Patients put off seeking care due to ‘dysfunctional’ NHS admin, warn patient groups and healthcare experts
Working with The King’s Fund and National Voices, Healthwatch England have today published new research about people’s experiences of NHS admin processes.
Lost in the System: the need for better admin in the NHS shows that issues with admin are widespread and are worse for some people, including those with long-term health conditions and people who are struggling financially.
The report warns that issues such as letters arriving after appointments, not being kept updated about waiting times for treatment and chasing test results can not only be frustrating, but they can also risk some patients not receiving the care or diagnosis they need on time.
Poor admin also affects staff working in the NHS who can bear the brunt of people’s frustration when patients have been given incorrect information, they do not know who to contact while waiting for care, or their test results have gone astray.
Highlights in the poll
New public polling conducted by Ipsos for the report reveals the scale of poor NHS admin.
While half, 52%, of the public felt the NHS is good at communicating with patients about things like appointments and test results, a quarter, 25%, said it was poor, and those who had actually interacted with health services in the last year reported widespread issues.
Of those who had used the NHS in the last 12 months, either for themselves or someone they care for, nearly two in every three, 64%, said they had experienced at least one issue with NHS admin or poor communication.
The common issues experienced include:
- 32% of patients have had to chase results following test, scans or X-rays
- 32% of patients have not been kept updated on how long they have to wait for treatment or care
- 23% of patients don’t know who to contact while waiting for care
- 20% received an invitation to an appointment after the date of the appointment.
Of those who have experienced at least one admin issue in the previous 12 months, 42% said they are less likely to seek care in the future due to their experience, and 47% reported it made them think the quality of care the NHS provides is poor.
Impacts of poor admin
Deeper analysis of the findings reveals that carers, patients with long-term health conditions, people from ethnic minority backgrounds and those struggling financially were all significantly more likely to experience issues with NHS admin and communication. The study found that 75% of patients with one or more long-term health condition had experienced an issue with NHS admin in the last year, compared to 57% of those with no long-term health conditions.
Patients and carers told researchers from The King’s Fund, National Voices and Healthwatch how poor admin has led to stress, anxiety and deteriorating mental health.
Many patients described being unable to cancel or reschedule appointments. One person described how they were automatically discharged from a service when they did not attend an appointment they had been unable to cancel. Another patient received a text confirming their appointment for the 99th January. Researchers also heard from a patient who is deaf and described how they are still called on the phone despite asking to be communicated with via text or email.
Perception of waste in the NHS
As well as making some patients less likely to seek care in the future, the research shows that poor admin drives a perception of NHS waste. Of those who have experienced at least one problem over the last year with NHS Admin, 61% said that it made them think money was being wasted, 56% said their time was being wasted and 55% felt that NHS staff time was being wasted.
Our Chief Executive, Louise Ansari said:
"Admin issues within the NHS and their impacts on people have been in the shadows for too long. We’ve heard countless stories of people whose NHS letters arrived after the appointment day or were sent to the wrong address while some had their referrals lost in the system.
"Admin errors are frustrating and can have serious implications for patient safety. If people miss their tests or scans, they will face a longer wait for their care, putting their health at risk.
"Poor admin puts the onus on the patient or their families, who often have to sort out the problems that NHS systems have created, while at the same time struggling with the health condition they need treatment for. This places a particularly heavy burden on disabled people and those who have a sensory impairment.
"Moving to a system that gets admin right and invests in admin staff development would have the potential to transform people’s experience of care, ensure equal access, and stop people getting lost in a system which is in desperate need of an overhaul."
Julia Cream, a policy fellow at The King’s Fund and co-author of the report said:
"The number of people affected by poor admin is stark. Today’s results lay bare the day-to-day dysfunction of an NHS that is too often not meeting people's needs and highlights the deep inequalities people experience when they are trying to access and engage with health services. Behind these numbers are stories of people who are worried about their health and struggling to get through the NHS’s front door.
"The government is trying to bring down waiting lists and improve access but these efforts will fail if the NHS cannot communicate effectively with people about when their appointment is or who they need to contact.
"Poor admin drives up perceptions of an NHS that wastes money and staff time and puts people off seeking care. Admin matters and it’s time that admin, and the staff that deliver it, are recognised for the value they bring."
Jacob Lant, Chief Executive of National Voices, said:
"Admin plays a crucial role in how patients experience health care, yet our research shows many people find themselves in an admin doom loop, trapped by no-reply emails and unable to access the person or answers they need. This goes beyond inconvenience, often risking people’s quality of care.
"The results of ineffective and inefficient admin are not felt equally across our society, and affect those already experiencing health inequalities more acutely. For people with multiple long-term conditions, the burden of managing admin is multiplied for each interaction with the system.
"NHS administration appears to be everyone’s job, but no one’s responsibility. The Government’s incoming 10 Year Health Plan provides a much-needed opportunity for NHS admin to be prioritised and for a commitment to be made to getting the basics right for everyone."
How to fix poor admin - recommendations
Together with The King’s Fund and National Voices,Healthwatch England are calling on the government and the NHS to:
- improve patient communication and admin, with the health service required to regularly report on patient experience of admin processes
- prioritise admin in the upcoming government ten-year health plan expected later this year.
NHS leaders and policymakers should ensure there is adequate training and development for NHS admin staff and that patients are part of the design, delivery and testing of new admin approaches.
