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The King’s Fund

We examined the experiences of people who have found administrative problems in the NHS have reduced their ability to access quality care.

  • Communication and administration
  • Health inequalities

The critical role of administration in quality care

Administration is a gatekeeper and enabler for quality care; when these processes go wrong, the effects go far beyond mere inconvenience. This is especially true for people with substantial needs who rely on the functionality of health and care services for quality of life. For them administration not only cuts to the heart of their healthcare experience, but to their wellbeing and life more broadly, as outlined in this video

National Voices undertook insight work in partnership with Healthwatch England and The King’s Fund. Each organisation contributed to a shared understanding of administrative burden but have taken forward their own conclusions.  

Read about Healthwatch England’s insight into the role of NHS administration in improving people’s experiences of care here. The King’s Fund have produced a long read entitled Admin matters: the impact of NHS administration on patient care

At National Voices, we conducted insight work in the form of interviews and an interactive workshop. We also consulted with our members on what they had heard on the topic of administration from the people and communities they serve. In addition, we hosted a workshop for 10 British Sign Language users in collaboration with our member charity SignHealth. 

Issues identified

Our report, produced as part of this research project, identifies administrative issues that fall broadly into the following categories:  

  • Bureaucratic barriers. 
  • Disconnect between NHS services. 
  • Human and system error. 
  • Rigid rather than compassionate and responsive process. 
  • A lack of inclusive and effective communication. 

Our research surfaces the impacts of administrative processes that are not functioning properly, which include:  

  • Causing significant distress and exacerbating mental ill health. 
  • Straining relationships. 
  • Financial cost for patients and services. 
  • Eroding trust in health services. 
  • Undermining people’s dignity and privacy. 
  • Exacerbating physical health problems. 
  • Consuming people’s time.  

The impact of poor administration is also highly likely to be unequal – people with confidence, good literacy or without specific accessibility requirements are more likely to be able to overcome barriers, develop coping strategies, know their rights, understand their options, and chase communications. By contrast, people who do not have those advantages are more likely to be detrimentally affected by administrative failures.  


Our report recommends that the NHS urgently looks to improve administration, tying in with its current priorities of tackling health inequalities and helping a pressurised and, at times, exhausted workforce become more efficient in the face of rising unmet need.  

We identified some key goals to improve patient experience and thus, health outcomes, in the areas of: improved care coordination; personalised patient communications; central involvement of experts by experience in the design and delivery of health services including the relevant administrative processes; improved workforce understanding of the importance of good administration; and compassionate communication.  

Although often sidelined when considering patient experience, administrative staff and processes are integral to patient interactions with the healthcare system.