Claim against NHS: how the process works and what you can recover

Published 15 April 2026

TL;DR

A claim against NHS providers follows the Pre-Action Protocol for the Resolution of Clinical Disputes before any court proceedings are issued
Claims against NHS trusts in England are defended by NHS Resolution under the Clinical Negligence Scheme for Trusts; the claim is brought against the trust, not the individual clinician
The process: obtain records, get expert evidence, send a Letter of Claim, await a Letter of Response (up to four months), then negotiate or issue proceedings
Most claims against NHS bodies settle without going to court; NHS Resolution settled over 15,000 claims in 2023-24
You can recover general damages for pain and suffering and special damages for financial losses including lost earnings and care costs
The time limit is three years from the negligent act or from the date of knowledge

A claim against NHS providers is the legal mechanism for obtaining compensation when NHS treatment falls below the required standard of care and causes harm. The NHS is not immune from negligence liability. NHS trusts owe patients the same duty of care as private providers, assessed by the same Bolam standard. The difference in practice is that claims against NHS trusts are handled centrally by NHS Resolution rather than by the individual trust's own legal team.

This guide explains the step-by-step process for bringing a claim against NHS bodies, what NHS Resolution does, and what you can expect to recover.

Who handles a claim against NHS trusts?

In England, NHS Resolution (formerly the NHS Litigation Authority) manages clinical negligence claims on behalf of member NHS trusts and foundation trusts under the Clinical Negligence Scheme for Trusts (CNST). When you bring a claim against NHS secondary care, your claim is effectively defended by NHS Resolution's panel solicitors.

NHS Resolution is not a court. It is a special health authority that handles risk pooling, claims management, and early resolution on behalf of NHS trusts. It reported total payments of over £2.8 billion in clinical negligence in 2023-24, settling over 15,000 claims. The majority of those settlements were reached without proceedings being issued.

For NHS primary care (GP practices, dental practices, pharmacy), NHS Resolution does not handle claims in the same way. GP practices are typically covered by medical defence organisations (MDOs) such as the Medical Defence Union or Medical Protection Society. The claim is brought against the practice and the individual practitioner rather than against a trust.

For a general overview of NHS-specific claims and how compensation is assessed, see the NHS compensation guide.

What is the pre-action protocol for a claim against NHS?

Before court proceedings can be issued, a claim against NHS providers must follow the Pre-Action Protocol for the Resolution of Clinical Disputes. The protocol is designed to encourage early disclosure, promote settlement, and avoid unnecessary litigation. The key steps are:

Step 1: Obtain medical records. Your solicitor sends a formal records request to the NHS trust. Trusts are required to provide records within 40 days. Records include clinical notes, nursing records, operation notes, investigation results, and correspondence between clinicians.

Step 2: Obtain expert evidence. An independent medical expert in the relevant specialism reviews the records and provides a written report assessing whether the treatment fell below the Bolam standard and whether that breach caused the harm claimed. This report is the foundation of the claim. Both breach and causation require separate expert opinions in most cases.

Step 3: Send a Letter of Claim. Once supportive expert evidence is obtained, your solicitor sends a Letter of Claim to the defendant NHS trust. The letter sets out: the facts of the treatment; the specific acts or omissions alleged to constitute negligence; the injuries caused; and the financial losses claimed. The Letter of Claim must be detailed enough for the defendant to investigate and respond.

Step 4: Await the Letter of Response. The defendant trust (through NHS Resolution) has four months from the date of the Letter of Claim to investigate and respond. The Letter of Response will either admit breach (in whole or in part), deny breach, or request more time with reasons.

Step 5: Negotiate or issue proceedings. If liability is admitted, negotiations on quantum (the value of the claim) follow. If liability is denied, the parties may attempt alternative dispute resolution (mediation) or proceedings may be issued in the County Court or High Court.

For the full step-by-step process including what happens after proceedings are issued, see the how to claim guide.

What can you recover in a claim against NHS?

A claim against NHS trusts can recover two categories of loss:

General damages compensate for pain, suffering, and loss of amenity. These are assessed by reference to the Judicial College Guidelines (17th edition, April 2024). General damages are a lump sum based on the severity of the injury and its effect on the claimant's life.

Special damages compensate for financial losses. These include: past loss of earnings (from the date of the negligent act to settlement or judgment); future loss of earnings (where the injury affects future earning capacity); the cost of care provided by family members or professionals; aids and equipment; property adaptations; travel costs; and the cost of private medical treatment necessitated by the negligence.

In high-value claims involving permanent disability or catastrophic injury, special damages can be very substantial. Claims valued at over £1 million are not uncommon where the claimant requires long-term professional care and has lost significant future earnings.

For detailed compensation ranges by injury type, see the compensation guide.

How long a claim against NHS takes

The duration of a claim against NHS providers depends on the complexity of the case and whether liability is admitted early. Straightforward claims where NHS Resolution admits breach relatively quickly may settle within 12 to 24 months of instruction. Complex claims involving disputed causation, multiple experts, and high value may take three to five years from instruction to settlement or judgment.

NHS Resolution has a policy of resolving claims at the earliest reasonable opportunity. For claims where the evidence clearly establishes breach and causation, early resolution is in the interests of both parties and NHS Resolution generally does not defend claims it knows it will lose.

Most claims that proceed to a contested hearing are high-value or involve disputed causation on complex clinical facts.

Time limits for a claim against NHS

The limitation period for a claim against NHS providers is three years from the later of: the date of the negligent treatment, or the date of knowledge. The date of knowledge is the date the claimant first knew (or ought to have known) that they suffered significant harm attributable to the treatment.

Children have until their 21st birthday. People who lacked mental capacity at the time of the negligence do not have the limitation period running while that incapacity continues.

Bringing a claim against NHS providers outside the limitation period requires the court's discretion under section 33 of the Limitation Act 1980. This discretion is exercised sparingly and should not be relied upon. Legal advice should be sought promptly.

For a full explanation of the limitation rules and the date of knowledge test, see the time limits guide. For how claims are funded, see the funding guide. For an overview of the NHS claims framework, see the NHS claims guide.

This page provides legal information, not legal advice. If you believe NHS treatment caused you harm, speak to a qualified solicitor who specialises in clinical negligence. Time limits apply and early advice is important.