One in ten people surveyed reported that the NHS has caused them physical or emotional harm, according to a new study by researchers at Oxford Population Health and the London School of Hygiene & Tropical Medicine (LSHTM). The study is published in BMJ Quality & Safety.
The research team surveyed over 10,000 members of the public in a series of telephone interviews during 2021 and 2022 to find out how common NHS-related harm is among the general public, how it affects people, and any actions they took in response.
A total of 988 (9.7%) respondents reported they had experienced harm caused by the NHS in the previous three years. Of those, 6.2% cited their treatment or care and 3.5% blamed the harm on a lack of access to NHS services.
Few of the people who reported harm chose to take formal action by lodging a complaint (17%) or pursuing legal action to obtain financial compensation (2.1%).
The findings indicated a number of inequities, including more women reporting harm than men, as well as higher estimated rates of harm among those who were not working, including people with disabilities or long-term health problems.
Older people, men, and those in low socioeconomic groups were less likely to share their experience with others, while older people were also less likely to make a formal complaint.
The rate of reported harm was higher than two previous British surveys in 2001 and 2013 (4.8% and 2.5% respectively). However, the researchers suggest this increase could, at least partially, be down to broadening the definition of harm to include psychological as well as physical harm, and harm through the lack of access to care.
Michele Peters, Associate Professor at Oxford Population Health, said ‘Most people who reported harm actively seek to understand why this has happened and find support for recovery after these experiences, although many of their responses are not visible in statistics on complaints because these are informal conversations or approaches. Those harmed by healthcare are looking for a compassionate and caring response from services. What they really want is to be listened to, to have their harm acknowledged, and get an explanation.
‘The voice of patients is key. It’s so important to ask these questions because otherwise people’s experiences and concerns could remain unheard, especially those of more vulnerable people who face more barriers to seeking support and to speaking about their experiences. Lessons must be learnt from this study about how to include the patient voice when developing and improving services to ensure high safety standards and good rates of patient satisfaction across the NHS.’
Helen Hogan, Associate Professor at LSHTM, said ‘These findings indicate that healthcare harm affects a considerable number of members of the general public. Our study is the first to put a number on the harm that results from people having to wait for treatment as well as the scale of harm caused by the care itself. It shows that there is still some way to go to improve safety across the NHS.
‘I’ve been studying patient safety and working in and with the NHS, including as a GP, for many years. It’s a complex challenge to pinpoint the cause of the problem and solve it. The vast majority of NHS staff do a fantastic job and prioritise their patients’ needs. But there are constraints and pressures in the system such as lack of time or not enough staff which can affect the quality of care they can deliver. Despite efforts to change culture, there may also not be enough support for staff to encourage them to welcome feedback and see it as an opportunity to learn and improve.’
The study highlights the opportunity to act on its findings by adapting services and improving training for staff at all levels across the NHS. The findings also support the creation of a dedicated service to support people harmed in healthcare settings that has the capacity to support patients and their families at any stage, from early contacts, to dealing with those involved in safety incident investigations, and reaching out to those who have disengaged from health services.
The 10,064 participants in this study were surveyed by Ipsos and sociodemographic quotas were set to ensure that the respondents were representative of the United Kingdom population.
The study was funded by the National Institute of Health and Care Research.