Kent NHS Trusts Paid £389m in Clinical Negligence Claims – Costliest Specialties by Trust
shepwayvox
Looking only at gynaecology opens one window onto Kent’s clinical-negligence bill. The full ledger is a much bigger, stranger picture: four acute hospital trusts recorded £389.2 million in damages and legal costs on claims closed over five years, while the most expensive disclosed specialty was obstetrics at three trusts and radiology at East Kent.
Gynaecology makes a tidy headline. Clinical negligence doesn’t make a tidy story. Behind every row in NHS Resolution’s spreadsheets sits an allegation that care went wrong and, sometimes, a life altered beyond repair. Yet the numbers don’t arrive in neat chronological order. A claim received this year may concern treatment given years ago; a case closed this year may have been fought over for just as long. The spreadsheet is less a snapshot than a long-exposure photograph.
From 2020/21 to 2024/25, East Kent Hospitals University NHS Foundation Trust, Maidstone and Tunbridge Wells NHS Trust, Medway NHS Foundation Trust and Dartford and Gravesham NHS Trust together recorded £293.3 million in damages and about £95.9 million in legal costs on claims closed with compensation. That makes £389.2 million altogether. This isn’t every NHS organisation in Kent; it’s the four acute trusts running the county’s main general hospitals.
The scheme is CNST, short for the Clinical Negligence Scheme for Trusts. In plain English, it’s the national indemnity arrangement through which NHS Resolution handles clinical-negligence liabilities for member trusts. “Damages” means compensation paid to a claimant. “Legal costs” combine the NHS’s defence costs with the claimant’s legal costs. They’re public costs arising from clinical-negligence claims, and they deserve proper scrutiny.
Nearly £1 in every £4 of the four trusts’ combined bill went on legal costs rather than damages — roughly 25p from every pound. It doesn’t follow that every penny was avoidable. Complex cases need expert evidence, specialist lawyers and careful investigation. Even so, a legal bill approaching £96 million raises a fair question about whether disputes are being resolved early enough, openly enough and without families being made to run a marathon merely to get an answer.
The two clocks that mustn’t be mixed up
Across the same five years, the four trusts had 1,546 claims or incidents notified to NHS Resolution. They also recorded 1,057 claims closed with damages and 571 closed without damages. Those figures can’t be turned into a success rate. They’re different crowds passing through different doors: many claims closed during the period were notified earlier, while many notified during the period remained open after March 2025.
NHS Resolution spells out the trap. Claims can concern incidents from years before, take years to settle and, unusually, appear more than once across year groups if a nil-damages closure is challenged and reopened. It also says annual rises and falls can’t be read as a trend because individual claims vary so sharply. Anyone dividing 1,057 by 1,546 and calling the answer a “win rate” would be comparing apples with wheelbarrows.
Who carried the biggest bill?
East Kent Hospitals recorded the largest five-year total: £143.8 million, comprising £105.8 million in damages and £38.0 million in legal costs across 407 claims closed with compensation. It also had the largest number of notifications among the four, at 636. That’s substantial, but NHS Resolution warns against treating trust data as a league table: East Kent’s services, patient volumes and clinical risks aren’t identical to those of its neighbours.
Medway came next at £111.3 million, including £89.4 million in damages, on 258 compensated closures. Maidstone and Tunbridge Wells recorded £73.1 million on 216, while Dartford and Gravesham recorded £60.9 million on 176. The order changes depending on whether the question is how many claims closed, how much compensation was paid or how much went on lawyers. One number can’t do all three jobs without making a pig’s ear of the comparison.
The combined annual bill was £63.7 million in 2020/21, fell to £52.8 million, shot up to £110.1 million in 2022/23, dropped to £69.0 million and then rose to £93.6 million in 2024/25. That jagged line isn’t evidence that Kent’s hospitals suddenly became twice as unsafe and then improved. A handful of very expensive settlements can move a year’s total like a heavy lorry hitting a small bridge.
Gynaecology wasn’t the costliest category
To find which specialty cost most, we need a different NHS Resolution table and a different time window. The complete specialty breakdown used here covers claims closed with damages from 2018/19 to 2023/24. Those totals shouldn’t be divided into the separate 2020/21-to-2024/25 figures above. They’re two lenses focused on overlapping, but not identical, periods.
Obstetrics covers pregnancy, labour and childbirth. Gynaecology covers conditions and treatment involving the female reproductive system outside that pathway. Radiology covers medical imaging and its interpretation. The labels describe the specialty attached to a claim; they don’t reveal the precise error, injury severity or whether several cases shared a common cause.
At East Kent Hospitals, radiology was the highest-cost disclosed specialty. Its 32 claims produced £22.8 million in damages and £4.4 million in combined legal costs, giving £27.23 million. Emergency medicine followed at £20.85 million and obstetrics at £18.90 million. Gynaecology, with 31 claims, cost £2.67 million. Radiology and gynaecology had almost the same number of claims, yet the former cost more than ten times as much.
That finding lands with a thud because East Kent’s maternity services have already been the subject of a major independent investigation. It doesn’t make those maternity failings less serious, nor does it prove a new radiology scandal. It simply stops the familiar story from blocking the view. The costliest disclosed category in this claims window was somewhere else.
At Maidstone and Tunbridge Wells, obstetrics was out in front at £30.95 million across 29 claims. Orthopaedic surgery was next at £9.99 million, followed by emergency medicine at £8.95 million. Gynaecology accounted for seven claims and £663,000. The gap is enormous, but it can’t tell us whether there were repeated similar mistakes or one exceptionally severe case. Aggregate data points to the cupboard; it doesn’t show what’s on every shelf.
Medway’s most expensive disclosed specialty was also obstetrics: £34.00 million across 28 claims, the largest of the four winning categories. Paediatrics came second at £16.10 million despite only seven disclosed claims, while emergency medicine cost £9.22 million across 44. Gynaecology cost £2.32 million across 12. Again, frequency and financial severity pull in different directions.
Dartford and Gravesham gives the clearest warning against counting claims and assuming the biggest pile must carry the biggest price tag. Gynaecology had 51 claims and cost £9.02 million. Obstetrics had fewer than half as many — 24 — but cost £29.55 million, more than three times as much. One catastrophic injury may outweigh a long run of lower-value settlements.
That’s why a crude “average payout” can be more fog than light. Dividing a specialty’s total cost by its claim count produces a number, but not necessarily a typical case. One life-changing settlement can drag the average skywards while the median — the middle claim when values are ordered — remains far lower. NHS Resolution doesn’t publish the individual values needed to calculate that median here, so the honest comparison is between disclosed totals and counts, not imaginary “typical” patients.
What the figures leave in the shadows
“Highest-cost” must be read as “highest-cost disclosed”. NHS Resolution suppresses categories involving fewer than five claims because detailed medical information could help identify individuals. It sometimes masks related totals too, preventing the hidden figure from being worked backwards. The published table isn’t a perfectly transparent shop window; some glass is deliberately frosted to protect patients.
There’s another gap. Some severe cases are settled through a periodical payment order, or PPO: an initial lump sum followed by regular future payments to meet continuing needs, often care for life. The table includes amounts paid up to the year of settlement but not future instalments already committed. The published figures can therefore understate the eventual lifetime cost.
Nor should the four trusts be ranked as though they were branches of the same supermarket. Larger hospitals treat more patients; specialist and complex services carry different risks; one event can generate multiple claims. The data hasn’t been adjusted for admissions, procedures, births or case complexity. It tells us who recorded the largest sums, not who provided the worst care per patient.
It also can’t tell us when the underlying treatment happened, what safety changes followed or whether the same problem recurred. A settlement year is an accounting marker, not the date harm occurred. The 2022/23 spike is a signal to investigate the cases behind it, not a ready-made verdict on that year’s frontline staff.
The questions that now need answers
The proper next step isn’t to gawp at £389 million and shout “scandal”. It’s to follow the money back towards the care. Why did radiology claims at East Kent cost £27.23 million? What kinds of obstetric harm drove the leading totals at Maidstone and Tunbridge Wells, Medway, and Dartford and Gravesham? Were they isolated, historic catastrophes or repeated patterns? What recommendations followed, when were they implemented, and how has each trust checked that the fix worked?
The legal-cost figures deserve the same treatment. Trusts and NHS Resolution should explain how often cases were resolved before proceedings, how long families waited, what proportion of costs arose on each side and whether earlier candour might have shortened the fight. A cheque doesn’t repair trust. An apology without learning is little better than sticking a plaster on a burst pipe.
This isn’t merely a Kent argument. In January 2026, Parliament’s Public Accounts Committee warned that government and the NHS still couldn’t demonstrate meaningful action on the underlying causes of clinical-negligence costs, despite repeated warnings over two decades. NHS Resolution says its purpose includes resolving concerns fairly, sharing learning and preserving resources for patient care. The local test is whether each Kent trust can show the learning, not simply book the payment.
That’s the story hiding behind the gynaecology headline. Women’s healthcare plainly matters, and Dartford and Gravesham’s £9 million gynaecology bill is no trifle. But a narrow category can become blinkers. The wider records show radiology leading at East Kent, obstetrics leading elsewhere, legal costs swallowing almost a quarter of the five-year bill and annual totals swinging too wildly for easy conclusions.
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