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Arthur, medical negligence claims cost the same to litigate as other claim types.

The main difference is that in all relatively modest claims the costs incurred are disproportionate to the value of the claim. Where a company might write off a £4k debt rather than incur £20k litigation costs, that does not apply here.

In a simple case (let's say a claim valued at around £5k for a pressure sore and minor surgery claim following a stay as an in-patient) the process might be:

1. Obtain and review records.
2. Obtain nursing report (non-CPR compliant report at around £75-£1k) dealing with breach.
3. Obtain vascular report dealing with causation (say £2,500 for a basic report).
4. At this point my inclination is to do a letter of claim so as to get investigations started earlier, and I get condition and prognosis evidence whilst I wait for a protocol response - I often cannot wait until a liability decision because limitation will become pressing.
5. Plastic surgeon report (or whoever is appropriate to give condition and prognosis evidence) (say £1,000).

So by letter of claim stage you may have ATE at £6k and expert fees incurred at around £5-6k. Add in maybe £5k costs and your total is around £20k already (1/4 of which is solicitor costs).

6. Liability denied on breach grounds - nurse expert reviews and changes opinion to CPR compliant report (add £750).
7. Liability denied on causation grounds - vascular reviews and gives opinion (add £1k).
8. Issue.

After issue I'll be thinking that the NHS may well want it's own evidence on breach, causation and C&P. If so, that will be 3 lots of expert opinion, 3 lots of expert discussion and quite possibly 6 experts at trial. If you're fortunate some narrowing of issues can occur.

Assume C&P is agreed and the argument is about breach and maybe causation. a 3 day trial with 4 experts present for each day. At £2k per day per expert that is £24k for experts alone. Add in a brief fee of around £10k.

I've made up the figures but it gives a flavour that in a low value claim the overall costs (profit costs, disbursements/expert fees and VAT) might well be £20k on a claim valued at around £5k.

By the end of a 3-day trial those costs may well be £50k for disbursements/expert fees alone. Tag on Counsel, profit costs and VAT and you're approaching £80k on a £5k claim.

It seems bonkers but that's the way it is, and in most cases that I've dealt with the solicitor profit costs are not the main figure. Hence the need to change the process.

My inclination is for there to be a positive duty on defendants to commence investigations as soon as they get a letter of notification and to have a period of 2 months or so to provide an initial indication of whether an admission will be forthcoming.

That might well knock into touch breach reports and a whole lot of time. If breach is admitted move onto joint causation and C&P reports where cases are less than £25k.

If they cannot respond or indicate a denial then the breach expert proceeds to a full CPR compliant report followed by a letter of claim etc. Then a protocol response before causation evidence is obtained.

I could witter on but coffee is needed.