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?

@Tempusfudgeit

I attended hospital for my son's day operation recently. We arrived at 7.30am to an empty ward. The nurse said the other three children just hadn't turned up.

It worked for us because we got the undivided attention of the nurses, play specialist, anaesthetist, surgeon and theatre staff, but what a shocking misuse of resources!

But doesn’t that strike you as odd? For everyone else to not turn up for an operation strikes me as very strange indeed - one maybe, but all of them?

The rule of thumb within is the NHS is DNA X1 or CNA x2 means you are removed from the waiting list or added to the end of the queue again if you do get in touch. Although, in this case I would be more flexible as you actually gave good notice. Some departments are very strict with it.

@AngryWhompingWillow thank you for the most patronising comment I've ever received on Mumsnet.

Yes. I. Know. It. Is. Funded. By. Taxpayers.

Is that clear?

The Trust that I work for telephones each patient to book an initial appointment, at a time that is convenient for them. Then the admins post a confirmation letter, so that there is no confusion.
Follow up appointments are booked face to face with admin before they leave and a card is given to them with the date and time on.

Managers and admins regularly ring our contact numbers to check that patients can actually get through OK. There is also an answerphone that is followed up hourly.

We have a maximum wait time of 15 minutes.
There are signs in the waiting room telling patients to speak to a receptionist if they have waited longer than this.

For this to work, we have to set certain rules,
If a patient arrives late, we explain that we will have to do a shortened consult with them as otherwise we will be running late for the next patient. If they are more than 15 mins late for a half hour appointment we can't see them at all.
We also have to be really strict about not letting consults over run, so I imagine from a patients perspective it all runs professionally and efficiently but it could seem a little impersonal?
Sometimes patients are lonely and would like a bit more of a chat, so pre covid we had the WRVS meeters and greeters befriending them in the waiting room.

The service you got was awful OP. I would definitely ring PALS.

it's funded by tax payers.
who might not be able to pay much taxes due to waiting times for appointments that leave them unable to work.
or that clash with work committments.

@ShitPoetryClub no it isn't impersonal as that's how dentists, opticians and other healthcare practitioners who do a mixture of NHS and private work tend to run their services. They know if they piss of their patients, then their patients can go elsewhere.

@NotPersephone people like me? Does the tone on this thread need to be so aggressive?

I respectfully, completely disagree with you, having made a career out of public health, and having a significant understanding of the constructs and impact of health inequalities.

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

It's the same everywhere. Admin are always ignored even when we can see what's going wrong (I'm not NHS, just overlooked admin). The NHS need more admin to get on top of it and sort it out. And the ones dealing with it need to be listened to.

Dentists usually charge for missed appointments, because they don't get paid if you don't turn up. Most dentists are self employed "associates" paid per treatment rather than per hour.

That's very different from hospital clinicians who are either salaried or paid per shift, so their income isn't affected if a patient doesn't turn up, they get paid anyway.

Because dentists are paid per treatment, they're more motivated to be more efficient in both treatment and admin.

But this is exactly my point. To a large proportion of mnetters, the NHS is disposable. Not really necessary. Could go private if they really wanted. In that context I can appreciate the general annoyance when it is clunky and inefficient.
To those of us for whom private healthcare is not a viable option....well I'm just really grateful to be able to see a Dr of any specialism for free, as needed. Clunky appointments system, waiting times and all. And I feel I am here to protect it.

Why would you want to protect an inefficient, badly managed, wasteful system?

I am a single parent living in a HA property, work in a supermarket for just over NMW so I definitely cannot afford private health care but I still do not want to defend the NHS as it is.

I am glad we have the NHS but that does not mean I should be grateful for a bad system and never complain - just because I'm poor doesn't mean I should have to receive substandard service and just accept it because I should be grateful I am getting any service at all.

I'm not suggesting for a moment that the NHS wouldn't benefit from more streamlined processes. But I do believe that a free, NHS appointment to see a consultant or specialist nurse should be treated as a priority by the patient, and not repeatedly rescheduled unless absolutely necessary.

But you haven't addressed the issues of the actual system failures that mean people do not attend much wanted and waited for appointments. The NHS's main barrier is the NHS - it needs better management.

Things like letters not arriving before the appointment date; short notice cancellations/changes; not being informed of important changes to the appointment such as a different location; having to take a whole day off work for a 10 minute appointment because the clinic is running 3hrs behind; nobody answering the phone when you try to cancel an appointment that you absolutely necessarily need to cancel so that it can be used for another patient ...

Resources are finite, and that's all there is to it.

Resources are finite ... so why are the NHS wasting them and then blaming patients?

[quote NotPersephone]**@opalescent* what about all the countries with universal healthcare and a functioning appointments system? (Most of the rest of Europe basically). As long as people like you make excuses for the NHS as some benevolent gift from heaven, a reason to tolerate crap service and poor outcomes, nothing will improve. It’s such a reductive argument: people who don’t venerate the NHS and all it’s staff (even the lazy/useless ones) clearly don’t care about poor people’s access to healthcare. I actually do care, which is why I don’t think anybody* should have to tolerate the piss-poor NHS. What we have unintentionally created is the most extreme 2-tier system bar the USA, where the only “choice” is to go fully private and that is inaccessible to the vast majority.

@nancy75 my thoughts exactly - sounds like the (2nd class post) letters to those patients are languishing on someone’s desk.[/quote]
Excellent post!

@HeyDemonsItsYaGirl

It's 2021 and time for the NHS to set up an online system for appointment management, like most GP surgeries.

Hard yes!

@Kazzyhoward my friend used to have that job - she wasn't a secretary but admin. She got a list of patients and collected their paper notes, checked for letters, X-rays (they are all online now though), scan results etc.

Interesting thread. I find it such a headache.

@HmmmmmmInteresting

My child was supposed to have a hospital appointment today at 9am. The letter said it would we would get a letter before hand to tell us if it would be telephone or f2f. I'm not sure how the issue could be dealt with over the phone but that's another thread

No such letter arrived and we have had no phone call. I'm fully expecting a letter in the post in a few days telling us we didn't attend and will need to be re-referred. The letter didn't give any phone numbers so we can't even contact them.

I see it all the time at work. We get a letter saying a patient DNA'd and the patient tells us they never received an appointment in the first place. Why is everything done by snail mail in this day and age? That's assuming the letters are sent in the first place 🤔

No phone call materialised yesterday. Lovely service.

@AngryWhompingWillow The parallels between the NHS and housing associations are STARK. Tenants often get letters saying they didnt allow access to the gas safety engineer when it was the engineer who didnt turn up. And the similarities between attitudes to tenants and attitudes to NHS patients are becoming more noticeable.
The right talk about the deserving/non deserving poor and the left talk about the deserving/ non deserving NHS patient. Quite a disturbing parallel

Agree @MercyBooth !!!

You are certainly not being unreasonable. Your first was not DNA, even if they never read your email in time - you did what you reasonably could to inform them as timeously as you could. You'd happily have turned up I'm sure but they wouldn't have been happy to see you.
It's also perfectly reasonable for a randomly picked out a hat date and time not to be suitable and sometimes somethings just cannot be rescheduled/cancelled to accommodate. It is very unreasonable to threaten to take you off a list because the one single date/time they offered isn't suitable.

I've had mixed experience with bookings. One consultant my daughter sees every 4-6months sends us to the reception desk on the way out to book our next appointment - and the admin person checks the date/time is suitable, so that is good. Also his secretary is also secretary for another consultant we occasionally see (who just sends out appointments) and if she sees appointments within a few weeks of eachother she will reschedule one so they are both on the same morning so we just have one morning to write off. That's the good.

I do also know of people who have had appointment letters arrive on the day of the appointment - fortunately postman was early that day and it wasn't a very early appointment.
I've also received the snooty DNA letter, for my wife, as she didn't attend an appointment with one of her consultants. She was incidentally an inpatient at the same hospital, in the same department, being treated by a team that also had input from this consultant, who had seen her regularly during her stay. Additional the team caring for her were aware she had a appointment at this clinic but advised the consultant would come down to see her at some point that day instead and as she was effectively bed bound it wouldn't be sensible to take her along to the clinic - and no need for me to do anything.
Now I know the letter was automatically generated as she did not 'book in' to the clinic with reception, but I'd have hoped a bit more of a tie up with the admission system or even a simple bit of admin oversight before things get posted out (that letter has a cost element to it), but the accusatory tone of the letter and the threat to remove her from clinic list if she fails to attend again was I felt a bit heavy handed.

I do have to echo the sentiments of others here that have commented - that in the case of the clinic with a regular 50% no show, or the operation where 3 out of 4 didn't turn up, someone should be looking into the cause here - something is going very wrong somewhere with the bookings and it is certainly not likely that that percentage are just choosing not to show up.

All this is down to Blair's obsession with waiting list times for political purposes only. Not to mention the fragmentation of NHS services that also happened on his watch.

NHS depts use any excuse possible to get patients off their lists so that waiting times don't breach the thresholds. It's crazy that one NHS dept is happy to waste GP time by referring a patient back to them to be referred again, just to reset the clock on the waiting list times/deadlines.

I remember back in the noughties, both me and OH had parents with health problems so between us we went to A&E quite a lot. It became a standing joke that if you weren't out within the 4 hours, you'd be there all day. The point being that once they knew they couldn't get you out of A&E (either discharge or admit) within the 4 hours, they'd breached the target, so it no longer mattered whether you were there 5 hours or 10 hours - you'd gone down as a "fail" in the waiting times target, and that was it - no one cared anymore how long you were there.

The NHS became target driven rather than patient orientated, where each dept only cares about it's only metrics/budget etc rather than the good of the patient.

Like with my OH's cancer treatment. His oncologist happily prescribes thousands of pounds of drugs every month because she's been granted funding for it. We've tried to get her to stop prescribing the drugs he's not taking, but she says it's "too much paperwork" to change the prescription and "it's not out of my budget anyway". Then, occasionally, his blood tests show an anomaly. Last time it was low iron levels. Instead of her prescribing iron tablets, she referred him back to his GP to do it, as, "I don't have the budget for them, it has to come out of his GP''s budget".

They're absolutely obsessed with targets and budgets. If a patient gets good care, that's a bonus, but it's no longer the main purpose of the NHS. Blair has a lot to answer for!

loads of similar examples - my DF got a letter in the post one lunchtime telling him that his consultant appointment was in 45 minutes time, he jumped straight in the car and made it, explained to the nurse he'd only go the letter that day, for her to reply "oh, we were wondering why no-one was turning up!".

DD had five years of braces, so we got pretty good at booking follow up appointments which meant that she didn't miss the same lessons each time. Except when they rescheduled an appointment to be during an actual GCSE exam, she rang up to change it to a day she could actually make, they rescheduled it again, to - guess when- during another exam, then threatened her with being taken off the clinic list as she'd "cancelled" twice. And the same thing happened during A levels, although that was easier to manage as fewer exams. But what helped immensely is when the orthodontic department admin took over the appointment system rather than general outpatients, as they realised that a organising clinic of mainly teenagers was going to be a bit tricky during exam seasons, and were able to be flexible (as well as reminding said teenagers booking their next appointment "when are your exams, do you have your exam timetable with you so we can work around it?").

Target culture is endemic in the public sector. HMRC are just as bad. They, too, are happy to shoot themselves in the foot to avoid breaching arbitrary targets.

HMRC routinely make spurious reasons not to do things, especially if something complex lands on the desk/in screen of a customer service "advisor" who doesn't understand what's written in a relatively long/complex letter. Rather than take time to read it properly, they'll just "reject" it and send a letter back saying x, y or z bits of information or documents were missing. Thus, causing you to write to them again, where it lands on a different person's desk/screen and if they can't be bothered to read it and understand it, you get it rejected a second time with another spurious reason.

I get the last laugh though, especially on a current case. It's a case where an earlier year's return needs to be adjusted giving a bigger tax liability. HMRC have "rejected" the corrected return and covering letters 3 times now, always on spurious grounds asking for information they already have (contained in each letter sent to them). I'm not playing the game anymore. If they don't process it, the client doesn't get the bill for the extra tax owed. We've done all we can, we've told them, and given them all information. If their staff are too lazy (or are playing target hitting games), then they can do without the money owed!