Calls for reform in the handling of medical negligence claims have gathered pace in Ireland throughout 2025. Much of the recent discussion has centred on the long-delayed introduction of pre-action protocols for clinical negligence. These protocols were first provided for in legislation a decade ago but have yet to be implemented. Their absence is increasingly seen as a key factor in the continued cost and delay associated with such claims.
The renewed focus follows broader procedural reforms in the courts, including the creation of a dedicated Clinical Negligence List earlier this year. While these changes aim to improve case management once proceedings are issued, there remains a clear gap in how disputes are managed before they reach the courtroom. Pre-action protocols are viewed as the next logical step in making the system more efficient, transparent, and fair for all parties involved.
What are pre-action protocols?
Pre-action protocols, often referred to as PAPs, are structured procedures that parties are expected to follow before issuing legal proceedings. Their purpose is to encourage the early exchange of information, clarify the issues in dispute, and promote settlement where possible. By requiring greater communication and disclosure at an early stage, they aim to reduce unnecessary litigation and improve the efficiency of the court system.
In practical terms, a pre-action protocol usually requires the following steps:
- A letter of claim setting out the nature of the alleged negligence and the injuries or losses sustained.
- A timely response from the proposed defendant, acknowledging the claim and indicating whether liability is accepted or denied.
- Disclosure of key medical and factual records to allow both sides to assess the strengths and weaknesses of the case.
- Consideration of alternative dispute resolution (ADR), such as mediation or early settlement discussions.
- A clear timeline for these steps, with the potential for court sanctions if either party fails to comply.
Similar systems have operated successfully in England and Wales for many years, where they are credited with reducing the number of fully contested clinical negligence cases. In Ireland, the legislative basis for such a protocol already exists, but the detailed rules have yet to be introduced.
The Irish legislative framework
The foundation for introducing pre-action protocols in clinical negligence cases is already set out in Irish law. Part 15 of the Legal Services Regulation Act 2015 provides for the creation of such protocols and empowers the Minister for Justice to make detailed regulations governing how they will operate. Despite this statutory basis, the necessary regulations have not yet been enacted, meaning the framework remains inactive.
Under the 2015 Act, the Minister’s regulations are expected to address several key areas, including:
- The content and timing of letters of claim and response.
- The disclosure of relevant records and expert reports prior to proceedings.
- The use and encouragement of alternative dispute resolution mechanisms.
- The sanctions or cost consequences for failing to comply with the protocol.
- Any exceptions or modifications that may apply in specific circumstances.
This legislative structure reflects a clear intention to align Ireland more closely with other common law jurisdictions that use pre-action procedures to streamline clinical negligence claims. However, until the regulations are finalised and brought into force, the benefits of this approach remain theoretical rather than practical.
The debate through 2025
The discussion around pre-action protocols has gained fresh momentum in 2025, as both professional bodies and policymakers have revisited the issue with new urgency. After several years of limited progress, a coordinated campaign has emerged to press the Government to implement the long-awaited regulations.
In March 2025, the Minister for Justice confirmed that regulations introducing a protocol for clinical negligence proceedings remain under active consideration. This was followed in May 2025 by a joint letter from fourteen organisations, coordinated by the Medical Protection Society, urging immediate action. The group, which included medical, dental, and legal bodies, argued that introducing a protocol would reduce stress for patients and clinicians while lowering the overall cost of claims.
Momentum continued through the year. The Law Society Gazette reported in June 2025 on a new academic study examining how such protocols could be designed for the Irish system. In July 2025, the Government’s Action Plan for Insurance Reform 2025–2029 formally included the introduction of pre-action protocols for clinical negligence as a specific policy goal, with progress expected by the third quarter of 2026. Further public statements in October 2025, including at the annual MPS conference, reiterated that the need for reform had never been greater.
Despite the wide support, no statutory instrument has yet been introduced. The continued delay has led many within the legal and medical professions to express frustration that, ten years after the enabling legislation was passed, the practical benefits of pre-action protocols are still out of reach.
Why stakeholders want PAPs
There is broad agreement among practitioners, insurers, and healthcare professionals that pre-action protocols could deliver meaningful improvements to how clinical negligence claims are handled in Ireland. The current system is often criticised for being too slow, too costly, and overly adversarial. By introducing structured steps before litigation begins, stakeholders believe that disputes could be resolved more efficiently and with less strain on those involved.
The key benefits identified by different groups include:
- For patients – earlier access to information, faster resolution of claims, and reduced emotional stress associated with lengthy court proceedings.
- For clinicians and hospitals – greater opportunity to investigate and respond to concerns before litigation, which can protect professional reputations and encourage learning from adverse events.
- For insurers and indemnifiers – improved claims management and potential cost savings arising from fewer fully contested cases.
- For the courts – a reduced caseload and better allocation of judicial resources through earlier settlements or narrowed issues.
Recent procedural reforms, such as the establishment of the Clinical Negligence List in the High Court, have improved post-issue case management. However, many commentators see pre-action protocols as the missing link that could promote earlier engagement, reduce costs, and enhance confidence in the claims process for both patients and healthcare providers.
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