Survey reveals high rate of NHS-related harm in Great Britain

Almost one in ten people in Great Britain experienced healthcare-related harm due to care or treatment they received from the National Health Service (NHS) or difficulties accessing care in the last three years, show the findings of a large population survey published in the journal BMJ Quality & Safety.

In more than eight out of ten cases, the harm had a moderate or severe impact on the respondent. Disadvantaged groups, including people with disabilities, long term conditions and those in lower socioeconomic groups, were more likely to experience NHS-related harm, and when they did the consequences were likely to be more severe.

The survey used a specially designed questionnaire to collect data from patients on the incidence and consequences of a range of NHS-related adverse events – not only medical or physical consequences of treatment or care, but also psychological harm and harm due to lack of access to care.

Ipsos administered the survey and used quota sampling to ensure participants and therefore results reflected the sociodemographic profile of Great Britain. Between November 2021 and May 2022, 10,064 people in England, Scotland and Wales completed the survey.

A total of 9.7% of participants reported experiencing NHS-related harm in the previous three years: in 6.2% of cases the harm was caused by treatment or care received and in 3.5% of cases it was due to lack of access to care. In most cases hospitals were responsible for the provision of that care. Incidents of harm were higher in women and lower in people aged over 65 years.

In 44.8% of cases the respondent said that the harm experienced had a severe impact and in 37.6% of cases a moderate impact. People with long-term illness or disability, or in lower socioeconomic or other disadvantaged groups reported higher rates and more severe impact of harm.

Around two-thirds of people who experienced harm shared their experience and sought support from family and friends, and almost 60% sought advice and support from professional sources. Around a third sought support from their GP surgery (34.7%), a similar number sought support from the health provider which caused the harm (31.6%), and 11.6% contacted the Patient Advice and Liaison Service (PALS) which is intended to provide an alternative to official NHS grievance processes in England.

Few people who experienced harm took any formal action, 17% made a formal complaint to the NHS and only 2.1% made a legal claim for compensation.

One in five survey respondents (21.6%) said they would not want to make a financial claim against the NHS for harm, which the authors say reflects patient "loyalty to the NHS."

Rather than compensation, what many patients who had experienced harm wanted was treatment or care to redress the harm by addressing physical or psychological needs (44.4%), an explanation of what had happened (34.8%) and access to treatment previously refused (29.7%).

Two-thirds of people who made a formal complaint felt it was not handled well and only around half were satisfied with their experience of PALS.

"When people cannot get validation of their experiences and adequate help with recovery through these routes, they may be forced to consider taking legal action," the authors write.

The authors highlight a number of limitations to their study, including that it was conducted during the covid-19 pandemic which may have led to higher rate of harm than usual and potential issues of representation and bias despite the use of quota sampling.

Nevertheless, the authors conclude, "This study found higher rates of NHS-related harm than previous surveys and showed the impact is likely to have significant consequences for individual patients, families and carers, health services and the economy."

The study is one of the first to explicitly assess actions after harm due to lack of access to care, they add. "An important finding of this study is that people harmed through a lack of access to care also require support, and the responses they desire differ from people who were harmed through treatment of care received. Having their situation recognized and being signposted towards appropriate support via a local healthcare provider may be vital in reducing harm in this group."

The findings also highlight significant inequities in rates and impact of harm, as well as in responses in the aftermath of harm. Taken together, the differences point towards socially disadvantaged people being more likely to be harmed, experiencing higher impact and being less able to advocate for themselves in the aftermath of harm, the authors say.