“Spiralling” medical negligence costs are placing an unsustainable burden on the health service and must be tackled urgently, the Irish Hospital Consultants Association (IHCA) has said.The representative body was responding to a report published on Wednesday by the National Treasury Management Association (NTMA) which showed the State Claims Agency was last year managing 10,658 active claims with an estimated outstanding liability of €5.46 billion. This is an increase of €108 million on the liability in 2024 and of €929 million on 2021.Although clinical claims represented just 38 per cent of the overall number of claims involving the agency, they take up 81 per cent of the overall estimated outstanding liability. The report said this is primarily due to the higher levels of settlements and awards associated with clinical negligence claims. There is also a “very high level” of settlements related to infant cerebral palsy and other catastrophic injury claims, it said.The State Claims Agency, which is a subsection of the NTMA, manages medical negligence claims brought against State bodies such as the Health Service Executive, the Irish Prison Sevice and An Garda Síochána.The IHCA said urgently required reform should address “escalating” costs and ensure patients and families receive early answers, early support and fair compensation.The association’s president, Prof Gabrielle Colleran, said the State’s approach to medical negligence is “no longer fit for purpose”. Too many cases become drawn-out legal processes taking years to resolve, creating unnecessary costs and prolonging what is “already an extremely difficult experience for patients, families and healthcare professionals”.For patients and families affected by adverse healthcare events, the system is delaying answers, accountability and appropriate compensation where warranted, said Colleran. Meanwhile, the rising cost of medical negligence litigation “continues to divert significant resources away from frontline healthcare and improved patient services our health system urgently needs”, she said. The NTMA report noted the estimated outstanding liability has increased by 21 per cent over the last five years, despite the number of active claims dropping by 7 per cent in that time. “Catastrophic injury claims, including some new categories of claims, due to their high value, are the main driver behind this increase,” it said. General claims inflation and the increased life expectancy of people with catastrophic injuries are also factors.The report said 59 per cent of claims involving the State Claims Agency last year were resolved without court proceedings being served. This is the agency’s preferred approach.Damages were paid out by the agency in 64 per cent of cases resolved in 2025, a slightly higher proportion than in 59 per cent of cases the year before. Only 2 per cent of cases involving the agency were the subject of a court judgment last year. The agency spent €97 million on claimant legal costs and €67.4 million on its own and other legal bills, which was a reduction on 2024. The bulk of these costs (€109.7 million) concerned medical claims.