, 2025-05-02 08:25:00
Much remains unknown about the harm linked to poor healthcare systems and lack of access to care. A survey of more than 10,000 individuals conducted by Michele Peters, PhD, senior researcher at the Nuffield Department of Population Health, University of Oxford, Oxford, England, and colleagues, published in BMJ Quality & Safety, found that nearly 1 in 10 people in Great Britain reported harm from the NHS treatment or care, or the lack of access to care, within the past 3 years.
This estimate is higher than those reported in other countries. However, the findings also highlighted significant disparities among the different patient groups.
Researchers noted that these findings exceeded those of two previous British surveys, which identified healthcare-related harm rates of 4.8% in 2001 and 2.5% in 2013. A study conducted in Norway in 2013 suggested that over 9% of patients experienced harm that worsened their overall health. In Italy, the Gelli-Bianco law states that “the safety of care is an integral part of the right to health,” which has gained international recognition. However, there are few data, particularly on the situation in Italy. Many studies are over a decade old and are limited to focusing on adverse events in hospitals or adverse effects of drugs.
The Study
The British survey aimed to provide a broader definition of harm, including emotional harm and issues arising from lack of access to care. The global market research company Ipsos conducted the survey between November 2021 and May 2022 in England, Scotland, and Wales using quota sampling to ensure that participants reflected the sociodemographic outline of Britain. The analysis included responses from 10,064 participants.
Overall, 9.7% of participants reported suffering from NHS-related harm in the past 3 years. Of these, 6.2% reported harm from treatment or care received, while 3.5% reported harm due to a lack of access to care. In most cases, hospitals are responsible for providing this care.
Risk Stratification
A clear social stratification of risk appeared, with higher rates of harm reported by women than by men (12.1% vs 7.2%). Socially disadvantaged groups are significantly at higher rates of harm — reaching 33.6% among those not working due to disabilities or long-term illnesses and 17.1% among those not working for other reasons — than an overall rate of 9.7%.
The impact of healthcare harm on patients is significant. In 44.8% of the cases, individuals reported a severe impact of harm, and 37.6% reported a moderate impact. The impact is greater when it arises from a lack of access to healthcare. According to 87% of the respondents, this resulted in severe (46.4%) or moderate (40.6 %) harm. In contrast, treatment-related harm was perceived as severe (43.6%) or moderate (36.2%) in less than 80% of cases.
The most common response to harm was to share their experience with others (67.1%) and seek support from family and friends. In addition, 58.8% of the participants sought advice from professional sources. This percentage was higher (64.9%) among those who suffered harm due to a lack of access to care. Specifically, 34.7% sought support from their general practitioner, and 31.6% sought help from the healthcare provider who caused the harm. Finally, 11.6% contacted the Patient Advice and Liaison Service, an alternative to the official NHS complaint process in England.
However, few individuals took formal action: 17% filed a formal complaint with the NHS, and only 2.1% filed a compensation claim. About 1 in 5 (21.6%) stated they did not wish to file a financial compensation claim against the NHS, reflecting “patient loyalty towards the NHS.” Older individuals, men, and those who are less educated or socioeconomically disadvantaged are less likely to take formal action.
Many patients desired treatment or care to redress the harm, including physical (44.4%) and psychologic harm, such as an explanation (34.8%) and access to previously denied treatments (29.7%). Two thirds of those who filed a formal complaint felt that it was not handled well, and only half were satisfied with their experience with the Patient Advice and Liaison Service.
Overall, the measured harm rates were higher than those in previous surveys. This increase can be explained by the broader criteria for defining harm, which now include lack of access to treatment and consider emotional and psychologic aspects, alongside the pandemic context in which the data were collected.
The reactive pyramid, with its wide base of informal responses and narrow peak of formal actions, suggests powerful barriers to accessing official restoration mechanisms. Such barriers may be cognitive (not knowing how to navigate complex systems), psychologic (fear of retaliation or being labelled as “difficult patients”), or structural (complex and unclear procedures). According to the authors, it may be necessary to create healthcare systems or procedures that provide both physical and psychologic assistance to patients who perceive that they have suffered healthcare harm. This should be done proactively: “Services supporting recovery after harm would need to identify populations most at risk and address any potential barriers to access for such groups. This may only be achieved by proactively identifying those harmed and offering support,” the authors concluded.
Situation in Italy
What do we know about health damage and how it is perceived by patients in Italy? “Not much,” answered Walter Ricciardi, PhD, full professor of hygiene and preventive medicine at the Università Cattolica del Sacro Cuore, Rome, Italy, and scientific advisor to the Italian Minister of Health during the COVID-19 emergency from 2020 to 2022, in an interview with Univadis Italy, a Medscape Network platform. “There are no specific studies. We have anecdotal evidence, mainly from organisations like Cittadinanza Attiva and the Tribunale per i Diritti del Malato (focused on protecting and promoting citizens’ rights in the healthcare system). We know the problem exists, but it is not being properly addressed.”
Ricciardi highlighted the issue of healthcare-related infections, noting that Italy holds a negative record in Europe, with infections contributing to 30% of the total deaths across all 27 European Union countries.
He added, “Italy is likely to follow the same trends as the UK, though with a few years’ delay. Historically, Italy has mirrored the UK’s social and healthcare trends. Our studies also show significant geographical disparities, especially between the North, Centre, and South, as well as social differences in health outcomes and access to care.”
Recent data reveal that 4.5 million Italians are now forgoing healthcare because they cannot access it unless they pay out-of-pocket.
According to Ricciardi, Italy also lags behind in handling complaints from patients who report harm. “In fact, these disputes are addressed only from a judicial perspective and not a substantive one. The relationship between healthcare facilities and poor patients. It is often poorly managed with insufficient and unprepared staff. Consequently, legal action is often the only option available to patients. This issue is growing, and there is now a huge volume of litigation. This is partly because, although Italy passed the Gelli-Bianco law, it has yet to implement the necessary decrees. Courts remain the main avenue for resolving disputes between citizens and healthcare system.”
Balancing patient protection with the safety of doctors and healthcare personnel, who are often victims of aggression by patients or their families, is a challenge.
Ricciardi concluded, “There are now thousands of aggressions because, in fact, there is still no plan in Italy for the recruitment and securing safe working conditions for medical personnel, both in terms of quantity, that is, adequate staffing, and in terms of quality, that is, in terms of economic compensation for services and acceptable working environments. These problems cannot be solved by militarising healthcare system, but only by simultaneously focusing on the needs of professionals, patients, and citizens, with an approach that is responsible, scientific, and centred on the needs of patients.”
This story was translated from Univadis Italy using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
