To think that if you cancel on the day with the NHS, you should be put to the bottom of the list?

[SaltAirAndTheRust]

Unless you have a good reason of course!

I’ve just started and I’m in my first week, in this week we’ve had multiple cancel due to nerves or just not turning up. Seeing the amount of work that gets them to this point, it’s staggering! I just can’t get my head around it

Problem is letters may get sent but that doesn't mean they get delivered.

Then there's the make an appointment digitally cancel by letter and then phone up to change. Telephone appointment cancelled yet Dr still rings, sadly person not available as they've been told its cancelled.

The system assumes people can just drop everything and attend. We were once given 2 appointments 30 minutes apart at 2 different hospital sites 11 miles apart and when we tried to change one the person couldn't understand why.

The system where I live is one dna your get discharged, you're allowed one change or discharged.

Fining isn't the answer IMHO.

As a clinician within the NHS I do think there has to be give or take with patients.

Most of the time if someone cancels we can fill their surgical slot with emergency/urgent work. If someone fails to attend we can't. Id rather someone called and cancelled, and was honest about the reason. If someone is too nervous to go ahead with surgery then we can think of alternatives. If someone is too nervous and feels they have to turn up that just wastes more time, as again it gives no opportunity for that slot to be filled, we will have prepped equipment etc.

I am also aware that we cancel last minute on patients for sickness or because of emergency work, and we ask patients to be forgiving of these situations. Therefore we should be forgiving back

Let’s pick this apart.

If I was charged, it would be the price of a nice bottle of wine. I’m happy to pay that for flexibility. I have family, childcare, transport, resources. So I can easily miss but won’t have to. If I want to though, I can.

A single mum, ESL, no help, unreliable transport, no childcare, is more likely to miss AND the charge could be really difficult for her.

You’re just compounding privilege.

Money is a poor motivator for behaviour change AND it’s discriminatory. And good luck trying to get that money. It’ll cost more than you’ve charged to get it.

My Dad had tried and failed with one but they kept booking another - it triggered his claustrophobia - parents kept having to cancel them and it was difficult to do.

I know one of the mother's at DC primary was putting her foot down and asking why it was needed - as it was traumatic and quite long for her DD and it wasn't always clear why it was being done.

The other things NHS is really good at is doing test- blood/x-rays ect and no-one looking at results.

DN - did x-ray to rule out less common presentation - no-one looked at it wasted 18 months with method that had no chance to work - and needed much more complex operations due to delay - only happend as GP did a referal to another hopsital as timeline of treatment was twice as long as initally suggested and sister was worried - took two trips to GP severla months apart.

Dad's text results - field before GP ever saw them - and they were difficult about Mum and him getting access to them.

Friend treated for pnd for two years before locum asked about goiter - they'd done the blood work no-one had looked at results - she didn't have pnd and thus wasn't a surpsie she wasn't improving with the anti depressants.

DD recently had a paediatrics appointment. I had moved the appointment myself originally with the secretary. I had 5 letters reminding me of the appointment in the post. The letter was also sent electronically. It was also sent on the NHS app and then we got 2 texts reminding us!

DH sees multiple different consultants in different hospitals, he also sees the practice nurse for injections. What we need is one portal with all the appointments in one place to view. If he makes the injection appointment on the phone, he gets a text with the details, if he makes it in person, he doesn’t! These are the ones he forgets. Sometimes it’s just too much on top of work and also some appointments are originally sent out over a year ahead of time!

Claustrophobia and violently loud noise . And it's one of the reasons they give you a 'panic button' so the scan can be halted

If it’s very common for people to cancel due to nerves then it suggests the pre-appointment support isn’t effective. That might be for all kinds of reasons but I think it’s the job of the organisation to understand and act on that first, before thinking about delisting or charging people for missed appointments.

OP, I work for the NHS too. We can’t penalise people for cancelling.. nerves and fear can be associated with bigger issues.
we do need a way of supporting people into care in a way but we also need a way to ensure people attend and understand the impact of missed appointments. It’s always been this way you’ll find.

My Nephew works on A&E reception in a big City General type hospital.

He says the level of entitlement in the public beggars belief.

@MrsTerryPratchett - "... Money is a poor motivator for behaviour change AND it’s discriminatory. And good luck trying to get that money. It’ll cost more than you’ve charged to get it"

Former NHS manager and management accountant here.

You're right - billing patients for DNA would cost more than it would recover, would waste more resource than the original DNA, and how would you make people pay up.

It won't happen

I agree the amount of appointments that payients simply do not turn up is disgraceful- not even a phonecall! We should start charging for missed appointments

Even if it did come across rude Op was obviously retaliating to someone who is clearly out to try get a rise out of someone judging by their comments.
It was very obvious in the OP they had started a new job within the nhs and are in their first week

Quite - she was telling us

I was backing up what you said, sorry it it came across differently. I notice she's disappeared...

I’ve had three. They terrify me. I’m claustrophobic. The best I had was glasses that allowed me to look out the bottom.

I agree in principle, OP, but I don't know how you'd 'police' it in practice.

But I have no patience or sympathy with people who take the piss with the NHS. If there were some way that selfish, stupid people who waste time and resources could be made to take the consequences, I'd be all for that. Yes, I really would, before anyone says 'But what if they NEED to be seen first?'

There is so much structurally wrong with the NHS, there's no easy fix for all its problems, but allowing people to muck about and waste everyone's time is crazy when resources are limited.

(One eg - and not quite the same thing as you're on about...

On an exceedingly hot day 2 years ago (40 degrees - warnings not to travel unless absolutely necessary) we had an appointment at hosp to get my husband's biopsy results. We got bottles of water, wet towels etc for the car and set off, labouring up the hill from the car park in the heat. Got there 20 mins early but were told we couldn't be seen because the previous appointment people were late...and they ended up being an hour late. Why couldn't the consultant have seen us first (appointment only 10 mins)? No explanation given.

Oh, and when we finally got in, he said 'Oh, I'm so sorry - you've had a wasted journey - the results haven't come in yet!'. Why, on that day of all days, couldn't someone have contacted us to save us that nightmare journey and 1.5 hours wait? Aaaarrrghhh. It's not rocket science.

Although I have no complaints about clinical things, I nearly always experience admin issues like this one with the NHS.)

I had a hernia repair in 2022. Had never had any sort of operation before and was quite enxious about it. Also it wan't being done at my local general hospital but at another one 25 miles away with a "poor" reputation.

Had a pre-op assessment the week before and the clinician doing it was great and made all my worries fade away - no problems and no nerves on the big day

Is the Swedish health service a badly run shambles populated with uncaring and judgemental staff, though?

I don't think fining is the answer either whilst there is a lot of disorganisation and bad communication within the NHS. I think it would create badwill amongst people rather than the goodwill needed to support it all being a better system. I'm not knocking the NHS at all, it has been a miraculous organisation for me when I've needed and I'm very grateful. But it's in the communication between depts and hospitals and admin etc where for me it's really falls short sometimes. I do understand this is also not easy to change with such a massive system and I'm sceptical when people just say AI will solve it all or just one big IT system will solve it all. There are so many difficulties and also threats that have to be constantly guarded against these days if you create overly large centralised IT systems. But that being said, my experience has been that there is a lot of separate systems or regions or health boards or even depts that seem not to communicate across each other very well.

I would also worry that you would end up disproportionately penalising the most vulnerable who do not have the money or capacity to deal with such fines. Those who are frail and very elderly are often those that need the NHS the most but might also be on many meds that might make them forgetful or struggle to keep on top of things. Not everyone has super organised family to help them. Those with undiagnosed dementia. Those on very low incomes who might struggle if help or transport falls through. Those with addictions who might be extremely vulnerable and in need of help but whose lives might be out of control or chaotic. Those with very bad depression. Those, yes, with very bad anxiety. Terrible anxiety is a mental health condition and it can also be a symptom of other conditions and sometimes of treatments, all of which renders the person more vulnerable.

Letters do go astray or are very late arriving or even sometimes are so far in advance that someone struggling with memory as a condition or side effect may struggle. I've tried to change appointments before and not been able to get through on the numbers given. As you say you are new, I would say this is unreasonable. I can't help but think this thread might not be that genuine as I can't quite imagine someone starting in the NHS posting this after a very short time with so little grasp of the wide range of issues and situations.

It depends. I had a letter sent to me for a breast screening appointment whilst I was on holiday for the day I returned. I had to cancel as I had no chance to change work meetings to accommodate it. I’ve also received letters notifying me of an appointment the following day.

Every single appointment I had booked this year has been cancelled at the last minute by the NHS. Some of them several times. Nobody at the hospital cares in the least about my time, my pain, the fact that I can't get my medication.

Can we bill hospital staff if they cancel and we're not informed? I had an appointment cancelled. Previous week they called to remind me and I got a text 2 days before. Turned up and they cancelled it 2 days previously. There was a letter in the post which I got the following day

If they can call to check I'm still coming why can't they call or text to tell me it's cancelled?

No, because the appointment letter can go missing in the post.

Secondly, who are you to judge that nerves aren't a good reason? You're not the one having the treatment/operation are you?

And appointments sent just by post? A big problem for some people e.g. in my case I shared a letterbox with multiple neighbours.

No worries!

Your comment came across fine and I knew you were agreeing with my point 🙂

Still waiting to learn more about this e-referral platform that's all the rage...