NHS Resolution told us that harmed children require care costs for decades into the future.37 Damages can include compensation for pain and suffering, care costs, future lost earnings, educational support and accommodation adaptations. They are calculated based on a claimant’s specific circumstances and to reflect differing needs throughout their remaining life. Compensation awards for these claims have also increased due to new precedents set by the courts, for example around access to innovative or novel treatment options.38 NHS Resolution told us that these changing precedents have driven up costs over time.39 One participant in our roundtable questioned whether the current tort based legal system was fit for purpose and whether there should be changes. Others suggested possible lessons to be learned from the private sector and how commercial insurers go about assessing high value claims. It was also suggested that an amendment to the Pre-Action protocol to better reflect the complexities of clinical negligence claims by providing a more realistic framework than it currently does for the investigation of those claims.40 Secondly, adopting 36 C&AG’s Report, paras 8, 2.19-2.10 37 Q 35 38 C&AG’s Report, paras 1.11, 2.8 39 Q 35 40 Pre-Action Protocol for the Resolution of Clinical Disputes – Civil Procedure Rules – Justice UK, updated March 2024 14 a similar approach to rehabilitation, specifically the Rehabilitation code.41 Also, the cost of expert reports in clinical negligence average £3,100 and quite often two reports are needed. Significantly we heard about the case of Wiseman, currently before the Supreme Court relating to lost years.42 We await the outcome of this case to understand its implications.