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

Appointments for surgery do not generally come with a day's notice - they come weeks if not months in advance, which gives you plenty of time to organise your work commitments

Not months here. Three weeks notice for a surgery date for DH, which has since been changed twice - hopefully happening next week if it doesn't change again. As I have to book time off work to care for our son (which DH would normally do), some notice is appreciated ...

*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.*

You really can’t think of any priority jobs or circumstances where people’s calendars are booked up that far in advance? Dear me. It’s a good job medical professionals don’t have their own health needs, isn’t it.

I feel so frustrated for you OP.

It's time the NHS/Gov introduces mandatory health insurance with exceptions for low earners, OAPs, and others. I'm not suggesting like in America, but like Germany, Australia, Switzerland et al.

I think if people were out of pocket, they'd definitely show up for their surgery!

If you answer the phone you'll get an appointment. If I go to voicemail I won't leave a message as I won't ever be available to deal with you if you phone back.

So once again, the NHS proves inaccessible for those of us with jobs where safeguarding stops us from having a mobile on us during the day, as well as a those other people who for other reasons can't answer their phone at work (which actually will include a load of NHS staff). Appreciate that's not this poster's fault, but shows yet another way the system is useless.

The NHS is broken. Patient expectation is at its highest. Capacity is at its lowest. I've been in the NHS since 1994 and am now in a senior position. I'm spent.

I have no admin staff at all. If you answer the phone you'll get an appointment. If I go to voicemail I won't leave a message as I won't ever be available to deal with you if you phone back. Yes the system is shot. It's a numbers game and I make it work for as many as I can

This is why I can spend 2-3 weeks at least in so much pain, taking as many painkillers as I can without overdosing. I teach so can't have my phone on. Department phone says they'll call within 48 hours. Often it's longer. But I can't stay off work, right by my online for 2-3 days. And I can't have my phone with me when I'm in class.

The system is awful for working people.

The NHS is broken. Patient expectation is at its highest. Capacity is at its lowest. I've been in the NHS since 1994 and am now in a senior position. I'm spent.

I agree the NHS is broken.
I'm not sure it's having (unreasonably it infers) high expectation to sometimes hope that you might get a preferred time frame for a phone call (I can think of numerous jobs where you would be unable to access your phone) or be able to call back , or the facility to cancel an apt without getting a bollocking the next time for not showing up

@MiddleParking

*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.*

You really can’t think of any priority jobs or circumstances where people’s calendars are booked up that far in advance? Dear me. It’s a good job medical professionals don’t have their own health needs, isn’t it.

No to be honest nothing in a diary is more important than your health so even if there was then its not as valuable as health.

Its rare you suddenly know you need surgery, usually months of appointments leasing up to it, so I wouldnt be booking a holiday or training until after anyway to mitigate risk of clashing.

End of the day if you don't have your health you could end up not being able to work or do things anyway or end up with long term problems because you put it off. Not to mention potentially suffering in pain more than necessary

@welshweasel

I had a new patient clinic today. 5 out of the 20 patients didn’t turn up. Yet we are constantly bombarded by expedite requests because people are waiting too long. It’s so frustrating.

Just a question, do you have a system to text the patients reminders of their appointments the evening before they're due to attend? I've certainly found that having both the GP and NHS clinics doing that helps attendance. But I do agree there are too many entitled people around just thinking that the NHS has to accommodate them. If you were really in such desperate need , you'd move mountains to keep appointments and set a bloody phone reminder!

@MrsPsmalls

Yup there is no slack in the system. I don't have time to deal politely with patients who can only come on a Thursday afternoon. I don't care if you have to cancel your holiday. Come or don't come. I can fill my slots 20x over. I'm a clinician who scrapes 20 mins every other week to book in patients for the next fortnight. I have no admin staff at all. If you answer the phone you'll get an appointment. If I go to voicemail I won't leave a message as I won't ever be available to deal with you if you phone back. Yes the system is shot. It's a numbers game and I make it work for as many as I can

Thank you for what you do

@Dreamstate No to be honest nothing in a diary is more important than your health so even if there was then its not as valuable as health.

How about when you get two important/urgent medical appointments on the same date but in different places?

That's happened to my OH many times (blood cancer). He needs MRI scans and full body x-rays a couple of times per year. He also needs monthly infusions (that take all morning), blood tests every two weeks (that Gp surgery now refuse to do so it has to be done in the oncology dept via appointment), haematologist consultant appointments every 3 months in person (and every month by phone), and needs a monthly appointment at the oncology unit to collect his chemo prescription.

Scheduling all that is an absolute nightmare and virtually a full time job. None of the different depts involved give a toss that you have other appointments with different depts. We regularly get the "random number generator" appointment letter through the post that are impossible to change, either because the telephone number is never answered or goes to voicemail which is never responded to, or because you get the jobsworth appointment clerk who simply refuses to even consider changing an appointment and glibly tells you to call the other dept to change their's instead! Of course, when the other dept appts clerk is also a jobsworth, you're stuck in limbo as you have two clashing appointments that neither dept will change!

This thread is just the usual NHS response of "patient blaming"!

"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"

Why are you even sending letters? It's archaic.

I've been diabetic since birth, nearly 50 years. Throughout childhood I was seen every 3 months by my consultant. Now I can only get an appointment once a year.

I take the day off work, travel up to London. Get there. Apparently my appointment has been changed to next month. I did not receive the letter.

I ask why can't I have letters emailed?
I ask why can't I have a text notification to confirm my appointment for the next day. apparently none of this is possible.

I get letters for appointments in in the middle of the day. I phone up, as soon as I get such a letter, and they tell me they haven't got another appointment for eight months.

Anyone who makes appointments must know that a woman in her 30s or 40s may possibly be working. why do you not offer and 8 am appointment 8 or a 4 pm but no 12:15?

Purple with red:

"I do think it's time the NHS examined this type of 'frustration' and learned from commercial organisations about how to manage their 'customers', time, appointments etc. It would save an awful lot of NHS time and money."

Clearly isn't working. Has no one stopped to question why?

It is absolutely insane that important appointments are still notified by letter. In 2021! And then NHS staff complain about non attendance.

It is a basic fact of dealing with the public that if you want to improve their behaviour, you have to improve your system.

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

The NHS "attitude" shines through here, doesn't it?

Simply no comprehension/acceptance that "some" appointment letters are sent out too late, i.e. the day before with a second class stamp, or, as we've experienced, franked the day of the appointment or afterwards. Or admin foul ups mean they've not been sent at all (i.e. stuck in a fouled up printer).

Unless the appts clerk has personally put the stamp on the letter, at least several days before hand, and personally put the letter in a post box, they've no way of knowing at all, that it's not their co-workers who've messed up, rather than automatically blaming the patient!

But as others have said, why are they using such an outdated mode of communication? Why not use email/text for patients who would prefer that, especially as it would almost certainly improve rates of appointment FTA.

(But I think we know why - email and text are easier for patients to respond to, and NHS don't want patients to respond, they just want patients to accept what scraps they are thrown at the convenience of the NHS).

If the NHS really wanted to be more flexible, they'd expand the online booking system so that patients could choose their own appointments, i.e. sooner if they are flexible or longer waits if they have specific time/date needs.

I got discharged from my cardiology appointment for non attendance. I received an appointment in the post, then a cancellation letter with another appointment. This has happened three times in a row. Then I received a letter telling me I’d missed my appointment and had been discharged for non attendance and wasting an appointment. I called up flabbergasted and asked why. I’d had an appointment abs missed it on x date of which I was not aware.

The next day I had a letter advising me of my newly scheduled appointment. The letter was dated the same day as the appointment . Called again was told there was noting they could do as a missed appointment was a missed appointment and I could no longer attend the hospital.

My GP were fantastic. I took all the letters in and asked what I was meant to do. They called the cardiologists secretary who confirmed I hadn’t even been booked in with them. They then got me booked in at a different hospital and I was seen in two weeks no issues. However I’m still black listed by the original hospital.

When the system fails the patient finding a human being willing to help us exceedingly hard.

No to be honest nothing in a diary is more important than your health so even if there was then its not as valuable as health.

My other childs health . Not for the first time I've had to reorganise for conflicting medical appointments.

I've had appointments marked DNA and patient discharged because "they couldn't get hold of me". This turned out to be because the referring nhs department failed to pass on my contact details and noone bothered to phone the referring department to get them.

I've had referral delayed by 6 months because a 2 floor clinic with no wheelchair access accepted a patient who would most likely to need a wheelchair after sedation. DS was then nearly discharged because I told the receptionist it was bloody stupid to reassure me they could definitely get DS out the building 45 mins after sedation when she hadnt even heard of my sons medical conditions. I've had an appointment cancelled on the morning of treatment because the medical screen 6-8 months before didnt notice that the only type of sedation available on site for potentially lethal to an individual with DS' medical condition.

I've had numerous consultant hours wasted because they have refused to do the tests which subsequently proved a medical problem.

I've had appointments cancelled that I've turned up for that they forgot to send the cancellation letter out for. I've had patient transport turn up for cancelled appointments (4-5 hour wasted round trip) despite me spending 45 mins on hold on the transport office to make sure they knew.

I haven't had a single referral reach its destination ever without my having to chase it. Sometimes without my manually dropping it off/scanning it to the relevant hospital in person then calling the secretary to check they physically had it in hand.

I've been calling a consultant secretary twice weekly leaving messages and they have failed to reply for three weeks.

Theres more. After 14 years dealing up close with the NHS. But I dont want to bore you.

There's a hell of a lot broken with our NHS and it ain't the patients. @pashaandMe

I get letters for appointments in in the middle of the day. I phone up, as soon as I get such a letter, and they tell me they haven't got another appointment for eight months.

Anyone who makes appointments must know that a woman in her 30s or 40s may possibly be working. why do you not offer and 8 am appointment 8 or a 4 pm but no 12:15?

The problem with this though is that everyone would want the 8am and 4pm appointments though, given a choice....giving a 12.15 apt means some people could and would be able to adjust working pattern or rearrange childcare etc but there should be facility to change apt for those that are unable to.

I got a we have discharged you letter because you didn’t attend would have been fucking helpful if I’d had the letter to attend…which I received 2 weeks after the fucking appointment!! I now have to be re referred….

So don’t you dare blame me for a shitty system!!

The NHS is overly large, overly bureaucratic and the processes are too complicated. If some of this could be fixed, then I suspect we might see improvements elsewhere.
DD has now been waiting 7 weeks for an "urgent" referral. I mean to be scheduled. My expectations are not so high as for her to have actually had the appointment. I have spent approximately 2 hours on the phone chasing it and spoken to about a dozen people in that time, all of whom tell me it's someone else's problem. Why is there not a simple "refer DD to right place; get appointment letter" type process. Instead there are about 4 admin hoops to jump through and if anyone misses out a step, no one proactively does anything about it, it's just left until someone like me gets the bit between their teeth and chases and chases until it gets done? Think of all the time that could be saved.

I feel sorry for children who do not have parents who have the time or the self confidence to constantly chase, follow up, argue, insist. They are probably languishing in the system for years.

On DD's flip side, I had to contact the hospital to point out they'd sent DD an appointment for 3 weeks after they'd discharged her. I suspect this would otherwise have gone down as a DNA.

The system is f**d.

Those saying if people prioritied their health people would always turn up. Yes there are some idiots but others will have to turn down dates due to childcare, work (because all well and good having
an operation but then starve to death because they didn't get paid)

Just this week I had a letter saying appointment 9.30 at my house. I phoned twice and had to leave messages due to the staff being a no show. I finally had a phone call at 10.50 to say apologies they had it in the diary for 10.30... well even if you did the HCP did not get to my house till 11.10...... how can the NHS expect patients to turn up when they aren't doing so themselves.

It is one thing saying surgery of x type can only be done on a Thursday and working with a patient to find a Thursday that works. But to say this or nothing is bonkers.

The NHS is beyond inefficient. It could learn a lot from private industries on how not to waste money.

I get booking clerks / receptionists may be bound by the rules but that doesn't make the rules right. Of course as a patient I am going to be upset and angry when I continually receive sub-standard care.

@MrsPsmalls you summed up many of the problems with the NHS

Patients are not numbers, they are not statistics and I am most defiantly not a textbook. Patients are people and need to be treated as so.

How is a nurse, a teacher, a police man, meant to answer your call if on shift? What about supermarket workers do they not deserve health care because they probably aren't allowed phones while working? I used to work in a call centre on minium wage and because of financial conduct rules I wasn't allowed my phone on me - I wouldn't have been able to answer my phone.

For appts that aren't urgent surgery there should be a system where you can choose from a calendar when you're at the top of the list. I've turned down 3 appointments for a gyn referal in a row now they come with less than 2 weeks notice, in the middle of the day. I need 2 weeks to book time off!

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

I think policies differ. My mum had to cancel one appointment because she had norovirus, and then had to cancel the second because she already had a medical appointment for something else and they discharged her and she had to get her GP to rerefer her.

And I also agree that you need to allow more flexibility with dates. There used to be a choose and book system which meant you could choose the available time and place that was most convenient. And you didn't receive a letter inviting you to an appointment that you had already missed.

I understand that people are a pain. But the NHS is inefficient too.