Page last updated at 16:39 GMT, Wednesday, 12 August 2009 17:39 UK

Missed Appointments: Your comments

Patients in a hospital waiting area

Patients who fail to keep hospital appointments cost the NHS more than £600 million a year, enough to run two medium-size hospitals, data has shown.

Between 2007 and 2008, 6.5 million appointments were missed in the UK, with hospitals losing around £100 per patient in revenue.

The Patients Association said missing an appointment was "unforgivable".

But are patients always to blame? BBC News website readers have been writing in with their views. Below is a selection of comments from patients and health professionals.

HEALTH PROFESSIONALS SPEAK

I manage a service providing NHS procedures in the community which are normally only provided in hospital. We are obliged by our contract with the NHS to provide our service through a home visit if the patient can't come to us because they are house-bound. About 15% of the housebound patients we visit aren't in when we call. How does that work then?
Anonymous NHS Provider, Merseyside, UK

As a GP I find it shocking the number of missed appointments. These same patients complain about access, but take no responsibility and it's the ill and elderly who suffer. This is not the government or doctors fault but a total lack of personal responsibility.
Shashi, Manchester

I work as a consultant in a large Trust and I can't remember the last time I had a clinic that wasn't significantly overbooked. It works a bit like an airline - the managers overbook clinics to make up for the non-attendees, anyway so I don't see how they are loosing money. As I see it many clinics run over capacity and thus the Trusts inevitably "over perform". The only people who loose out are the patients as not enough time is spent with them to assess, diagnose and treat in a manor that is not rushed or confusing to them.
Anon, Sheffield

As a hospital consultant I have frequent non-attendees at my clinics. However, it is not true to say they cost money because I run my out-patient booking systems like a scheduled airline. I overbook by about 30% so patients who fail to attend do not waste any time whatsoever. On the odd occasion when all people booked to attend turn up, I miss lunch...
Tim Reynolds, Burton-on-Trent

As a very busy neurology medical secretary at a large university teaching hospital it is extremely frustrating when patients fail to attend appointments. We have consultants sitting in clinics for several hours waiting for their next patient to turn up. Not only does this waste time for the consultants but as secretaries we have to write to the GP's copying the patients in to the letters and then spend time arranging further appointments.


I think patients who fail to attend hospital appointments should be charged


We have persistent offenders as well, who usually make a complaint when they are discharged!!!!! I think patients who fail to attend hospital appointments should be charged as do patients who fail to attend dentists appointments. If they thought they would be sent a bill for missed appointments it may make them think twice!!!
Jill Holmes, Manchester

We operate partial booking - a letter is sent out inviting the patient to phone and make an appointment that suits them. So then they are given a date that suits, one that they choose, then we send out an appointment letter to confirm. Then some still don't turn up! In this case the patient should be dropped from the list - putting them to the back of the queue just means they will be a problem again in the future! Instead we have to pander to them and give them more chances not to turn up.
Diane, Edinburgh

Working in the NHS the effect of people not turning up for appointments is obvious. The effect of overbooking when they do all decide to show up will be staff rushing to see all their patients and each one getting a rushed, substandard service. How about using the approach of giving an appointment time 20 minutes before the patient is due to be seen? That way if they don't show up, I can see an inpatient, do some paperwork, etc. rather than waiting around for half their appointment time to see if they'll arrive and not having enough time left to do anything productive. My records for no shows are one patient arriving from a list of four and three patients arriving from a list of seven.
Phil Smith, Leeds

I work as a speech therapist and run a paediatric clinic. Non-attendance is by far the most frustrating part of my job. For the month of July 2009 attendance was only 59%. Unfortunately it is often the children who need the most help that don't attend (or rather their parents don't bring them). There are no shortage of referrals and people often have to wait several months for their first appointment, which wouldn't happen if fewer were missed. It is no new problem and is, in a lot of areas, getting worse.
Liz, Swindon, UK

PATIENTS VIEWS

I was given a real flea in my ear for missing a hospital appointment. I apologised profusely that I'd forgotten and tried to make another one. I was told I'd have to be re-referred. The appointment was to get to the bottom of my short-term memory being lost after an acquired brain injury. I couldn't remember anything at the time and was treated horribly by people who *knew* what the appointment was for. Good to see such caring attitudes in our NHS.
Sarah, Sheffield

I have experienced poor correspondence from the NHS. I had to wait six weeks for a kidney scan and after I received a letter at very late notice, I turned up for my appointment and the waiting room was empty. According to the medical technician none of the patients had got their letter, except me. So no one had turned up for their appointment, leaving this urgent resource sitting idol. Now that is "unforgiveable".
Marcia, Hove, East Sussex

There is one solution - charge anyone who misses an appointment. A dentist or even a hairdresser will charge for a missed appointment, why not doctors? Whilst some appointments mentioned in your article are made months in advance this is not the case in GP surgeries and there are still high numbers of 'no shows'. Longer term perhaps GP appointments should all be charged, subject to the usual concessions, but prescriptions should all be free.
Grumpoldmal, Wokingham, England

Over booking is not the way to go, this just makes patients wait longer to be seen, I have osteoporosis and find it difficult to sit around in waiting rooms from hours on end and have since cancelled all further appointments for seeing a consultant until they get their act together. The last time was last month, I wasted petrol, parking and lost a half days pay to attend an appointment that I ended up cancelling while I was there.
Nev George, Frodsham

My father-in-law recently missed an appointment at his local hospital. Not his fault because the hospital made the appointment without asking and he had already been moved into a nursing care home 200 miles away.
Rachel, Wales

If you can't get through on the phone to make an appointment, how do you get through to cancel one? My mother-in-law's doctor has a system where you turn up at 8.30/9.00 in the morning, get given a number to see the receptionist, make an appointment, go home, and then turn up again for your appointment! All because people can't get through on the phone. Not a great system if you are 86, and have to rely on lifts and taxis to get anywhere.
Amanda Paybody, Milton Keynes, England

The hospital told me they would write to me to tell me when my next appointment would be. The letter never came

I missed a hospital appointment, I'm not proud of it. I have multiple sclerosis and at the time had twice yearly appointments with my neurologist. At the time of my previous appointment the hospital told me they would write to me to tell me when my next appointment would be.

The letter never came and I booked a holiday approximately five months after my previous appointment. On my return I phoned the hospital who told me the appointment had been while I was away, I can't tell you how embarrassed I was.

Luckily they were able to see me a couple of months later and were happy to continue my medication, which allows me to hold down a job, in the meantime, but it was a strong warning that I need to be more proactive in keeping my appointments. I haven't missed one since.
Simon Brown, London, UK

My wife received a letter with her appointment date through the post on the morning of the appointment. The hospital claimed that they posted it two weeks previously. They lied as the letter was dated only six days previous. That went down as a DNA so I wonder if Trusts are using this as a deliberate tool to fiddle some figures.
Gordon Allsop, Newbury England

Patients are often irresponsible and take the NHS for granted

I'm not surprised to hear so much money is wasted in this way. No, I've never missed a hospital appointment but did once miss an appointment at my local surgery - and felt really guilty about it. I saw on the notice board there that an average of 40 appointments are 'no-shows' every month. The surgery now operates a 'three strikes and you're out' policy.

Patients are often irresponsible and take the NHS for granted. We should pay a fee if we miss appointments without good reason (and evidence) because we reduce available surgery time. I often have to wait days for an appointment with the practitioner I want to see.
Mary Macilwraith, Wigtown

What about the money the NHS wastes? I had an appointment booked, had to take my last half day of annual leave for an appointment, went to the hospital to be told that the doctor I was seeing was ill and my appointment had been cancelled. The rude nurse told me that I had been informed. Her boss later confirmed that they had been unable to get hold of me, they had phoned once (withheld number) and not left an answer phone message. Therefore, I will have to take an unpaid half day off to attend an appointment because no one could be bothered to leave me a message or try to speak to me.
Rebecca, London, England

My local hospital uses text alerts, and doesn't seem to overbook, and I've always been seen on time, which is fantastic. But my brother, in another part of the country, regularly goes to clinics where they overbook horribly because of people not turning up, but they end up with too many patients for the clinic. So those who do turn up end up waiting for literally hours. At times, this has meant he has missed an appointment at another hospital, because he was still waiting 3 hours after he should have been seen at the first one. He got the receptionist to call and apologise for him and the consultant was kind enough to wait until he could make it, but it was really embarrassing.
Sue, Oxford, UK

Whilst I agree with the comments and sentiments expressed above and I would not wish to see patients appointments rushed, more should be done to keep us informed when scheduled appointments are running late. In the last two years of hospital visits I have spent in excess of eight hours over and above my scheduled appointment times and this translates into lost work time and the extra (and expensive) car park charges.
Robert Booth, Norwich, UK

There is a flaw in many hospital systems where no scheduling of reminders is possible. Pretty hopeless when some appointments are 6-12 months in advance.
Mr G, Salford, Lancs

In my experience out patient no shows are often the fault of the hospital system. Because of the government 18 week target and low secretarial manpower in hospitals, appointment games are played. Patients are given temporary out patient slots guaranteed to change later. The paperwork is always too slow and either the patient doesn't get the new appointment date or it arrives too late.
Paul Roblin, Oxford, UK



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