Missed appointments hit NHS
PATIENTS skipped more than 360,000 hospital appointments in Wales in a year – leaving NHS services to count the cost.
Figures seen by the Local Democracy Reporting Service show about 368,000 outpatient hospital appointments in Wales were no-shows in 201718, out of 4.9 million that had been booked.
The number of noshows fell from 2016-17, when there were 378,000 skipped appointments. But patients not attending appointments remains a big issue for health services – there were 1.5m no-shows from 2014-15 to 2017-18.
The average cost for a missed appointment varies between Wales’ health boards but is generally about £150.
Dr David Bailey, a GP in Caerphilly and chairman of the Welsh Council of the BMA, said missed appointments were adding weeks to waiting lists for routine appointments.
He said most missed appointments happen when patients forget to turn up or don’t phone ahead when they can’t make it – but some were caused by NHS admin or communication errors.
Dr Bailey said: “Missed appointments are a huge strain on a taxpayer-funded service. Patients are waiting longer to be seen.
“Patients frequently tell me they phoned weeks in advance and told the hospital they can’t attend an appointment and they get letters saying they have been taken off the waiting list.
“[But] some patients are just being feckless and don’t turn up to appointments. It’s selfish behaviour and should be stopped.”
Dr Bailey said the BMA was not calling for charges for missed appointments because some patients who do not attend are vulnerable.
He acknowledged there were admin problems at some hospitals and messages sometimes don’t get passed on.
Dr Bailey said: “I suspect the majority of most appointments are missed as people have not bothered to turn up. But you can’t say the NHS is completely blameless in this – there are issues around record-keeping.”
He added there were fewer missed appointments in primary care since patients began receiving text alerts.
Abertawe Bro Morgannwg University Health Board, which covers Swansea, Bridgend and Neath Port Talbot, and offers more than 600,000 outpatient appointments a year, says improving outpatient services is a priority.
“The health board had more than 56,000 outpatient no-shows in 2017-18.
Replying to an Freedom of Information request, the health board said: “We have been reviewing the outpatient booking process to explore options for patients to confirm or rearrange appointment dates via text messaging. The health board has also introduced a text remind- er service.
“The health board is exploring opportunities to deliver outpatient activity in a different way including providing outpatient sessions in primary/community settings, exploring the use of new technologies such as Skype, increased provision of non-consultant led services, email/telephone advice lines.
“Work has also been undertaken to review existing models of best practice to inform new approaches to the management of follow-up appointments.”
Cardiff & Vale University Health Board, which had more than 96,000 no-shows in 2017-18, said missed appointments had a considerable impact.
A spokesman said: “Each missed appointment has a degree of waste associated with it, with an estimated financial cost of an average of £160 per appointment.
“Further, when an appointment is missed, it puts strain on staff, as the details of each failure to attend usually requires clinical review to determine whether another appointment should be made or not.
“Administrative staff will then need to update the system and send an additional letter to the patient, as well as to the referrer in cases where no further appointment will be made.
“This incurs a further financial impact (printing, enveloping and postage).
“Where rescheduled appointments are necessary, future clinic slots have to be used, taking capacity away from patients awaiting a first or subsequent appointment.
“This can lead to increased waiting times and may also place a burden on clinicians who have to fit more patients into their clinical sessions and/or undertake additional sessions.
“The latter also has an administrative impact for staff who have to set up and support these clinics, as well as nursing staff who invariably provide assistance.”
A Welsh Government spokesman said: “Every year the Welsh NHS sees over three million outpatient appointments. Patients and health boards have a role to play in en- suring that arranged appointments are attended and there has been a publicity campaign to highlight the cost of missed appointments.
“While health boards are responsible for having efficient appointment systems in place and ensuring appointments are well-attended, we continue to work closely with them to reduce missed appointments.
“We are aware a number of health boards are already using a variety of different tools to remind patients to attend appointments, including text messaging and phone reminders.”
Patients who fail to turn up put extra strain on NHS resources