By Nick Triggle
Health reporter, BBC News
Solicitors can charge up to £600 an hour
Fees being charged by solicitors acting for patients in NHS compensation claims have soared, the BBC has learned.
The annual bill in England now tops £90m - a 122% increase in four years despite the number of cases remaining relatively stable.
The NHS Litigation Authority blamed it on a rise in no win, no fee claims which had led to some solicitors doubling their rates to £600 an hour.
But a leading firm said cases were becoming increasingly complex.
About half of the cases the NHSLA sees now are brought by solicitors on a no win, no fee basis as opposed to well under a fifth at the start of the decade.
Chief executive Steve Walker said the trend had been caused by the tightening eligibility criteria for legal aid - only children or those cases deemed in the public interest get state funding.
"Solicitors are not doing anything illegal, but it is pretty unattractive that these fees are being charged.
"There is no reason why they should be vastly different from what we pay our own legal teams, but they are.
"Their argument is that they have a higher mark up because there is a risk they will end up with nothing, but in reality they cherry-pick the cases they are most likely to win."
Four years ago, the NHS paid out £40.9m to the solicitors of patients in cost under the clinical negligence scheme for trusts, but by 2007-8 that had risen to £90.7m.
In comparison, the fees charged by the NHS's own lawyers was £29.3m in 2003-4, but had only risen by 48% to £43.3m last year.
In each of these years, the number of cases being resolved was just over 6,000.
Under no win, no fee arrangements solicitors agree what is called a success fee with their clients when they take on a case.
It is not uncommon for this to be 100% of their normal fee, meaning the top London solicitors who charge £300 a hour or more for NHS compensation claims can see their fees rise to £600.
Jonathan Fielden, chairman of the British Medical Association's consultants committee, criticised the action of solicitors.
"These organisations are encouraging a compensation culture and making a lot of money out of it.
"All the money that is going to lawyers is money being taken away from patient care.
"Obviously there is a need for the system, it is just that solicitors should do more to keep their costs in order like the NHS is doing."
But John Pickering, head of personal injury at Irwin Mitchell, the biggest clinical negligence legal firm in the country, denied lawyers were playing the system.
He said: "We do not cherry-pick cases. Of course, we take on the ones we think we can win, but we also take on other ones that are more risky.
"On top of this, cases are becoming more complex.
"People are living longer so working out the arrangements needed to care for people who have been permanently harmed is harder.
"It means we have to spend more time on them consulting with a whole range of financial advisers and medical experts."