It has long been claimed that the risk of litigation influences the way some health care professionals approach their work, in the form of 'defensive practices' adopted by individuals. As medical malpractice litigation continues to escalate, the cost of claims is now beginning to have an impact upon the NHS in terms of the handling of claims and the development of more comprehensive risk management policies. It is extremely difficult to assess whether malpractice litigation is bad for health care, by inducing wasteful and potentially risky defensive medicine, or good for health care by deterring substandard provision. The attitude of the English courts is generally supportive of the medical profession and the National Health Service, who are seen as being hard-pressed by a phenomenon that could easily spiral out of control. This is reflected in an extremely cautious approach to finding medical professionals liable for negligence. But, despite the judicial hesitance, claims rates are continuing to rise.