review and the pressure building for faster, less adversarial resolution. He spoke about it with a mix of relief and concern. Relief that the system might finally change; concern about what might get lost in the process. One point he raised has stayed in my mind. It was about what happens when there is less room to challenge an expert report that does not quite hold up. ‘If everything’s moving faster,’ he said, ‘there’s just less chance to really dig into the papers.’
This is a legitimate concern worth dwelling upon.
The case for reforming clinical negligence resolution in England has been made convincingly and from all sides - by patients, clinicians, lawyers and policymakers. The David Lock KC review, commissioned as part of the NHS 10-Year Plan, represents the most serious attempt in a generation to address a system that is widely agreed to be too slow, expensive and adversarial. The direction of travel seems to have been welcomed by most.
I ask a practical question from outside the legal debate: as the system is redesigned, could this be an opportunity to give scientific evidence a more defined role in the process?
A different kind of question
Expert witnesses engage with research as part of forming their opinions. A good expert understands the literature in their field, knows which studies carry weight and draws on that knowledge alongside clinical experience when advising on a case. That is exactly what they are instructed to do and it is demanding, skilled work.
But there is a practical reality worth acknowledging. In a typical case, an expert may cite multiple studies across a broad evidence base, while simultaneously applying clinical judgement to the specific facts of the case, responding to the opposing expert and working within tight timeframes. The depth of methodological scrutiny that each individual paper receives – its study design, inclusion criteria, statistical approach, confounding variables and whether its limitations qualify the headline conclusion – is inevitably shaped by how much one person can reasonably do within those constraints.
This is not a criticism of experts; it is an observation about workload. We are asking one role to do two different things at once: form a clinical opinion and provide granular methodological analysis of the research supporting it. Both matter and both take time. And in practice, the clinical opinion – which is what the expert is primarily instructed to provide – will rightly take priority.
Reform gives us the chance to ask whether there is value in supporting
that process with a dedicated step for examining the research base at the methodological level. Not as a challenge to the expert’s conclusions, but as a complementary layer of analysis that strengthens the evidential foundation on which they are building.
Why look at methodology at all?
If an expert opinion is grounded in the literature, it can feel intuitive that the methodology is already ‘in there’. Often it is. The difficulty is that in medico-legal reasoning, the literature is frequently being asked a more specific question than the original study was designed to answer.
That gap is not a failure of the research or the expert’s reasoning; it is a consequence of using population-level evidence to answer individual, case-specific questions.
Methodological review is not about criticising experts or rerunning peer review. It is about identifying the inferential limits of the particular studies being relied upon: what the design can support, what it cannot and where general findings are being stretched into patient-specific conclusions.
That matters because many of the pressure points in contested causation are not clinical disagreements, they are scope disagreements: association versus causation, average effect versus individual probability, generalisability across populations and the impact of confounding or selection bias. These are not abstract academic issues; they determine how much weight a particular study can carry in the reasoning chain.
In a faster system, early positions carry more weight. The earlier the evidential foundation is clarified, the less time and cost are later spent debating what a study ‘really shows’.
Faster resolution makes this more relevant, not less
In a faster system, there is less time to interrogate whether the studies cited in an expert opinion were designed to answer the specific question the case requires. There is less opportunity to identify if general findings are being applied to individual contexts where the fit is not straightforward.
This is not an argument against faster resolution. It is an argument for being explicit about where the scientific evidence review sits in a reformed process.
If scrutiny of the research base is treated as something that happens later, as a consequence of adversarial challenge, then a faster process simply reduces the likelihood that it happens at all. But if methodological review is built in as an early, routine step, it supports faster resolution by narrowing the scope for later disagreement about what the science can and cannot show.
An expert whose opinion rests on research that has been examined for methodological ‘fit’ is in a stronger position, not a weaker one. And where the research does not fully align with the question being asked, identifying that early allows it to be addressed constructively, before it becomes a point of dispute that slows the process down.
Mediation depends on the quality of the evidence going in
Greater use of mediation and early resolution is a likely feature of reform, with clear advantages: it is less adversarial, less costly and often less distressing. Mediation is designed to reach an agreement, not to test evidence. That makes the quality of the evidence entering the process more important.
Expert opinions set the evidential starting point for mediated negotiations. If the research underpinning those opinions has been examined at the methodological level before mediation begins, all parties can proceed with greater confidence that the foundations of their argument are solid.
Independent scientific evidence review at this stage would strengthen mediation rather than complicate it. It would support expert opinions where the research is strong and surface any limitations early, when they can be addressed constructively rather than emerging later as points of contention.
Lower-value claims will benefit most
Reform discussions have rightly focused on lower-value claims, where legal costs frequently outstrip compensation. Streamlined resolution of these cases makes clear sense.
But lower-value claims are not necessarily simpler in their scientific content. A claim involving delayed diagnosis, a disputed treatment pathway or an adverse outcome following a routine procedure may involve the same methodological questions as a high-value case, the same reliance on observational studies, the same gap between population-level findings and individual-level causation.
Expert witnesses working on these cases face the same intellectual demands but often within tighter timeframes and with fewer resources. A focused assessment of whether the cited research relied upon fits the claim could be built into streamlined pathways without undermining speed or cost-effectiveness.
This would also give expert witnesses working under time pressure an additional layer of support: confirmation that the research they are relying on has been independently examined. And it would give solicitors and their clients greater confidence in the evidential foundation of the case, whichever side they are on.
What this could look like in practice
This is not a call for additional steps, but for using reform to place scientific evidence review more deliberately within the process. That could include:
- Evidence review at the pre-negotiation stage. Before mediation or early resolution begins, an independent assessment of the research base is conducted, not to second-guess the expert opinion but to confirm that the studies being cited are methodologically capable of supporting the conclusions being drawn from them.
- Support for expert witnesses. Providing experts with an independent review of the key literature before or alongside their instruction – helping them identify where the research is strong, where t
- Recognition that faster resolution increases the importance of getting the evidence right first time. In a system with fewer opportunities to revisit the evidence later, the quality of the initial evidence base matters more, not less. Building in early review is not an additional cost; it is an investment in getting outcomes right at the point where it is simplest to do so.
The question worth asking
Expert witnesses do essential, skilled work. Solicitors build cases with care and diligence. But the research that underpins both – the studies, the methods, the populations, the limitations – is a separate layer that benefits from its own kind of analysis.
A reformed system can build that in. Not as a check on anyone’s work but as a strengthening foundation. That would be good for experts, good for solicitors and good for the people whose outcomes depend on getting the science right.
Dr Carolina Stamboulid is a scientific evidence analyst and founder of Episteme Scientific Consulting
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