From Recommendations to Action: Healthcare Litigation Reform Moves Forward

The Department of Health recently published its Implementation Plan on health-related claims. Building on the recommendations of the Working Group Report issued in 2024, it sets out actions to strengthen safety, prevention and claims resolution. It is a positive step for patients, families, insurers and the health system. The question now is whether this momentum will finally deliver the long-anticipated introduction of Pre-Action Protocols and resumption of Periodic Payment Orders. Our Medical Law team discusses the Implementation Plan.

What you need to know

• On 16 October 2025, the Minister for Health published the Implementation Plan for the Recommendations of the Interdepartmental Working Group on the Rising Cost of Health-Related Claims.
• Building on the 2024 Report, which set out six priorities for reform, the Plan provides a structured framework to deliver progress in both the short and long term.
• Its objectives include open disclosure, patient safety, litigation reduction and court reform, with a new and welcome emphasis on delivery.
• The Implementation Group, chaired by Professor Rhona Mahony, brings together all key institutions across health, justice and the courts. This joined-up approach under independent leadership is vital to addressing efficiency and rising claims costs.
• Ranging from clinical governance to mass actions, the Plan’s most closely watched measures from a litigation perspective are Pre-Action Protocols, Periodic Payment Orders, and the discount rate.

The rising cost of medical claims continues to pose a major challenge for Ireland’s health and legal systems. To address this issue, an interdepartmental working group was established in 2023 and reported in 2024 with clear priorities for reform. The Implementation Plan, published on 16 October 2025, sets out six priorities and 30 recommendations to reduce the need for litigation in healthcare and improve the process for everyone involved. Crucially, it is designed to turn those priorities into action. While it contains wide-ranging reforms across patient safety, open disclosure and maternity care, much of the focus now turns to whether it can deliver the long-promised and eagerly awaited Pre-Action Protocols (PAPs) and Periodic Payment Orders (PPOs).

Delivering on the six priorities

The Plan’s six priorities focus on:

• Strengthening clinical governance
• Improving patient safety and open disclosure
• Enhancing incident management
• Providing better pathways for catastrophic birth injuries
• Reforming litigation and
• Managing mass actions through structured, non-adversarial schemes

The key is that the Plan now turns recommendations into real, practical action with a focus on delivery. Its wide scope reflects the reality that reducing the cost of claims is not simply a legal challenge but also one of prevention, patient safety and system learning. Each priority is designed to contribute to a more responsive and sustainable system overall.

Progress already made

Some reforms are already in place. The Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 has commenced, placing openness at the heart of the response to adverse events. The High Court has introduced new practice directions in clinical negligence proceedings, signalling greater efficiency. These measures show momentum and demonstrate that recommendations are being translated into tangible changes.

Litigation reform

One of the Plan’s strongest themes is the need to make litigation more efficient, less costly and less adversarial. Measures under consideration include structured case management, streamlined court procedures and a more consistent approach to mass claims. For insurers and defendants, these reforms offer the prospect of earlier resolution and greater predictability. For patients and families, faster outcomes mean reduced uncertainty and stress. The overall benefit is a fairer, more efficient system that allows resources to be directed where they matter most, to patients and their care.

In terms of case management and court procedures, the new practice directions HC131 and HC132 already mark a welcome step in this direction. However, looking ahead, the Plan’s most closely watched commitments are the introduction of PAPs and resumption of PPOs. Draft regulations for PAPs are expected by the end of 2025. Regulations for PPOs will introduce a new indexation rate, addressing the barrier that has limited their use since 2017. Once again, the Plan indicates that PPO regulation will be in place by year end 2025. In parallel, the discount rate in catastrophic injury cases will be set by the Minister for Justice, rather than the judiciary, with a mechanism for regular review. Together, these 2025 targeted reforms promise greater predictability for all those involved.

PAPs would require parties to exchange information and expert evidence at an early stage, encouraging earlier resolution and reducing the need for prolonged proceedings. PPOs, meanwhile, have the potential to transform catastrophic injury cases by replacing one-off lump sums with structured annual payments. For families, this change provides certainty of lifelong support. For Insurers, it ensures more predictable, sustainable financial planning. Given that catastrophic injury claims account for more than half of total costs, PPOs are arguably the single most important reform being discussed.

Conclusion

We welcome the publication of the Implementation Plan and the commitment it represents from Government and agencies. By consolidating earlier initiatives, embedding patient safety, streamlining litigation processes, and paving the way for PAPs, the Plan is a highly positive development. It reflects a shared determination to create a more efficient, transparent and sustainable framework for managing healthcare claims. With the Plan classifying key reforms such as PAPs, PPOs and the discount rate as “short term,” there is now a clear expectation that these measures will be finalised before the end of 2025. If delivered, they would mark a decisive step forward in transforming how clinical claims are managed.

For more information and expert advice, please contact a member of our Medical Law team.

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