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Information: Alastair Gray

The safety and quality of health care is a controversial topic that frequently makes the news. So conducting reliable research in this area is important, to ensure that policy is evidence based.

Current research

Current research is based on a grant from the Nuffield Foundation, entitled “Funding clinical negligence cases: Access to justice at reasonable cost?” 

The research is examining three main questions:
(1) trends in clinical negligence claims in comparison to other personal injury areas;
(2) the role of funding mechanisms in determining who makes clinical negligence claims, the types of claim and claim outcomes;
(3) the potential effects on clinical negligence claims of reforms to legal procedure.

To understand trends in clinical negligence claims, we are conducting a large population survey to estimate the rate and severity of any harm that members of the public consider themselves to have experienced as a result of their medical care. The survey closely matches one conducted in 2001, and should therefore provide a clear idea of changes over the last decade. Results will be available at the end of 2013. 

Previous research

Insuring patient safety

The arrangements which govern the compensation of patients when they are harmed by the medical care they receive have been investigated by Alastair Gray and Oliver Rivero-Arias along with colleagues from the Universities of Nottingham and Surrey, as part of the ESRC Public Services Programme.  A final report on this work was completed in early 2007. Results from work in this area have been published in the Journal of Health Economics, and the Journal of Public Administration, Research and Teaching (JPART).

Previous research in HERC has estimated the costs of adverse events, and the relationship between adverse events and personal injury litigation has been explored on behalf of the Department of Health and the Lord Chancellor's Department (now Department of Constitutional Affairs).

In 2002, Alastair Gray in collaboration with Paul Fenn from the University of Nottingham (Business School) and Neil Rickman from University of Surrey (Department of Economics) was asked to undertake a package of research work to support the enquiry of the Chief Medical Officer into policy alternatives for patient compensation. This involved the design and analysis of a national MORI survey, a simulation of the costs and health service implications of different policy options, and a detailed literature review. Some results of this work were published in the Economic Journal in 2004.

In parallel with this work, Oliver Rivero-Arias completed during 2004 a research project funded by the Department of Health Patient Safety Research Programme into the uses of medico-legal databases to provide information on the epidemiology of patient safety and adverse events. This involved collaboration with the School of Primary Care and the Manchester Centre for Healthcare Management (both at the University of Manchester), the Department of Surgery, Imperial College, London and Nottingham University Business School.

Alastair Gray has undertaken a detailed literature review for the National Patient Safety Agency on the epidemiology and economics of adverse events in health care, and has begun work with the NPSA to identify ways in which principles of cost-effectiveness can be applied systematically to patient safety. This has been published by the NPSA.


Fenn, P, Gray, A, and Rickman, N (2007). Liability, insurance and medical practice.

J Health Econ, 26(5):1057-70.

Gray, A (2005). Adverse events and the National Health Service: an economic perspective. A report to the National Patient Safety Agency.

Fenn P, Gray AM, Rickman N (2004). The Economics of Clinical Negligence Reform in England. The Economic Journal, 114: F272-F292. 

Fenn P, Gray AM, Rickman N, Carrier H (2002). The Impact of Conditional Fees on the Outcome of Personal Injury Cases. Journal of Insurance Research and Practice, 43-48.