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.

Oh, and they do it all in Welsh as well as English!

You beat me too it!

That’s a waste of resources, IMO.

As the OP, may I re-intervene to suggest that the system is flawed, and that we should ALL ask for a standardised version? Across the entire NHS. And that repeat DNAs should be de-prioritised for treatment. Hear all the MH excuses, and understand most are problematic, but it's a cheap get out clause for too many people too. I would propose that missed appointments are charged for too, but I don't think my tin foil hat could be sufficiently reinforced.

I called to chase a referral made for Ds in September, I’d been calling weekly because it’s really affecting his quality of life and our rural post has been hit and miss. Today I was told they’d tried many times to get in contact and since I hadn’t replied they’d cancelled and a new referral would be needed. I cried. They couldn’t tell me if it was a letter or a call but last week they were telling me they still didn’t have an appointment time. I’m on my phone all day for work and check every voice mail.
similarly dd and I sat for 2 hours at the covid booster because they couldn’t work out which dose she need after turning 12. She cannot have been the only child in the country who turned 12 last year. 3 vaccinators, 2 nurses and 2 doctors wasted their time trying to work out what to do.

If 2/3rds don't show, that's way about average even for the NHS and needs investigating. Where's the communication going wrong? Are these people in hospital for something else, dead, got covid and can't attend? Do they have cognitive, memory problems, dementia? Are they reliant on public transport or hospital transport and can they get there? I agree there's a crappy minority of people who don't show, but I don't believe 2/3rds don't show for a heart procedure as they just can't be arsed, if that's the stats for that surgical team at that hospital, then they need to spend a lot more time reading about how others manage DNAs to minimise them. It is typical in the NHS that people keep going with inefficient systems for years when it would be better stopping for a week, assessing what's going on, and then implementing a better system, there's even been research on this.

As for letting people know, a lot of people with cognitive decline, who are elderly or hard of hearing or struggle mentally do much better if they can pop into GPs surgeries and talk to a real person. Having to negotiate complex phone systems or online passwords becomes a nightmare for them, this happened to one of my relatives and in the end I had to take over all care as they could not advocate for themselves to get proper care, appointments, prescriptions, because they couldn't understand what was being said on the telephone. This tendency to think more email, more texts is better does not apply to much of the population, indeed the end of the population that is the sickest. The current triage systems benefit the sharp-elbowed middle aged pushy people like me who insist on getting what they need from the system, a lot of older/less pushy/cognitively impaired/hard of hearing people can't do that.

@Grimreapers with that username, anything specific you’d like to share? 👀

This project, to standardise systems across the NHS cost billions and had to be abandoned.

I'm afraid that's part of the problem with the wide windows of time that patients are given, e.g. 'between 8am and 1pm' or 'between 12 noon and 6pm'.

And I've had calls come on the wrong day, and not at all. You become cynical.

Also a lot of parents are dealing with their DC's challenging behaviour and difficult home circumstances, and their lack of enthusiasm around and engagement with the phone call should not necessarily be mistaken for 'flippancy'. Lots of people come across quite oddly on the phone anyway with strangers. I have a relative who would sound 'flippant' but she would have been wound up real tight and churning out word salad.

Hear hear!

OP, what do you mean by "standardised for all" please?

This is an excellent post

If that many people are not showing there is a flaw in the system. That’s massively above normal no show levels.

My DD has “missed” 5 important appointments in the last six months.

2 she was in hospital already and I was assured that they’d let the relevant department know. Dept said they were never told.

1 letter arrived three days after the appointment.

1 letter simply never arrived.

1 she had Covid - we tested her the day before as requested (due to the type of ward she was going to). She tested positive. I rang the number on the letter 146 times that day and the next morning and never once got through. I tried the hospital switchboard, even asked the Secretary of her main specialist for advice. We finally managed to speak to someone the afternoon of when she was due in, sadly after a slot had been wasted.

Every other appointment she’s had in that hospital (which is many) has gone smoothly. Those 5 were all the same department…

Doesn't surprise me at all.
Happens all the time in our service.
People phone up that morning to book and DNA their appt that afternoon.
We've had 1 patient DNA 10 appts in the past 4 months, another who has made 12 online appts in the past 3 months and DNAd them all.
We're not allowed to refuse further appts, but it's frustrating when clinics are fully booked and you're trying to fit in an emergency to be seen.

Absolutely agree with charging for missed appointments, a £40 fee would put most people off failing to attend. Vets, and dentists do this and my hairdresser demands a £20 deposit for every appointment.

When I started my last hospital job there were 3 consultants in the department and 3 secretaries. When I left there were 5 consultants and one secretary. Management were busy trying to get the consultants to give up their offices and start hot desking. It was getting more and more chaotic. Appointments are now largely outsourced to a separate appointment system that can be very hit and miss.
I am a full time patient now, attending a couple of different hospitals. On the one hand, the system of texts and reminders is pretty good, OTOH, the number of changes and cancellations is difficult to keep up with.
The only appointment I ever missed was one for which I had been told I would get a letter. Letter never came and my GP was informed I DNA. I explained and he just rolled his eyes and said it happened all the time.
That said, there are a lot of people who just take it for granted that they can just make another appointment. They are not paying at the point of care so they don't appreciate the cost.

I recently had a small procedure carried out by an NHS dermatologist , I didn’t receive an appointment letter but thankfully received a text msg from NHS 2 days before reminding me of my appointment. Had I not signed up to receive txt reminders I’d have been a DNA stat. I still don’t know if it was an NHS admin or Royal Mail error.

Goes to show it’s not always the patients fault if they miss a hospital appointment.

It would simply mean anyone with memory or cognitive problems would not get care.

By standardised, I mean an initial appointment letter to the address at which you registered with your GP, followed up by an SMS reminder if you have a mobile phone a week ahead if the procedure is routine and scheduled, or a personal call if it's an urgent situation. Or, perhaps, it's not really serious, will resolve and does not require a follow. I know I sound shrill here, but I have a huge anger at people not attending appointments, for their personal health, that the taxpayer is funding. And to be completely frank, I do not think that "mental health" issues should be an easy automatic get out clause.

Good Lord, we would have referred your child to safeguarding after 2 "was not brought" appointments. Which would have at least flagged up the issue with you not getting the appointments.
That dept wants a shake up for sure.
146 unanswered calls is outrageous.

Friend failed to take her DD to a hospital appointment. She forgot about it. Her husband had died two weeks before.

It wouldn't work. There'd have to be "exceptions" and the people with exceptions would be the vast majority of the no-showers. And what would you do with the people who just refused to pay? Deny them NHS service? There'd be uproar.

This has happened a few of times to us. Halfway to the 'specialist' or 'consultant' on a day we have both booked off. (Both needed as the one going to the appointment may not be able to drive back,) So we are 15-25 miles into the journey and the receptionist/assistant rings and says the consultant is unable to see us today due to 'unforeseen circumstances.'

Some consultants are a law unto themselves and really do think the world revolves around them. They think NOTHING of cancelling an appointment on the day if it inconveniences them, or something else comes up. Never mind the fact one (or two if the partner is going) people have taken holiday leave or lost money from having time off, to GO to the appointment! They get paid six figures no matter what, and are clueless and ignorant as to what bother they cause the 'nobodies' like us!

When DH went for an appointment in 2019 to a particular consultant, his appointment was 9.15am. We live 40 miles away, so had to leave at 8am because of the rush hour. 10.45am my DH got in. Only the second appointment in and it was an hour and a half late. Turned out later, that the consultant hadn't even come in til 10am. His first appointment got called in at 10.15am (after said consultant had had a coffee and a chat to his peers,) and came out at 10.30am.

DH didn't get called in for another 15 minutes after that! AN hour and a HALF after his appointment time. No apology or anything! DH came out at 11am, and the receptionist was phoning people due in that afternoon after 2.30om CANCELLING their appointments, due to unforeseen circumstances! The unforeseen circumstances were the Consultant was lacklustre, lazy, sloppy, and was nearly an hour late getting in!!! And THEN didn't see anyone for another fifteen minutes!!!

So whilst there ARE people who CBA to turn up, there IS another side to it all. Many of the specialists and consultants and hospital staff are at fault too sometimes.

So all the people without memory or cognitive problems should suffer? People who are absolutely desperate to see a specialist and have to wait years on waiting lists? We should just accept there are hundreds of no shows every week in every Trust, but it’s ok the no-showers have cognitive problems and don’t take any responsibility.

If patients do not have the mental capacity to be able to attend appointments then they should be assigned to a community MH team who can support them.

The variety of systems doesn’t help. I manage all my elderly mums appointments. Her GP and her hospital appointments are on different nhs systems with different logins. She dropped out of regular gp visits a couple of years ago because it was just too complicated for her to get an appointment, and her has health suffered permanently because of it. I realised what was happening and stepped in, and now it takes a lot of my mental energy to keep on top of it.

She attends a regular eye clinic for macular degeneration, and a couple of times she has been during too unwell on the day to attend, and there is just no way of getting through to them to let them know. I had to leave a voicemail at another hospital in the same network, I doubt the message got through in time. Another time I went to the clinic anyway on my own to let them know and apologise as I understand the DNA problem, and they could not have been less bothered. On the other hand the most recent appointment was last week and I managed to get her through the door only to find they’d cancelled the appointment 90 minutes beforehand while I was travelling to her and phoned the wrong number to let us know. So there are frustrations on both sides.

The clinical care itself is great, when you can get it (60 week waiting list for a neurology referral for a new urgent problem), but the interface between admin and patients can be poor. I suspect it’s so variable across the whole nhs due to differences in systems, processes, the way the doctors want their clinics to run and even the number and/or ability of the admin staff. I do wonder how much improvement in the efficiency of clinics and reduction in waiting lists could be achieved through investment in the administration - even something simple like enough time for someone to be able to ring all the patients on the next days list to speak to them in person would catch many of the issues raised by previous posters on this thread.

From my experience, that is the standardised procedure already...but I've lived in the same place for years. I know people who have experienced a lot of problems due to change of address and phone number.

the last text I had from my GP said "we don't seem to have a mobile number for you, can you ring us, we have a query about your repeat Rx". 🤔 The receptionist was so frazzled, when I called, she couldn't compute what was odd about it. I don't even have a landline either! But jokes aside, I am a regular with my GP so for my phone number to fall off their system was odd...but clearly it hadn't fallen off as they texted it.

aren't they logging in to about 14 different systems every day in hospitals?