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? 😅

Do you think, I haven’t asked a hospital not to give us appointments before 10 am? They know perfectly well, she has the most severe epilepsy, an epileptic encephalopathy and challenging behaviour. They have seen her screaming her head off, because she’s fallen onto her shoulder during a drop attack five minutes before the appointment; and they’ve called a taxi to take her and us to A & E; or they comment she’s had three seizures during the appointment in their clinical summary. That is why she is under all these people! It’s like me pointing out the sky is blue!

Thing is is not all about you can you imagine the amount of time that would take to check every single appointment
just take some responsibility and if you get an appointment that’s unsuitable ring up and change it

totally agree but also every service - even inside the same trust - seems to have a different arrangement and you end up having to figure things out as you go because it’s so disjointed

and don’t get me started with the hospital that has gate numbers rather than wards 😬 it’s fine once you know but wtf! Way to go to make it hard work

i often reflect that my dm would never manage without me to navigate the health services for her

I'm delighted that your patients can do that but you're being wildly optimistic to assume that your experience is universal across the NHS.

For a start you assume that the patient is given a phone number to call. And that number still exists in the phone system. And it is answered. And that the phone number is actually for the administrators of the clinic it's supposed to be for. And that the person answering the call has the ability/time/interest to actually make that change. And that once a new appointment is made, the original appointment is actually erased from the booking system.

I promise you, I have encountered all those problems either for me personally or on behalf of my mother. The phone not being answered is pretty much endemic.

It's just a way to manipulate the waiting list figures so politicians can proudly announce that they've cut waiting lists etc. Not by actually seeing more patients, but by removing patients from the waiting lists, often wrongly. Blair/Brown played the same kind of games under their tenure.

Yup, my DH has experienced all that almost weekly for the past 8 years since he was diagnosed with cancer which has also caused other conditions including several broken bones meaning he's been under the orthopaedic dept on and off for several years, plus problems with his throat which has meant he has a "ongoing" open file with ENT, again for several years.

It's a nightmare trying to firstly even get an appointment (even though they're always put down as "urgent" due to his cancer/chemotherapy), then of course, there's no option to choose, so when one finally comes through the door, he often has to try to phone to change it, and yes, usually either the phone number on the letter is out of order, or always an answerphone that never gets responded to, or completely the wrong person, or if you manage to speak to the right person, the answer is often that they'll just send yet another "random" appointment that likewise will probably need to be changed. It's virtually impossible for them just to agree a new appointment date/time on the phone. Must create so much extra workload, cause more wasted/missed appointments etc.

It's worse for him because every single month he has the same sequence of appointments for his monthly chemo drugs, i.e. first a blood test, then x days later a consultation with the haematologist, then y days later an infusion, and z days later he has to pick up his oral chemo drugs (inc in a package of lots of others such as anti viral, anti bacterial, etc). Haematologist won't "tick the box" to authorise the infusion/drugs without a blood test for obvious reasons. Same pattern every single month now for 8 years. Every single month, they cock it up, i.e. haematologist appt letter before the blood test appointment letter etc., or drug pick up appt before consultant appointment. Or he turns up on the agreed date to pick up the drugs only to find they've not been ordered! Meaning every single month he has to phone to re-arrange the appointments, of course, with 4 different people! It's apparently impossible to just go to reception and make all 4 appointments for the following month, even though all 4 are held within the oncology department!

The mind boggles!

Not just inside the same Trust, but inside the same hospital too! And even within the same hospital, different departments use different Apps, some don't put anything on any app (no blood tests, no consultant letters), whilst others use different apps.

Oh yes. I think I know that hospital. My poor old mum was convinced we were going on a plane somewhere.

Absolutely rolling my eyes at the suggestion to ring up and cancel an appointment. What silly billies we are! None of us thought of that...

Respectfully, one can call of course. Whether the phone is answered is quite another matter. 54 minutes was my record and that only works if I've no meetings/other commitments.

Do you appreciate that the time of patients is as valuable as yours?

I tried to cancel an appointment I couldn't attend. Phoned three times. Held on for about 30 minutes each time, still number 52, 34, 46 in the queue.
Tried to cancel on the app. " This hospital is not part of this system"
Tried the email on the hospital website. Bounced back.
Eventually I tried PALS who kindly sent me an email address that wasn't on the website.
Many people wouldn't be able to navigate through all that.

Yes, but if I have to cancel my clinic, I call and let patients know. Why can they not extend the same curtesy to me?
Yes, our admins work different hours and sometimes there is nobody to man the phones. They start work at 6.30am and they do pick up answerphone messages from the night before as soon as they get in and can redistribute appointments from the cancellation list. There is also an email address we print on top of all appointment letters of someone can't call.
I appreciate that not every department does, I can only speak to my service.
Despite out best efforts, people still routinely miss appointments with no attempt to contact us.

DD was noted as a no show a few times by our local hospital. I followed the instructions given to call , to cancel or rearrange the appointment and it wasnt recorded for one reason or another.

You've hit the nail on the head. I have the secretary's number for rheumatology and the clinic has an answer phone. No problem (although the lack of apology when there is a 90 minute delay is unacceptable) but that is not the case for orthopaedics or the MRI/scanning dept - for those, calls go through a separate appointment line and they are not answered swiftly.

There is a huge variation between hospitals/departments in the same trust.
Rheumatology - very good email system
Gynaecology absolutely hopeless, phone never answered, no email
Haematology, no published contact information at all

All above same hospital.

Yup, same with our local hospital. It's all completely fragmented, disjointed and dysfunctional. It's not just patients they have poor communication channels with, it's between doctors/departments too.

DH, who has cancer, has just had a major leg operation. Afterwards, Haematologist asked DH whether the orthopaedic surgeons had done a biopsy on the growth they removed as part of the operation. DH didn't know. He didn't even know the haematologist wanted it biopsied. Haematologist asked DH to ask the orthopaedic surgeon at the next review! DH asked and surgeon confirmed they hadn't and didn't know he should have done. Cue phone calls to the cancer nurses and after several phone calls, turns out the haematologist claims she'd left a message on the orthopaedic surgeon's secretary's answerphone but followed it up with a letter (paper letter!) which had only just been typed and sent to the surgeon, so arrived several weeks after the operation!

If consultants don't even have decent communication channels between themselves in the same hospital (in fact across the corridor), what hope have patients got of any communication?

Yes, and wait another 6 months for an appointment, as happened to DH this year, or as in DD1’s case possibly two years time? We have had five appointments cancelled by the hospital and one face to face appointment in two years, when she’s supposed to have one every six months. It’s taken me two complaints to Pals to get another face to face appointment.

@Catza - she hasn’t had a patient passport at any of the tertiary or quaternary centres, she’s been under, but then when she’s under the best consultants in the UK at the top neurological hospitals, with a neurological diagnosis, who needs her condition explaining to them? They know it causes cognitive deterioration, hyperactivity, aggression, irritability, autistic traits and her sleep eegs are so abnormal, they don’t even know if she goes to sleep? Then there’s the ultra rare genetic metabolic disorder causing mainly neuro-psychiatric symptoms like depression, anxiety, emotional lability, psychosis, hallucinations….

But none of those things automatically spell out she can't have a morning appointment. Not to mention that consultants themselves are not making these appointments. They have admin staff who are not aware of the ins and outs of your daughter's condition. Ask them to make an alert on the system about reasonable adjustments she needs.

Very elderly people often still don’t have electronic communication. My father has neither a mobile phone or an email address.

@LathkillDale what you describe sounds so very hard and I wish the people in charge of things for your appointments were exercising a little more understanding and empathy. It must be exhausting.

Thanks, it is. Research shows upto 75% of parents get divorced with a DC with her condition. The whole family has post traumatic stress. I’ve suffered carer breakdown twice, and ended up under mental health services, and DH has had two heart attacks. Her sister has complex PTSD, OCD, health anxiety, etc. That’s why she now lives in a specialist centre, costing the NHS over £250,000 pa - mainly, because I couldn’t cope with dealing with the too fragmented NHS. There it’s all onsite (except for the metabolic disorder).

I work in dentistry. The non-attendance can be soul destroying when access to NHS dentistry is so difficult. We send out email reminders a week in advance with paperwork ( via an online app type feature) to fill in which is then attached to the patients notes via the magic of the internet. It has reduced paperwork considerably and after 12-18months of patients moaning and resistant to change they are now much more impressed with how smoothly appointments run.
Back when we used paper forms it would take some patients15-20minutes to complete stuff which had the effect of causing delays all through the day. Patients now know that if they fill in the paperwork ahead of time they often arrive and are seen at their appointed time.
We still have some who don’t have emails or a smartphone but funnily enough it’s not the elderly population. The system also helps illiterate patients who can get assistance from family in private.
We also ring every patient the day before to confirm. It doesn’t cost us anything ( obviously time but if staff are not tied up sorting paperwork out they have time to contact patients) because we use wifi phones, again we had a few disgruntled patients but they now understand how much more streamlined our system has become.
It’s really important to update patient details and medical histories, but the phone calls also allow patients to update us with regard to access. We get advanced warning if someone can no longer make the stairs so can organise clinics accordingly.
As a result we now have far less no shows and if someone cannot make an appointment we get 24hrs notice so we can use the appointment to bring other patients appointments forward.
I have noticed that some NHS departments are starting to use “e” systems to increase efficiency. The general public have a tendency to resist change but with electronic notifications and form filling it can only get better. Eventually.

@Crwysmam my lovely dentist just sends a text message. It's private and they hold £70 in hand for dentist and hygienist appointments. Acts as a deposit in the event of late cancellations or no shows. Funnily enough there are hardly any.

The biggest problem with the NHS is that no money passes hands.