About inflexible NHS appointments?

[RedLemonadeNTaytos]

I’m willing to be told AIBU if there are any NHS hospital staff that know better than me, but I am SO frustrated today with the attitude of the guy I just spoke to in the ultrasound department and need to get some perspective.

GP referred me for a scan due to heavy periods & bleeding between periods. I got an appointment within a month but the day before it I was ‘pinged’ by Track & Trace. I phoned the appointments line & the hospital switchboard repeatedly that day and the day of the appointment to tell them I couldn’t make it l, but never got any answer. I also sent an email to the generic appointments address. I think I tried the phone about 30 times, though! (Luckily I obeyed T&T, as I did actually have covid).

Anyway, called GP to explain and ask to be re-referred. Letter came through 3 weeks later with an appointment time but it’s on the first day of my new job. Not ideal, in fact a massive pain, as I am attending a large staff meeting as their new manager in the morning, then going on an expensive and non refundable bit of training in the afternoon.

Finally got through to hospital on the fourth day of trying the ever ringing line, hoping to rearrange l, and was told because I had ‘DNA’ one appointment, this was all they could offer me, they couldn’t give an alternative date, and I will need to go back to my GP to ask to be re-referred, but they may NOT offer me an appointment because I have ‘failed to attend’ two appointments.

I wasn’t expecting to be given any date or time I fancied, just an alternative to my first day in a new job. It just seems so bureaucratic and time wasting, and the reasons the guy on the phone gave were jumbled and didn’t make sense and he was really bloody rude!

Why is the system so inflexible?

I got a DNA telling off letter from my GP after I failed to attend an appointment at the eye infirmary. I rang the eye infirmary to explain I'd never received a letter, only for them to confirm that indeed, they could see they had never notified me of the appointment.

But why aren't NHS staff raising this kind of issue internally themselves?

we do! but nobody listens to a band 2 receptionist or appointment maker, or a band 3 medical secretary!

YANBU it’s shocking.

But at the same time the citizens of this country need to know what a complete and utter shit storm is happening in our hospitals right now. These issues are shouted form the roof tops but nobody could give a flying fuck. NHS staff are screaming that the system has broken but there’s no one to listen. There’s too many people and not enough resources.

What do you suggest is down to fix it?

Ds is disabled and requires lots of reasonable adjustments to access healthcare and we do as his carers. Some departments have always as far as they can always offered what is required. Others have been 'computer say no' from the start and we have had to make complaints to get beyond that. A lot of inflexibility is due to attitude rather than not possible

There really are no spare appointments and the chronic underfunding means that there are very few admin staff.

You don't get a delivery from John Lewis at a specific time, so tbh it's not realistic to get an appointment phone call within the hour of your predicted time. I'm not sure I would be happy paying extra taxes, just so people can have an appointment that facilitates the rest of their engagements. We'd probably have to run at 70% capacity for that.

digital.nhs.uk/services/e-referral-service/helping-patients-manage-their-referral-online

Please all also show this to your GP. We all now (most of us) are using the NHS App, this is the next step. It's there, get your GP's to use it.

You didn't DNA - that stands for "Did Not Attend" and means you left them wondering where you are on the day.

You rang them in advance and told them you couldn't make it, so it's not a DNA.

I had a similar thing with my second Covid vaccine and was surprised they wouldn't be more flexible with someone who was trying to get vaccinated.

The bureacracy is just awful in the NHS.

My trust text me an appointment invitation, has a code to log in to the website, then have the option of confirming, cancelling or asking for it to be rescheduled.
I didn't realise it wasn't common place, it works really well.

It's all part of this www.nhs.uk/nhs-services/online-services/nhs-log-in/

Yanbu - I don't understand why appointments are still done by letter when it is such an unreliable system and there is no way for the clinic to confirm whether someone is even aware of an appointment on an arbitrarily decided day/time, which leads to DNAs and no way to prove who is at fault (hospital/postal service/patient).

If the system was that you got a letter asking you to call and arrange an appointment, with a follow up trigger if someone hadn't got in contact within a certain time period (to account for people forgetting or not receiving the initial letter), then it would be much better. Because the onus is on the patient to make contact before any appointment is made, appointments are less likely to be wasted by people not having received the initial letter so DNAs because of that would nonlonger be an issue and are more likely to be attended when someone can have some say in their appointment day/time and can make it when they can attend.

I have been waiting for a surgical referral for 9 months. A month ago I received a phone call at 4pm on a Monday for an appointment at 9am Friday ... which would be fine if not for the fact that it is a specialist hospital 80 miles away, I work on Fridays, I don't have a car and I have a school aged DD. The fact it is so far away is something they would have been aware of from both my address (as it it an entirely different county that is not within that Trust) and as I am specifically on the system as a referral from a different Trust because there is no specialist provision for this issue within my local Trust.

The person who called was very put out when I asked if there was any way I could at the very least move the appointment to later that day and acted as though I was being ungrateful for not physically being able to drop everything to be at an appointment 80 miles away with less than 4 days notice. Eventually she begrudgingly changed my appointment time to 1pm on the Friday ... which turned into seeing the consultant at 2:40pm when I turned up on the day.

I got lucky in that my boss is flexible and was willing to let me have the day off at short notice because it is a medical appointment and she knows how long I have been waiting for this referral; my dad was home (he works offshore) and was both able to drive me to the appointment as well as have the time to hang around waiting all afternoon and my exDH was happy for DD to go to his house after school until I picked her up because otherwise I would not have made it to the appointment, all because the system is backwards.

"Why is the NHS so inflexible?"

Because we have hundreds of thousands of people on our waiting lists!

Because when people cancel we have no alternatives to offer them

Because hospitals are still operating under COVID rules, masks, 2m gaps, cleaning between every patient... etc etc

My advice is use email whenever you can.

Vote in a government that invests in the NHS

There really are no spare appointments
Sounds like there are actually lots of spare appointments that are being wasted because they can't notify people properly.

yanbu
when my dc was ill we went private for that reason.
we calculated that losing pay due to having to take unpaid leave and for hotel stays near the nhs specialist hospital would have cost us a lot more than private consultations and treatment.

@TankFlyBossW4lk that's not true.

Different hospitals are more or less organised than others.

The NHS is really a postcode lottery.

YANBU. Short-notice appointments sent out by mail can easily be missed. Appointments sent out centrally don't state that a 10.00 am ENT appointment means you should turn up at 9.30 am for a hearing tests, or that the Endocrine clinic appointment needs you to be proactive on blood tests. The ENT receptionist sitting next to the Audiology receptionist can't co-ordinate appointments for you. The NHS is very good at telling you how much a missed appointment costs them, but don't give a second thought to the cost of your time sitting in the reception area when the clinic for a routine check up is routinely running two hours late. It doesn't feel like an equal partnership.

@TankFlyBossW4lk

There really are no spare appointments and the chronic underfunding means that there are very few admin staff.

You don't get a delivery from John Lewis at a specific time, so tbh it's not realistic to get an appointment phone call within the hour of your predicted time. I'm not sure I would be happy paying extra taxes, just so people can have an appointment that facilitates the rest of their engagements. We'd probably have to run at 70% capacity for that.

There'd be spare appointments if the NHS admin staff organised appointments properly to avoid all the wasted ones.

@Hillarious

YANBU. Short-notice appointments sent out by mail can easily be missed. Appointments sent out centrally don't state that a 10.00 am ENT appointment means you should turn up at 9.30 am for a hearing tests, or that the Endocrine clinic appointment needs you to be proactive on blood tests. The ENT receptionist sitting next to the Audiology receptionist can't co-ordinate appointments for you. The NHS is very good at telling you how much a missed appointment costs them, but don't give a second thought to the cost of your time sitting in the reception area when the clinic for a routine check up is routinely running two hours late. It doesn't feel like an equal partnership.

Yep, no "joined up" thinking at all. My OH (Blood Cancer) has had literally dozens of pointless/useless appointments and has thousands of pounds worth of drugs he isn't going to use in the cupboard. It's an absolute disgrace, but the staff, from consultants down to appointment clerks, don't give a toss about the waste and efficiency - it's always "someone else's" fault and problem and no one ever takes responsibility. That's just the waste of NHS resources, not the mention my OH's wasted time, travel costs, lost wages, etc.

He had a consultation with a specialist a couple of hours away. Turned up "on time", at 9.30, but didn't get to see the consultant until 1.30 (it was one of those clinics where everyone was given the same 9.30 time!). The consultant had an empty file on his desk, no referral letter, no test results, etc. His first words were "what are you here for?" Then we were sat like lemons as he made numerous phone calls trying to find where the referral letter was, which no one could find, so he tried to phone OH's oncologist, but she wasn't contactable, so tried the oncologist secretary who didn't work Wednesdays, and so it went on. It was close to 2pm by this time, the consultant hadn't had his lunch and the waiting room was full of ALL the afternoon's appointments (who'd all been given 1.30!), so he took some scribbled notes based on what we told him, i.e. diagnosis, drug treatment (as best we could remember), and then just glibly said, we'll make another appointment and showed us out. That was one of the region's top cancer consultants. What a waste of everyone's time.

We got another appointment about a month later, which was slightly better as he'd got the referral letter faxed through, but we had the same stupid 2/3 hour wait with everyone else in the waiting room, and when we finally got in, he couldn't access the blood test results - apparently it was a different system that his trust used compared with our trust, so that was a wasted appointment too!

You'd really have thought that someone would be checking a few days in advance of consultations, that everything was in place ready for the consultation. Presumably he had a secretary? Wouldn't that be her job?

@TankFlyBossW4lk

There really are no spare appointments and the chronic underfunding means that there are very few admin staff.

You don't get a delivery from John Lewis at a specific time, so tbh it's not realistic to get an appointment phone call within the hour of your predicted time. I'm not sure I would be happy paying extra taxes, just so people can have an appointment that facilitates the rest of their engagements. We'd probably have to run at 70% capacity for that.

There would be plenty of spare appointments if the system was set up better. The reason there are no appointments is because they are "taken" by people who will either never show up (because they never receive the letter in the first place or have tried in vain to cancel the appointment that they cannot attend but nobody will answer the phone) or are wasted because adjustments necessary for the appointment to happen haven't been made. That is not the fault of the patients, it is the system/administration's fault.

As for the delivery analogy you are totally wrong. I have just had my groceries delivered. I booked a delivery appointment last week for between 15:00 and 16:00. Therefore I had every right to expect my shopping to arrive within that hour. At lunchtime I received a text update to say my delivery driver was on schedule and my shopping would arrive between 15:00 and 15:30. The driver arrived on my doorstep at 15:18.

If a supermarket can create an appointment system to get your weekly shop to you within less than an hour window then I don't understand why the NHS can't ensure that phone appointment times are honoured.

but there are all of 12 (!) parking bays available outside the hospital I'm at, which serves at least three London boroughs

I have been to the four London hospitals nearest my home, and it wouldn't cross my mind that driving to any of them and parking was generally a viable option. (I have driven and dropped off/picked up family members, which is different.)

There may be expensive NCP car parks near some of the hospitals, but I'd guess it would be cheaper to take an Uber both ways than to use those.

Complain to PALS and it will be changed. But the answer re the inflexibility is easy. We are so oversubscribed and so judged on our waiting lists that getting someone off the list by any means is encouraged. Plus if you were really prioritising your health you would make the appointment and miss the meeting. Its embarrassing to miss the meeting but not life threatening.

As far as I know, zone 1 and 2 London hospitals operate on the premise that exactly zero of there patients will be able to drive there and park while they are seen.

In case it's not clear, I think the people who expect to drive to zone 1 and 2 London hospitals have the wrong expectation. I don't think hospitals should be offering parking. NCP can do that, if they think there's enough demand.

YANBU. Short-notice appointments sent out by mail can easily be missed.

Yes!

We recently got a DNA for an EEG appointment for my DD that we didn’t know we had.

DD had been referred for an urgent EEG regarding some suspected absence seizures.

We received the appointment letter, but it was clearly dated 2 days after the appointment - the postage frank on the envelope was also dated 2 days after the appointment date, so wasn’t a typo on the letter.

Given I can’t travel back in time, there wasn’t anything I could do.

When I called, I got the rudest woman I have ever spoken to and was told DD had been removed from the list as we had wasted an appointment so would need to be re-referred.

I had been emailing the paediatrician’s secretary on and off, so I emailed her with a scan of the letter and she sorted it out for me.