Missed NHS appointments - to fine or not to fine?

[FactualFrank]

With regards to actually collecting fines, I would say that the fine should be paid on arrival for a future appointment, be it one week later or five years later.

Don't pay, don't see a NHS Doctor.

But that appointment could still have been used by somebody else if they fail to show. And what if they fail to show multiple times? A better optoon would be them having to pay the fine before the next appointment booking is actually accepted. If they can't pay, then that appointment space can be used by somebody else.

[Paul Waine]

http://www.bbc.co.uk/news/health-38899811

worth a read.

Excellent post, Sidney. Best post on this thread by a long way. I've learned some things by reading it. All countries should look at how other countries manage their health care systems - and be prepared to change to follow the best.

I'm picked out a couple of sections below. I recommend all read this BBC report comparing NHS and Germany's health care.

NHS Health Check: How Germany's healthcare system works

"The day after his hip replacement, Georg Thoma was cheerfully sitting up in bed. Like most Germans, the businessman pays into compulsory health insurance. He contributes 7% of his salary before tax and his employers match that amount. In return, patients get access to care which is so rapid that national waiting data is not collected. "The doctor said to me that I have to decide when I get the operation. Normally it takes three or four weeks."
Georg travels for work to the UK and tells me he was astonished to hear that patients can sometimes wait months for a similar routine operation.
Germany's spending on health care is relatively high, just over 11% of its wealth, compared to 9.8% in the UK and it has more doctors and hospital beds per patient than the UK. Georg's operation was carried out in an 80-bed hospital in one of the Black Forest towns in the south-west region Baden Wurttemberg. But even in Germany's well-funded system, the financial viability of a hospital this small is not guaranteed."

Different systems
Germany
Nine out of 10 Germans pay 7% of their pre-tax salary into statutory health insurance, matched by their employers
Pensioners and the short-term unemployed also contribute, children are covered by their parents and the federal government compensates for the rest
The highest earners, civil servants and the self-employed have private insurance but use it to access the same doctors and hospitals
There are more hospital beds, and doctors per patients than in the UK, and you can go directly to see a specialist based in the community
Germans also pay a smaller amount into long-term care insurance, but families have to pay a significant amount for social care

UK
In every part of the UK, the NHS is paid for out of general taxation and the proportion of public money allocated to it is a matter of policy for each of the devolved governments
Patients have direct access to a GP, but have to be referred to see a specialist, who mainly work in hospitals, with the exception of some specialities like psychiatry
There are waiting targets, but for some routine operations patients can face waits of many months
Social care is means tested and access is increasingly restricted to those with the highest level of need. There is no insurance to cover for old age care

The lessons for the UK are that money on its own is not the only solution, although it does ease pressure in the system considerably.
Finding better co-ordinated ways of looking after patients, often elderly, with the highest health needs is a priority.
And in Germany, despite the long-term care insurance, families still have to contribute a significant amount to looking after older people.
However, there is a mechanism for sustainable funding for social care that is very different from the significant reductions in care budgets seen in the UK.

[HatfieldClaret]

That's all right if you have money to burn and the cost of a holiday is petty cash. Not many of us are in that position. If a cataract operation can be put off for a week at no inconvenience to the hospital, then why shouldn't it be?

If someone is waiting for a knee or hip replacement then why would they book a holiday when they know it might clash. Most Trusts will offer 2 dates. If neither is accepted then it's back to the GP to refer you when it's convenient for you.

But like I say, the hospitals admin needs to seriously improve.

[CrosspoolClarets]

The BBC report comparing to Germany was very simplistic but still had some very good bits. You could tease out the pros and cons of both systems fairly well. We are better in many ways - efficiency, community nursing etc. Germany is better in others. The report was right to point out that funding levels are only a small part of it.

The top five things I would change, off the top of my head, are:

1. Charge for missed appointments, and offset it a bit by scrapping parking charges.
2. Restructure to remove the purchaser / provider split, merge with social care, and have a combined health and social care with money devolved to each region on a fair basis. Tertiary activity, where patients are seen outside their region for specialist stuff, could have an arrangement to fund it correctly too. This would obviously remove perverse incentives where hospitals are paid more for doing more, instead money goes to funding agreed required capacity.
3. Raise the funding level to a developed world average, and completely devolve the spending of it to the regions, a bit like Manchester are doing now. Politicians should have strict limits on what they can do. Consider funding this with a new insurance plan but this could be a red herring.
4. Make the entire focus on value for money, not on efficiency. In other words, maximising patient outcomes and minimising the cost of those outcomes. That involves a complete redesign of the work NHS finance teams do, with them working closer to clinical teams instead of in a dark room somewhere (my specialist area).
5. Performance manage the regions and the services within them from NHS Improvement, with a complete focus on value for money (if patients suffer, e.g. on trolleys in corridors, that is poor VFM and thus a poor rating). Make clear to the public how each region is doing service by service, focusing on capacity, demand, and performance.

There you go, a solution for the NHS. I’ve been making this kind of suggestion to fairly important folk for 30 years, it’s major but “do-able”, but will any politician have the balls to do it? Not a chance, Labour and Tory alike. We’re stuck with the shambles we have.

[Sidney1st]

Great post Crosspool.

Out of interest what's your opinion of poor senior managers who jump ship before they get the boot and join another trust on the same pay etc?

[DavidEyresLeftFoot]

Why "shut the debate down?" Is the NHS "sacrosanct" so that it cannot be discussed? We know it has it's shortcomings?

Sorry I didn't want to write any longer post than I did! No i'm not denying there are issues that could be sorted. It just annoys me when people trot out the usual lines of inefficiency without having the first clue about how the NHS actually functions. The two main areas that are absolutely screwing the system are PFI and pharmaceutical companies. It's already been discussed elsewhere about procurement of drugs. It's scandalous that the companies get away with such variation in pricing. The NHS should be able to negotiate drug prices based on total use within the system - and reap the benefits accordingly. Unfortunately the opposite seems to happen. PFI don't even get me started on.

I mentioned about lack of beds earlier and it is a real issue. Over the years we've closed all community beds which could have been used for some of the "bed blockers" for want of a better term. Again, to quote the Germans they have 3 times the number of hospital beds and double the number of doctors. Clearly that allows you to do more in terms of timely access to elective services.

[DavidEyresLeftFoot]

So years of financal waste and mismanagement by successive Labour and Tory governments can be ignored then?

You mention a reduction of beds over the last parliment, meanwhile previous governments partially or fully closed other hospitals which has also contributed to this shortage but don't worry about mentioning that.

Several people on here have stated that control of the NHS needs to be taken away from Politicians who use it for point scoring and it needs to be ran in a manner that is in the middle of Tory cuts and Labour giddly pouring money into it.

Sorry I didn't want to write too much in a single post. I don't disagree with what you've written - my feelings aren't led by affiliation to any party. I've voted in different ways over the years. It's a fact though that since the late 70s we've virtually halved the number of acute hospital beds in this country. The results of that have finally come home to roost.

Add that to the mindboggling staffing policies of the last 2 governments and you realise why the staff have also finally had enough. There's only so long you can run a service at full throttle on the goodwill of your staff.

Regarding the flu jab - it only works on i think 3 strains. Viruses mutate all the time. So it's far from effective in everyone. Flu (proper flu) kills. And yes, hospitals are full of the elderly and immunocompromised patients who are seriously sick with it. They're the ones waiting in A&E corridors, not the people who've stubbed their toe.

[Paul Waine]

Sorry I didn't want to write any longer post than I did! No i'm not denying there are issues that could be sorted. It just annoys me when people trot out the usual lines of inefficiency without having the first clue about how the NHS actually functions. The two main areas that are absolutely screwing the system are PFI and pharmaceutical companies. It's already been discussed elsewhere about procurement of drugs. It's scandalous that the companies get away with such variation in pricing. The NHS should be able to negotiate drug prices based on total use within the system - and reap the benefits accordingly. Unfortunately the opposite seems to happen. PFI don't even get me started on.

I mentioned about lack of beds earlier and it is a real issue. Over the years we've closed all community beds which could have been used for some of the "bed blockers" for want of a better term. Again, to quote the Germans they have 3 times the number of hospital beds and double the number of doctors. Clearly that allows you to do more in terms of timely access to elective services.

Hi DELF, no worries. Agree about PFI, agree about pharmaceutical companies with generic drugs. Politicians (and civil servants) errors in both cases.

Again and again I feel that "free at the point of treatment" is the underlying cause of all the NHS ills. Give people health insurance policies. Let them decide what health care treatment they need and where they are going to get it done. Let doctors/hospitals compete for their patients "custom." It will soon sort out the capacity needed and place the beds/hospitals/doctors et al where they are needed - and with the medical skills that are needed.

Crosspool refers to the "agreed required capacity." But, who is deciding on that capacity? Under the NHS it is politicians (whether national or local) and medical bureaucrats and, maybe, doctors. We need the patients to be involved - and the doctors/hospitals to follow the patients' money.

Crosspool also speaks about "value for money." But, who decides on "value for money?" Again, politicians, bureaucrats and doctors. Again, what about the patients? The NHS have decided some people can have hip replacements - but must wait 18+ weeks before their operation, they've also decided some other people cannot have hip replacements, Why? What about the individuals all having the money to make their own decisions? (Of course, for "hip replacement" substitute any other elective health care need).

Compulsory health care insurance, with provisions that everyone has health insurance so that no one is excluded from good health care, can give us a better health care system than the one we've had for 70 years.

There are a lot of things the BBC report on German health care doesn't say: who owns the hospitals? who employs the doctors? who decides how many beds are required? and, so on and so on.

Germans are paying 7% of the gross salaries for their health insurance - and their employers pay an additional 7%. (BBC doesn't say whether the self-employed pay 7% or 14%). I guess we'd all be surprised how much of our tax goes to fund the NHS. Maybe if we all had our own health insurance and saw what we were paying for it, and we also had control over how we experienced health care we would be happy to see the UK health care system well funded.

Just a thought.

[joey13]

He is right about winter flu. The reason for the current crisis is largely because the elderly or those with comorbidities are suffering from flu.

The flu vaccine is always made months before they are sure what strain of flu it will be. Basically they guess because they have to. Once the flu is here its too late to manufacture the volume needed before the outbreak. The vaccine worked last year but it doesn't seem that way this year. The vast majority of wards in my trust have more than 3 elderly patients who should be on elderly wards but are not because there are no beds. That has a knock on.

Closing A and E departments isn't necessarily a bad thing either. Before Burnley General closed both Blackburn and Burnley had A and E departments which didn't have all the specialists in the same place. That's a nightmare particularly in poly-trauma. Now go to Blackburn no matter what is wrong the speciality is there. Tories reducing beds and staffing is the issue, not closing A and E departments.

Flu vaccine doesn’t work for over 65s
http://www.dailymail.co.uk/health/artic ... inter.html" onclick="window.open(this.href);return false;

[dsr]

If someone is waiting for a knee or hip replacement then why would they book a holiday when they know it might clash. Most Trusts will offer 2 dates. If neither is accepted then it's back to the GP to refer you when it's convenient for you.

But like I say, the hospitals admin needs to seriously improve.

For one thing, I knee or hip replacement is a much bigger thing than a cataract - I'm not sure you could call it "minor". And for another, usually you aren't immobilised by hip or knee trouble, just in pain. And the suggestion that you shouldn't book a holiday for the next 18 months just because you might be scheduled for an operation seems a bit cruel - getting away for a bit of sun, for example, could do the patientr a world of good.

It's not a difficult system really. At some point, the hip replacements for 1st July are going to be scheduled. This will be before the 8th, 15th, 22nd July etc. So make your list of 1st July appointments and send them out. Any patients who are booked away can ring back and ask for it to be put back a week into the wide open unbooked spaces of the 8th. The newly vacant space can be given to whoever is now top of the waiting list.

Is that so hard?

[CrosspoolClarets]

Response to Sidney and Paul:

Manager rotation (a la Premier League) - it only tends to be the Chief Execs with the occasional other senior staff member. On one hand, there is an argument that “compromise payments” should be repaid if a new job is found within a timescale, but on the other hand, a bit like football, the CEOs often get the boot due to politician or doctor fallout (and contrary to popular opinion, not all doctors are whiter than white). Also, CEO is an unpopular, stressful and thankless task, with arguably only one job in each town so changing often involves a forced relocation for the whole family. These are some of the UKs top people, being paid far less than a FTSE100 CEO to run a far more complex organisation with far more staff dissent and politician bullying. I tend to be sympathetic.

Capacity - to decide capacity one also has to predict and decide demand. Patients should of course get a huge say in where they are treated, and how. But this is possibly the most complex of any organisation in the world in any industry or sector. Patients cannot be expected to decide. Nor should politicians. The experts should, i.e. the CEOs referred to above and their senior teams, involving all disciplines including medical, surgical, nursing, business planning and finance, and contrary again to popular opinion, all are equally important to the NHS because they all have the optimum expertise in their particular field. For example, trying to run a £1bn hospital without any corporate expertise would indirectly probably lead to thousands of extra deaths each year.

Value for money - again, the patients should of course get a huge say, but the experts should choose. There are worldwide VFM standards being developed. Personally, I think it should be broad. Paul turns up at GP with a sore knee aged 50. Plays a lot of sport. Turns out he needs a menisectomy. The outcome - the degree to which he is treated as pain free and quickly as possible, gets back to sport quickly, and doesn’t go back to the GP with recurring symptoms. The “outcome”, and thus VFM, should measure all that but the NHS doesn’t do it - Paul doesn’t even get asked for feedback from his GP or hospital when he gets back after his op. This should all be measured for every patient, and the “optimal” pathway agreed with patient groups for each condition. We are in a big data world but don’t use it. So yes, patients should be involved, but trust the real experts to know what they are doing (not the politicians).

Sorry to ramble, I’m currently leading a project at the moment that we hope will be world leading with some of the above, outside the NHS, so it is a bit close to my heart. I’m only posting now cos I’m stuck in a hotel bored after a day slogging away at it. The weaknesss in the NHS though that I talked about earlier make doing what I am doing almost impossible were I to try it in the NHS. It’s not all one page page sufficiently, too much kicking it around politically.

[Sidney1st]

Interesting reading, cheers.

[Rick_Muller]

Germans are paying 7% of the gross salaries for their health insurance - and their employers pay an additional 7%. (BBC doesn't say whether the self-employed pay 7% or 14%). I guess we'd all be surprised how much of our tax goes to fund the NHS. Maybe if we all had our own health insurance and saw what we were paying for it, and we also had control over how we experienced health care we would be happy to see the UK health care system well funded.

Just a thought.

Here’s a thought Paul, how about we all contribute a percentage of our salaries for things like the NHS, and while we’re at it, state pensions and the state benefits system... let’s say about 12% of our weekly income for, let’s just pull some figures out the air, earnings between £157 and £866 per week and an additional 2% on top of that for earnings over £866. If these payments were ringfenced to only provide for these services it would be great wouldn’t it?

It already exists - it’s our National Insurance payments. Trouble is, politicians seem to want play games with the funds and screw it up. Said before, it needs to be outside of normal government control and a cross party system set up to manage and control it. If it’s not enough, and we need to pay more then so be it.

Crosspool has some great commentary on the subject, thanks for the input.

[Paul Waine]

Response to Sidney and Paul:

Manager rotation (a la Premier League) - it only tends to be the Chief Execs with the occasional other senior staff member. On one hand, there is an argument that “compromise payments” should be repaid if a new job is found within a timescale, but on the other hand, a bit like football, the CEOs often get the boot due to politician or doctor fallout (and contrary to popular opinion, not all doctors are whiter than white). Also, CEO is an unpopular, stressful and thankless task, with arguably only one job in each town so changing often involves a forced relocation for the whole family. These are some of the UKs top people, being paid far less than a FTSE100 CEO to run a far more complex organisation with far more staff dissent and politician bullying. I tend to be sympathetic.

Capacity - to decide capacity one also has to predict and decide demand. Patients should of course get a huge say in where they are treated, and how. But this is possibly the most complex of any organisation in the world in any industry or sector. Patients cannot be expected to decide. Nor should politicians. The experts should, i.e. the CEOs referred to above and their senior teams, involving all disciplines including medical, surgical, nursing, business planning and finance, and contrary again to popular opinion, all are equally important to the NHS because they all have the optimum expertise in their particular field. For example, trying to run a £1bn hospital without any corporate expertise would indirectly probably lead to thousands of extra deaths each year.

Value for money - again, the patients should of course get a huge say, but the experts should choose. There are worldwide VFM standards being developed. Personally, I think it should be broad. Paul turns up at GP with a sore knee aged 50. Plays a lot of sport. Turns out he needs a menisectomy. The outcome - the degree to which he is treated as pain free and quickly as possible, gets back to sport quickly, and doesn’t go back to the GP with recurring symptoms. The “outcome”, and thus VFM, should measure all that but the NHS doesn’t do it - Paul doesn’t even get asked for feedback from his GP or hospital when he gets back after his op. This should all be measured for every patient, and the “optimal” pathway agreed with patient groups for each condition. We are in a big data world but don’t use it. So yes, patients should be involved, but trust the real experts to know what they are doing (not the politicians).

Sorry to ramble, I’m currently leading a project at the moment that we hope will be world leading with some of the above, outside the NHS, so it is a bit close to my heart. I’m only posting now cos I’m stuck in a hotel bored after a day slogging away at it. The weaknesss in the NHS though that I talked about earlier make doing what I am doing almost impossible were I to try it in the NHS. It’s not all one page page sufficiently, too much kicking it around politically.

Appreciate your response, crosspool. I know you do a tough job in health care sector.

I'd give you an argument about the challenges of FTSE100 CEO compared with NHS Trust CEO. The former have most often got a global business to run and more employees in their business than in any individual NHS Trust. I'm sure there are a large number of challenges for NHS CEOs and management of resources, agreeing and co-ordinating plans with the other NHS "stakeholders" and making the right choices are critical.

My key point about (1) capacity and (2) vfm is that in a health insurance funded care system these decisions can be made by the "fund holder" i.e. the patient with the health insurance and health needs on one side and the competing health care providers on the other. Competition for the patient's payment should generate "cost-efficient capacity" to do what is needed when it is wanted.

If I'm paying - through my health insurance - I'm best placed to judge personal vfm if I need health care to enable me to get back playing 5-a-side again. But, if you asked the guys I played with, one or two might say their knees will be less painful if Paul doesn't play any more.

And, Paul isn't 50, I'm now 64. Would the NHS judge it vfm to get me back playing 5-a-side at my "bus pass" age? (Note: my cardio consultant has said I'm fit to go skiing. I guess he might not be making the NHS vfm decision, either).

[dsr]

These are some of the UKs top people, being paid far less than a FTSE100 CEO to run a far more complex organisation with far more staff dissent and politician bullying. I tend to be sympathetic.

For one thing, that's a sign that FTSE directors are being paid far too much, not that health service directors are being paid too little.

But for another, their job is very different from a FTSE director because it's a completely different emphasis. The FTSE director's main worry is to bring in the customers and bring in the money. That's the hard part. Looking after the expenses is easier. The NHS directors don't have that worry at all because the customers will keep on coming - they only have to deal with the expense side.

[Paul Waine]

Here’s a thought Paul, how about we all contribute a percentage of our salaries for things like the NHS, and while we’re at it, state pensions and the state benefits system... let’s say about 12% of our weekly income for, let’s just pull some figures out the air, earnings between £157 and £866 per week and an additional 2% on top of that for earnings over £866. If these payments were ringfenced to only provide for these services it would be great wouldn’t it?

It already exists - it’s our National Insurance payments. Trouble is, politicians seem to want play games with the funds and screw it up. Said before, it needs to be outside of normal government control and a cross party system set up to manage and control it. If it’s not enough, and we need to pay more then so be it.

Crosspool has some great commentary on the subject, thanks for the input.

Great idea, Rick. I'm sure if the government wanted to change the NHS funding from taxation based to compulsory health insurance then they would roll in the NIC contributions into the health insurance premiums. But, as you identify, NIC just goes into the general pool of taxation, and our contributions are nothing like Germany's 7% of all gross pay, plus additional 7% from employer - just for health care (including some social care, I think). We also qualify for some state benefits from our NIC records, JSA, state pension etc - and then others who don't have NIC payment record can also qualify for some state benefits.

I think the only way to get it outside government control is to make it personal health insurance policies and let the patient decide where their health care is provided; maybe this could include health care in other countries.

[Hipper]

How has the population increase and aging affected things?

From what I can see, over the last thirty years - 1987-2017 - the population of the UK has gone up from 56.8 million to 65.2 million.

The percent of those aged over 65 has increased over thirty years - 1984-2014 - from 15% to 18%.

Meanwhile the number of NHS beds in England has gone down from 299,000 to 142,000 over the same period.

https://www.theguardian.com/news/databl ... n-data-ons" onclick="window.open(this.href);return false;

https://www.kingsfund.org.uk/publicatio ... ed-numbers" onclick="window.open(this.href);return false;

https://www.ons.gov.uk/peoplepopulation ... 2015-09-30" onclick="window.open(this.href);return false;

[HatfieldClaret]

For one thing, I knee or hip replacement is a much bigger thing than a cataract - I'm not sure you could call it "minor". And for another, usually you aren't immobilised by hip or knee trouble, just in pain. And the suggestion that you shouldn't book a holiday for the next 18 months just because you might be scheduled for an operation seems a bit cruel - getting away for a bit of sun, for example, could do the patientr a world of good.

It's not a difficult system really. At some point, the hip replacements for 1st July are going to be scheduled. This will be before the 8th, 15th, 22nd July etc. So make your list of 1st July appointments and send them out. Any patients who are booked away can ring back and ask for it to be put back a week into the wide open unbooked spaces of the 8th. The newly vacant space can be given to whoever is now top of the waiting list.

Is that so hard?

Knee replacement ops shouldn't be funded for people who just kinda want want kinda just after my summer hols but before Xmas so I can get my shopping done, oh and not half term week. Every other Saturday is out as well coz Burnley are still in the Prem and my mate wants to go to Ibiza for his stag do. Can you not just cancel someone elses this Friday.....

When you are dealing with a waiting list of over 100 at 1 hospital for a knee replacement declining a date will put you back several weeks. You either need the op or you don't. If you don't need it then come back when you do. Waiting lists are generally done a couple of months in advance. They cant do more than that because they don't know which staff will be on leave etc. Everything will not always go to plan though; even surgeons and anaesthetists get a bad cold, have childcare problems or a prang on the way in to work.

[Lancasterclaret]

My Mum is going through the knee replacement process now.

If only it was just one appointment you have to book and the NHS to schedule.

Like a great many things that sound ace when they are a catchy soundbite or come across as eminently sensible, the actual reality of what it involves is slightly harder and more complex than that.

I'm still struggling though to get my head around the concept that the NHS should work around around peoples holidays btw.

[CrosspoolClarets]

For one thing, that's a sign that FTSE directors are being paid far too much, not that health service directors are being paid too little.

But for another, their job is very different from a FTSE director because it's a completely different emphasis. The FTSE director's main worry is to bring in the customers and bring in the money. That's the hard part. Looking after the expenses is easier. The NHS directors don't have that worry at all because the customers will keep on coming - they only have to deal with the expense side.

That is true but hospitals (not CCGs) have to pay great attention to their activity which directly drives their income, and must have a clear understanding of which activity is loss making. I would state with conviction that managing activity (I.e. customer volume) is far harder in a big NHS trust than, say, a FTSE 100 bank or energy company.

To put that in context, a fairly big NHS Trust like East Lancs will probably have 1m+ unique “customers” each year, consuming resources and attracting income. Every one is unique, even for a boring minor elective operation. The hospital will also have 10,000+ unique “products”, I.e. treatments and consultations of different types. Even within a product (using my above example of a menisectomy) there may be 5,000 customers in a year and every one is different. Some stay in for 1 day, some 2. Some take 19 minutes in Theatre, some 27. Etc.

Companies like Shell and Barclays will be way, way short of this type of complexity. I see management consultants come in who have worked at these places and it blows their mind.

Wrapping all that in the context of income, expenditure, capacity, demand and patient outcomes for the whole of East Lancs is a challenge unparalleled. It is so hard to plan, and to manage, and the expertise is needed corporately while the doctors and nurses “get on with the job of treating people”. Then you get posts like Paul’s above, quite reasonably saying that as a “customer” he wants a big say. Quite right, but it is hard factoring all those opinions into that mix, and I’m not sure health insurance will be a magic bullet to allow it to work better.

[ClaretCliff]

Just a couple of observations from recent personal experience:-

In December I went for an Abdominal aortic aneurysm screening. Turned up at the venue and sat down with 3 or 4 other men. The medics came out of the treatment room and called out the name of the next person. If they received no response they moved on to the next name in the list. Over 50% of the names called out whilst I was there were absent. The screening is voluntary and so I can imagine that some chose not to attend as well as those who simply forgot. Why not at least ask for confirmation of attendance when the original letter was sent out?

Earlier last year I received a letter offering me a date and time for an appointment. The letter said if the time was not convenient than I should return the enclosed slip stating that I could not attend and I should give a list of other dates when I could not attend. I would then be offered a new date. There was no guidance on timescale, ie. dates within next week/month/quarter, etc. I didn't think I would be available for the next 3 Christmas periods but didn't think that would be of much help to them . Surely a single phone call would have been much more efficient during which we could agree an appointment date - instead at least two letters were sent by them and one by me. (The was no provision made for me to ring them on receipt of the first letter).

[dsr]

Knee replacement ops shouldn't be funded for people who just kinda want want kinda just after my summer hols but before Xmas so I can get my shopping done, oh and not half term week. Every other Saturday is out as well coz Burnley are still in the Prem and my mate wants to go to Ibiza for his stag do. Can you not just cancel someone elses this Friday.....

When you are dealing with a waiting list of over 100 at 1 hospital for a knee replacement declining a date will put you back several weeks. You either need the op or you don't. If you don't need it then come back when you do. Waiting lists are generally done a couple of months in advance. They cant do more than that because they don't know which staff will be on leave etc. Everything will not always go to plan though; even surgeons and anaesthetists get a bad cold, have childcare problems or a prang on the way in to work.

You're deliberately misunderstanding. (I hope.)

My mother had a holiday booked when her second cataract appointment came through. She rang Airedale hospital (which I think is a lot more understanding and efficient about these things than Blackburn) and told them she was on holiday; they recheduled it for the week after. It was not an inconvenience, and it saved a few hundred pounds. Is that so unreasonable? The NHS is supposed to be free at point of use, but that becomes irrelevant if they're insisting people cancel holidays at vast expense.

If you can point to the posts where I mentioned Christmas shopping and stag dos, I'l be impressed.

[SonofPog]

So many people saying.... the NHS needs to change, or the NHS is so inefficient.

WRONG- DONT BELIEVE THE TORY PRESS WHICH IS FUNDED BY USA PRIVATE MEDICARE.

(Sorry for shouting, but this is one of the biggest lies the press tells us, the DAily Hate just loves to run a negative NHS story,

But here's the true, the NHS is one of the most effective and COST effective health systems in the world. Regularly being voted number 1.

https://www.theguardian.com/society/201 ... are-survey" onclick="window.open(this.href);return false;

(The USA is bottom, a lot, it's the most ineffective health care system because of collective bargaining and shameful profit rackating)

Yes the NHS is big, yes it has no flexibility, and yes sometimes it can go slow. But it's a bl00dy marvel, staffed buy real heroes.

Keep the NHS publicly funded and free at the point of use!

(P.s Labour didn't throw money at the NHS, they through money at private companies via PFI contracts which were very generous and completely put all the risk into the government, hmm where have we heard that before... those new hospitals will be still be paying off for decades to come)

[Erasmus]

I missed an appointment at the GPs a few days ago. I just lost track of the dates over Christmas and it slipped my mind. I think I deserved to pay a £10 or £20 fine, but I can appreciate that this would be harsh on those at the lower income levels.

[Inchy]

Most trusts have now cancelled all elective surgery until Feb at the earliest on the demands of J.Hunt. Trusts get paid a large chunk of money for these elective ops and this will only increase their debt problem. Because trusts are fined for long waiting lists I imagine trusts will now be forced to contract out many of these operations to the private sector. What a joke

[HatfieldClaret]

You're deliberately misunderstanding. (I hope.)

My mother had a holiday booked when her second cataract appointment came through. She rang Airedale hospital (which I think is a lot more understanding and efficient about these things than Blackburn) and told them she was on holiday; they recheduled it for the week after. It was not an inconvenience, and it saved a few hundred pounds. Is that so unreasonable? The NHS is supposed to be free at point of use, but that becomes irrelevant if they're insisting people cancel holidays at vast expense.

If you can point to the posts where I mentioned Christmas shopping and stag dos, I'l be impressed.

I'll admit getting on my high horse and being argumentative. Sometimes it's not a problem to re-schedule and I'm glad it worked out for your mum.

I work for the NHS and do see and deal with some patients living in la-la land, and we have a couple of thousand outpatients a day coming through the doors for one reason or another, so everyone's expectations just can't be met.