NHS Admin Failures Erode Patient Confidence, Report Finds

Poor administration in the NHS is undermining patients’ experiences of care, according to a report by the King’s Fund, Healthwatch England, and National Voices. 

A survey for the report revealed that 20% of patients received appointment notifications by letter or text after the scheduled date in the past year.

Almost a third (32%) had to chase results of tests, scans, or X-rays, and a similar proportion were not updated on waiting times. Almost one in four (23%) had not been told who to contact about care while waiting for treatment.

Communication Breakdowns Drive Complaints

The report found that poor communication is the most common cause of new complaints about hospital and community health services, making up 17% of grievances. Other commons frustrations include:

• The NHS app’s ‘cancel appointment’ option directing patients to an appointment line, which then offers irrelevant automated options.
• Long wait times for phones to be answered.
• Patients being transferred to the wrong department.
• Recorded messages stating no one is available before disconnecting the call.
• Text messages received from numbers that could not be called back.
• Patients unable to cancel auto-generated appointments, resulting in a ‘did not attend’ flag and automatic discharge.
• Call handlers who can cancel but not reschedule appointments.
• Patients unsure whom to contact when given incorrect information.
• Lost test results and referrals.
• Delayed or unshared diagnoses.

Systemic Dysfunction in Daily NHS Operations

The report, titled Lost in the System, described these issues as “day-to-day dysfunction in how the NHS communicates with people”. The authors highlighted that such failures contribute to “perceptions of an organisation that is wasting money, time, and staff resources”.

The report noted that public satisfaction with the NHS is at “an all-time low”. The 2023British Social Attitudes survey found that only 24% of respondents were satisfied with NHS services, the lowest level since 1983, while just 13% expressed satisfaction with social care. 

More than 40% of patients said poor administration made them less likely to seek care in the future. Patients with disabilities, long-term conditions, or cancer, are disproportionately affected. 

Getting the Basics Right 

The report emphasised that while well-functioning administration is “essential to the delivery of high-quality care”, it is often overlooked. Getting the basics of administration right included ease of booking, changing or cancelling appointments, receiving letters at the right time, and ensuring that doctors have accurate patient notes and test results. 

Poor and under-resourced administration can leave staff to bear the brunt of patient frustration and anger, while also impacting efficiency and productivity. Poor administration contributes to non-attendance, as patients may be unaware of appointments, given the wrong time, or have been unable to rebook an appointment they know they cannot attend.

Outdated Tech & Data Systems 

Asked to respond by Medscape News UK, a spokesperson for NHS England described the report as “timely” and said that it highlighted “yet another consequence of the long-term capital starvation faced by the NHS”. Too many organisations were still struggling with outdated tech and data systems that were unable to support effective patient administration.

“We have begun to address this through investment in front line digitalisation and the NHS app, but we know we need to go much further to make sure patients have the information they need in the right place and in a timely way,” the spokesperson said. 

Poor Admin Compromises Health 

Also commenting to Medscape News UK, Rachel Power, CEO of the Patients’ Association, said: “Behind every complaint about NHS administration is a patient struggling to get the care they need.” Communication failures, appointment delays, and lost test results “don’t just cause frustration, they can lead to serious consequences for people’s health. 

“Patients and staff alike need admin systems that are well-resourced, intuitive, and designed to work for everyone. Without investment in these systems, it’s frontline staff and patients who pay the price”.

Medical Staff Frustrated Too

Dr Victoria Tzortziou-Brown, vice chair of the Royal College of GPs, concurred. In a statement, she said: “GPs get just as frustrated as our patients when their care is disrupted by admin issues and IT failures.” GPs and practice staff were often involved in chasing up test results, missing letters, and appointments, she said, and this added to the bureaucratic workload at a time of increased demand and a severe shortage of GPs. 

Delays and confusion can deter patients from seeking care when they need it, and this often impacts most on the most vulnerable patients, according to Tzortziou-Brown. “These issues aren’t the fault of hardworking administrative staff across the NHS, but a symptom of a system that is chronically overstretched and understaffed, relying on patchy, out of date processes and digital infrastructure.”

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.