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.

What sort of sanction would you envisage for my DNA when I was actually at a hospital at another hospital at the time. An important appointment (more important - it was a surgery review).

But their time is more important, really. Because they are the people who hopefully are going to find out what ails you, and even more hopefully, how to put it right.
Ive sat in hundreds of clinics etc in the past few years, and it is annoying when your appointment says ‘9.30’ and you realise that actually that means the morning clinic. It’s even more weird when you can’t work out why someone who comes in after you gets seen before you…..but I have also seen all the people who turn up at midday for the morning clinic, who don’t turn up at all ( well, haven’t seen them but been told, obviously) who have not bothered to follow the instructions about bringing medication, or taking their preparations, the people in the lung clinic who stink of smoke…..

So it is tedious, but my relative is still alive eight years later, which would not have been the case without all those visits. So the doctors’ time was more important, really.

Why is sanction your first thought?
All the many many reasons so many people have put here on your thread and your first idea is let's sanction them.

If we go down the sanction route then the NHS better get used to it too. All the sanctions when they fail to send letters in time, cancel at the last minute, book appointments for a day when who you need to see isnt even in. And on and on. I suspect that inside a month the sainted NHS will be bankrupt.

@AutumnCrow, investigations on the scale of national population that we are talking about here suggests a whole parallel NHS to investigate the problems. The NHS is already among the world's largest employers, behind the Chinese Army and Walmart, so replicating it would scupper the whole UK economy. So three (or five?) DNAs would suggest to me that the patient is not taking treatment seriously, and should be sanctioned and perhaps asked for a card deposit payment before further appointments were finalised. Refunded on attendance but forfeited if DNA... for children and everyone else too. My DMIL could not at 93 with dementia have gone to any hospital appointment without a carer's assistance, and locally we were able to book appointments to accommodate carer availability, even if we/DMIL had to pay extra time for the carer. Her GP wanted a chest X-ray, but I booked it to suit us both, so I chose the mini hospital not the big one. And then they were resurfacing the car park!

And, being fortunate, our postal services are functioning well, even with no-delivery strike days. It must be much more difficult if there's a huge backlog, but this is a rural low-income backwater and public sector jobs are considered well-paid here.

@Moonatics, sanction isn't and wasn't my first thought. I know comms and appointments can be shite but if you read the post directly above, or nearly so, you'll see that I suggest three or five DNAs before asking for an appointment fee, to be refunded on attending. But I would rigidly impose whatever sanction is considered reasonable across the population from newborn to ancient, regardless of excuses. Somehow, we have to impose an understanding that the NHS is not free to abuse.

I work in the community outpatients and the DNA rates are appalling. Despite us now contacting all the patients via telephone a day or so before hand they still don't turn up. (The ones who DNA are always the ones who don't answer their phone, rather than simply letting us know so we can offer the appointment to someone else who is needing to be seen). It's so frustrating.

If the patient had died, it will flag up on the patients records. At least in the trust I work for but I'm pretty sure it will be the case in most trusts.

Its still recorded as a DNA when you call on the day of….so that’s not a solution

Yes 👏
Funding has not kept up with population growth, ageing and inflation. That’s the real problem. Lack of funding means poor admin. Which means missed appointments.

Just on this thread there have been posts saying that this 'flagging' isn't happening, and the bereaved relative has been contacted about a 'DNA' of someone who died six months prior.

The way that data is held by the NHS is a patchwork of inefficiency, alas.

Such as? I’ve seen no such thing for my friends DM who has suffered several strokes and has memory issues due to them.

The NHS has 200,000 more staff than in 2010. That's in the article I linked yesterday @antelopevalley . Population growth, ageing and inflation are all factors making it tougher, but it isn't quite as simple as starving the NHS of funds. Some of it is the failure to use the resources properly. And, please, don't come back with the PPE corruption trope. We all understand that in a crisis (which it was) some money is wasted, because nobody knows what will work best or most efficiently. Haul Mone over the coals by due process as and when; recover any ill-gotten gains. Happy to see that happen.

Apologies, the post above should have been addressed to @Onnabugeisha , not @antelopevalley .

I think @Moonatics is correct some sort of investigation or public inquiry should first be done to find the reasons for the DNAs. Because your statement:
Somehow, we have to impose an understanding that the NHS is not free to abuse. Is a gross assumption that the cause of the DNAs is due to patient abuse. How do you even know this is the cause without some sort of study? And only, it wouldn’t require a ‘parallel NHS’ to do this. A five person investigation team working for a few months could do it.

It is that simple actually.
The failure to use resources “properly” is due to chronic underfunding leading to chronic under-staffing. You need sufficient staff in order to be efficient with resources.

This thread is a small survey, but even so the vast majority of DNAs recounted here are not due to patient abuse of the NHS because they “can’t be arsed” to attend appointments.

I’d suggest you have a look here to start btw:
nhsfunding.info

Across the population of 70 million people? Somehow I dont see five people digesting that and getting to a recommendation. Public inquiries run for years and end up costing millions. I am not even suggesting that patient abuse is a serious problem because most people in contact with the NHS are at least concerned if not ill.

Most low to mid income taxpayers do not pay enough in tax to cover what they take out of the "system" and I wouldn't expect them to. Society takes more from those who earn much more to subsidise them; it's over a lifetime, rather than year by year. I think that's fair and reasonable.

When I write "not free to abuse", I'd like you to understand that I mean nothing worse than trying a salt water gargle for a child's sore throat, and then visiting the pharmacist, before rushing to the GP for an antibiotic prescription for something that a healthy immune system will deal with in a few days. We are rushing into a situation where there will not be antibiotic remedies for major health issues because too many people over-medicate childhood ailments and cause microbial resistance to much more serious problems. And because industrial meat production uses too many antibiotics to rear cheap meat under unhealthy conditions.

I am not viewing this through a political lens.

In the trust that I lived in , it was nearly impossible to re schedule and appointment. Nobody answered the phones. I'm guessed my trust had a high number of dnas because people couldn't cancel. My appointment was for when I was on holidays and I tried for 2 days to cancel. So in the end I gave up.

If we were ever given trust-specific stats, it would be a lot more straightforward to see which trusts performed well and which didn't. And then, the public like you and I could ask that the underperformers followed the systems that got the best results. How is that controversial?

Well, you wouldn’t be asking all 70 million people. 🤨
So yes a 5 person team could do it in a few months if you wanted to be thorough. It would involve a bit of data mining. Then a patient survey of a decent sample size- you’d select various Trusts in representative regions for England, Scotland and Wales to cover urban and rural so you could get some granularity in the data. Could even do a You.gov survey to augment the results and get a feel for whether demographics and digital divide played a part.

When I write "not free to abuse", I'd like you to understand that I mean nothing worse than trying a salt water gargle for a child's sore throat, and then visiting the pharmacist, before rushing to the GP for an antibiotic prescription for something that a healthy immune system will deal with in a few days.

Thats a completely different context to your comments about patients who “can’t be arsed” to attend appointments and your comments on sanctions/fines after 3-5 DNAs for every patient from newborn to elderly. I’m not sure why you’re trying to say that your comments & agreement with others comments along this line was really about the over use of antibiotics (which doesn’t even happen anymore and hasn’t for a decade at least both in the NHS and in livestock farming). The Strep A crisis is a clear case of reluctance to prescribe antibiotics.

That is shocking OP! They should be ashamed of themselves. I was recently 10 mins into a appointment the staff very apologetically asked if I could please step outside for a moment so they can do the height and weight of another patient. No problem for me at all and they were very apologetic saying “sorry to be so unprofessional”. Anyway it transpired that the lady they needed the stats for was meant to have her appointment at 1pm but had just sauntered in at gone half 2! Then when I left she was outside insisting she just needed to pop to the loo quickly instead of fill out the paperwork she was meant to have brought with her already completed. I couldn’t believe it! It was just plain disrespectful of the NHS professionals’ time and resources. I don’t know if it’s a sense of entitlement or they just don’t care but I can’t get my head around people who behave this way!

@Onnabugeisha I would be happy to turn that dimension over to you to run and organise, because it's not something I know anything about. If you thought it could be done with a sample size of 5, or 500, once I understood your qualifications, I'd tell you to get on with the task. Come back with a solution, please.

And I don't think the two situations are poles apart as you suggest. Most of us, and I include myself, could probably live healthier. I could be 5kg thinner which wouldn't hurt. But I think we need to consider health and nutrition more wholistically, but still with an eye on what's realistic, affordable and accessible to most of the people, most of the time. Food production and consumption play directly into public health.

I have NOT on this thread ever suggested that people CBA'd to atteb=nd, although I think some can't. My OP asked why the no-show rate could be so high. 66% in the example I gave.

My son is often in hospital - more time in hospital than out of hospital. He has lots of missed appointments.
One if which they actually rang at 10am to check he was well. I said he was well and I was packing his bag. We have a SATs machine at home so all good. We missed his 3pm procedure because at 2pm we were blue lighted to hospital. This was the 4 time he had missed it. I genuinely wish things could be different.

Jonnypiratesfriend, your situation with a very ill child is absolutely NOT what is being talked about here. You clearly have more urgent things to worry about. Sending my best for your lad xx