To think that if the NHS sends you an appointment for a significant surgical procedure, you turn up>

[XingMing]

DH has waited two years for a (complicated) day surgery on his heart. He turned up for it at 7 am this morning and of the six scheduled booked patients, two arrived. There was a surgical team of ten arranged, who stood around waiting. If this is the normal, and the doctors, surgeons and nurses seemed to think it was, then complaints about underfunding the nhs funding needs should be kicked backed to the public. It's reasonable to expect the treatment paid for via taxation, but it is unreasonable to be so cavalier about non attendance. This was a procedure that cost the NHS £20k or more in salary costs... and two-thirds of the list were no shows. Can you tell that I am incensed for the people on waiting lists and the taxpayers funding the waste? For the record, the roads were all clear.

My DD has complex health issues, at one point she was being seen by 7 different specialisms at 4 different hospitals across 3 health boards. One time she had 3 appointments for the same day at 3 different hospitals. I picked the most urgent appointment to attend and cancelled the others in good time - still got letters to say she wasn’t brought.

One of the trusts send text reminders “you have an appointment at this time on this day” two days ahead of the appointment but no mention of which department. I spent the two days calling round but no one could find her on their system and, again, we got a wasn’t brought letter. Turns out the appointment was for a new specialist she hadn’t seen before and we hadn’t received a letter to tell us about the appointment.

When I phoned to rearrange I was told any department in the hospital could look to see what appointments had been booked for her and confirm her appointment but after speaking to 3 departments who transferred me from pillar to post, where no one could tell me, I gave up.

Until admin systems work efficiently the DNA issue isn’t going to resolve itself because there’s too much confusion and poor communication.

I missed a scan because the hospital didn't send me a letter, or it got lost, I had no idea until I was chasing it. Then I missed the next one because I had covid, but nobody answered the phone so I could only email and they pooched it up two days later. My dad missed some cancer treatment due to a bad fall and being in hospital.

I wouldn't be so quick to assume these are people not wanting to attend.

I didn't mean prepaying (that's an obvious no for the NHS so didn't think I had to say it!)

I meant they could be more proactive in emailing/ reminding people about their appointments, making them confirm, etc.

I would propose that missed appointments are charged for too, but I don't think my tin foil hat could be sufficiently reinforced.

you literally waded through dozens of reasons - down to either slow post or NHS admin inefficiency - that people DNA to come up with that gem, OP.

Firstly it would be better if the NHS were more efficient and that would mean robust, compatible systems and enough people to administrate them. And secondly it is not beyond possible that people are asked, at the time of booking an appointment, how they would like to be contacted.

Then for a DNA a follow up to find out exactly why, with no blame attached, would help to fine-tune the processes

One tip I would give is that if you are waiting for a fairly urgent appointment, find out who is the secretary of the relevant consultant who runs the clinic and then call them for cancellations. I never wait years for referrals, I just call the secretary and often they will have had cancellations on the day or for a couple of days time. I am prepared to go on short notice. Another trick is to find out who is the consultant who heads the clinic, go and see them privately for £200 and then they will place you back in the NHS system for further appointments or tests, it just starts the ball rolling quicker, I've done this twice.

That's what I mean about sharp-elbowed middle-class pushy people like me getting better treatment. In a very inefficient system with limited resources, some people do better than others. Quieter, nicer, uncomplaining people, or people who are limited by cognitive capacity, MH, hard of hearing, any reason, being older (which is millions of very needy people) come last in this system. It is not fair, but neither is getting much sicker or even dying whilst waiting two years to be seen.

I'm a nurse- yes. This is a bad day for sure, perhaps appointment letters were delayed (which elderly patients often rely solely on) and DNA rate is also higher around Xmas because people don't want to still be in recovery and would prefer to have it automatically rescheduled in the new year. And then don't give us notice because they feel they don't have a valid reason to cancel.

I will second this suggestion to find out the Consultant’s secretary, in my old job I would have a ‘reserve’ list for the inevitable cancellations and if someone was urgently waiting I would ring people on the clinic list to check they were still coming, just in case I could free up a slot for the waiter. It took time but it meant the precious clinic slots were utilised and I could fit it the patient who needed to be seen urgently. Also to note is that some Consultants will allow overbooking so we could fit urgent patients in that way.

I’m sorry, I didn’t mean to imply it was the admin staff’s fault in any way.

(From my own experience) it is unquestionably a management issue which starts at the very top and filters down to everything. Contracts being given to the wrong people, advice being ignored, change not being implemented, etc. it happens in many, many industries but unfortunately the NHS is so vitally important to us both individually as well as a society.

You can only work with what you’re given and as you say you’re understaffed and using the systems to the best of your ability.

I won’t even get started on this shift to everyone just using email and refusing to pick up their phone. The phone is a wonderful tool and it’s a shame people are finding themselves so unable to utilise it!

Pavlova31 · Yesterday 22:27
The local health authority has an online portal where you as a patient can access digitally both letters and test results. Always kept up to date,“

not helpful to elderly patients with no internet and little or no family support.

OP here. Thanks for all the comments overnight.

@Brefugee, of course there are lots of reasons why people might not attend. But this hospital, which I've got to know pretty well in the last 10 years, with familial experience of A&E, cardiology, orthopaedic trauma, oncology, radiotherapy and dermatology in the last 12 months, is actually very very good and quietly efficient. It serves a low-income city plus a big, low-income rural catchment including a large elderly population.

The administration is generally good. We had two letters, three text messages and a phone to confirm everything, plus a courier delivery of the medication needed in preparation. This clinic has been planned since mid-October, before the mail strike.

It was day case surgery and all patients were told to arrive by 7.30am.

It was cold, but dry and not foggy, the roads were clear and mostly gritted.

The condition being treated is irksome and causes anxiety but it's not life-threatening. It mainly affects people who have undergone and survived quite major heart issues, so while one, even two, could have died waiting the chances of two-thirds doing so are statistically unlikely. Not impossible, but unlikely.

Of course, there are always going to be people with mental health issues and disorganised home lives: I am not sure how the NHS solves all the social ills.

again - totally ignoring all the reasons people have given here on multiple occasions.
It seems you can't put yourself in other people's shoes?

@AliceS1994 your explanation was exactly what the senior nurse told DH. People don't want surgery this side of Christmas.

What about me

I had two letters last week from my local hospital. The first I opened was giving me an appointment with the consultant for October 2023. I have been waiting since January. The second letter was telling me that my same appointment in June had been cancelled. The problem being was that I never received the letter about the June appointment. I then spent ages on the phone checking up if I needed further tests before seeing the consultant and was told that it appears a lot of letters go missing or were never sent in the first place. I wohave been marked as a no show for an appointment I never knew about

I'm not ignoring valid reasons Brefugee. But there are strong opinions on both sides expressed here. Not quite sure why you need to be snarky.

Unfortunately I think the system just doesn't account for humans. It sends out letters without thinking hang on that's been rearranged with only a weeks notice that might he tricky.

DP and I both have had this from our GP surgery. They only have our mobile numbers, which have been triple-checked with the surgery.

We have both waited around all day for a phone appointment that never comes. Bang on 6pm (when the surgery shuts and their phone lines go on to recorded message) we've had texts to our mobile phones saying 'we tried to call you twice but you didn't answer so you have will have to ring Reception to make a new appointment'.

But we can see that no-one rang. It's annoying to think that this might wrongly be on our records as 'DNA'. As for fining us - good luck in the magistrates' courts with all the people who can't pay or won't pay inappropriate 'fines'. They can't be refused treatment by the NHS, so it would be a massive administrative shambles. And speaking personally, I'd get the Information Commissioner involved as well regarding inaccurate data being held against my name.

But fining will never happen. I'd bet good money on it, for all the reasons given above.

Yep totally normal unfortunately. Happened with my elderly parent, I was horrified

I’m sure there are some admin mistakes and genuine DNA but there are just so many without any real consequence.

I worked in a maxillofacial day surgery unit when young doing procedures under GA. Well FML the amount of people that just could not comprehend not eating or drinking anything at all. I used to have to do the first round of questioning, no I haven’t eaten anything, well I just had some shreddies sticks in my mind and then getting arsey becuse they couldn’t have surgery.
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I used to think it would be better to not go in to the long blurb but just write and say if you eat or drink anything you may die on the table, yes actually die and it will be your fault.

I too have used these tactics as it is the only way. My parents struggle but it is because they assume that the nhs works when it just doesn’t. They think well I have been told that I’m on the list so I must be in the list. Wrong!

you have to constantly chase your referral and appts. You cannot rely on the fact that info is passed correctly between departments.

@XingMing I usually find your posts interesting and thought provoking. This one especially so.

I voted YANBU but only by a whisker. While the care my family has received from the NHS has been excellent, the logistics have been a big problem. DH and I have both had our share of hospital appointments. I DNA’ed once because the date on my letter was weeks after the date they had me down for and there was no further communication. DH has sometimes missed DNAing

@XingMing It is a very high rate if DNA, way above the normal. So something has gone wrong. That could be issues with hospital transport, letters not being sent out, or no coordination so changed addresses, people already in hospital, or who have phoned to cancel as too ill not to attend, not recorded accurately.

The admin in the NHS has been slashed. The government keeps saying the NHS can save money by slashing "pen pushers". But doing that causes inefficiencies. You need admin workers to make things work properly.

I’m a sonographer and pretty much all my appointments turn up x Would love a DNA occasionally as my list as overbooked!!

My DH waited absolutely ages for an important appointment as he refused to do this, even though I kept telling him to. He is now getting excellent multi-disciplinary treatment for this. But it is frustrating it took so long.

Yes I do a regular pacing clinic and the DNA rate differs from week to week but can be high.

Having said that the system for letters, admin etc is diabolical so often it's not patients fault. Really wish they would sort it out or start using text messages to remind them the day before.

The NHS IT/admin systems are beyond a joke really and totally lead to this sort of thing happening more than it should.