1,390 Scots don't turn up for hospital appointments every single day

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THOUSANDS of patients are failing to turn up for hospital appointments in Scotland on a weekly basis, costing the NHS millions of pounds, figures seen by The Scotsman reveal.

In some areas of the country, 20 per cent of appointments are missed by patients who fail to inform their hospital that they will not be attending.

It means valuable time that could be used by other patients is often wasted, at huge expense to taxpayers, and adds weeks to waiting times.

Last night, doctors and campaigners said that, with the average consultant appointment costing about 100, the number being missed was "a disgrace".

Figures obtained by The Scotsman under Freedom of Information legislation show at least 1,390 hospital appointments are missed every day in Scotland.

However, the figure is likely to be much higher, as many health boards were unable to supply numbers for missed inpatient appointments, while others do not collect data on clinics with staff such as physiotherapists and dieticians.

The NHS is likely to feel extra pressure from missed appointments as it attempts to hit an 18-week target from GP referral to treatment by the end of 2011.

The largest number of DNAs – "did not attends" – in Scotland was reported by NHS Greater Glasgow and Clyde.

The board said that 228,877 outpatient appointments were missed last year – 627 per day – the equivalent of 20 per cent of all appointments.

In the first nine months of this year, 6,729 cardiology appointments were missed in Glasgow alone, along with 15,503 in orthopaedics and 11,182 appointments in general surgery.

Glasgow was not alone in battling a large number of missed appointments, which shows signs of increasing in many areas. And, worryingly, people booked as inpatients for treatments including surgery are also missing appointments, meaning that valuable theatre time is wasted unless hospitals risk overbooking facilities to take account of non-attendance.

Dr Peter Terry, chairman of the British Medical Association in Scotland, said:

"The fact that so many patients just don't turn up is an absolute disgrace.

"It is amazingly selfish. Not only are they wasting the time of staff in the hospital and the valuable resources put in place for them, they are also depriving other patients of an appointment they could have taken.

"The most shocking thing is you often get people who fail to turn up for two or three appointments."

Other figures showed that NHS Highland saw 11,556 inpatient and outpatient appointments missed in the first nine months of this year. In the whole of 2006, the figure was around 15,000.

In its diabetic clinics, the proportion of missed appointments increased from 12.4 per cent in 2006 to 14.4 per cent in 2007, while

missed appointments in neurology also increased, from 8.9 per cent to 12.5 per cent.

Meanwhile, NHS Lanarkshire reported 53,166 missed appointments between July 2006 and June 2007.

In NHS Lothian, more than 78,000 appointments were missed in 2006-7, with 70,516 in the first nine months of this year alone. Missed outpatient appointments in the region surged from 74,493 in 2005-6 to 76,926 in 2006-7. Inpatient non-attendances also rose from 1,127 to 1,167 over the same period.

The largest number of missed appointments was in the board's ophthalmology department, with 6,690 missed in the first nine months of the year, followed by 6,660 missed appointments in orthopaedics.

Elsewhere, NHS Forth Valley saw 8,461 missed appointments in 2006-7, and Tayside reported 28,524 – accounting for 10.6 per cent of all appointments.

Even the smaller health boards experienced difficulty with missed appointments. NHS Borders recorded 5,125 missed appointments in 2006-7, while Dumfries and Galloway saw 5,656 missed appointments in 2006. NHS Shetland reported more than 500 missed appointments in 2006-7.

Grampian, Fife, Ayrshire and Arran health boards collectively accounted for approximately 80,000 missed appointments a year. Western Isles and Orkney did not respond to the inquiry.

Dr Terry, a consultant obstetrician and gynaecologist, said that some clinics would overbook to take non-attendance into account. But he warned this could lead to problems if everybody did turn up, and said his own clinic in Aberdeen was the victim of patients missing appointments.

He added: "The cost can be immense if you have set aside two or three hours' operating time and a bed for someone who does not turn up. There is no doubt that the rate of people not attending is going up. Some people do not appreciate the health service, maybe because it is free to them. It is shocking."

Margaret Watt, of the Scotland Patients' Association, said it was "totally unacceptable" that so many valuable appointments were being missed by patients.

She added: "Part of the problem is appointments are made so far in advance that pat-ients simply forget. We need some kind of system to remind people of their appointments nearer the time."

Ms Watt said missed appointments were not always the patient's fault: "We had a situation recently where we were trying to arrange an ambulance to take a patient to hospital for his appointment, but it did not turn up. That was not his fault.

"How many appointments are missed because of a lack of transport? We need to put more resources into getting transport to take patients to hospital."

Dr Andrew Walker, a health economist at Glasgow University, said the actual cost of missed appointments depended on what was done during the time when patients did not turn up.

He explained: "If the doctor does nothing, that is clearly a waste. But if they use that time effectively, such as chasing up test results or doing other work, it is less of a waste."

Nicola Sturgeon, the health secretary, said: "It is disappointing when patients fail to turn up for appointments. It is unfair to patients, places a burden on the NHS and wastes the time of GPs and other healthcare professionals. I want patients to have more rights in the NHS – but it is important to remember that they also have responsibilities.

"We are determined to improve the availability of primary care through making access to GPs more flexible and appointments easier to book.

"The Scottish Primary Care Collaborative has been working with NHS boards and practices across Scotland to ensure people can make appointments at a more convenient time."

Ms Sturgeon added that GP practices using a system of booking more flexible appointments were reporting a fall in the number of patients failing to attend appointments.


HOSPITALS are not alone in suffering the consequence of missed appointments.

Campaigners estimate that 1.5 million GP appointments are missed every year in Scotland, at a cost of 31.5 million.

Across the UK, it is thought that more than 20 million practice nurse and GP appointments are missed a year.

A survey by health education charity Developing Patient Partnerships (DPP) found that 97 per cent of GP practices agreed that missed appointments were a massive waste of NHS resources. And 72 per cent of GPs and 41 per cent of the public said they would support striking off patients who regularly missed their appointments.

Another deterrent may be to charge patients who do not turn up.

Nearly two thirds (65 per cent) of the public and even more practices (68 per cent) said they would support charging people 10 for missed appointments.

The average GP appointment costs around 21. But many see depriving another patient of a slot as more serious than the financial burden.

It is thought appointments are missed due to a mixture of patients forgetting about them, getting held up doing something else or deciding they no longer need to see a doctor.

Despite the extent of the problem, the British Medical Association remains reluctant to support charging patients for missing appointments.