Communicating properly in any field of professional endeavour is an essential prerequisite for its success. You will fail if you do not communicate properly with those with whom you engage at all levels of the enterprise, be they clients, customers or patients. Good communication strategies encourage trust and should display empathy and understanding.
Legal and patient safety perspective
From a legal and patient safety perspective, past litigation cases often have a direct correlation with communication. If the nurses, doctors and others had communicated properly with the patient in the first place, there would have been no legal claim or complaint. It is often said by patient safety legal stakeholders that what patients most often want is not to sue or complain. What they require is an explanation of what occurred, an apology and an assurance that what happened to them will not happen to anybody else. That lessons have been learnt.
A focus on protecting the reputation of the organisation
We also have the issue that trusts and others can be more concerned with protecting their organisational reputation than communicating openly with patients when adverse health events occur. There is, as I have said in my previous BJN columns, a prevailing view that the NHS demonstrates too much of a defensive culture when it comes to responding to patient safety incidents. A focus on protecting the reputation of the organisation inhibits proper patient communication strategies. Developing communication strategies may also be seen by some health professionals as being a soft skill and one which they automatically have – a skill that does not need to be worked on as much as other skills.
The former Parliamentary and Health Service Ombudsman (PHSO), Rob Behrens stated in his report:
‘We found that the physical harm patients experienced was too often made worse by inadequate, defensive and insensitive responses from NHS organisations when concerns were raised.’
PHSO, 2023 : 8
He further discussed the concept of ‘compounded patient harm’. This is where the patient or loved ones try to investigate and understand why the adverse incident occurred and receives a poor response. The harm they have suffered is aggravated or made worse by the further actions of others: nurses, doctors, the trust. The PHSO noted several factors that contributed to compounded harm:
- A failure to be honest when things go wrong
- A lack of support to navigate systems after an incident
- Poor-quality investigations
- A failure to respond to complaints in a timely and compassionate way
- Inadequate apologies
- Unsatisfactory learning responses.
These are not new findings, and they can be seen in the reports of several major NHS patient safety investigations over the years, including at Mid Staffordshire. These problems continue to be stubbornly persistent and plague the NHS. They seem almost unsolvable as another patient safety crisis investigation report often reveals the same problems occurring. History has not served the NHS well when it comes to health professionals and others learning the lessons from past adverse healthcare incidents and changing practices. Improving communication with patients is one of those patient safety lessons that continues to be an issue in the NHS.
Recent research
Recent research was published by Healthwatch (2025a; 2025b) and Cream et al (2025) (the latter written in partnership between The King's Fund, Healthwatch England and National Voices). The Healthwatch report (2025b) revealed important failings in patient communication by health professionals and others in the areas of patient discharge and NHS administration (which I call NHS back-office functions).
These are important areas inextricably linked to NHS care and treatment. Premature discharge and confusion over arrangements and advice, could well feature as issues in a clinical negligence case. As could failures in the appointment system and test results delays. These could cause treatment delays and possibly contribute to wrong diagnoses.
Problems with discharge
Healthwatch (2025a) has drawn on previous research findings (Healthwatch, 2023), revealing concerns with people's experiences of hospital discharge arrangements. Many people reported not being given the right support or information when being discharged from hospital. Key findings from 2023 included:
‘Over half, 51%, of people weren't given contact information for further help or advice when leaving the hospital, contrary to government guidance. Nearly a third, 32%, felt unprepared at discharge … Over one in five, 24%, reported an excellent hospital discharge experience, with 37% reporting either a mixed or neutral experience.’
Healthwatch (2025a) research has found that people have not been involved in discharge planning. Inappropriate decisions can result from this. Healthwatch states several concerning issues about patient discharge arrangements. These include where patients have been discharged (Healthwatch, 2025a):
- Before seeing a consultant
- Before being properly diagnosed.
- Without any follow-up care in place
- Without medication or information about how to manage at home.
Patients have told Healthwatch about being given unclear information on discharge and the report gives several instances. Steps that will improve hospital discharge are stated and these include:
- Following existing guidance
- Providing more resources for social care
- Providing better data on hospital discharge.
Problems with hospital discharge have long been a problem in the NHS and are well known. They have been frequently mentioned in Care Quality Commission patient surveys. This issue is a persistent and stubborn one. It should not be in a modern-day NHS.
Lost in the system: the need for better administration
In patient safety terms, NHS back-office functions are vital to establishing a proper NHS patient safety culture. If patients do not receive appointments, referrals and test results on time, then major patient safety issues can result and serious harm to patients could occur. This could result in them making a clinical negligence claim.
At another level, valuable NHS resources are also being wasted by, for example, patients not attending clinics because they were not informed on time about their appointment.
There are a myriad number of issues that can be related to the NHS back-office function, which operates behind the scenes when patients are being cared for and treated.
Cream et al (2025), for The Kings Fund, Healthwatch and National Voices, have produced an excellent and detailed report that looks at NHS administration and patient communications. Major problems are highlighted in the report, such as letters arriving after appointment times and patients not being kept updated about waiting times for treatment and having to chase their test results. The report begins with a statement that is worrying in terms of NHS patient safety culture development:
‘Most people can agree that how the NHS communicates with people around appointments and ongoing care – whether it is by phone, post, text, app or in person – needs fixing.’
Poor communication: a driver of complaints
There is a discussion in the report about how poor communication is a driver of NHS complaints:
‘Recent data on NHS complaints shows that not only has the number of complaints increased but that the largest proportion of new complaints made about hospital and community health services by individual subject area was communications, making up 17% of complaints.’
The report also states that the burden of poor NHS administration does not fall equally on patients and that some suffer more than others. These are patients with additional needs, hearing or sight impairment, learning disability and long-term conditions. Literacy levels also differ among the general population, making it harder for some people to navigate what is a complex NHS system, the report states. Also, not everybody has or can afford the internet or mobile phones or has easy access to them.
The report highlights efficiency and productivity issues with NHS back-office failures, with millions of appointments being missed each year. This costs both the patients and the NHS, with people being unaware that an appointment has been made for them, or that they have been given the wrong appointment time, or are unable to rebook, the report states.
Key findings
The Cream et al report (2025) has key findings:
- Around half of the people surveyed think that the NHS is good at communicating with patients about things such as appointments and test results
- 32% think the NHS is poor at keeping people informed about what is happening with their care and treatment; 28% said it is poor at ensuring there is someone for patients to contact about their ongoing care
- Nearly 1 in 3 people (32%) said they have had to chase for results of tests, scans or X-rays. The same proportion (32%) said they had not been kept updated about how long they would have to wait for care or treatment.
The Cream et al (2025) report states that there is a need to start thinking differently about NHS administration and to recognise its value. There is optimism expressed in the report and it is noted that there are opportunities to improve matters. Increasing national (and political) attention on administration is welcomed. The report states that this will need to be matched at a local level. To improve NHS administration, several priorities are given in the report, which include: putting administration on the agenda, measuring patients’ experience of administration and developing clear goals and targets for local systems.
Conclusion
Patient safety and good communication practices go hand in hand, you cannot have one without the other. Unfortunately, the NHS has had for many years, and continues to have, serious weaknesses with both. Sadly, communication failings are vividly shown in many patient safety investigation reports.
There can be seen to be a direct correlation between patient communication failures, litigation and complaints when you talk to stakeholders in the area such as health lawyers. If we improve our patient communication strategies, I have no doubt that there will be less litigation and fewer complaints.
The reports discussed here shine a bright light on two key areas of NHS patient communication: patient discharge and NHS administration. Serious failures in both these areas have been identified and these need to be urgently addressed. They seriously impede the development of a proper NHS patient safety culture.