Still lost in the system: the urgent need for better NHS admin

A year on from our December 2024 poll, our latest research shows no improvement in people’s experiences of NHS admin. NHS admin plays a central role in shaping how people experience and perceive the NHS. Our findings point to a major opportunity for government and NHS leaders to act.

Introduction

The dysfunction in how the NHS communicates with people day-to-day – whether by phone, post, text, app or in person – was laid bare in our national poll findings published just over a year ago. 

Lost in the system showed that nearly 2 in 3 people who had used NHS services in the past 12 months had experienced at least one issue with admin or communications, and 1 in 5 people reported being invited to an appointment after the date of the appointment. Our work also looked at public attitudes to NHS admin and communication, and found that nearly a third of people thought the NHS was poor at keeping people informed while waiting for care and treatment.  

The 10 Year Health Plan conceded that the NHS had ‘not got the basics right’ and since we surfaced these issues, there have been some signs that stakeholders are willing to improve NHS admin. The Royal Mail has worked constructively with patient bodies to prepare for the rollout of an NHS-specific barcode to make sure NHS appointment letters get sent to patients in time. NHS England is also working with stakeholders to produce new minimum patient experience standards for elective care (albeit behind its original deadline of September 2025). The elective reform plan, published in January 2025, promised more timely confirmation to patients that specialists have received GP referrals, and clear communications throughout patients’ time on waiting lists. 

To understand whether there has been a change in people’s experience of NHS administration and communications, or their views on how the NHS is performing in these areas, we commissioned repeat polling one year on. Conducted again by Ipsos, it was undertaken in December 2025 and aimed to track the reality of the public’s experiences since our December 2024 poll.¹ 

The results overall make for difficult reading. Not only has there been little change in people’s experience of NHS admin since our previous polling, but general perceptions of NHS admin and communications have actually got worse.  

Overall attitudes

Overall attitudes to NHS admin and communication with patients 

As in 2024, we asked people how good or poor they think the NHS is on three key aspects of NHS admin and communication. We found that in 2025, attitudes were more negative than they were in 2024 across all three areas. 

When we asked people how good or poor the NHS is at communicating with patients about things like appointments and test results, over 2 in 5 (43%) said it was good, while nearly 1 in 3 (30%) said it was poor. This is worse than in 2024, when over 1 in 2 (52%) said it was good and 1 in 4 (25%) said it was poor. 

Responses on the other two aspects of admin have also worsened. In 2025, nearly 1 in 3 people (32%) said that the NHS is good at ensuring patients have someone to contact about ongoing care (compared with 43% in 2024), while just over 1 in 3 (34%) said that it is poor (compared with 28% in 2024). Nearly 1 in 3 people (32%) in 2025 said the NHS is good at keeping people informed about what is happening with their care (compared with 42% in 2024), while nearly 2 in 5 (38%) said it was poor (compared with 32% in 2024).  

When we looked at the results by demographic group, we found that there continue to be differences in perceptions of NHS admin between different groups of people. 

In 2025, people who have a long-term health condition were more likely to say that the NHS is poor across all three areas we asked about: keeping people informed about their care and treatment, such as referrals and waiting times (45% compared with 36% of those without a long-term condition), ensuring there is someone for patients to contact about their ongoing care if they need to (38% versus 32%), and communicating with patients about things like appointments and test results (34% versus 29%). In fact, this pattern is more pronounced than it was in 2024, when the difference was evident in the first two areas but not in the third.  

As in 2024, people who said they were really struggling financially were also more likely to say the NHS is poor in all three areas. In 2025, they were more likely to say the NHS is poor at: keeping people informed about their care and treatment, such as referrals and waiting times (59%, compared with 33% among those who are ‘very’ or ‘quite’ financially comfortable); ensuring there is someone for patients to contact about their ongoing care if they need to (52% versus 30%); and communicating with patients about things like appointments and test results (41% versus 26%).  

Specific issues

Experience of specific NHS admin and patient communication issues among those who have used NHS services  

We asked people whether they had used a range of NHS services in the past 12 months, either for themselves or someone they care for. Those who said they had used the NHS in either of these ways (around 1,900 of all those we polled) were then asked whether they had experienced any of the specific issues listed below. These issues were based on those that regularly feature in the public feedback gathered by Healthwatch England. 

The picture in 2025 showed no improvement on the one we found in 2024. 

In 2025, 2 in 3 (66%) of those who had used an NHS service in the past 12 months (either personally or for someone they care for) said they had experienced at least one of the issues listed. There was no statistically significant change from the result in 2024 (64%).  

In 2025, nearly 1 in 3 people who had used the NHS for themselves (32%) had to chase the NHS for their results. A similar proportion (33%) said they had not been kept updated about how long they would have to wait for their care or treatment. Nearly 1 in 4 said they had received an appointment letter or text after the date of the appointment (23%) or had not been told who to contact while waiting (24%), and nearly 1 in 5 (18%) said they tried to contact the NHS to change or cancel an appointment but had not been able to. Again, in each of these areas, there was no improvement on the responses we saw in 2024. 

As in 2024, the data shows that poor admin has a disproportionate impact on carers. Across all of the issues we asked about in 2025, they are more likely to be experienced by people when they access services for someone they care for than for themselves personally. 

Again, this pattern shows no improvement since 2024. 

Impact on perceptions

The impact of poor admin on perceptions of the NHS 

We asked those who had experienced at least one NHS admin or communications issue about how it affected their perceptions of the NHS. The results in 2025 were very similar to those in 2024, with the top three answers all relating to waste. 

• 3 in 5 people (60%) said it made them think that NHS money was being wasted. 

• More than half felt that their time was being wasted (57%). 

• More than half felt that staff time was being wasted (57%). 

Poor admin also affects people’s perceptions of the quality of NHS care, with nearly half (49%) saying that their admin experience made them think the quality of care is poor. A similar proportion said the experience made them think the NHS doesn’t understand what it’s like to experience poor admin (56%) or that the NHS doesn’t think it’s important to prioritise these kinds of communications (52%). Most worryingly of all, as in 2024, over 2 in 5 people (44%) said that poor admin made them give up on seeking care or treatment this time, and a similar proportion (41%) said it made them less likely to seek care in future. People who were employed (45%) or from an ethnic minority background (54%) were more likely to say it made them give up.  

What does our latest polling tell us?

Patients’ experiences of NHS admin are still being overlooked  

Our 2025 polling shows that people continue to feel lost in the system; they are still having to chase test results, they still aren’t being kept updated on how long they will have to wait for treatment, and they are still being invited to appointments after the appointment date. Though disappointing, this repeat in the findings from 2024 is perhaps unsurprising and underlines the problem we have identified previously. Despite evidence showing that admin is a major issue affecting people’s experience of care (our polling adds to this evidence), and recognition of this problem nationally and locally, poor admin is still not being treated as an urgent issue.  

Poor admin is still being felt unequally  

Our recent polling also shows that poor admin continues to affect some groups more than others. Carers, those from ethnic minority backgrounds, and people who are struggling financially are all more likely to report experiencing poor admin. The fact that poor admin is falling disproportionately on certain groups means it is likely to be exacerbating existing health inequalities. For example, the financial impacts of poor admin – such as missing work or paying for travel twice due to an incorrect appointment letter – are likely to have a bigger effect on people on low or no incomes.  

Patients and carers with long-term conditions are also more likely to experience an admin issue, and the proportion is even higher (nearly 4 in 5) for people with multiple long-term conditions. This may be a result of more frequent use of NHS services, but it is a worrying finding given how important it is that people with multiple long-term conditions receive correct information about their appointments, receive timely test results, and know who they can contact when their symptoms worsen. 

Public awareness of poor NHS admin is growing  

What has changed since our previous polling is people’s views on NHS admin. Our 2025 update shows that fewer people think the NHS is good at admin and communications, while a growing number of people think it is poor – even though the numbers experiencing poor admin have not changed. This suggests that people are increasingly aware of the problem of poor NHS admin, and that this perception is being driven by factors beyond their own experience (or that of someone they care for) – such as the experience of their friends or family, or stories in the media. Although worsening perceptions of NHS admin may help galvanise action, there is a risk that these negative perceptions will become embedded in the public mind and, as we’ve seen with other public attitudes to the NHS, become an entrenched view.  

This is particularly worrying given what we know about the impacts of poor admin. As we found in 2024, our 2025 polling shows that poor experiences of NHS admin shape perceptions of the NHS overall, leading people to conclude that it is wasteful. This aligns with attitudes expressed in the 2025 British Social Attitudes survey, which found that more than half of people disagree that the NHS uses the money it has efficiently. Our polling also found that for nearly half of people (49%) who had experienced admin issues, the experience  made them think that the quality of NHS care is poor.  

Most worrying of all though, the experience of poor NHS admin can affect people’s willingness to seek care, with many people saying it has put them off seeking care either on this occasion or in future. These effects were reported by those who had direct experience of poor admin (either themselves or for someone they care for), but the findings signal the risks associated with a growing perception that the NHS admin and communications are poor – both for the NHS, and for people’s health.  

Increased use of the NHS App isn’t the only answer to poor admin 

The NHS App is often considered a key part of the solution to poor NHS admin, in line with the 10 Year Health Plan’s ambition to shift from analogue to digital, and supporting a transformation in patient communications. Our polling found a slight increase in the number of people using the NHS App: nearly 2 in 5 people (38%) saying they had used the app for themselves personally in 2025, up from 1 in 3 (33%) in 2024.  

However, whereas our 2024 polling found that people who had used the NHS App were more likely to say the NHS was good at the key aspects of admin we asked about, in 2025 this was not the case. There was no statistically significant difference between those who had used the NHS App and those who had not, in terms of their views on how good the NHS was at communicating with patients about things like appointments and test results. In the other two areas we asked about, NHS App users were actually more negative: they were more likely to say the NHS was poor at ensuring there is someone for patients to contact about their care (38% compared with 34% overall); and more likely to say the NHS was poor at keeping people informed about what is happening with their care (42% compared with 38% overall). When it came to experience with specific admin issues we asked about, no clear pattern emerged between those using the NHS App and those who hadn’t used the app.  

Good admin is not a ‘nice to have’ 

Our polling in 2025 reinforces what we’ve known since we first began work on NHS admin back in 2019. Admin can shape people’s experiences and perceptions of the NHS overall, and yet it is often poor, and often forgotten.  

Good NHS admin is not a ‘nice to have’. The fact that poor admin puts some people off seeking care is a very concerning finding, and should be a strong enough argument in itself for making admin work better for patients. But patient experience is important too. The Secretary of State for Health and Social Care, Wes Streeting, has spoken about his determination to build the NHS around patients, giving them the ease, convenience, choice and control they expect in other parts of their lives. It’s hard to imagine how this will be achieved without the improved approach to admin we have called for previously, recognising that people have different needs and preferences when it comes to communication. In a context where satisfaction with the NHS remains low (albeit improving), improving NHS admin should be seen as a key opportunity for improving  overall satisfaction with the NHS. 

In ‘Lost in the system’ we set out the reasons why admin is so often overlooked, including the lack of measurement of patients’ experiences of admin, and the tendency to design admin systems from organisational rather that patient perspectives. Achieving the shift required is a cultural challenge as much as an operational or financial one; it will need action on multiple fronts, as we set out in ‘10 actions the government and NHS leaders should take on NHS admin’.  

We still don’t have the whole story on NHS admin  

Our polling in 2024 and 2025 shines a light on the issue of NHS admin, offering insights into how people experience it and what the impacts of poor admin can be. But it also raises some important questions.  

In both years, a pattern emerged in the data telling us that some groups of people are more likely to experience poor admin than others. We can guess at the reasons for this – maybe people with multiple long-term conditions are more likely to experience an admin issue because they use NHS services more regularly than others? Maybe experiences and perceptions of admin are shaped by expectations, and maybe these vary with age? The reality is probably much more complicated, but understanding what drives differences in experience – whether that is admin systems, the context of people’s lives, or other factors – will be key to understanding what needs to change to improve everyone’s experiences of NHS admin. 

We also have an initial – and worrying – insight into some of the impacts of poor admin, but not the whole story. Our polling tells us about some of the ways that poor admin can affect people using the system, from influencing their views on its quality and efficiency to affecting their willingness to seek care. But we still don’t really know what this means for people’s health, either in the immediate or longer term, or on an individual or population basis. Nor do we know what the economic impacts of poor NHS admin are, and how these play out across individual organisations, the NHS and beyond. Again, a fuller understanding of the consequences of poor admin should help shape work to improve it. 

We believe there are some key steps the government and health care leaders should take now to improve patients’ experiences of NHS admin – you can see the 10 actions we have identified here.