Missed ap­point­ments hit NHS

Glamorgan Gazette - - Your Views - MATT DISCOMBE news­[email protected]­line.co.uk

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.”

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Pa­tients who fail to turn up put ex­tra strain on NHS re­sources

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