To think the NHS is already on its knees and people shouldn't just cancel or not turn up for appointments without consequence?

[youarenotkiddingme]

This has been sparked by a situation by a friend but is a general AIBU.

My mum has cancer and has been treated amazingly by the NHS. She's attended all appointments and rearranged where absolutely necessary as soon as letters have arrived. As a family we've seen the best the NHS has to offer and the dedication of its staff.

I'm undergoing extensive dental treatment and often see the signs about how 30-50 people didn't turn up for appointments that month. Afaik dentists strike patients for doing it more than once.

However this holiday a friend has cancelled optical appointments on the day half an hour before the appointment for all her DCs because they want to meet friends or have had a sleepover the night before and don't want to go.
Both times these have been rearranged.

However I can't help thinking with such stretched resources there should be consequences for doing this? Maybe some financial penalty (set payments for missed appointments without suitable reason) or a time penalty before you can rebook?

There are people desperate for appointments who are waiting long periods of time when they could have been seen.

AIBU? Am I thinking this issue can be solved more easily than the reality allows? I'm interested to hear others views and any solutions people know of and have.

[Lilyoftheforest]

YANBU.

IMO people should have to pay a mandatory £10 when they book a GP appointment, then when they turn up, they get it refunded. If they don't turn up, they lose the tenner. Same with hospital appointments,

You will see a massive drop in people cancelling their appointment if they can't make it.

[NeedMoreSleepOrSugar]

I totally agree that people should not miss appointments for trivial reasons, however I think it would be very hard to enforce penalties, for example

• presumably exceptional circumstances wouldn't be penalised, so missy purple would just lie about the reason for cancelling
  
• putting a time limit on rebooking may mean that whatever the issue is Will get worse in the meantime and therefore cost more to treat
  
• charging for public services is complex, but fining even more so - what if the person can't or won't pay? What if the person bit attending the appointment, as in your example, is a child - should they be punished for an adults poor decision making?
  

No idea what the solution is, but unfortunately I don't think it's easily solved

[SchnooSchnoo]

I think people need to stop blaming the general public for the state of the NHS and look at where the fault really lies.

[WhooooAmI24601]

YANBU that your friend was being U to cancel last-minute for no real reason; I try to teach the DCs that regardless of being tired/fed-up or just can't be bothered that it's not ok to flake on appointments or people.

I don't know about fining people, though, because it could lead to some people not bringing children to appointments because of previous fines, and potentially the children missing out on dental/medical care.

[Davros]

My local hospital has a random collection of ways to inform you about appointments. Sometimes you make the appointment there and then after an appointment. Sometimes they say they'll let you know. Sometimes you get a reminder text, sometimes s phone call. Often appointments arrive by post ..... or not. I've been told I've missed appointments I knew nothing about until I get a letter telling me I missed my appointment. I certainly wouldn't be paying a fine for missing something I had no idea about.

[Lilyoftheforest]

I wasn't talking about fining though. Just a payment of a tenner when booking and then returning it when they turn up.

If people had to pay a tenner to make an appointment, they would be a LOT less likely to miss the appointment (or forget to cancel it.)

My GP texts me the day before and then on the morning of the appointment to remind me, but not everyone has a mobile.

And although there are many reasons for the NHS being in trouble financially, people missing appointments is a big problem and does cost the NSH a lot of money.

[BillSykesDog]

It would cost more to set up and administer the suggested systems than it would save.

[youarenotkiddingme]

Thanks for replies. Yes it's true it's complicated and children will suffer because of poor parenting - which in MH friends case I believe it is.

That's a very good point about conditions getting worse and making more work - more expensive treatment.

I'm not blaming the public for the state of the NHS. But as a public when we are concerned about it and complaining about how it's run it's very contradictory to then just waste the time and resources that are available.

[MargaretCavendish]

If people had to pay a tenner to make an appointment, they would be a LOT less likely to miss the appointment (or forget to cancel it.)

They would. The problem is that some of the most vulnerable people would also not make an appointment at all if they had to pay even £10 up front, which is a pretty undesirable side effect.

[Davros]

And those who can afford a tenner would think they can just not turn up and let the tenner go. I have been a very, very extensive user of the NHS for 20+ years and the biggest problem imo is the same as it's always been, the admin and waste. Systems have modernised but they are no more efficient or effective

[wonkylegs]

I'm often at the mercy of my disorganised hospital trust who often muck up my appointments. I've been accused of not attending appointments I've never been notified of in the first place and I've turned up to appointments to be told that I'm there on the wrong day despite having letter / appointment cards that say otherwise.
I don't make my appointments they do, I then get sent the details and have to change them if I can't make it. I have to go every 6wks for monitoring and see consultant & specialist nurse 4 times a year and generally bend over backwards to fit in with them but they don't make it easy.
If I don't attend my treatment gets stopped so there is a very real consequence for me.

[BarbaraofSeville]

I'm not sure I understand how missed appointments cost money. Of course, other people could have taken those appointments, but considering how behind they usually are, how much more of a mess would they be in if everyone did turn up to all appointments?

[TheWayYouLookTonight]

I've never missed an appointment without cancelling it, but it strikes me that in GP surgeries where it takes 3 weeks to get an appointment, people are more likely to forget in that time without some sort of effective reminder. Of course the reason it takes 3 weeks to see a GP will be in part because of all the missed appointments, so it becomes a bit of a Catch-22.

[BodyformForYou]

Yes I think there should be some form of fine system in place.

It is a nightmare to get appointments around here, especially evenings

[Stormtreader]

Ive missed 3 appointments in the last 12 months, 2 I only found out about from the letter telling me Id missed them, and 1 was rearranged without anyone telling me.

Why there isnt a central page that you can log into with your NHS number and a password that tells you about your appointments baffles me as an IT person, it wouldnt be difficult to do. Email and text reminders as well, not difficult and surely cheaper than the cost of the missed appointments in terms of staff times and resources being wasted.

[mummymeister]

I think hospitals and gp surgeries could use technology more and in a smarter way to remind patients. making people pay a token amount will cost more to administer than it raises. you would either have to charge a stonking amount to make it worth it or look at ways to work smarter.

The basic problem which no political party will touch with a barge pole, is that the NHS is clearly no longer fit for purpose. it needs a total re-design and overhaul but because it has become some sort of sacred cow anyone who even dares to suggest this is shouted down. Look at some of the stuff from Frank Field. made good sense but ultimately too much hand wringing about a beloved institution.

throwing money at it makes bugger all difference. we need some proper joined up care which means treating old people with all their health and social care problems from one budget under one roof.

The NHS is a bit like the Corbyn situation. its all going to have to collapse before most people are willing to consider a rebuild.

[Starlight2345]

Actually the cancellled appointment may of been filled.. I phoned up for my DS last month and was seen within half an hour ( It was an emergency appointment) far better than not cancelling at all.

£10 is not an affordable outlay to some.

It is annoying but also a few years ago I got my DS seen the day before appointment..He had got worse so cancelled the appointment. I then phoned up next day and saw duty DR.. His morning appointment had not been cancelled.. So it was on my notes..I only happen to know this as I had to go back...How many missed appointments are publics fault..

[AllTheWittyNamesAreGone]

My hospital likes to send you the letter telling you the date of the app AFTER it passed and then get shitty when we don't turn up.
Sometimes they cancel the app 20 mins before the app and don't tell us till we get there
My son had a lifelong serious condition and not having his drugs, physio causes him actual pain for days. Not getting these apps is awful

It works both ways, the nhs have big flaws on their side too

[GhostofFrankGrimes]

First you run it down, then people complain, then you privatise.

[hackmum]

wonkylegs: "I don't make my appointments they do, I then get sent the details and have to change them if I can't make it."

I think this is a good point. Obviously the whole system could be vastly improved if the NHS introduced online booking - this isn't simple to do, but it's not impossible, and would probably lead to a reduction in missed appointments.

At the moment, the NHS still relies very heavily on paper processes - for example, there have been several occasions when my daughter has received a letter in the post informing her of an appointment, and then a week later received another two letters in the same post - one cancelling the original appointment, and then another offering a new appointment date. It shouldn't be beyond the wit of the NHS to combine two letters into one, or even better, do the whole thing by text or email.

[RhodaBorrocks]

I'm not sure I understand how missed appointments cost money

In a nutshell: Hospitals get paid by CCGs on a per patient basis.

When a patient DNA the hospital doesn't get paid for that appointment.

The following year's budget for each department is then calculated on how much money they made last year, so it's calculated only on attended appointments.

If a high number of people DNA then less money is allocated to the budget, so the service can only afford to put on fewer appointments than before.

Add in government budget cuts and you've got even less money to put on running services.

That's roughly what the NHS means when it says missed appointments cost money. Think of all the consultants, junior doctors, nurses, reception staff, back office staff, cleaners etc who are still needing to be paid despite patients not turning up. Then the service posdibly has to lay on extra appointments to cover the missed ones whilst trying to deal with new appointments in a timely way so as not to breach waiting targets.

Where I work does send text reminders and they've been hugely helpful. But they don't stop the repeat offenders - it's often the same people who repeatedly DNA. Patients often also do things like move house or change phone number but don't tell the hospital, then letters go astray. They even get their own post codes wrong which results in royal mail not delivering letters! But at the same time, staff should check these things at every appointment and in their hurry to make appointments they don't always do this. It's a combination of things, but generally speaking, staff and patients all need to be more conscientious about appointments and the NHS as a whole.

[wilma60]

My doctors surgery puts up a sign each month with the number of issued appointments and it has been up to 600 missed in one month. Think of all the time that's wasted with the doc waiting for people to turn up. It makes it bad for other people because we can't get appointments. I often have to wait up to three weeks to get one with my GP. If it's an emergency I can phone on the day and speak to a duty doctor and they will then see me if they think it's necessary.

[youarenotkiddingme]

Storm that's an excellent idea about a central log in.
Schools often employ some VLP now as a quick way to get information out.

I get text reminders for all ds appointments and my dental and gp ones.

By costing money I see that having to run extra and longer clinics to accommodate all the spill over of patients still waiting. If each clinic has 20 no shows a week for 100 appointments eventually you then have a weeks worth of appointments to make up - paperwork, phone calls, texts, lighting, hearing, dr and nurse hours all cost money.

But essentially i think where an appointment in an annual check up (as in friends case) when it's cancelled because something better comes along there has to be some kind of consequence.

[Whirltime]

I think alot of problem is post. We don't have a good post service here. It seems to take forever to get things. We often get letters after the dates arrived and also in the times they ring up book with you and say they will send the letter out and you must have the letter to able to attend. Had to phone up on day and tell them letter not arrived and they have had to rearrange.

[Chattymummyhere]

They need to set up appointments like dentists and salt do. Reminder texts 24hrs prior to the appointment and you can simply text back no if you are unable to attend so they can then rebook the slot.

They should also unregister you if you don't attend an appointment and you haven't cancelled.


Although it is funny all the missed appointments yet doctors/nurses/clinics still run so far behind. 40minutes late for simple vaccinations yesterday and that's after I saw the nurse turn 3 people away as their newborns hadn't had their baby check yet, so I got in 3 appointments faster but still 40minutes late.