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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

to rhink the reason why so many NHS appointments are not attended is......

134 replies

HookedOnHooking · 18/05/2015 14:00

People simply cannot get through to cancel or change them.

I have rung over and over and over again and cannot get through. Currently been on hold for 20 minutes.......

OP posts:
NorahDentressangle · 19/05/2015 07:57

I think if you are ill and worried you will turn up.

Many appts are follow ups or routine check ups or whatever and people don't remember as they aren't concerned.

Perhaps telling peeps to come back only if they are worried about something.

Mousefinkle · 19/05/2015 07:59

I received the letter for DD's two year review the day after the appointment. Likewise I never received my booking in appointment letter for the midwife. They use second class mail and quite often send the letter only a couple of days before the appointment.

So yes, not everyone missing appointments is doing it purposely. Personally I think they need to move to a text system like the dentist.

SirChenjin · 19/05/2015 08:03

Hospital appointments for ongoing check ups don't fall under the 'come back if you are worried' categories though. I don't know know if my son's heart condition is worsening - I certainly wouldn't want to wait until there were visible signs before I tried to make an appointment, so it's vitally important that we attend. There have still been 'communication fuck ups' - certainly not a case of cba.

It would be interesting to see the communication fuck up figures - I wonder if any NHS Board or Trust have ever collected them. I suspect not.

wonkylegs · 19/05/2015 08:09

I had a consultant who constantly changed clinics, cancelled appointments, forgot letters - I complained and changed consultants after a particularly bad run when I needed more support as I was pregnant but he cancelled time & time again. I have never had a problem with this new consultant.
I did ask for my record to be changed as I had a DNA for a specialist nurse apt that nobody had told me about until I got a snotty letter & phone call from my GP about it - I pointed out that if they checked my medical records they would see I'm not psychic!

wonkylegs · 19/05/2015 08:13

However DH has people who don't turn up (and don't cancel) because they are on holiday, forgot, don't want to see him because they are scared, couldn't get time off work but didn't know what to do, are ill - most don't seem to realise that if they cancel even at quite short notice somebody else can have that time as lots of people can and will turn up from the waiting list.

SomewhereIBelong · 19/05/2015 08:34

my MIL did not turn up to her chest scan results appointment because she was in hospital for chest problems - she told the nurse, AND the consultant she was under at the hospital WHO SHE WAS GOING TO SEE AT THE APPOINTMENT - yet STILL she got the snotty "you didn't turn up, do it again and we discharge you from the list" letter. (despite being told by everyone in the ward that it was sorted, had been postponed etc...)

MrsDeVere · 19/05/2015 08:40

This reply has been deleted

Message withdrawn at poster's request.

Moreisnnogedag · 19/05/2015 09:04

What do people expect the letter to say though? That's a pretty standard line, although I will alter it for elderly frail patients or patients with complex and multiple problems to a 'I hope all is well but appt missed. As per hospital policy if second DNA will be removed from f/u'.

I have once eventually rung a bloody nursing home to speak to the manager after they'd DNA'd three appointments (I know they got the letter because my secretary rang to check). The poor man had dementia and a cast on his arm, he was difficult and they didn't want to send to hcas with him so just didn't rock up Angry

LurkingHusband · 19/05/2015 09:30

(Checks calendar)

Oh, look, it's the 21st century. Over 50% of the population own a smartphone which will have (whether they know it or not) access to an online calendar.

Step 1: All NHS records record a patients email address and mobile number.

Step 2: When an appointment is issued, the system sends an iCal [internet Callendar] message to the email address. Most online calendars automatically accept this, and will pop up a reminder some time before the appointment (maybe 24/48 hours before).

Step 3: Simultaneously with the iCal reminder, a text alert (old school SMS) is sent to the phone.

The only really hard part of the scheme is the fact that there are at least 20-30 completely incompatible systems in use throughout the NHS. However, having worked on similar systems before (safety critical ones) I'd cost the whole project in terms of a few million. That's LurkingHusband money, which is real. If you get the government to cost it, I'd be surprised if you had much change from a billion. They're never one to spend a pound if ten will do.

Yes, not everyone has smartphone etc etc. However, enough do to mean that the above system would really have a positive impact on appointment attendance. Meaning everyone benefits.

However, having had a bruising experience with public sector "experts" I doubt it will happen. Sad. It's too simple, cheap and effective. None of which helps a government IT project when there are so many complex, expensive and ineffective systems to spend money on.

ThumbWitchesAbroad · 19/05/2015 09:42

I remember the Wessex RHA computer system fuck up - whoa, that was an expensive balls up all right. Shock

JaWellNoFine · 19/05/2015 09:51

I don't understand why, in the this day, I cannot just get an email that says:

You have been allocated an appointment slot to see a Consultant. Please log in to xxxx and select suitable appointment time.

Supermarkets manage to do deliveries like this. It's not hard.

I am far less likely to miss an appointment if I have some control over when it is. But sending random dates to people regardless of their availability and then complaining that they didn't make it seems counter productive and like a waste of resources.

MrsDeVere · 19/05/2015 11:26

This reply has been deleted

Message withdrawn at poster's request.

LurkingHusband · 19/05/2015 11:44

MrsLH attended one of her appointments yesterday. There was a sign up saying last Month (April) there were 587 missed appointments (if you cancel, it's not recorded as a missed appointment).

This is at a rehab facility, which isn't very large. I dread to think what the nearby hospitals have as a total (although one single department in a local hospital had about 220 a month regularly).

I have no idea how much an appointment costs the NHS. I suspect £50 is too low a figure, but if we use that, then the 587 missed appointments translates to over £25,000.

A month

that's £300,000 a year. And that's a small facility. It clearly runs into millions ! And that's just our local area.

Want to save the NHS ? Start using it Sad.

Of course, if I were Mr. Cameron, and I discovered that a certain %age of appointments aren't kept (I've never seen a figure less than 10%), then I'd know exactly where my axe would fall. Clearly we don't need 10% of the NHS.

Stormtreader · 19/05/2015 13:57

LurkingHusband, have you actually read any of the other comments at all? The people not being notified of their appointments until after they were due? People not being able to get through on the phone to cancel or move? My many many attempts to move an appointment which ended up still being a DNA?
Or did you just fancy a little smug moment of "well, I attended MINE"?

LurkingHusband · 19/05/2015 14:28

Stormtreader

Did you read my previous comment with a suggested simple system to help the vast majority of people with appointment reminders and notifications ?

And why, oh why, oh why, are we relying on a device invented in the 19th century as our primary means of communication in the 21st ? Not only that, but a device which requires a live human being at the other end to be of any use, and to cap it all, a device which puts the onus on the requester rather than the responder ?

moonbells · 19/05/2015 14:56

Can I just point out that while it seems logical to request emailed appointments, the current national legislation on patient confidentiality and data protection forbids it because emails are not considered secure?

Only emails from nhs.net accounts to other nhs.net accounts are deemed secure. ie staff to staff.

And GPs are not NHS staff per se. They don't have nhs.net emails.

We wish we could email appointments out too!

LurkingHusband · 19/05/2015 15:18

Can I just point out that while it seems logical to request emailed appointments, the current national legislation on patient confidentiality and data protection forbids it because emails are not considered secure?

Whereas popping a letter in the post is the gold standard of security ?

And one of our local hospitals uses a telephone system which relies on the recipient "hanging up" if they are not the person named, before the system goes on to read out the appointment details.

As a general rule, if you call "bullshit" when "data protection" is mentioned, you'd be right. It's not a reason for not doing something. It's an excuse.

Incidentally, how does "emails are not considered secure" square with Camerons massive "digital by default" spending programme for government services ? Especially when he's publicly calling for there to be no email security of any description ?

ClayCourtSeason · 19/05/2015 15:30

I absolutely agree OP. I take the missed appointment statistics with a very large pinch of salt. A few years ago I was referred for physio by my GP. A couple of weeks later, within a few days of each other I received seven different appointments between three different locations. It took me several days ringing several numbers and being kept on hold, to get it sorted, cancelling six but keeping the one that suited me best - or so I thought. I duly turned up for the one I thought I'd got and they had never heard of me. Then I received 'you didn't attend' letters for most of the others, all cc'd to my GP. So I then got shirty letters from the GP too who didn't appear to realise he had signed several. When I took it up with the practice manager she at least had the good grace to apologise and we both saw the funny side. But I never got physio on the NHS, I made a private appointment in the end.

Sidge · 19/05/2015 15:45

moonbells some (most) GPs do have nhs.net accounts, I work in a GP surgery and all clinicians have nhs.net accounts as do our colleagues in our locality. We can't use them to email patients regarding clinical care. we do have an online system which allows patients to make appointments and request medications etc once something like Patient Access has been set up, but you can't use PA for clinical stuff.

We also can't leave messages for patients on their voicemail or answerphones unless they have signed a waiver allowing us to do so, and often can't contact patients by phone as they don't always keep us informed of any changes in contact numbers, such as no longer having a landline or changing their mobile number.

Snail mail is the least preferred option for informing patients of changes to appointments etc but sometimes it's all we've got available.

The NHS definitely needs to revise it's digital communications policies. Our local hospital (for most departments) allows the patient to call to make the appointment as it suits them once referred.

RandomMess · 19/05/2015 15:49

It would probably be worth the staffing and phone bill for a real live person to phone 24 or 48 hours in advance to check with the patient if they are attending.

I know my osteopath said his DNA dropped dramatically once they started doing this.

Services like CPN - I think their high DNA is I part due to the issues that the people under their care have.

madreloco · 19/05/2015 16:09

Nope. Most appointments are missed because people don't value the time and expertise of the people they are meant to be seeing. They don't directly pay so they don't see the wastage.

Perhaps you would get through on the phone if there were more people to answer it, if so much money wasn't wasted in the NHS.

LurkingHusband · 19/05/2015 16:10

Here's a true story about why one set of appointments was missed.

Patient had an abnormal eye exam at the opticians. The conscientious optician wrote to the GP requesting a referral to the local eye department. Referral issued, and patient confirmed with GP.

After 6 months, with no appointment, patient checks with GP. GP confirms referral, and hospital confirm appointment issued, but not attended.

All very mysterious. GP re-requests. Hospital re-issues. Once again, patient enquires after a few months to be told appointment was not attended.

Curiouser and curiouser. Then, one day, out of the blue, the patient receives some forwarded post from the address they lived at 2 years before the opticians request. Patient manages to speak to hospital who admit having the wrong address (god knows where from - the GP had and forwarded the correct address).

Problem solved ?

Oh no, patient still missing some appointments - although patient now able to speak to booking desk after each appointment, so non-arrival of letters not a problem.

Patient does all they can to ensure everyone has the correct address. They all do, and swear there is no way post can be sent to previous address.

Post continues to be sent to previous address.

Finally, on a very busy day, the patient is asked to carry their notes between the orthoptics and ophthalmology departments. Patient opens said notes and discovers a sheet of pre-printed labels (with several missing) for the old address. Patient destroys sheet without telling anyone and order is restored. Patient recalls Fawlty Towers scene with diner and Spanish Omelette muttering "I've torn it up - you'll never see it again" to themselves.

You really couldn't make it up. And I haven't.

SirChenjin · 19/05/2015 17:39

mad - I would suggest that the NHS should look at its procedures and staffing quotas first if they want to address wastage (having worked for the thing for the last 25 years)

madreloco · 19/05/2015 19:51

there being other sources of wastage does not negate this one.

SirChenjin · 19/05/2015 20:18

I didn't say it did negate this one - what I said was there are other causes of waste in the NHS that should be addressed first. You could put 100 more people on the phone, but if you don't have the correct services, skill set, clinic times, procedures, processes and so on and on in place then it's not going to improve anything.