Why does the NHS (or at least in my experience) create this kind of admin?

[laurellas]

Went for a gastro appointment with a consultant I had waited months for. Finally prescribed the medication I need. Consultant said they would write to my gp. Cue message from GP asking if I want the medication and to fill in a form to confirm I still want it (why wouldn't I want a medication that was confirmed by a consultant 3 days ago?). Before this I had to keep filling in forms to ask whether I still wanted to stay on the waiting list for the initial appointment. I missed one of them by accident and didn't confirm on time so they took me off the list so I had to call them and ask to be put back on, but I was put to the back of the queue again (my fault but annoying as it delayed my treatment significantly). My grandmother turned up to an appointment that had been cancelled because she did not confirm she wanted it, she's 84!! She doesn't check emails and she can't read her text messages properly.

I am guessing this is so people don't take up appointments they won't turn up to? Maybe it would work better asking people to cancel if no longer needed rather than auto cancelling if they don't confirm? Or maybe it's just something they do in our area and not others?

Am I just being a miserable sod? 😅

@GingerdeadMan the effort of getting a GP appointment, attending it to then get a referral to hospital & then as you say waiting for said hospital appointment, confirming it, chasing things up etc.

@Morosagree, one of my older relatives gets transport but often the appointment is too early for the transport or the transport is delayed/cancelled.

Imo it’s far more complex then people being too lazy to turn up.

I am aware she does not have carers, this is the jist of my point.

She isn't being excluded by anyone either. NHS are communicating with her in no different a way to they do with anyone who is capable of living independently and without aid/help.

From your description, it's clear that she's encountering some difficulty precisely because she's still determined to eschew help or care, so it's hardly then either the fault of the NHS for presuming she either is not in difficulty and to act accordingly, or presume she is being aided to continue to live independently, and they are not "excluding" her in any way because they are acting according to the facts in their possession, i.e. this is an elderly but otherwise wholly independent and capable individual.

The problem here is emphatically not on the NHS's end, and to be honest it's a little bit concerning how you are totally denying your MIL's struggles and reinforcing the palpably nonsensical notion that she is still fully independent. She's clearly not, or at least, not capable of being as wholly independent as both you and she evidently think, and the problems and issues arising from perpetuating this are entirely yours and your MIL's doing.

Massive dose of reality and honesty missing here.

@Cadeaukatze I agree. I recently had a dental check up. I was bombarded with text reminders about the appointment from 1 month in advance and then ramped up to daily a few days before. The text also contained a dodgy looking link to click on to complete medical forms before the appointment "to save time on the day". I didn't want to click on the link so thought I'd take my chances - along with all the old folk - and complete the forms on arrival. But not filling the forms in via the link just led to more chaser messages. I'm not even sure how secure their links are given that they're extracting personal medical history from patients! The constant bombarding of patients with reminders in this way only serves to p*ss them off, surely?
Ditto, my optician (private). Sends reminders messages, followed by a reminder message which says 'click YES to confirm attendance', which i did, only to then get a phone call the following day to check that i would be attending my appointment the day after!

@XDownwiththissortofthingX I think it is you who is missing the point. She is an elderly lady living independently who is registered blind. To assume she can read emails is nothing short of stupidity and anyone that stupid has no place working in the NHS!

A good deal of the admin created is caused by people not showing up- so it is unsurprising they ask you to confirm , as you yourself did not turn up- you can't really complain about inefficiency when you don't even turn up.

Because there are far fewer secretaries (with the threat of more cuts), we have managers who have no clue what our actual jobs involve and make us work like we’re in a typing pool, 1 person covering 3 jobs because of sickness. Shall I go on …

If we were allowed to work with our consultants and do our own work then the letters would be out the same week (or at the latest the next). I miss those days. Also add to this because the letters are so late the phone calls chasing them at least treble, more delays.

HRFT but digital exclusion is a real thing. And yes i understand about saving money and stuff by using technology, but not everyone has the technology, or the technological mindset, or even the headspace to use it. For example I'm ok with older tech but I mistyped a word on this post and for the life of me couldn't stop MN deleting it even though I just needed to move one letter.

Its not just an age thing, mental health can significantly affect your techno interactions.

What if you lose your phone/change your number blah blah?

Check with people first, are you ok if we send text to confirm the date is ok?
No contact? Send a letter to confirm as a minimum.

I think you need to redo your diversity training, fairness doesnt mean equal treatment, it means equal access.

It's really not. Anyone alive and managing their own NHS treatment in 96 had dealt with post their entire life.
There are a lot of people who still don't have smartphones/use email. I help family in this situation, but not everyone has that help. And after paying tax their whole life, they don't deserve to suffer/die just because their kids moved abroad/died/they never had any. Several people I know probably wouldn't be here if they hadn't had help to get care. Their age group are less likely to miss appointments too, as long as they get a letter or phone call.

Mainly, appointments in our area, are still sent out by letter. They arrive after the appointment date. This has happened to four people I know well. All check emails!

I wouldn't mind this, though it is difficult for older people. No shows cost a lot of money.

What annoys me is how much time I have to spend managing the treatment for my own conditions. For example, my medication of 125mcg daily being issued as two different prescriptions of 100mcg and 25mcg. Issued on different dates each month. Only one month issued at a time, I can only request them about 5-6 days before I'm due to run out, but I also have to allow about that length of time for the request to be processed.

I had to chase up myself about increasing my dosage now I've entered my second trimester. And at a recent blood test where I kept the form to bring with me for 7 weeks before the appointment and handed it to the phlebotomist at the hospital, they said they apparently weren't instructed to test my iron and thyroid as I'd been told and as made sense for the medicines and changing doses I'm on. So I had to chase the GP again, pharmacist did a form requesting my blood test and asked me to book it. Now I've tried calling back twice around working hours and haven't managed to get through.

Feels like another part time job at times! Stuff that would just get missed if I wasn't on top of it. And I'm literate and of sound mind, can use technology too.

My late husband would often miss outpatient appointments because something had happened that meant he was actually an inpatient when the appointment came round. Despite telling the staff every single time, including the consultant dealing with him as an in and an outpatient, the appointments were seldom cancelled. And that’s before you consider that if you are being seen by more than one consultant in different departments there is the risk that outpatient appointments will be made for a time when the patient is already in the hospital for something else! The system doesn’t seem to be set up for patients under more than one consultant, even though as people live longer (sad,y not my husband) that becomes increasingly likely. A patient already in hospital can, I think, be excused for not checking that new appointments have been made by another department while they are there. It’s more surprising that across different specialties they can’t see, or don’t look, at what other appointments a patient has. It wouldn’t seem to be beyond the whit of even scheduling software from the last century to highlight conflicts ;)

My late husband would often miss outpatient appointments because something had happened that meant he was actually an inpatient when the appointment came round. Despite telling the staff every single time, including the consultant dealing with him as an in and an outpatient, the appointments were seldom cancelled.

I am sorry for your loss.

This is a problem that I've encountered while dealing with my mother's appointments, too. She spent over a month in hospital recently yet she still kept getting notified of appointments in other - or even the same! - hospitals. I did my best to re-schedule them but I think there were at least a couple that probably ended up being recorded as no-shows. If the appointment reminder says "call this number to re-schedule the appointment" and that phone number either doesn't exist or is never answered then what can you do?

Respectfully, I am 66. I use a smart phone, have a laptop, and am technologically competent. Admittedly my 90 year old mum isn't.

My 90 year old mother in law uses email and text, even WhatsApp. Admittedly that is unlikely to be standard.

I work in an outpatient clinic, today had 40 patients booked in to appointments and less than 20 turned up!

I’m English but live overseas and this is also another reason why I’m not in a rush to return. The healthcare is better where I am - admittedly, I have to pay for it but I’ve been ‘lucky’ to have had several things treated which I know I would just have to put up with if I was at home.

It's all to try and reduce the DNA rate. You'd be surprised at how many people just don't turn up. Mental health appointments have a particularly high rate of DNA, which is why a lot of services have an opt in mechanism.

I am a clinical lead in a very busy NHS department. We send out appointment letters and texts, then reminders a couple of weeks before the appointment. If patients want to change the appointment it gives us time to fill the slot. We got many no shows. Our policy now is if you do not show for your first initial assessment you are discharged back to the original referrer. This has reduced our no shows as patients are learning that if they don’t attend they are discharged and they have to get a new referral. Our no shows have started to reduce from what they were. We state it on the letter now and there are notices advising of this in our waiting area. Our service is an outpatients department so not life saving, but the amount of wasted appointments was astonishing

However there is a digital reasonable adjustment flag- your GP can put on her records. It's for things like communication difficulties, unable to read, needs extra time, needs things explained in a different way, has language codes for interpreter services etc.... I would get her to contact the GP, or agree for a family member to have emails/ texts for her.....
However in my NHS dept with a short 2 week waiting list- even with phoning a patient to make the appt, send a letter, and phoning/texting to remind 2 days before we still have a 10% no show rate ....

Yep! A friend is visually impaired, his trust sent a email/text that has a link you have to complete. Once the link is opened it isn’t compatible with any software for the visually impaired, so the form can’t be completed and be can’t even find out the date/time of his appointment as its on the link. His trust also do not accept phone calls confirming you are attending.

He has had to resort to using patient choice so he is referred to a neighbouring trust who don’t treat people with visual impairments like scum.

Your friend needs to ensure that he has the reasonable adjustment flag on his records. It's only come in this year....

Your consultant is a bit of a prick.

I work in a GP practice. I think our patients must be the luckiest in the world by the sounds of it because our GPs are amazing! The experience and knowledge they have is immense!! I absolutely love my job. But. Its really bloody frustrating when everything is done at our end to make sure that patients get onto waiting lists for consultants, and they have to wait 18 months to see someone, and be treated. Then to fall through the cracks because they havent received an appointment letter. That automatically comes back to us in general practice, and the assumption is that we are shit nd havent done what we needed to do. My own GP practice is actually shit to be fair 😂

But it’s ok for the NHS to waste families’ time over and over again, by informing them of an appointment and then cancelling it a few days later - some of whom are also highly paid professionals, whose time is in demand. Most of his career, DH was earning more than NHS consultants; but as he is self employed, all time he has to take off is unpaid leave.

DD1 has a genetic disorder and needs a hospital appointment every 6 months, when they do urine and blood tests, to check inter alia the levels of her ammonia, because it’s a neurotoxin. She’s supposed to be under “close surveillance”!

What justification can there be for giving an appointment in June 25, cancelling it a few days before, giving another appointment in July 25, cancelling it a few days before and then giving the next appointment in November 26, but cancelling it this time in July 26? So, considering they didn’t send another appointment date, that would mean DD1 would go two years, without being seen - when it’s on the hospital department’s own website that they cannot provide proper care, unless they see the patient face to face at least once a year?

DH tells his clients, who want to see him - give me three times and dates, and I’ll make one them. He doesn’t cancel.

The GP in our family tells us, it’s middle management, who are not even clinicians, who mess about with these appointments, and increasingly, he has to tell patients to make a complaint just to get a hospital appointment! I had to make two complaints over the latest cancellation to get DD1 an appointment.

The hospital unilaterally decided recently to start using a third party app to send the appointment letters - but it sends a code to my landline number for me to input, before I can access the letters. I got rid of my landline ages ago, so I couldn’t access the latest letter! When I rang up the telephone number on an old letter from the hospital, to ask when the appointment was and to delete my landline number, they said it wasn’t on their system anyway, but it must be on another system in the hospital? How can there be two separate databases in the same hospital for families’ details?

Now, my GP practice has informed me, they are using Patient Knows Best, not the NHS app! I tried to show my Dexa scan to an osteopath recently and there was nothing there for it on the NHS app!

This country is low on productivity and we believe, one of the reasons for this, is how much time people waste, hours and days trying to deal with automated or digital systems, designed to save money for big organisations like the NHS? We believe the cost to the economy is far greater!