Objectives. The aim of this article is to provide an estimate of the proportion of the general public reporting healthcare-related harm in Great Britain, its location, impact, responses post-harm and desired reactions from healthcare providers. Design. We used a cross-sectional survey, using quota sampling. Setting. This research was conducted in Great Britain. Participants. The survey had 10 064 participants (weighted analysis). Results. In our survey 9.7% participants reported harm caused by the National Health Service (NHS) in the last 3 years through treatment or care (6.2%) or the lack of access to care (3.5%). The main location where the harm first occurred was hospitals. A total of 37.6% of participants reported a moderate impact and 44.8% a severe impact of harm. The most common response to harm was to share their experience with others (67.1%). Almost 60% sought professional advice and support, with 11.6% contacting the Patient Advice and Liaison Service (PALS). Only 17% submitted a formal complaint, and 2.1% made a claim for financial compensation. People wanted treatment or care to redress the harm (44.4%) and an explanation (34.8%). Twothirds of those making a complaint felt it was not handled well and approximately half were satisfied with PALS. Experiences and responses differed according to sex and age (eg, women reported more harm). People with longterm illness or disability, those in lower social grades, and people in other disadvantaged groups reported higher rates and more severe impact of harm. Conclusions. We found that 9.7% of the British general population reported harm by the NHS, a higher rate than reported in two previous surveys. Our study used a broader and more inclusive definition of harm and was conducted during the Covid19 pandemic, making comparison to previous surveys challenging. People responded to harm in different ways, such as sharing experiences with others and seeking professional advice and support. Mostly, people who were harmed wanted help to redress the harm or to gain access to the care needed. Low satisfaction with PALS and complaints services may reflect that these services do not always deliver the required support. There is a need to better understand the patient perspective following harm and for further consideration of what a person-centred approach to resolution and recovery might look like.
Commentaire du Dr Marius Laurent (PAQS)
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Le système de santé anglais est responsable d’un dommage chez 9,7% des patients qu’il prend en charge, soit par les soins qu’il prodigue (6,2%), soit parce qu’il n’a pas été capable de les prodiguer (3,5%). C’est d’autant plus troublant qu’il est aussi le système vers qui le patient va se retourner pour corriger le dommage qu’il subit. Les patients le plus souvent atteints sont les femmes, les malades chroniques, les patients sans travail et les catégories socioculturelles défavorisées. Moins d’un quart de ces patients émettra une protestation ou portera plainte par voie légale. Bien davantage chercheront une explication ou des informations auprès de proches ou de professionnels de la santé. Ce que le plaignant désire, c’est avant tout la réparation de son préjudice, des explications sur ce qui s’est passé, et un accès aux traitements qui lui ont été refusés jusqu’ici. On n’est que modérément surpris de constater qu’ici comme ailleurs, ce sont souvent les patients qui ont le plus besoin d’un système « social » de santé qui en souffrent le plus : ils n’ont pas d’autre recours. Une plus grande attention aux catégories à risque serait bienvenue.
Crocker H, Cromwell DA, Modha S, 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 Qual Saf. 2025. Doi : 10.1136/bmjqs-2024-017213.