John Tingle, Associate Professor, Birmingham Law School.
Communicating properly in any field of professional endeavour is an essential prerequisite for its success and this is particularly so in health care. When past clinical negligence cases are analysed and patient complaints there can be seen to be a direct correlation with communication. If health carers had communicated properly with the patient in the first instance, then they most likely would not have made a legal claim or complaint.
Litigation or making a complaint: the last resort.
Litigation or making a complaint is often the very last resort for most patients. What they most want is an explanation about what occurred, an apology and an assurance that what happened to them will not happen again to anybody else. That lessons have been learnt. They have not received this and feel that litigation or complaining is now the only way forward. Unfortunately, the NHS is poor in some quarters of learning the lessons from past adverse health care events as the frequently published patient safety investigation reports in NHS care quality crises show. There reports also often contain chronic examples of failures in patient communication.
Protecting the reputation of the organisation
In discussing patient, health care communication strategies in the NHS there is a need to also factor in the tendency for some health organisations to be more concerned with protecting their own reputation than talking openly and properly with a patient, who has suffered an avoidable adverse health care event.
There is a prevailing view amongst many stakeholders in patient safety and health quality 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 does inhibit proper patient communication strategies.
The former Parliamentary and Health Service Ombudsman (PHSO), Rob Behrens stated :
“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.” (p.8)
He discussed the concept of ‘compounded patient harm.’ This is where patients or loved ones try to investigate more and understand why the adverse incident occurred and they receive a poor response. The harm they have suffered is made worse by this.
Not new findings
These are not new findings, and they can be seen in investigation reports of several major NHS patient safety investigation reports over the years including the Mid Staffordshire inquiry. These problems continue to stubbornly persistent and plague the NHS.
Two recent reports
Two recently published reports, by Healthwatch (2025) and Cream, Wellings, Wenzel et.al (2025), reveal important failings in patient communication by health carers and others in the areas of patient discharge and NHS administration (which I term NHS back-office functions).
These are key areas inextricably linked to NHS care and treatment. Premature discharge, confusion over arrangements, advice, could well feature as issues in a clinical negligence case. As could failures in the appointment system, test results delays. These could cause treatment delays and contribute to wrong diagnoses being made.
Healthwatch: From hospital to home: improving patient discharge.
Healthwatch’s report is an update on their previous report on people’s experience of hospital discharge and the report states that many of the issues identified then are still with us. The report states that people have told them about not being involved in discharge planning. Inappropriate decisions that can result from this and the report gives examples. These include where patients have been discharged:
“1. Before seeing a consultant
2.Before being properly diagnosed.
3.Without any follow-up care in place
4.Without medication or information about how to manage at home”, (p.4),
Steps that will improve hospital discharge are stated in the report and include, following existing guidance, review secondary workforce, more resources for social care and better data on hospital discharge.
Problems with hospital discharge are well known.
Problems with hospital discharge have long been a problem in the NHS and are well known.
Lost in the system: the need for better admin: Cream, Wellings, Wenzel et.al (2025),
In patient safety terms, NHS back-office functions are vital to establishing a proper NHS patient safety culture.
Major problems are highlighted in this report with letters arriving after appointments. Patients not being kept updated about waiting times for treatment and having to chase their test results. The report begins with a statement which 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.” (p.1)
“-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, while 28% said it is poor at ensuring there is someone for patients to contact about their ongoing care…” (p.6).
Conclusion
Serious patient safety have been identified in the reports which need to be urgently addressed as they seriously hamper the development of a proper NHS patient safety culture.
This blog is based on a column recently submitted to the British Journal of Nursing.