The Lord Chancellor took a breather last month from leafing through wallpaper books, ransacking the nation's art galleries and unearthing abandoned Pugin water closets. Lord Irvine unveiled his long-anticipated legal aid reforms, which were expected to abolish state aid for all money and damages claims and replace it with free enterprise in the shape of lawyers' no-win, no-fee deals.

In the event, the reforms stopped short of their initial threat. Aid will continue to be available for medical negligence claims for at least two or three years, while lawyers gear up to handle them under no-win, no-fee (otherwise known as conditional fee) agreements and the insurance industry develops products to finance them.

In the meantime, trusts and health authorities can probably expect more claims and more successful ones.

Legal aid, which up to now has been available to any solicitor who wanted to handle a medical negligence claim regardless of expertise, will be restricted to those of proven know-how. To obtain a legal aid certificate, solicitors will probably have to be members of one of the specialist panels run by the Law Society and Action for Victims of Medical Accidents, who have a higher success rate than non-specialists.

For plaintiffs who don't qualify for legal aid on financial grounds, lawyers are already bringing medical negligence claims under conditional fee arrangements, despite the high up-front costs of investigation. Insurers are coming forward with innovative products to back claims once seen as too risky to insure.

The good news for HAs and trusts is that Lord Irvine plans to introduce a new, tougher merits test to ensure that the state finances only cases with a good chance of success and those where the benefit will outweigh the likely cost.

This will need legislation and the government hopes to include it in a bill, possibly in the autumn, which will also implement reforms to make civil litigation speedier and cheaper.

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