NHS waiting times - the flip side

[PashaandMe]

Just reading how massive the NHS backlog is, how long people are waiting etc etc

I manage a waiting list of over 2000 patients for my service. I have 2 booking clerks under me and a team of admin staff. Any one of them will tell you the hardest part of treating a patient is getting them in in the first place.

We call patients and offer surgery dates and around 50% of the time they are turned down. The best one I’ve heard so far is that someone was “going out to lunch” that day. We have people phone up the day before surgery to say they’re going on holiday or to ask if they can come in the next week instead. We have at least 3 people just not turn up for surgery every week.

We can’t just call the next patient because they have to be swabbed and isolate for 3 days before surgery.

We can’t discharge because they DNA - once a consultant has said they need treatment it is very difficult to discharge without it.

We can discharge if they turn down 2 consecutive dates. But they will accept them and then just cancel the day before which doesn’t count as turning a date down.

It’s an absolute shit show

I actually think NHS should be tougher, as many say your given your appointment weeks to months in advance. Noone has a diary booked up that far in advance unless its a family do or event.

Quite a lot of people have their diaries booked up that far in advance for things far more important than ‘a family do or event’ that’s quite the lack of imagination!

I'm a dentist and see the other side of this.
Our local hospitals only give people a fortnight to respond to a letter asking them to make an appointment. When they try, they can't get through, the appointment isn't made and they get removed from the waiting list.
Then there are those that DNA'd their appointments so are not offered another, they don't get a second chance. I always take the comments that they didn't receive letters with a pinch of salt but these are patients that turn up to dental appointments without any issues.

From my own experiences apparently I missed 2 mammogram appointments in the last 18 months- I definately didn't receive those appointments and I've sat in clinics where the Consultants couldn't attend but no-one had cancelled the clinics.

This is the kind of attitude I hate about the NHS. Take whatever you get and be grateful because after all “it’s free

Welcome to the world of the social housing tenant.

It was seen as fine and dandy for us to get this attitude so its no wonder its seeped into other areas.
First they came for me............etc.

This makes me very cross, I've been waiting two years and one month for an operation and as of this morning when I rang the waiting list coordinator they have no upcoming slots for me and can't give me a time scale, so to hear people are turning down care, eating when they are not supposed to and cancelling at the last minute is really disappointing and something the NHS needs to look at.
The waiting list coordinator I spoke to today sounded as frustrated as I am. In fact I said I would be happy to shield indefinitely so I could come in at short notice but that's not possible as my surgery needs several specialties.

@PashaandMe were you planning surgery before 10am for the 4am tea and toast person?

I’ve had 4 ops this year, 3 I was given 1 week’s notice. Good job I was able to attend what with the isolation period included now. But people may need to organise childcare. They may have difficult employers to deal with who make it hard to take time off for a hospital appointment, god forbid you may need surgery. People need to keep a roof over their head, put food on the table. I understand there are people who are just thick but so many people are under enormous pressure these days, not just those who work for the NHS.

My own consultant appointments are usually given months in advance and I get a text reminder which is much appreciated. My consultants, their staff and the trust are brill, I have no complaints myself. Except for that one time when I waited for 2.5 hrs only to be told I’d been booked onto the wrong clinic and my 1 hr journey to the hospital was wasted and I wouldn’t be seen. A whole days pay gone and I had to pay parking, tunnel fees and petrol.

It's not a take what you get scenario necessarily. The NHS isn't withholding dates from patients

We dont have theatre dates for each type of op every day. The next slot to accomodate patients is not tomorrow it could be 6 weeks away, certain consultants only operate certain days or have clinics on a monday for example. Obviously more urgent surgery will get prioritised and so minor ops have to work around these, we have a lot of trauma at the minute and a lot of lower level urgent stuff that needs doing. Each speciality is fighting for theatre time, and it's not easy to get more theatre space. Especially if patients cancel last minute and your list isnt full!

We have lots of last minute cancellations and it's frustrating. Lots of people not have covid swabs and then not being able to have surgery. Yes it tends to be on the more minor end of surgeries but not always.

@MillyMollyMardy the hospital dental GA list is often one of the longest hospital lists, you do have to be quite strict. There are lots and lots of patients in pain on that list that have waited a long time for their procedure and de quite desperate. You have to be fair. IHospital DNA rate for dental is not higher than in practice, which suggests it's not a hospital problem.

We can discharge if they turn down 2 consecutive dates. But they will accept them and then just cancel the day before which doesn’t count as turning a date down.

And you can't work out why dysfunctional, inflexible policies that make it difficult for people to access treatment might be driving this? For instance, if someone is in a position where accepting the date offered could mean they lose their job and therefore their home, but the only way to decline a date without losing access to treatment is to agree and not turn up.

Perhaps you are unaware of how privileged you are as an NHS worker with your sick pay policies, but most people are in a much more vulnerable position.

It's also not difficult to imagine why something as scary as surgery might get postponed at the last minute if a patient doesn't feel ready or panics during the night. If they're talking to someone with the attitude you've displayed here, I can see why people would offer excuses instead of feeling confident to say "I'm too scared to go ahead right now".

But let's not let humanity get in the way of blaming patients for the NHS procedural and structural failings. This is the reality of an organisation that exists to serve human beings with complex lives yet tries operate as if it were merely processing cardboard boxes in a warehouse. Unsurprisingly, it doesn't work very well.

I have no respect for NHS staff who think it is acceptable to demonise patients like you have chosen to do. Do you think publicly disrespecting patients is going to change their behaviour in a positive way? If so, you're in for a shock.

On the other side of the coin my DD had treatment for a (relatively minor) issue at our local hospital a few years ago. The appointments could only be made in school time and although i could get to the hospital in around 20 min, i always left 45 min to allow for parking/motorway traffic, so even if seen on time it was a lengthy period off school (and usually a day off work for me).

The appointments were made 6-8 weeks ahead. On a few occasions, nearer the time I realised we couldnt make that time and called the number given, to cancel. (Always at least a week in advance) Sometimes I left an answer phone message or I spoke to a member of staff.

None of the messages were acted on or got through and at the next apt we got a lecture about being no shows and accused of simply not turning up. This happened on more than one occasion. I followed the advice on the letter to call the specified number if we couldnt make the appointment. I would not have accepted a fine as a no show. This wasted the drs time, and could have freed up an apt for someone else. (This was pre covid)

I’m guilty of being a DNA. Went to A&E with an issue, which could have been life threatening, tested and determined not and sent away being told a follow up will be sent. 2 days later get an appointment for a scan 3 months time. Think sod that I’ll use my private health insurance. Ring up and cancel the NHS appointment - all fine, they understand why and say they will note that on my notes. A week later receive an appointment via text for 4 weeks time with a nurse practitioner for the same issue. Text says that I can cancel the appointment by return text message. So I do that. Twice. No response. No further details about what clinic it is or how to speak to someone to cancel. So I leave it and assume it is cancelled as I did what was asked in the only appointment information I received. Yep - get a stroppy letter saying I DNA.

Similarly my DM passed away. 6 weeks later I get a stroppy letter saying she DNA a follow up clinic for the condition she passed away from, from the same hospital trust she passed away in. Afraid I binned that and thought sod it - I didn’t think I needed to inform the hospital she passed away in that she wouldn’t be attending future appointments(though had informed the dentist and others). Why can’t that be automated?

@54321nought

I have had experience of being given a hospital appointment that I cannot attend, and having absolutely no way at all of contacting the hospital to tell them that, the phone lines are open for such a short time, and I can't get an answer, in spite of spending my whole lunch time on hold repeatedly.

I have also had to leave an appointment which was running 6 hours late, because of having to collect young children, and having no possible way of communicating that to hospital staff, in this case because the queue to talk to the receptionist was longer than I was capable of standing up for.

I have also been reprimanded for missing an appointment in the past, when I was contacted during the day, and told to come straight to the surgery, and even though I informed the receptionist that I was several hours away and would come as fast as I could, by the time I arrived I was not seen as I was "too late"

so I don't think it is always the patients fault that appointments are missed

I hav

Agreed, what are your systems like from the patient point of view? What are the numbers like exactly and have you spoken to the patients that cancelled last minute? Sometimes the letters get sent out very late, and the posters experience above is not unusual. Don't forget that many people can't wait on hold for a long time, especially if they work. Do you have alternate routes of communication? An appointment well in advance and a couple of reminders in the patients preferred communication method will bring expectations higher.

It might not help with the people that are being genuine dicks, but sometimes managing patient expectations with clear roads of communication or even a phone call / text the day before may improve rates. Your hospital systems should be able to automate this too.

Are you able to network with a manager from mental health services or addictions services - I worked in this area and the patients had very low rates of appointment attendance and they had many tricks up their sleeve to improve attendance and punctuality.

@Lovelydovey
I knew ours couldnt be the only dept where it was impossible to cancel or rearrange an appointment. Now that I've had the issue of being down as a DNA when I followed their procedure to (attempt to) cancel or rearrange an appointment I'm sceptical about how it's always patients "just not turning up" that causes a backlog.

I have no criticisms of the actual medical service provided by the NHS - both my parents had extensive medical issues and were treated with the utmost care - but the communication system and workings of it are virtually broken.

@PashaandMe

Ah I love the “I didn’t get my appt letter” patients. They ALWAYS get the “we’re discharging you because you didn’t turn up” letter though

But sending a letter is so bloody old fashioned, and it can easily be true.

Our post service where I live is rubbish, we get post maybe 3 days out of 5, post goes elsewhere etc. Sometimes you get a letter with a date next week which is impossible to do because your diary is full and you can't move stuff.

The whole approach of 'we'll send you a letter with a date and time and expect you to make it' it part of why people get frustrated with the NHS, because funnily enough people have other commitments. Every other organisation that has appointments gives the patient some choice to book a slot which works for them too (including private healthcare so it can't be impossible)

From another perspective DS2 had prolonged hospital treatment over several years, mostly outpatient. Virtually every time we got a letter cancelling an appointment and giving a later one. Often appointments were postponed a couple of times. Twice we got discharged because we hadn't attended appointments that the hospital had cancelled. Lucky we kept the letters. DNA isn't always down to the patient.

A system not fit for purpose with entitled workers who really don't realise how messed up the system is.

I get you I worked a procedural clinic on Monday and 50per cent of the patients didn’t turn up. Certain medications have to be ordered to use for this clinic and it’s a waste of money and resources. It’s not uncommon for this to happen.

I've reached the top of the list and had 2 separate operations during lockdown so I can't identify with the stories in the press about huge delays. I can't imagine how awful it must be for anyone that has had their surgery delayed, especially life saving surgery.

Time and time again, reports are produced and promises are made to make the NHS more patient centered. It is a constant struggle. DH sits in meeting after meeting, where the prime discussion are how to make changes to suit the provider. No, no, no. The system should be there to suit the patient. Patient held records, patient directed appointments, patient choice, patient focused. Power needs to be removed from the provider and put in the hands of the patient. Not unsurprisingly, that is not very popular within the NHS. Here endeth my rant!

If the NHS sent a text message the day before an appointment reminding people of the day time and location (like my GP does), they’d get less DNAs. On multiple occasions I’ve got appointments by letter for a date that has already past, if I’d got a text I could have gone. Dating a letter 6 days before an appointment and expecting it to work through the hospital and postal system (2nd class) in time is unrealistic.

How much money could the NHS save if they used an email system rather than paying to send everything by post. Less DNAs, overall less money spent on communication costs (postage must cost them a fortune) and more patient good will.

CarrotTops if you've got a 2% DNA rate that is amazing as that's what we run at, but people make their own appointments, have an instant confirmation and get a reminder. We also know which patients live/work nearby and may be able to attend if we get a cancellation. It's not perfect but we're not dealing with such huge numbers.

I think that with modern technology and being aware that people don't always have flexible diaries people should be able to have to some choice around appointments. Most people don't want to waste hospital resources, there will always be those who don't care about this or are disorganised and fail appointments and ideally there should be some penalty for this but in my own experiences; letters arrive late, clinics are rearanged multiple times (4 times for ds's last consult), referrals go missing, patients can't get through, appointments are flagged as DNAs when the patient cancelled. This all adds up to a tremendous cost to the NHS and hits the waiting lists but does anyone ever regularly follow up with the missed appointments and audit why they FTA?

All surgery patients are called by a booking clerk. They are offered a date and either accept or decline. Their covid swab appointment is booked on the same call. They are reminded that they need to self isolate for 3 days. A letter with all of this information then goes out. Our booking clerk goes through the surgery diary every Monday and call all of the patients for that week to remind them.

@PashaandMe

Ah I love the “I didn’t get my appt letter” patients. They ALWAYS get the “we’re discharging you because you didn’t turn up” letter though

Actually @PashaandMe it happens a lot. I used to work in Endoscopy (nurse), a significant proportion of our DNAs were down to poor communication, letters going out way too late, wrong dates or times on letters, wrong instructions on letters etc… Totally unfair on patients, totally inefficient for the service, totally frustrating for the staff, and frankly embarrassing too.

It’s totally unrealistic to expect individualised bespoke appointment slots which can be cancelled and changed at short notice with the volume of patients who come through the systems.

Also the computer systems are antiquated and don’t allow patients to choose their own.

We do send text reminders a couple of days before, but this can cause problems too because it offers the option of cancellation of the appointment, which then needs manually rebooking.

There is limited admin time to do this and it’s an enormous job. This leaves little time to fill the cancelled slots at short notice. Some people make multiple cancellations for various reasons and this can stretch on for months!

Alternative view. I have cubital tunnel syndrome both sides. Had pins n needles elbow to hands. Limited hand function. Made worse by driving and typing. My job precovid was all driving and typing. Now WFH but typing requirements same. Precovid I needed bilateral surgery. In lockdown I have been exercising inc weights. I don't need surgery anymore. I'm ok. How many referrals in could we avoid if we treated people in a different way?

@MiddleParking

I actually think NHS should be tougher, as many say your given your appointment weeks to months in advance. Noone has a diary booked up that far in advance unless its a family do or event.

Quite a lot of people have their diaries booked up that far in advance for things far more important than ‘a family do or event’ that’s quite the lack of imagination!

Not really, either your health is your priority of it isn't. I wouldn't consider surgery as something to just put off either.

Its one of those things where it just takes precedence.