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Date: 03 March 2014

Today's Topic: Missed NHS appointments cost the NHS about 700m a year

Triggers: BBC News Report

My Grump: What is wrong with people?

I call them FTU's (Failed to Turn Up), but the NHS calls them DNA's (Did Not Attend).

The number of DNA's we are talking about here is staggering. In the year to October 2012, 7.3 per cent of hospital outpatients missed appointments without calling in advance to cancel or reschedule. 7.3% is equal to 6.7m patients who did not bother turning up to their hospital appointments.

Patients who fail to attend NHS appointments cost the NHS about 700m a year. These six million appointment slots wasted annually also delay treatment for other patients, and actually this to me is the saddest thing of all, that someone is so selfish that they deny someone else care when they don't care for themselves.

It seems, the worst perpetrators for missing scheduled appointments are men. Come on guys, get your act together, I know you think it'll get better by itself, but what if it doesn't? Burying your head in the sand is not the answer. Keep your appointment, or don't make them in the first place.

Between October 2011 and October 2012, there were 92.9 million outpatient appointments in England, but only 80 per cent of these appointments were actually attended. That is not to say hospitals are blameless here. My own experience with hospitals is that they cause confusion by cancelling appointments and rebooking them, sometimes more than once. I always write appointments in my diary, as I'm sure most people do, but those that take phone messages or written appointment changes often only keep the letter. This can cause patients to turn up when they dont have an appointment and not turn up when they do.

But I can't really see how that is the hospital's fault. They are juggling appointments for 70 million people + illegals, and fitting these around consultants golf and trout fishing trips. Nah, sorry, I jest. The patient is the one who is ill. For crying out loud, keep your appointment and get it fixed.

Rather than make a fuss and take these people to task, the NHS response is to over book appointments by 10% to account for the DNA's. This means when there are not as many DNA's as expected, your appointment can run hours late. And you sit in the waiting room fuming because you think the little dear that went in front of you is struggling to get her stockings on.
Government Spending Chart 2012-13
NHS bosses are desperately trying to save money. The health service has been charged with making 20bn in efficiency savings by 2015. This is out of a budget that has reached the dizzy heights of 130bn.

It is true that hospitals need to use more innovative solutions to tackle the number of people who miss appointments. One simple idea being offered is to use texting appointment reminders to patients. Email, Skype or even plain old fashioned postal reminders, also could work well. Even though I have it in my diary, my dentist always calls me the day before an appointment to make sure I have remembered, and to remind me of the time.

Whilst this is a good idea, we're missing the point yet again. Patients are not taking responsibility for their own care. This is the bit I find so incredible. People don't care about their own health to keep an appointment they went out of their way to make, as if the very act of making the appointment is all that is needed to satisfy their own recovery. No, that's step 1, you actually have to go on and take step 2, and keep your appointment. Is that really so unrealistic?

Two Bedfordshire practices took part in a study where in the previous year, they had seen a total of 4,200 DNAs. For one month patients were asked to write their appointment times down themselves. This was found to cut DNAs by 18% compared with the previous six months' average. Another idea was to ask patients who booked over the phone to repeat back the time and date of their appointments, which cut DNAs by 3.5% compared with the previous month.

It is clearly a big issue and something needs to be done about it.

However, I have a different idea.

I think one of the reasons we have this problem is because the NHS is free at the point of sale. Of course it's not free, it's just that people treat it as if it's free. And what do you do when you think that something is free? You undervalue it, or don't value it at all. You just think it's there to pick up the pieces, your pieces, as and when you abuse yourself, even though you have a responsibility to not put yourself in that position in the first place.

As evidence I point to the Friday/Saturday night binges that you see on the news, with people falling all over the road and pavement, pissed out of their skulls. And what is this ridiculous craze for 'necking'? People drinking all manner of dangerous concoctions (that's if they actually do - I doubt the worst of them). But even so, encouraging the lesser intelligent among us to drink a couple pints of bleach is downright criminal.

I hate the fact that politicians spend their whole time dreaming up new ways to tax us, and so when a new fine is announced on the news I realize this is brought in as a revenue raising exercise as much as a keeping us all in line exercise. However, these people are taking money and time from you and me, from all of us who are paying for the fact that they don't give a monkeys for the money they are wasting, when all it would take is a quick phone call to free up that appointment for the next person on the list who has already been waiting for far too long.

So I'm afraid I would be in favour of a fine for non-attendee's, and it should reflect the real cost of lost time to our NHS. 700m divided by roughly 7m DNA's is 100 per appointment. So that should be the fine. Make it clear on the appointment card, or hospital letter, that this is what you will expect to pay if you don't give notice of non-attendance or make a cancellation call well in advance of the appointment time. The hospital, or doctors surgery, will at that time, give you a random number (hospitals can generate their own list of numbers in one column and assign your name and hospital number against it), to prove that you cancelled in time.

Sadly, it seems this is the only language some people understand.

Please share your thoughts below, thank you.

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