The future of the NHS is in the spotlight, thanks partly to the debate raging in the United States about the best way to reform healthcare.

Criticism of the health system by some American politicians has prompted a show of support for the institution in this country.

But however affectionately the British people feel towards the NHS, it is clear that no government will be able to pour resources into it over the next few years.

For a decade, some NHS managers enjoyed regular and generous funding increases.

Those days are gone, at least until the public finances get into a better state, which may not happen until a long time after the recession is over.

Despite increases in state funding, the health service already faces constraints on its resources. There will always be things it could do to help the sick that it simply can’t afford.

So it is essential that the NHS spends its money wisely, and this may become even more important in years to come.

Unfortunately, it appears that millions is being spent on legal fees, with £17 million going to lawyers in 12 months, in the West Midlands alone.

The expenditure is a result of cases for clinical negligence bought by patients. It is probably inevitable that hospitals and health trusts will make mistakes and patients must have some means of recompense when it happens.

But the fact that health trusts paid £48 million in one year, including compensation and legal fees, seems surprising. It’s a lot of money. Of that money, more than a third of it went on lawyers’ costs. And perhaps this partly explains why the total figure is so high.

A health trust which fights a case stands a chance of winning in court, but may be asked to pay massive legal costs as well as compensation if it loses.

However, a health trust which agrees to settle out of court, although it will still have legal costs to pay, may face a much smaller bill at the end.

Some trusts may decide that settling out of court is the lesser of two evils, even if they believe there was no clinical negligence.

It is far from clear that the current arrangements benefit NHS patients and taxpayers.

And there can be no good reason for solicitors representing complainants claiming far more than the lawyers representing health trusts themselves.