The relationship between negligent care, malpractice claims, and adverse events does not tend to hold providers accountable for substandard care. In addition, a case study presented the tension between malpractice claims and patient safety initiatives with a series of proposed targeted reforms. This United Kingdom study surveyed 227 patients and relatives who were taking legal action and found that 70% were seriously affected by the incidents with long-term effects on work, social life, and family relationships. The respondents were also impacted by the unsatisfactory explanations from providers about their adverse event, including no assurance that it would be prevented in the future. The authors conclude that a "no fault" compensation system would fail to address all patient concerns involved in litigation decisions.