Adam Morris : NHS is Losing patience with hospital no-shows

Published on Friday 18 September 2009 09:54

IT HAS been one of the biggest bugbears for hospital managers for years. Every year tens of thousands of patients simply don't show up for operations which in some cases they have been waiting months for and could transform their lives.

The problem cost NHS Lothian alone almost 3 million last year as more than one in ten outpatients were no-shows.

As public spending comes under new scrutiny, with extra pressure to cut out waste, it is no surprise that missed appointments are again in the spotlight.

Given that health service bosses have been trying to sort the problem for years – remember all those polite posters in GP waiting rooms? – is it a problem they can realistically make inroads on?

NHS Lothian has gone as far in the last two years as to offer patients a chance to choose dates and times that suited them to visit hospital for treatment.

If it bent over any further to try to accommodate people it would surely fall over.

But this "nice" approach does not appear to have worked as the number of no-shows has actually risen by 3,000, or around 13 per cent, inside a year.

So is it time to throw away the carrot and bring out the stick?

The health board is certainly ready to try, bringing in its most radical tactic yet to discourage non-appearance, by penalising those who fail to appear without good reason.

That means anyone missing their appointment risks being sent to the back of the waiting list unless there is an over-riding medical reason to treat them more urgently.

It is, on the surface at least, a tough but fair approach but it is not without its problems.

It is not easy as you might think, for instance, to sort out the timewasters to be "punished" from those with genuine reasons for failing to turn up.

One consultant told the Evening News he had more sympathy with some of those involved than you might expect.

"It's not just a case of lazy, care-free people selfishly not appearing at hospital. Some people can be very scared, these appointments can change their lives, and in some cases they simply cannot face them," said the consultant.

"It's not a viewpoint we support, but it is a reality. It's vastly different from cancelling a meeting at a bank or gym."

Agreeing which patients should be "punished" also takes up medics' time.

The early indications are that this approach – perhaps even just the threat – may be having an impact. The health board says preliminary results for the year to date since the new approach was introduced appear to show an improvement in the situation.

The health board though is not relying on this tactic alone.

A record will now also be kept of why a patient has missed an appointment in an attempt to identify any recurring trends.

A telephone reminder scheme, which will see a courtesy phone call made shortly before their appointment, is also due to start next month, although this is not an entirely new tactic.

"Patients who simply don't turn up delay treatment for other people as well as themselves," says NHS Lothian's director of strategic planning and modernisation Jackie Sansbury. "We are working to actively encourage patients to keep their appointment dates."

A pilot scheme will also be launched next month which will see outpatients offered appointments within seven days of their referral, which is hoped will keep the date and time fresher in their mind.

Something will have to deliver results if the health board is not to fall foul of the Scottish Government.

It has introduced nationwide targets for missed appointments, which demand the health board cuts the rate to nine per cent by the end of March 2011, although some other health boards have even more work to do.

The British Medical Association welcomed NHS Lothian's telephone reminder system, pointing out many appointments are made far in advance.

It also praised the idea of trying to identify trends which could explain why people miss appointments, saying: "Examining why such a high number of people are missing appointments could help cut this waste."