How much do missed hospital appointments cost Scotland?

Many Scots are skipping hospital appoitments. Picture: Lisa Ferguson
Many Scots are skipping hospital appoitments. Picture: Lisa Ferguson
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Major research has uncovered the cost to NHS Scotland of missed hospital appointments. The findings also reveal what type of appointments are most commonly skipped by Scots.

Missed hospital appointments are costing the Scottish healthcare services more than £21 million a year, it has emerged in a report by NHS Health Scotland.

Missed appointments are costing the NHS in Scotland millions of pounds every year

Missed appointments are costing the NHS in Scotland millions of pounds every year

The scale of hospital appointments classed as DNA - or did not attend - has been revealed in a report which also looks at who is most likely not to turn up for outpatient clinics.

Research shows there are around 1.8 million first-time outpatient appointments made in Scotland each year.

The study, published earlier this year, found that around 10 per cent of these appointments were classed DNA, with each appointment costing the health service an estimated £120.

A patient lobby group said that more needed to be done to understand why people did not show up.

it is important that all health boards understand why patients are not attending appointments and look at ways to reduce this

Shona Robison, Cabinet Secretary for Health, Scottish Government.

The report shows that men living in urban environments had the highest risk of not turning up to hospital and those in the 15 to 29 age group were more likely to skip appointments

General psychiatry was most likely to see missed appointments, with 17 per cent of females and 20 per cent of males at risk of not attending.

Outpatients in neurology and urology were also at higher than average risk of not attending.

Females were most at risk from missing gynaecology outpatient appointments. Male attendance at gynaecology clinics may be a coding error (we were unable to verify this) but may reflect appointments by those who are considering or are in gender transition or invited to fertility clinics.

Men were also at risk of failing to attend outpatient clinics with ear, nose and throat specialists followed by appointments with experts in urology and dermatology.

The study showed that those living in the most deprived neighbourhoods were most likely not to show up.

A man living in one of the most deprived neighbourhoods had a 17 per cent risk of not attending, with the figure dropping to seven per cent for those in the least deprived areas.

Men in urban areas had a 13 per cent risk of not attending outpatient appointment compared to a seven per cent risk for those living in the very remote spots of Scotland

The report found that physical location of health services could be a barrier but the patients perceived worth of attending the appointment was also at play.

Those with alcohol and drug issues had a “particularly high” rate of DNA at psychiatry appointments, the report found.

Dr Jean Turner, a former hospital consultant and GP and patron of Scottish Patients’ Association, said the issue must be understood in human terms.

She said: “If people are not turning up for appointments who should be attending appointments, how can you treat them effectively and get them the most appropriate treatment for the best outcome? We shouldn’t be thinking of this in just a financial sense.”

Dr Turner said that it had long been more difficult in getting men to engage with health services.

She added: “Quite often you would get them to come to clinics and they were always a little bit scared of outcomes. There needs to be work done to figure out why young men as a group need special attention.”

Dr Turner said GPs had to “sell” appointments to patients and ease their minds as to what was likley to happen at hospital.

“You have to allay fears. Look at gynaecology, women can feel vulnerable and they probably see it as a good reason as to avoid the situation.

“GPs have to be able to explain that a lot of work goes into making people feel comfortable and to get across that it is not embarassing. For the doctors involved it is just an everyday job.”

Dr Turner said that appopintments could be missed by the “plate spinning” of everyday life and highlighted that the vast majority of patients did attend when expected to do so.

However she did add that difficulties in getting transport to hospital and asking for time off work could be a factor in people not showing up.

Health secretary Shona Robison said there had been a “slight decrease” in the rate of patients who had missed appointments over the past five years.

She added: “However, it is important that all health boards understand why patients are not attending appointments and look at ways to reduce this.

“The Scottish Government is committed to supporting health boards with consistently and reliably securing and providing reminder services through texts, emails and social media. This will be able to be tailored for patients who are most likely to not attend.

“Health Scotland also recently published a report looking at those who did not attend appointments over a 10 year period from 2002/03 to 2011/12. We welcome this report which will provide boards with further learning on the issue of non attendance.”