NHS Resolution and the Clinical Negligence Scheme for Trusts (CNST)

NHS Resolution is the public body, attached to the Department of Health and Social Care, that handles clinical negligence claims against the NHS in England. It was called the NHS Litigation Authority until 2017. Its main scheme, the Clinical Negligence Scheme for Trusts (CNST), has run since 1995 as a public mutual: trusts pay an annual contribution, and the scheme pays claims on their behalf. There is no insurance contract and no private reinsurance; the Treasury is the payer of last resort. Since April 2019, a sister scheme, CNSGP, covers general practitioners the same way. The governing law is common law negligence: the 1957 Bolam test for breach, the 2015 Montgomery ruling for patient disclosure. The 2024/25 figures give the scale: £3.1bn paid out, of which £1.3bn for maternity, and 14,428 new claims and reported incidents. The provision for future liabilities stood at £60.3bn at March 31, 2025. The estimated annual cost of harm for CNST incidents fell from £4.8bn to £4.6bn, driven by the personal injury discount rate, raised in January 2025. For an underwriter, the scheme matters in two ways. It sets the benchmark price for large bodily injury losses in the UK, which private hospitals insure in the commercial market. And it shows what an obstetric long tail costs, settled through indexed periodical payments over decades. Not to be confused with medical defense organizations, which offer discretionary indemnity.