Patients put off seeking care due to ‘dysfunctional’ NHS admin, warn patient groups and healthcare experts 

Lost in the System: the need for better admin in the NHS

Letters arriving after appointments, not being kept updated about waiting times for treatment and chasing test results, are all commonplace issues impacting large numbers of patients, finds new research from The King’s Fund, National Voices and Healthwatch England.    

The organisations say 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.  

A new report, Lost in the System: the need for better admin in the NHS shows 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 authors warn that issues with admin can not only be frustrating, but they can risk some patients not receiving the care or diagnosis they need on time. 

New public polling conducted by Ipsos for the report reveals the scale of poor NHS admin: 

• Nearly two in three (64%) patients and carers have experienced at least one admin problem over the last year such as lost test results, inability to change or cancel appointments, or receiving incorrect information.
• One in five (20%) people who used the NHS in the past 12 months received an appointment invitation after the date of the appointment.
• Of those who faced admin issues, four in ten (42%) say they are less likely to seek care in the future.
• Research shows poor communications around appointments is driving public perceptions of NHS waste with 61% of those experiencing an admin issue saying it made them think NHS money is being wasted.

Deeper analysis of the findings reveals that people with long term health conditions, alongside other groups experiencing health inequalities are significantly more likely to experience issues with NHS admin and communication. The study found 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.  

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.

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.

Louise Ansari, Chief Executive at Healthwatch England, 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.     

Administrative 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.

Recommendations

The King’s Fund, National Voices and Healthwatch England say they want the government and the NHS to focus on improving patient communication and admin, with the health service required to regularly report on patient experience of admin processes. They are also calling for admin to be prioritised in the upcoming government ten-year health plan expected later this year.    

The three organisations recommend that NHS leaders and policymakers 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.   

Notes to editors

For further information and case studies, please contact The King’s Fund media team on 020 7307 2585 or mediaoffice@kingsfund.org.uk.   

For the full press release please visit The King’s Fund website.

The full report and polling results are published here.

About us

National Voices is the leading coalition of health and social care charities in England. We have more than 200 members covering a diverse range of health conditions and communities, connecting us with the experiences of millions of people. We work together to strengthen the voice of people: patients, service users, carers, their families, and the voluntary organisations that work for them.  

The King’s Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.    

Healthwatch is your health and social care champion. If you use GPs and hospitals, dentists, pharmacies, care homes or other support services, we want to hear about your experiences. As an independent statutory body, we have the power to make sure NHS leaders and other decision makers listen to your feedback and improve standards of care. We can also help you to find reliable and trustworthy information and advice. Last year, we helped nearly two million people like you to have your say and get the support you need. www.healthwatch.co.uk