Patients must have 'more realistic expectations' of the NHS', health secretary Frank Dobson has warned.

In a letter to 50 royal colleges, lobby and patient organisations Mr Dobson expresses concern about 'the evergrowing tendency' to seek compensation.

Responses to the letter will be used to formulate a strategy to tackle the rise in litigation.

Ways are also being sought to reduce the number of incidents leading to claims and improving the genuine grievance procedure.

Mr Dobson told the Royal College of Midwives' annual conference in Bournemouth last week that litigation was costing the NHS around£200m a year.

He also told delegates the NHS white paper, which does not mention midwives, had 'referred just to nurses for brevity'. He assured midwives: 'Nurses, yourselves and health visitors will have representation through the setting up and running of primary care groups.'

Delegates still passed an emergency motion calling for midwives to be consulted on PCGs and health improvement programmes.