When we talk about patient experience in the NHS, the conversation often starts with the things that are easiest to see and measure: survey scores, complaints, waiting times or whether someone felt informed and involved in their care.
All of these matter, but they largely tell us what happened after a patient has moved through a service.
If the experience was poor, the cause may sit much earlier in the way that service was designed.
A patient does not experience the NHS as a set of organisational structures. They experience a journey. That might begin with a GP appointment, move through diagnostics and outpatient care, involve a hospital admission and then continue into community services.
Patients can be left repeating information, chasing appointments or working out who is responsible for what happens next
Different teams, systems and processes may sit behind each part, but for the patient it is one course of care.
When those parts do not join up, patients can be left repeating information, chasing appointments or working out who is responsible for what happens next.
The 10 Year Health Plan recognises this challenge, setting out an ambition for more continuous, accessible and integrated care.
Making that happen depends on understanding how patients move through services and designing around that experience, rather than expecting them to navigate the structures behind it.
Understanding how patients use services
This starts with understanding what patients need, what they do and where they struggle. User research can sometimes be misunderstood as simply asking patients whether they like a service or what they would change.
In practice, talking to patients and staff, observing how services are used and mapping the journey can show where processes are creating unnecessary work, information is unclear or assumptions about how patients behave do not match reality.
The result is not only a better patient experience, but often a more efficient and effective service for staff as well.
Patients often find their own ways around processes that do not quite work for them. Someone may repeatedly ring a department because they do not know whether a referral has been received, while another patient may keep their own record because information is spread across letters, apps and conversations.
Staff develop workarounds too, from separate spreadsheets to additional phone calls. These workarounds create friction not only for patients, but also additional workload for staff.
Understanding these behaviours can show where friction exists in a care journey and where relatively small changes could make the service easier to navigate.
It also challenges the idea of an average patient. A digital appointment may make access easier for one patient and create another barrier for somebody else. Language, disability, digital confidence, work, caring responsibilities and access to transport can all affect how someone uses a service.
Designing around patients does not mean creating a different pathway for every individual
Designing around patients does not mean creating a different pathway for every individual. It means involving a broad enough group of people to understand how different needs affect the way a service works in practice.
Small decisions can have a big impact on experience
Recent changes to planned care communications provide a useful example. In July 2026, NHS England published new minimum standards developed with patients, unpaid carers, patient representatives, clinicians and NHS teams. Among the changes, patients should receive at least three weeks' notice of new planned appointments.
Giving somebody reasonable notice might seem like a basic administrative issue, but it can determine whether they can arrange transport, take time off work, organise childcare or prepare properly.
The experience of care starts before somebody enters a consultation room, and decisions about communications, booking processes and the information patients receive can all affect their ability to engage with the service.
The same applies when patients move between different parts of care. The CQC's 2025 Adult Inpatient Survey, published in August 2026, found improvements across several areas of inpatient care.
More than 58,000 people took part in the survey. However, involving families and carers in discharge planning and accessing care after discharge remain areas of difficulty.
A patient may have received very good clinical care in hospital but still have a poor overall experience if they leave unsure about medication, follow-up support or who to contact if something changes.
Designing experience in, rather than measuring it afterwards
Patient surveys, complaints and other forms of feedback remain important. They help organisations understand where patients are struggling and whether changes are making a difference. But they should not be the first time we discover that a process is difficult to navigate.
By that point, the service may already have been commissioned, implemented and embedded in day-to-day practice.
Bringing patients and frontline staff into service design earlier allows teams to test assumptions before they become part of the pathway.
Mapping how somebody moves through a service, observing where they need to ask for help and understanding the workarounds used by staff can reveal problems that are difficult to see from process maps and performance data alone.
Those insights can then shape the service, helping teams understand where technology could make things easier and where the underlying process itself needs to change. This can improve patient experience while also reducing duplication, unnecessary administration and avoidable demand.
This is particularly important as the NHS introduces new digital services and redesigns care around neighbourhoods.
Technology can make services easier to access, give patients greater visibility of their care and reduce administrative burden. But adding another digital route to a poorly understood pathway can just as easily create another place for patients to get stuck.
The NHS will always be complex. Good service design cannot remove that complexity, but it can reduce how much of it patients are expected to navigate themselves
The NHS will always be complex, with different organisations, responsibilities and clinical pathways. Good service design cannot remove that complexity, but it can reduce how much of it patients are expected to navigate themselves.
If we understand how patients access, use and move through care, patient experience becomes something we build into the service from the beginning, rather than something we only try to improve once the results come back.
