People from minoritised groups in the UK experience a complex and interconnected set of factors that increase their risk of harm when using NHS services, according to a new qualitative study by researchers at Oxford Population Health and the London School of Hygiene & Tropical Medicine. The study is published in BMJ Open Quality.
The study draws on in-depth interviews with 48 people from minoritised groups from across the UK who reported harm from NHS treatment, delays in care, or lack of access to services. Participants were selected on the basis of ethnicity, faith, disability, sexual orientation or gender identity, with many reporting more than one of these characteristics.
The researchers used a socio-ecological framework to explore how contributory factors to harm operate across five levels: individual, interpersonal, community, organisational and societal.
Key findings:
- Most participants described experiencing moderate or severe physical and/or psychological harm, often with long-lasting impacts on their health and wellbeing;
- Participants described a wide range of experiences that contributed to health-related harm, including delayed diagnoses, inadequate pain management, poor coordination of care, and dismissive or discriminatory interactions with healthcare professionals. Many said they felt ignored, stereotyped or treated as a burden, which left them feeling unsafe, losing trust and reluctant to seek further NHS care;
- Some participants reported hiding aspects of their identity during consultations for fear of stigma, while others avoided healthcare altogether or sought treatment abroad;
- Language barriers, limited access to professional interpreters, and NHS environments perceived as unwelcoming or “one size fits all” further compounded these risks;
- Cultural and community attitudes could lead to acceptance of unsafe care for some participants. For others, however, community networks were described as providing support that empowered them to positively influence healthcare safety.
The researchers found that these factors rarely occur in isolation. Instead, they reinforce one another, creating a cumulative effect that increases the likelihood of both physical and emotional harm for people from minoritised groups.
While previous research has often focused on individual behaviours or communication problems, this study highlights the importance of wider organisational and societal influences, including structural discrimination and exclusion within healthcare systems.
Michele Peters, Associate Professor at Oxford Population Health, said the findings show why tackling safety inequalities requires action beyond the individual clinical encounter:
Our study shows that people from minoritised groups often experience harm not because of a single failure, but because of a web of interacting factors across the health system that leave people perceiving the system as unsafe. Improving interpersonal care is important, but it is unlikely to be enough on its own. To make the NHS a genuinely safe space for everyone, we need to address the structural and institutional processes that drive exclusion and discrimination.
The research also highlights how feelings of being unsafe or disrespected, often viewed as issues of ‘patient experience’ rather than safety, can play a significant role in patient-reported harm, particularly when combined with barriers to access, low trust and previous negative experiences.
Helen Hogan, Associate Professor at the London School of Hygiene & Tropical Medicine, said ‘Often harm or safety are assessed from the clinician’s perspective, with little attention paid to the patient perspective, and even less so for those from minoritised groups. Listening to the voices of people from minoritised and less-heard communities is essential for building a safer and more equitable health service.’
The study also raises questions about how patient harm is recorded and addressed, noting that existing safety reporting systems often fail to capture emotional and psychological harm, which disproportionately affects minoritised groups.
As the NHS is constitutionally committed to reducing health inequalities, the findings underline the importance of taking into account diverse and less-often-heard voices to ensure an inclusive, equitable, and high-quality health service.