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Anon at 14:15pm - yes, very sadly, denials in clinical negligence cases (whether for breach or causation) are the norm. Contrast this with PI, where the reverse is broadly true and an interesting question emerges: why? Granted clin neg is not as black and white as PI, but I still don't think this accounts for the discrepancy we see.

I do a mixed-bag of PI and clin neg work (c. 30/70 split) and have worked in both Defendant and Claimant roles for over a decade. In my opinion, the only way we are going to see real change is if we start considering and tackling (1) why denials are so prevalent and (2) the reason patients / their bereaved families decide to sue in the first place.

I'd suggest that the initial denials often have far more to do with protectionism and knee-jerk reactions on the part of the implicated health professionals, Trusts and Defence Unions, than on any assessment of the merits of a particular case.

In terms of the decision to sue: Most people realise that to err is human; if I had £1 for each client who told me that they would not have pursued a claim had they only been given the truth and an apology, I'd have a tidy sum.

We need to get to a stage where doctors and Trusts feel able take accountability for mistakes and place the interests of injured patients and / or their families first. The current work on the Duty of Candour and any follow-up pursuant to the most recent report on Hillsborough, if managed well, could greatly improve the transparency and accountability of potential defendants. Allowing parity of publicly-funded representation at Inquests could also reduce expense for defendants on those cases with tandem clinical negligence claims (albeit that the costs of would come from LAA funds instead, creating a burden elsewhere on the public purse).

Perhaps radically, I think that only mandatory, mutual, WoP disclosure of expert evidence and / or mediation within the protocol period will help encourage early admissions / settlement and stop the all-too-common practice of defendants only obtaining comprehensive expert evidence after proceedings have been issued.

There may be something gained by looking at the provision of NHS care for claimants with ongoing care needs, but this would need to be a very different system to that of general NHS access and probably only with the facility for independent, patient-appointed, care managers and leave to apply to the court for privately-funded care if the NHS is failing to meet its obligations.

What is clear to me, however, is that the principle that an injured person be properly compensated for their injuries must not be diluted - either in the sum they receive in settlement, or in their ability to access good quality care. That may seem the simplest solution for defendants, but it goes completely against justice in its truest sense.