Researchers call for improved support in light of findings from new study to measure self-reported healthcare harm
Almost 1 in 10 people say the NHS has caused them physical or emotional harm, according to a study from the London School of Hygiene & Tropical Medicine (LSHTM) and the University of Oxford.
Patients described being negatively affected either by the treatment or care itself, or because they hadn't been able to access services.
The researchers say the study, published in BMJ Quality & Safety, highlights issues which may be hidden from official data on patient safety, and that action must be taken to listen to people's concerns to improve support services and provide staff training.
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.
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.
Study author Dr Helen Hogan, Associate Professor at LSHTM, said: "These findings indicate that healthcare harm affects a considerable number 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."
Study author Dr Michele Peters, Associate Professor at Oxford Population Health (part of the University of Oxford), 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 seek support and to speak 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."
Dr Hogan highlighted the opportunity to act on the findings from the study by adapting services and improving training for staff across the NHS.
She said: "When NHS treatment itself or the lack of provision of such treatment results in physical or psychological harm, the impact on health and wellbeing can be long-term. Despite this, few people choose to take formal action by lodging a complaint or pursuing legal action to obtain financial compensation.
"This means there's a window of opportunity especially with more informal interactions throughout people's dealings with the NHS that can make a huge difference to how someone feels about their care. We need a culture shift that welcomes feedback from patients, and more training and support to the entire team, for example receptionists and healthcare assistants.
"Our findings suggest current services fall short in addressing the needs of people harmed by healthcare. This potentially worsens harms and prolongs recoveries, which is both damaging to patients and ultimately leads to longer-term conditions that are more expensive to treat.
"It's time to consider creating 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 authors acknowledged limitations in the study including the fact the survey was carried out during the COVID-19 pandemic, and that surveys do not capture depth and nuance.
The study was funded by the National Institute for Health Research Policy Research Programme.
Publication
Crocker et al, Patient-reported harm from NHS treatment or care, or the lack of access to care: a cross-sectional survey of general population prevalence, impact and responses. BMJ Quality and Safety. DOI: 10.1136/bmjqs-2024-017213
