NHS. Why do they do this?

[bestbefore]

I asked GP ages ago for a dexa scan.
She did the referral
I didn't hear for awhile so checked & was told to be patient - fair enough
This week I get a text for an appointment- no mention of what it was for but I guessed dexa. It's for a date next week that I can't do. I can text to cancel, which I do.
I then get another text which says a new appointment will be set for me and if I can't make 2 more appointments my details will be removed from the system.
I then get the letter, 2 days later, with details of the scan.
There's a number on the letter to call re appointment so I call and explain I've cancelled and could I rearrange? No I'm told they will schedule it for me.

This is ridiculous isn't it? Why is it so crap? Why isn't there an online thingy where you can book it with say a code from the gp? I know that costs money but so does silly letters and people answering the phone but unable to do anything!

This is one of my absolute bugbears. The NHS appears to exist in a sort of 20th century bubble when it comes to the use of technology to expediate communications, cut admin costs and improve services. It’s like nobody with any level of seniority has the first clue how modern private sector organisations communicate & interact with their customers.
They just carry on as they have always done, obsessed with sending out letters in envelopes physically stuffed, carried, transported & delivered by humans like it’s forever 1989. Recently I attended a hospital clinic & was treated by a nurse who showed me the actual bit of paper she had filled in and the envelope in which she intended to post it to my GP. Incredulous, I asked why she didn’t just e-Mail the information? ‘Systems don’t talk to each other’, she replied. In 2023. You literally couldn’t make it up.

@mondaytosunday

I call patients and withhold my mobile number because
I don't want them calling back when I am in clinic or with another patient or off sick or on holiday or in meetings or don't have their notes to hand or have no idea who they are, or don't have access to my protocols, or have a mouthful of food or any number of other reasons.

If they ring the dept someone will answer 9-5 and there is an answer machine out of hours. If I am available I will take their call if not a message will be given to me when I am.

I got a referral from my GP.....that sent me a text with a letter attachment that said at the top "you do not need to do anything" but telling me the dept would be in touch to make an appointment, and what to do if I didn't hear by a set date.
A month later (before the set date) I got an NHS letter in the post nagging me to make an appointment, but not telling me what dept it was for but did give me a link to an online booking system. After shuffling through various correspondence I used reference and password in first letterin the link and booked an appointment.
Would have been much clearer if original text letter had said go to this link using references above and book appointment. Would have saved a letter and my appointment might be a month earlier.

People have been so conditioned that they have to think the NHS is amazing that they cannot accept that it’s a completely shit service and we should all demand better. Companies all over the world have computer systems that Russia can’t hack - what a stupid excuse. You’d think the NHS could have a decent one and yet, the appointment system is crap and we still use paper notes! And that’s not mentioned all the other things that make the NHS like a health system from the third world.

Being able to book your own appointment on a day and time to suit you should be the very basic service to expect in this day and age.

So happy you received good care!

However, that's not always the case and it's right that we stand up for ourselves and say when care is not up to standard. My DGM is dying because she was fobbed off by GPS for too long, and is now in hospital being let down by everyone. Ignored, left alone to soil herself and not cleaned up and in pain. The only time she's been treated with dignity is when family visit and help her, it's not acceptable and I'll continue to say that and fight for her because she, like many others, is a human being and deserves dignity.

To be honest I’m of the view you really need to appreciate the ‘free at point of use’ concept of the NHS and move hesven and earth to attend appts.

i work for a team in which we allocate appointments (phone usually in first instance) we used to contact each and every patient in advance to book them in but it was a whole full time job for someone and we still had a DNA rate if around 20% ( equivalent to two full time senior nurses diaries per week).

the service is now under so much pressure we book in maybe 1-2 weeks in advance people just get a text to advise them and DNA rates have reduced by at least 10%.

We do have a manned phone line though whereby people can call to reschedule if they genuinely cannot make it and we greatly appreciate if people do let us know.

Also just to add that I see a Consultant privately about one heslth problem and I can book online and always loads of slots to choose from inc short notice. However it costs me just under £300 a time, so if this the service we want for the NHS this us the level of funding per consultation we would have to resource for! Not happening!

I’m under the care of two hospitals for two different conditions.

If I’m not able to cancel/re-arrange any appointments how do you propose I attend clashing appointments? Split myself in two?

The hospital changes my appointments all the time. But when I had to change it because I just couldn't make it. I was told it would be 18 months before being seen again.

Honestly, I work in the NHS and am a huge advocate, but the appointments administration is generally terrible.

A few weeks ago a letter came to our address with someone else’s name on it. It was for someone who has certainly not lived here for 8 years, possibly ever, for a breast surgery clinic appointment 5 days hence. The letter said to ring the number overleaf to rearrange, but there was no number overleaf. Astonishingly shit (and the hospital’s information governance team were suitably horrified), but how can this happen?

DH has also received two letters on the same day, with the same date of creation, for the same appointment time/date for the same clinic. One said it was a face to face, and one said it was a phone appointment and not to attend. Insane.

This has just reminded me I got a call from someone (no idea who) in the NHS saying they needed to update ds address as they were worried they hadn’t been able to make contact. We moved NHS trust areas 3 years ago. We changed GP, Dentist and school, he’s been treated at hospital in the new area for something different. I apologised as asked what I was supposed to do to update his details. Register with a gp, I’d done that. I asked which clinic was trying to contact him. He had no idea. So what was the next step. He d send me a letter to let me know what to do … there’s been no letter for months but I don’t know where to start phoning. This can’t be the best system.

Perfectly reasonable.

If scammers, however, can make the number they are calling from look like a regional, local landline, or like a regular mobile number, the NHS can provide an NHS identifier to the number you call from.

*I've never had a letter that doesn't say what the appointment is for?

The texts won't say what the appointment js for because of patient confidentiality. *

Not helpful when your children also have appointments. You can't tell who the appointment is for until the letter arrives. Or which condition, either.

Not convinced by the patient confidentiality argument, anyway, as I have had both non-name texts and named texts.

The text won’t say what it’s for as it could be seen on the screen by anyone. It’s GDPR.

DH is on supposedly 3 monthly scans to check his cancer doesn't sneak back in. In reality they take place after his consultant chases for them because apparently the concept of block booking is beyond anyone at our local trust, so they are not on a predictable schedule. You can bet if a scan appointment had come through for the dates we've booked for our first holiday in years he'd have been calling to reschedule, not because it's not important to monitor for cancer recurrence but because people with long term or chronic conditions are in fact entitled to try to participate in whatever aspects of normal life they are able to.

I don't think people should cancel because they can't be arsed but the idea that DH should not be able to rely on keeping any personal or professional commitments for the next 5 years just to save someone 5 minutes of admin time is abhorrent.

Oh yes and a £50 deposit @GatesOfBabylon ? Really, you want people to have to decide between an urgent cancer referral and feeding their kids?

During the postal strikes of last year, I didn't get notification of a mammogram & it's now on my records forever that I missed a hospital appointment.
When I turned up for my mammogram this year, the nurse said disapprovingly 'oh I see you missed your appointment in December'.
There were bloody postal strikes! I didn't get ANY post for nearly 3 weeks!!!!

The thing that pissed me off was the lack of coordination between different departments. Comorbidity is not a rare occurrence, and it's not unusual that patients may be waiting to be seen by more than one clinic. But then you get a letter with no details of what the appointment is for, and a separate letter to tell you how to create an account to change appointments and and you can't be sure which it is... and I was just dealing with one hospital, though separate departments. How people manage when they have more than one hospital - that must be even more challenging.

I'm intelligent, used to dealing with bureaucracy, work in IT, so technically competent- and I found it a struggle to work out what I needed to do when. How people who are not well educated, or living with a cognitive disease or struggling to think because of on-going pain (things you might see in health are,) how they manage, I don't know - well, I do, because there are missed appointment stats, but I'm willing to bet a good percentage of these are because of miscommunication rather than patients can't be arsed.

I had one letter telling me my gynae procedure date had changed and would now be a phone consultation. I did ring to ask if that were really the case (even if I were prepared to flash my bits at the camera, without a speculum and lighting, it would not be helpful for the investigation,) and they said that the wrong letters had gone out for that day. Now, I don't know if I'd have got a second correction if I'd not called to query it, but I suspect that they would have had a few patients that day who were no shows because they were at home waiting for a phonecard which would never come.

It would be far better for both staff and patients if there was a lot better admin, coordination, and communication in the NHS. It is technically possible, but not without investment, and there have been too many years without that.

Say Wash has three dc: Amy, Bob and Chris. How does it violate GDPR if the text states whether the appointment is for WAD or AAD or BAD or CAD?

No. This is a misapplication of GDPR. If they are so worried about somebody else reading a text on my phone, which only opens to my fingerprint, then how can they justify sending me a paper envelope which could be opened without my knowledge by anybody in my house - or in any other house if the post is mis-delivered - containing even more personal details on the paper letter?

They had a system for a bit where you had to book appointments. The majority of people who go to hospitals are elderly or disabled. Many could not manage it and GPS were often asked to help book appointments.

Try getting mental health care...
Would-be client- 'Hi, I've been on the waiting list nine months, can you tell me when my sessions might start?'
Them - 'Oh, we removed you from the list six months ago, when you didn't attend your appointment.'
Would-be client - 'You didn't send me an appointment!'
Them - 'Oh, yes we did! Oh... no... we 'phoned you.'
Would-be client - 'No, you didn't. I haven't spoken to you since the triage call, and I haven't had any missed calls.'
Them - 'Well, you must have given us the wrong number then.'
Would-be client - 'No, I didn't. I double-checked at the time. I record all my calls and I can prove it.'
Them - 'You did! [Reads out a telephone number with one digit missing]

They're up to all sorts of tricks.

The NHS is a sacred cow that can never be criticised. Many moons ago I started my career in the NHS.

It’s underfunded for sure but it’s not the only problem. I lasted six years and then retrained. It was the best decision I ever made.

Hope it gets sorted op.

I work in NHS admin and we have an app for patients to cancel appointments but they cannot reschedule, it's a nightmare.

A system where patients can reschedule their own appointments would be wonderful and save so much time, even if patients only have access to half of the clinic appointments for rescheduling and the other half are left for emergencies and other patients.

Disagree that people should not be allowed to reschedule, for a start single parents would be disadvantaged. People should not have to cancel holidays, weddings or funerals to attend medical appointments, not to mention there are many doctors/nurses who are seen in secondary care- should they cancel appointments for patients so they can attend their own appointment?

Nonsense. My antenatal texts from hospital and midwife give me all the necessary info.

And what if it clashes with another health appointment? I’m under the care of three different hospitals at the moment, plus extensive GP involvement. It’s always been easy to reschedule an appointment. In general I’m always offered a slot and asked if I can make it first before it’s confirmed.