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.

Signing off for tonight. Please keep adding to the conversation.

Well, as I said it would use multiple threads of inquiry:

• data mining could be done to find # missed appointments and # cancellations with a few key strokes and that could cover all appointments NHS wide. Probably could go back 5yrs at least. This would give you an initial DNA rate. Your 66% rate is on a sample size of too tiny to mean anything, but I’m sure you know that already.
• then you could do Trust cases which would be all appointments in representative trusts get reasons for DNAs for past 30 days. Sample size would be at least 5,000 I would say.
• then you’d do a You.gov survey which would run itself and probably be a few thousand minimum, more if well advertised.
• you could add a question to the NHS patient satisfaction surveys that already go out, and then those survey managers would then feed the team the responses for that one question & demographics. This piggybacking would get you another 5,000 or so.

Not sure what you mean about qualifications….been Director level in civil service so very familiar with the FTEs needed to get this sort of task done. It’s not as unusual as you think. We’d often get the Ministers office sending such a question on the fly just for a debate in the Commons. Or do you not know how political footballs result in a constant snowfall of data requests? Running a government organisation is nothing like running a business (done both) as you have more top down demands for data due to the need for public transparency and to justify every penny spent.

So, yes 5 people for a few months could do a very thorough job of answering why DNAs happen. I suspect it’s not happening because the current government knows the answer would not be the narrative you have bought of lazy, entitled patients not bothering to show up… and that these DNAs being CBAs are actually isolated incidents.

Not quite the same as your DHs situation, but just to offer an interesting dimension - a friend of mine has some significant MH issues and is on a lot of mediation, as well as having some chronic health conditions which require monitoring etc.
Friend recently sustained an injury and phoned to cancel a health check. When they spoke to the relevant person, they were asked if they nweded to cancel their medication review.
The thing is, they knew nothing about the medication review. Someone in the MH team had made an appointment for them, but they hadn't been informed.*
The process is such that if you simply don't turn up, you are then 'blacklisted' and go to the back of the appointments queue.*

*This is how my friend described it to me, from their own experience

There's some accounting chicanery around the additional National Insurance that goes to the NHS. It always gets spent first, so savings are always against other lines in the accounts.
Underspends were more than the money on the side of the bus in the last published accounts - almost £400m per week.

@XingMing thanks for starting a great thread, that hasn’t gone down the usual route of it’s all the Tories fault.

I think there are so many valid points on this thread about the NHS. I think that it’s become so scared that it is very hard to have an honest conversation about it and there are, unfortunately, many many cases of wastage, mismanagement, DNA’s, an very elderly population with lots of co-morbidities, an obesity epidemic costing the NHS millions every year , etc. I do think Dr’s and nurses should be paid more for the job they do but I do wonder how much money could be saved and used to pay staff properly if the public didn’t take it for granted and if we started to look after ourself a bit better and take more responsibility.

My df tried to cancel an appointment recently because he'd just come out of hospital after a heart bypass operation and was unable to manage; would have tried to reschedule for a few weeks later but after waiting for 90 minutes on the phone, yes 90, he gave up. Maybe that's why some are DNAs - they've actually tried to cancel but been unable.

I disagree. Getting 10 or 12 plus people to turn up and hang around from the beginning of a clinic time, many with parters/relatives, means that 50 plus hours of peoples time is wasted to keep 3 hours of a doctor happy. That’s bonkers. Those 50 contribute more to GDP in that morning than the doctor, though they can’t work independent of each other of course. The doctor is there for the same amount of time whether people have 20 minute slots that they’re asked to arrive to, or all in a herd The clinic model is purely to cover up inefficiencies elsewhere. It shouldn’t be tolerated by patients, and wouldn’t be in any other developed country. It also in part I am sure explains the no shows. Regulars know that 9am doesn’t mean 9. It means somewhere between 9 and 12. And if the hospital doesn’t care enough to be precise, why should a patient be precise about when they turn up?

You’ll be surprised how many of then would have died / been admitted to A&E while they wait for their op & the consultants / nurses have no idea.

Here's another as this happened today (well, yesterday now)...

Physio appointment not at hospital, private clinic being used by the NHS (i dont know how that works, I am an NHS patient, not paying for private treatment)...

I had made it clear when the referral was made, that the referring doctor needed to spell out I am a wheelchair user. I need an accessible venue, and due to my size and my disabilities, my power chair is pretty large.

This was apparently understood, I was sat in front of the referring doctor IN said chair at the time.

I was assured the venue was indeed accessible.

I trundled along there today - guess what?

No. It wasn't accessible, nor would it have been accessible had I been in a tiny narrow manual chair, never mind a hulking power chair. The ramp offered was also not fit for purpose (too short and steep, not nearly strong enough for the weight of me + chair, I declined to try it), and in any case when someone got out a measuring tape, the door not wide enough to get through.

I sat, in the freezing cold on the street, during this humiliation.

Then I was told 'we'll have to record this as 'did not attend, tell your GP to refer you elsewhere'. I wouldn't bet that the reason why I could not attend was actually noted anywhere, just a DNA box ticked.

I actually don't give a fuck whose fault this was, it wasn't mine. But this is NOT a one off, not by a long shot.

I have had to wait in corridors rather than waiting rooms - waiting room not accessible (to any wheelchair user, not just one with my specialist needs) and been missed because I was called in the waiting room, and no one came out into the corridor as promised.

I have had to have CONSULTS in corridors or jammed in a doorway, rather than in the room in private... and been refused on a couple of occasions as the consultant wasn't comfy with that, but again, recorded as DNA.

I have been left without my chair (A&E then admitted to ward, you can't take a wheelchair in an emergency ambulance) and huffing and puffing when I ask someone to read my notes rather than bark 'surely you can manage it, it's not far', at me pointing out i CAN'T WALK and do not have my chair... I missed an appointment in the same hospital that way too, told a porter would fetch me. They didn't, and no one informed the department two floors down where I was and why I wasn't there.

I have missed countless appointments because they were not in ANY way accessible to me, because hospitals and other venues are NOT accessible.

So before we start sanctioning DNA's, a huge overhaul is necessary - and it won't happen, because beating patients with the 'well you lot waste our time' is far easier and a great way to suggest the NHS is a poor system and could be sold off and run better privately.

Oh, @WiddlinDiddlin this is beyond awful. I am so sorry for your experiences.

Can PALS help you?

@WiddlinDiddlin what a sorry state of affairs. You must be ground down by it all.

Whatever happened to the "choose and book" initiative that was supposed to solve the problem by letting patients choose their hospital, time of appointment, etc. I remember there being a lot of media appearances by the senior politicians of the time. I only managed it once - at a GP appointment about 15 years ago, the GP gave me some kind of code to enter on a website which would give me choices of location and appointment times. Seemed a good idea at the time and worked for me. But never seen sight nor sound of it since. I suppose it's another "initiative" which cost billions but quietly forgotten!

Whatever happened to the "choose and book" initiative that was supposed to solve the problem by letting patients choose their hospital, time of appointment, etc

I remember that, I used it for ds. Would have been about 15 years ago. Seemed to be quite efficient.

But there again, until covid I could book non-urgent GP appointments online up to six weeks in advance. Not anymore. I have to phone (or use their alternative to an e-consult system which is only "on" between 9-5) and have a telephone call first.

It seems that if something works for patients it is swiftly removed.

Interestingly someone said in a Times comment yesterday that the NHS still uses letters as a form of rationing, as the system could not keep up with email etc.

Did you read my earlier post? If you are dead, you can't answer your phone so it's not surprising that the DNAs are the ones that don't answer!

The simple way to avoid most of the DNAs is to not give appointments to those that don't confirm them a few days before. A system of confirmations would help enormously and would open up a lot of last minute appointments for others.

Not everyone can always answer their phone. Lots of people aren't allowed their mobiles when at work (such as teachers, shop workers, etc). Why didn't you send text messages to those who didn't answer their phone?

Perhaps, though, now you'll understand how annoying it is when a patient tries to phone the appts office to cancel/change an appointment, but the phone constantly rings out or goes to answerphone, where you leave a message but no one gets back to you!

It works both ways. NHS appt phone lines should be staffed 5 days per week, at least 9-5, rather than the sole responsibility of a random clerk who works part time a few random days each week, so it's like trying to hit a moving target to actually speak to them!

@lieselotte

Interestingly someone said in a Times comment yesterday that the NHS still uses letters as a form of rationing

Very similar to what a GP posted on a Mumsnet post a few years ago. She said that GP surgeries deliberately kept "routine" appointments set for six weeks hence to "put off" people - she admitted they put on extra clinics if the sixth week was full and would remove clinics if the sixth week wasn't filling up. She was very clear it was a deliberate tactic to try to weed out the time wasters who would find alternatives (such as pharmacy) or simply not bother. I really wish I'd book-marked the post as it confirmed what a lot of people suspected.

I don't think there's any doubt at all that the NHS "Could" do things better and more efficiently, but there's just not the will within the management of it to do so. It's easier for them to constantly whinge about under-resourcing and low pay as it serves their motives better than actually genuinely improving patient experiences.

@Badbadbunny Our family can always get seen in the same day by a GP. Maybe that is because we are never timewasters?

That is just so bloody offensive.

I'm not a timewaster, I'm very rarely even ill enough to bother a dr at all.

The last time I was off sick from work for more than two days was 2006. And even if we go with two days, the last time I was off for two days was 7 years ago.
Til last week.
I'm ill, I'm in pain, I need to see a bloody dr to get sorted, but noooooo. I have to use enconsult, wait two days for a phone call, get the drugs I need, find they are useless, use econsult, wait two days for a repeat phone call, get the drugs I need. Randomly get called to organise physio ( not required at all, never asked for and a scan would be more use) they organise a phone consult but no wait it's in person, neither of which happens.

I did finally after almost two weeks get invited in to see an actual GP and finally the pain has gone.

If there is a repeat of this I'm going straight to a and e, fuck this waiting in pain shite.

I think that's GP dependent tbh

OH is ECV with cancer and on chemotherapy.

He tested positive for covid last week. Phoned oncology dept to get the anti-viral treatment he'd been told was essential if he caught it. Oncology just told him to contact his GP who'd do the referral. That was a week ago. Still no referral done.

Initially "triaged" by receptionist who said they didn't do anti-virals for covid, so OH has to go through the whole story about being ECV, on chemotherapy, etc., told her he had a letter from NHS saying he was entitled to these anti-virals amd that the oncology dept had told him to contact GP for a referral to get them. Receptionist then said someone would get back to him.

Next day, nothing heard, so he rang again, same palaver with a different receptionist, told the same thing etc. Again, eventually relented and told someone would ring back.

Next day, nothing heard. Same rigmarole with receptionist. Same outcome, but this time a nurse practitioner phoned back to tell him he wasn't eligible - this despite him having a letter saying he was and his oncologist telling him to get them. Had to email the NHS letter to her. Next day she phone back, yes, indeed, he was eligible and she'd "put it on the list" for the GP to do the referral.

Each day, nothing heard, so he phoned, and get the same fobbing off. All the while, he's really suffering from covid symptoms and getting more and more worried.

Yesterday, he phoned again, and receptionist checked records and yes, the referral has now been made, 8 days later! But she couldn't say when the hospital would get back to us, and refused to give us a phone number for the relevant dept for us to chase it up ourselves. So now we're waiting, and have no way of contacting them to find out how he's going to get the anti viral drugs.

They're absolutely hopeless. No wonder there are long phone queues and delays etc when they simply don't do what they're asked to do and patients have to constantly chase them up. If they did their job first time of asking, they'd get fewer "chaser" phone calls!

That’s very offensive to those of us who’ve never wasted NhS time yet can’t get appointments.

given some of the stories on the thread is amazingly tone deaf.

Thank you everyone for the clear, thoughtful responses. Horrified by the routine casual cruelty of your treatments and therapists, @WiddlinDiddlin. Don't NHS architects consider powerchair users when calculating door dimensions? Obviously not.

Fascinated by your description of how civil service is expected to generate the statistics for political questions in the here and now, @Onnabugeisha , and accept your view that nobody wants to know the answers.

@RunLolaRun102, WRT this particular daycase clinic, it wasn't that patients have been waiting up to two years and died in the interim, because the appointments were booked only six weeks ago -- after a phone call from the clerks to establish that the surgery was still needed and appropriate. The procedure is to correct an atrial flutter, which is unsettling but not life-threatening. It's just something that is often needed to reset and reboot the mechanical heart valves for people who have already had MIs, bypasses and pacemakers. DH has the full house.

And, I am sure the weather kept some people at home. There's been a lot of black ice and driving conditions early in the morning have been atrocious.

Sorry to be absent all day... but I'll be around more from now on.

@XingMing I am confused by this quote and not sure if it was referring to mine earlier:

"@RunLolaRun102, WRT this particular daycase clinic, it wasn't that patients have been waiting up to two years and died in the interim, because the appointments were booked only six weeks ago"

My DH was waiting for an appointment in 2019. The consultant finally emailed him last week with details of a date and time for an appointment in 2023 - over two years after he had died!

And, there used to be an automated phone call system that would have caught the lack of letter - but that didn't happen this time.