The £91.8 million warning sign: what rising gynaecology claims mean for NHS providers and the insurance market

Insights

5 minutes

18 June 2026

The recent Healthcare Today report, which found that the NHS paid £91.8 million in gynaecology-related claims over a five-year period, should be viewed as more than a headline statistic1. It highlights the growing pressures facing women's healthcare services, reflects the increasingly complex medico-legal landscape, and raises important questions about how clinical risk is identified, managed and mitigated.

While obstetrics often attracts greater attention due to the severity and value of individual claims, gynaecology presents a different but equally significant challenge. From a risk perspective, it is characterised by a high volume of claims that, collectively, create a substantial financial and operational burden.

For healthcare providers, commissioners and insurers alike, the findings reinforce the need for a more proactive approach to risk management. Improving patient outcomes and reducing claims costs are closely linked. Without greater focus on prevention, early intervention and learning from recurring causes of harm, the current trajectory is unlikely to be sustainable.

As demand for women's health services continues to grow, strengthening clinical governance and investing in effective risk management will be essential to delivering better outcomes for patients while supporting the long-term resilience of the healthcare system.

The wider clinical negligence landscape

To understand the significance of £91.8 million, it must be placed within the broader context of NHS clinical negligence liabilities. Clinical negligence claims payments made in 2024/25 was £3.1 billion2.

These figures represent long-term liabilities arising from incidents already incurred, meaning the financial consequences of today’s risk environment will extend decades into the future.

The National Audit Office (NAO) has repeatedly warned that the rising cost of clinical negligence poses a significant risk to the financial sustainability of the NHS3.

Since 2010, annual spending on clinical negligence has more than doubled. While obstetric claims account for a high proportion of total damages value, non-obstetric specialties – including gynaecology – represent a substantial volume of claims and ongoing financial leakage.

The £91.8 million figure therefore sits within a broader environment of systemic cost escalation driven by:

  • Rising damages awards
  • Increasing claimant legal costs
  • Greater patient awareness and willingness to litigate
  • Judicial inflation and updated compensation guidance
  • Workforce and operational pressures within the NHS

Why gynaecology claims are rising

From an underwriting perspective, several converging factors are increasing exposure within gynaecology.

  • Diagnostic delay and cancer pathways

    A significant proportion of gynaecology-related claims stem from allegations of delayed diagnosis, particularly in cases involving ovarian, endometrial and cervical cancers. As awareness of women's health issues continues to grow, so too do patient expectations around timely assessment, diagnosis and treatment. For independent providers, growing demand for women's health services places increasing importance on robust referral pathways, timely access to diagnostics and effective follow-up processes. Where delays occur, or where patient journeys become fragmented, the risk of adverse outcomes and subsequent claims increases. From an underwriting perspective, exposure is often driven by operational and governance factors as much as clinical decision-making. Providers that can demonstrate strong oversight of patient pathways, clear documentation and proactive risk management are better placed to reduce both patient harm and litigation risk. Variation in patient pathways can significantly increase risk. Where referrals, diagnostics or follow-up processes are inconsistent, the potential for missed or delayed diagnoses rises, increasing the likelihood of claims.

  • Surgical complications and informed consent

    Gynaecological procedures, including hysterectomies, laparoscopic surgery and prolapse repair, carry recognised clinical risks. When complications occur, claims often focus not only on the outcome itself, but on whether patients were adequately informed of the risks and treatment options available to them. Litigation frequently centres on: • Alleged failure to warn of material risks • Inadequate documentation of consent • Surgical injury to bowel, bladder or ureter • Post-operative infection or haemorrhage • Poor follow-up and communication The legal test for consent, clarified in Montgomery v Lanarkshire Health Board (2015), has fundamentally shifted the litigation landscape. Clinicians must ensure patients are aware of material risks and reasonable alternatives. Failure to evidence this process clearly in clinical notes increases the defensibility challenge for medical malpractice insurers.

  • Workforce and system strain

    Demand for private healthcare continues to grow as patients seek faster access to consultations, diagnostics and treatment. The UK private healthcare market is now estimated to be worth almost £14 billion , while over one million private tests and scans are carried out each year, reflecting the increasing role of independent providers in meeting patient demand. This growth brings both opportunity and risk. As services expand, maintaining consistent oversight across patient pathways becomes increasingly important. Workforce shortages remain a challenge across the wider healthcare sector, with independent providers often drawing from the same clinical talent pool as the NHS. In gynaecology, where care frequently involves multiple consultations, investigations and follow-up appointments, continuity and coordination are critical. Delays in reviewing results, communication breakdowns and gaps in documentation can all contribute to adverse outcomes and, ultimately, claims. As patient volumes increase, strong clinical governance and operational resilience become essential in reducing risk and maintaining high standards of care.

  • Judicial inflation and damages growth

    The Judicial College Guidelines for the Assessment of General Damages in Personal Injury Cases continue to influence rising compensation levels . The financial impact of gynaecology claims is being driven not only by the number of claims received, but by the increasing cost of settling them. Rising compensation awards, higher care costs and broader inflationary pressures have all contributed to upward pressure on claim values in recent years. Even where claim numbers remain stable, rising settlement costs are increasing the overall cost of risk. Higher-value claims can affect indemnity costs, insurer appetite and the affordability of cover, making effective risk management more important than ever.

What this means for healthcare providers

As claims costs continue to rise, insurers are placing greater emphasis on how clinical risk is managed and evidenced. Areas attracting increased scrutiny include:

  • Clinical governance and oversight
  • Incident reporting and learning culture
  • Referral and diagnostic pathways
  • Informed consent processes and documentation
  • Consultant claims histories and specialty mix
  • Quality and consistency of clinical records

As a result, providers may experience:

  • More detailed underwriting reviews at renewal
  • Increased focus on claims trends and risk controls
  • Greater scrutiny of governance and audit processes
  • Upward pressure on premiums where claims experience deteriorates
  • Higher excess levels for organisations with elevated risk profiles

In a more challenging claims environment, strong governance, robust data and a proactive approach to risk management can help providers demonstrate quality, improve insurer confidence and support access to sustainable insurance cover.

Beyond claims defence: the shift to prevention

The financial trajectory makes one point clear: defending claims alone is not a sustainable strategy. The National Audit Office has emphasised the importance of learning from claims to reduce future harm. At Howden, we see a growing need for integrated risk strategy combining:

  • Claims analytics

    Claims analytics beginning with mining historical claims data to identify recurring themes and systemic weaknesses. This includes analysing patterns linked to specific procedure types, individual clinicians or teams, time-to-diagnosis intervals, and recurring documentation gaps. When approached rigorously, claims data becomes more than a record of past incidents; it becomes a forward-looking risk tool. Advanced analytics enable organisations to identify trends early, intervene before issues escalate, and embed targeted improvements in clinical governance and operational processes.

  • Pathway stress-testing

    Pathway stress-testing involving mapping the full patient journey, from referral through to discharge, to expose structural vulnerabilities. This process can highlight bottlenecks in access to diagnostics or surgery, weaknesses in result-handling systems, handover risks between teams, and communication breakdowns that increase the likelihood of adverse outcomes. In an environment where elective backlogs remain a persistent challenge, scenario modelling is particularly valuable. It allows boards to understand how delays or capacity constraints may translate into litigation exposure and to plan mitigations accordingly.

  • Consent framework reviewing

    Consent framework reviewing has become increasingly critical in the post-Montgomery legal landscape. Compliance now requires more than obtaining a signed form; it demands demonstrable shared decision-making and clear documentation of material risks and reasonable alternatives. Structured consent audits provide assurance that processes are consistent, defensible and patient-centred. From an underwriting perspective, robust consent governance can materially influence how risk is assessed and priced.

  • Insurance structure optimisation

    Insurance structure optimisation is equally important in the context of sustained claims inflation. Organisations should regularly stress-test the adequacy of indemnity limits against realistic loss scenarios, review excess structures to ensure appropriate risk retention, and assess aggregation risk across specialties and sites. Consideration should also be given to run-off exposure and the integrity of retroactive dates. Inadequate limits or poorly structured programmes can create significant balance sheet vulnerability, particularly as damages and legal costs continue to rise.

The strategic question for boards

The £91.8 million paid in gynaecology-related claims should be viewed as more than a measure of past performance. It is an indicator of the risks healthcare providers will continue to face if underlying issues are not addressed.

For boards and executive teams, key questions include:

  • Do we understand the drivers behind our claims experience?
  • Where are the greatest risks within our patient pathways?
  • How effectively are we identifying and responding to diagnostic delays?
  • Are consent processes consistent, robust and well documented?
  • Do our governance frameworks provide sufficient oversight of clinical risk?
  • Are we using claims data and incident trends to inform decision-making?

These are no longer purely operational or compliance considerations. As claims costs continue to rise, they are increasingly becoming strategic issues that affect patient outcomes, organisational resilience and long-term financial performance.

A specialist response is essential

Healthcare risk is complex. Gynaecology carries unique clinical, operational and reputational exposures that generic insurance approaches cannot adequately address.

At Howden, our healthcare specialists work with:

  • Private practice consultants
  • Independent hospital groups
  • Specialist women’s health providers
  • Insurers underwriting medical malpractice

We combine deep market relationships, data-led risk insight, detailed claims trend analysis, governance advisory capability and programme design expertise to deliver informed, strategic insurance solutions tailored to the healthcare sector. Insurance should not sit at the end of the risk conversation. It should inform it.

At Howden, we believe that effective insurance is not just about paying claims. It is about enabling safer healthcare systems. Get in touch with Simon Gale to find out more.

Simon Gale

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Divisional Director - Healthcare
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  1. NHS pays out £91.8 million in gynaecology claims - Healthcare Today
  2. NHS Resolution Annual report and accounts 2024/25
  3. https://www.nao.org.uk/reports/managing-the-cost-of-clinical-negligence-in-trusts/
  4. Montgomery (Appellant) v Lanarkshire Health Board (Respondent) (key point two)
  5. Private healthcare growth weakens as the market is hit by individual cutting back on out-of-pocket spending on healthcare - LaingBuisson (key point three)
  6. https://www.judiciary.uk/publications/guidelines-for-the-assessment-of-general-damages-in-personal-injury-cases/ (key point four)
  7. https://www.nao.org.uk/reports/managing-the-cost-of-clinical-negligence-in-trusts/