The consequences of overlooking the admin front line

In most health and care settings, the first person you speak to will be a member of the administration (admin) staff rather than a health professional.

Admin staff act as the front door to the NHS – sorting out appointments or transport and helping patients make sense of a complex and often confusing health and care system. They're stationed at the 'back door' too – explaining what happens after your appointment, where to go next and what to expect.

And in a health and care system under acute strain, admin staff frequently bear the brunt of patient frustration and anger when faced with long waiting lists and test results that have gone amiss.

Admin staff are often recruited with little experience of the NHS and can be placed very swiftly in situations where they have to reassure and support patients. The low banding (and pay) accorded to their role belies the skills needed to support patients from all walks of life who might be stressed and anxious about their health. And in a health and care system under acute strain, admin staff frequently bear the brunt of patient frustration and anger when faced with long waiting lists and test results that have gone amiss.

Yet despite the critical role admin plays in patient care, it is often overlooked and under-resourced. But if I'm reading the runes correctly, the outlook looks brighter. Admin is slowly working its way up the agenda and getting the attention that admin staff – and patients – deserve.

Take cancer, and yes, I know cancer care is not always representative of NHS services more broadly, but there’s a lot happening with its admin right now that merits a closer look.

For starters, cancer services have access to data on patient experience of admin through the cancer patient experience survey (CPES) – one of the few national surveys that asks patients for their views on admin. Recent analysis of the 2022 survey suggests that the quality of administration is the key driver associated with a high rating of care.

The cancer workforce strategy also recognises the role admin and other non-clinical roles can play in increasing capacity of the cancer workforce and improving patient care. New patient co-ordination and navigation roles highlight the importance of admin, and the role great admin plays in a cancer team. The training offered by the Guys Cancer Academy is a strong example of how non-clinical staff are being supported to deliver excellent patient care. This online training gives staff information about cancer and its treatments, and critically, also recognises the role admin staff can play for patients as part of a wider team.

Inequalities in accessing a diagnosis and treatment in cancer care have long been recognised, but acknowledgement of the additional barriers that poor admin can play is more recent. It is clear that the burden of poor admin falls more heavily on some groups, such as those with communication needs, poor literacy, poor digital access, or those managing multiple long-term conditions. This means there are substantial opportunities for admin staff to play a part in addressing health inequalities, and many consider it an essential element of their role. The Wessex Cancer Alliance, for example, supports staff to develop the skills and confidence to ask if someone missed an appointment because they couldn’t afford to take time off work, afford the bus fare, had caring responsibilities, or perhaps never received any communication to let them know they had an appointment.

It is clear that the burden of poor admin falls more heavily on some groups, such as those with communication needs, poor literacy, poor digital access, or those managing multiple long-term conditions.

Finally, cancer teams have access to dedicated quality improvement support through NHS England’s Cancer Improvement Collaborative. This year, as its theme for 2024, it has chosen the administration of cancer care and its role in reducing health inequalities. Admin staff, along with patients, are invited to form quality improvement teams with their clinical colleagues. Successful teams will get access to a programme of learning and support.

So, we can see that there is a welcome focus on admin in cancer care. I mentioned earlier that cancer might be an outlier – it has more resources than other areas, as well as its own workforce strategy, alliances and national survey. It also has an advantage in that it has placed a premium on patient engagement and patient experience for many years. Perhaps it can now be argued that it is reaping the benefit of a better understanding of the priority and importance that patients and carers place on admin. This is something that all services could benefit from, too.

The people and the processes that shape how the NHS communicates with patients and carers really matters. It impacts on the trust and confidence they have in the NHS as well as their perceptions of waste and efficiency.

The King’s Fund has been partnering with Healthwatch and National Voices to push patient experience of admin up the policy agenda. Great patient care starts and ends with admin and we are keen to work with others to improve it – at the NHS’s front door, at the back door, and all along the pathway, too.