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.

My dd has ds and so has lots of regular appointments, mostly for various health screening eg. hearing tests, sight tests, blood tests etc. Our previous system was the hcp gave you a slip to take to the reception stating when your next appointment is: 3 months etc. and they made you an appointment and printed out the letter there and then. Apparently, some people were forgetting their appointments, so they have changed it to we will send you an appointment nearer the date. This is crap. I get a letter a week (if I'm lucky) before, with no consultation about if we can make it, as we may have other appointments such as speech therapy, eye clinic I have another child to get to school etc. The hospital then gets shirty if I need to cancel.

I do think there's a big difference between cancelling (for a good reason) and just not turning up. I have had some admin staff being very rude when I've had to cancel, when for instance, dd had a chest infection and couldn't make a hearing test. Our hospital take you off that clinic if you cancel more than once, too.

The problem with switching to online booking is that it really disadvantages people (disproportionately the elderly) who feel unable to use the online system. My GP stopped letting you book on the day appointments online as it meant that it was impossible to get one by calling, which really angered those who saw calling as their only option.

The system for appointments at some of the large teaching hospitals is hilariously disorganised. We have twice been accused of not attending appointments, by letter, when no letter was sent and even their system showed this (as I phoned up to find out why we had been wrongly put down as non-attenders)! Other times we have been to the follow-up and had the discharge letter, then given another follow up which is unnecessary. Cancelling is then queried even though the original doctor definitely said only telephone follow up required. As for the letters arriving on the day for the appointment, this is common practice. Another one is being sent to the wrong department, we now turn up 30 min or more early so if we have to run 20 minutes down endless corridors to a different outpatients clinic we have time to do so.

The best systems are where they use your mobile/telephone to confirm so that if any of the above random letter/wrong location problems have occured, which is probably 1/3 of the time for us as we attend a lot, then it is picked up quickly.

The system for appointments is chaotic and even very diligent patients fall foul of it and then get put down as no shows.

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

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

These.

Agree it's all part of the cunning plan.

The Government keeps making cuts to hospital beds, cuts to spending in real terms, insisting upon impossbile "efficiency savings", browbeating frontline clinicians over targets etc etc, because they want to blame the staff when the wounded dinosaur finally keels over. No government wants to actually pull the plug & take responsibility.

Then it "will have to" be privatised.

I don't think patients realise the actual cost of their "free NHS" - the fact that each prescription (free to many) & appointment (free to all) is actually paid for by their GP surgery, whether they bother to use it or not.

It is unsustainable.

And of course the GP is charged for each blood test, X-ray etc.

Admin is an issue for sure. I missed DD's physio assesment because I got a letter telling me about it the day after! So I didn't know about it, I was told to wait for an appointment which I did. Now I have to wait for another referral.

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.

^
This... it's all to easy to blame the Tories. NHS funding has increased in real terms by about 10% since 2010.... in some ways healthcare is a victim of its own success. We can do so much more than we could 20-30 years ago to improve health, and because we 'can', the expectation is that we 'will'. I don't think people value things as much if we get them for free... one (partial) solution would be to make people pay for all non-essential treatments. For instance, I had ear wax removed the other week... I'd happily have paid for that.

I think appointment systems are part of the problem.
Ds had a routine appointment at one hospital department this week. After the appointment we booked the next one in 6 months time which meant we could book at a time that worked for us.
Another appointment arrived this week for a different hospital department, this appointment being on a school day. They got annoyed when we couldn't do it. School day appointments don't work because ds with severe sn doesn't co operate and is aggressive because of the routine change. We were told we would be sent another one in 6 - 8 weeks which we may well have to change again.

I work for a dentist who charges for missed appointments. People still dont turn up. And get irate at being charged

I hate the idea of charging for missed appointments. At one point in my life DH and I had £30 per week between us to live on after rent and bills. That had to cover travel, food, any clothes etc. I remember us once debating whether I should skip my antipsychotics for a week or he should skip his asthma inhalers as we couldn't afford both. We would have given up the doctors if we had to make a down payment to go.

These days we're much better off. £10 is an amount I leave as a tip in a restaurant. It wouldn't stop me missing an appointment at all (I don't miss appointments). It's a really subjective amount of money that penalises the most vulnerable.

Its not really meant to be punitive in our case, but to contribute to running costs, which are still incurred if people dont turn up.

There is a HUGE percentage of 'no shows'. Can't recall it off the top of my head but it is terrible.

The NHS is hugely wasteful; I've had friends and relatives get duplicate letters for appts , (I don't mean reminders) all done by snail mail etc which is a waste of paper, postage and people time.

They need to get in the 21stC with emails, texts and so on. Ok not all patients have access to these but many do.

Another bug bear of mine is that the national screening programme for breast, cervical cancer etc is not joined up. I have my check ups privately and the results are sent to my GP. So they are 'on the system'. I'm not actually being negligent! But the GP practice doesn't feed this to the national screening system so I get constant reminders and have to phone them to opt out. So someone's time and valuable resources are being wasted because no one is telling them I've had my mammogram and smear with Dr so and so, and don't need the NHS one.

This is the opposite of what you are talking about but it still shows alack of joined up thinking and a waste of money.

LouKout - sorry, I was more thinking about GPs, not dentist. Although, to be fair, I did once miss a dentist appointment, got charged, couldn't afford another appointment and wound up losing my tooth due to not being able to afford an appointment for six months.

But such is life. Being poor sucked. I wish that we could just accept higher tax as a country and support better socialised healthcare of all kinds.

Yes. I do see your point actually too :)

The idea that if you don't turn up, the Dr is waiting for you is laughable. Even the length you wait in an out patient clinic is variable. Some clinics run well and you might be seen within half an hour of your appointment time. At some op clinics I've often waited 2+ hours after my appointment time. The Drs and staff then have to deal with people who get upset or even aggressive, which is not fair on them. They seem to regularly overbook clinics because they expect some no shows, how else can it be explained?

I'm fully behind you OP but the reality is that some people who ought to pay can't or won't pay. So then you get into the situation where the admin to collect 'fines' would cost more than the actual fine.
I can imagine that people who don't pay prescription charges- that's 80% of all prescriptions- would be let off .

Maybe being sent to the back of the queue would be better than a financial penalty.

I got a letter last month rearranging an appointment for ds that we had "missed" ... turns out they had forgotton to send out the initial letter!

The children's hopsital he attend sends out text reminders a week before which is much better. If the local hospital had done that I would have tjought "hey what's going on?" Phoned them and then been able to attend

I have only ever missed 3 appointments in the NHS - all were due to the appointments having been re-arranged but the original dates not being cancelled by the admin staff.

Our local hospital has a telephone reminder system which triggers a phone call exactly 7 days before your appointment. It is one of those long and arduous "press 1 if you are XX" Press 2 if you can come to your apptmt. Press 1 to confirm that you pressed 2". I live in an area where the demographic is very elderly. I commented on the system to the clinic admin lady once because the system does not acknowledge that I am receiving calls as a carer for another individual and therefore had to lie to the 1st question in order to confirm the apptmt. She asked if I wanted to be removed from the system but I said it was fine now I knew how to work around it. SHe showed me the long list of people she had to delete from the reminder system as they couldn't cope with it!

The reason for 2 hour waits is because everyone is told to turn up at the same time- eg 2pm. This is based on the belief that X percentage won't run up at all.

It's highly inefficient but also shows no regard for the customers.

I am lucky enough to have private medical cover. If my dr is running 10 mins late they apologise profusely. If on the other hand I missed the appt with no contact I'd be billed I'm sure.

I have only ever missed 3 appointments in the NHS - all were due to the appointments having been re-arranged but the original dates not being cancelled by the admin staff

I have heard this time after time.
No accountability for staff, no sackings, no consequences. The public suffers.

I have 100% support for front line staff - drs, nurses, HCP, - but the admin staff are just hopeless most of the time.

Probably the exception but I can get a routine GP Appt within a few days and rarely have to wait more than 10 minutes past an Appt time. Surgery also texts an Appt reminder the day before and a week before (e.g. For advance booked immunisations). Have had issues with hospital letter system but specific departments and hospitals rather than pervasive.

The CCG system doesn't help, where to allocate resources is decided by the wrong people. Ultimately there are trusts making surpluses and deficits but it shouldn't be postcode dependent. What is funded and what isn't should be across the board.

I totally agree re admin staff. For pen and paper pushers, an NHS job has perks in terms of hours and benefits you just don't get in the private sector - not to mention sick pay - so it irritates me beyond belief at the incompetence of some of them.

NB. no complaints at my GP surgery again, they go above and beyond. Was talking about a wider scale.

I'm another one with real issues about hospital booking systems. As someone with a longstanding condition who attends outpatient clinics and goes for tests not infrequently I've been told on numerous occasions I've missed appointments that I've never been notified of.
For example, I was told I needed a scan and that I would get an appointment for after the scan to review the results with the doctor but to cancel the appointment and rearrange it if it came through before the scan date.

Appointment came through in the post before scan had come through so I phoned to cancel and said I couldn't yet rebook as I didn't know the date of the scan. They told me that was fine.

A month later I'd heard nothing so phoned again to be told I'd missed the scan... They'd sent it to my old address of 4 years ago, despite me having updated it and despite the outpatient appointments in the intervening 4 years going to the correct address. They then told me as I'd "not attended" the appointment with the doctor (that I had been told specifically to cancel if the scan hadn't happened) that I'd been taken off the clinic list and would have to be re referred to the specialists by my gp (despite having seen the specialists every 6 months for 10 years plus) and that it was a 9 months wait.

It took a very long argument involving multiple people to get me back on the list. I'm still waiting for this scan some 5 months on.

There are definitely issues with people not attending appointments but the "did not attend" lists are not accurate either! And hospitals in particular need to get their systems fit for purpose before striking patients off waiting lists through no fault of their own.

I love a DNA me. I am a sonographer. Our appointment times aren't really long enough and If I am at full capacity I am generally overstretched and get little or no thinking time and generally run behind. A DNA in he middle of a list brings a bit of relief /catch up time/ ensures I get a brew. Am sure most health professionals feel the same.
If it was the first appointment I would be a bit miffed mind!