Missed NHS appointments - to fine or not to fine?

[jdrobbo]

Huge fan of our NHS, but a radio show on the way home from work got me thinking.

Each day, thousands of appointments are missed across the country, without cancellation.

If the NHS were to introduce a flat £10 fine for everyone who doesn't attend an appointment without prior cancellation, what would your thoughts be on this?

It would save the service an astronomical amount.

J

[bob-the-scutter]

I agree. As long as I can also fine the NHS for every cancellation!

[bfccrazy]

Make it £20 and I'm in favour - If someone cant be bothered to call and cancel an appointment ..... Then they can't complain at being charged for it. Obviously there will be extenuating circumstances which would mean they had to miss it - But I would guess most won't fall into that category.

[taio]

I suspect the cost of administering such a scheme with a £10 flat rate fee would mean astronomical savings wouldnt be achieved.

[Mrpotatohead]

Fine and after 3 strikes ban people from using the service completely*. Inconsiderate people who can't attend an appointment and don't have the common courtesy to make an alteration are a real bug bear of mine. It isn't hard to attend an appointment, its even less difficult to make a phone call if you're unavailable.

*somewhat tongue in cheek.

[Dyched]

Make people pay for certain treatment

Eg. Prick decides to drink 54ltrs of vodka and needs stomach pumped. You pay prick.

Prick decides to wack someone with a weapon. You pay prick.

[dpinsussex]

£20 up front payment. Excluding kids.
Refund when turn up or knocked off any prescription costs.

[ElectroClaret]

I suspect the cost of administering such a scheme with a £10 flat rate fee would mean astronomical savings wouldnt be achieved.

This.

After collection/admin/red tape (including the inevitable appeals) the gain would be minimal.

[Spijed]

I reckon about 80% of all people in A&E don't really need to be there either.

[taio]

I reckon about 80% of all people in A&E don't really need to be there either.

Whilst several studies have shown a high number of inappropriate A&E attendances, it's not even close to 80%.

[Pimlico_Claret]

I was an NHS dentist for twenty years. Prior to the new 2006 dental contract we were allowed to charge for missed appointments at our discretion , we charged £5.00. It worked. The new contract stopped us from doing this, guess what, missed appointments quadrupled. It's not rocket science.

[Rick_Muller]

Whilst several studies have shown a high number of inappropriate A&E attendances, it's not even close to 80%.

Do you have evidence to prove this either way? I recall from senior management meetings in a NHS trust that the figure for some hospitals in the NW were higher than 80%, some were lower too - it appeared to be subject to location and social economic issues.

[bobinho]

£10 nowhere near enough. The NHS would need to employ thousands of people to implement, manage, data collect, blah, blah, blah.

Make it £50.

And for self inflicted (drink related) dickage, all treatment to be paid for.

We have lost sight of why the NHS and the welfare state were introduced. Bloody hell, we are sending people for boob jobs because small saggy tits makes em unhappy!!!

I’m sure there will be people who start skriking about “quality of life” and all that, but this sort of shite is crippling it.

There will also be those who suggest (for example) smokers with lung cancer should pay also, but this I believe needs some thinking about.

Anyway, yeah - fine em.

[taio]

Do you have evidence to prove this either way? I recall from senior management meetings in a NHS trust that the figure for some hospitals in the NW were higher than 80%, some were lower too - it appeared to be subject to location and social economic issues.

Around 11 per cent of people who attend A&E are discharged without requiring treatment, and a further 39 per cent receive guidance or advice only (NHS Digital 2017). This does not mean that all these people are attending A&E unnecessarily or could be cared for elsewhere. For example, someone who leaves A&E without being admitted to a hospital bed may well have attended appropriately because they required assessment or clinical advice from A&E professionals.

[Rick_Muller]

Let’s just fund the NHS appropriately instead of cutting the funding year on year as this government does [yes I know they put more money in than ever before, but it hasn’t accounted for inflation or population increases - the real investement per person has been dropping for years under governments of all colours]

[dpinsussex]

We have lost sight of why the NHS and the welfare state were introduced. Bloody hell, we are sending people for boob jobs because small saggy tits makes em unhappy!!!

Brilliant , that made me proper laugh. And absolutely agree.

Wait till the labour argument most "normal" people cant afford to pay for treatment argument . Its free all the time some other muppet pays for you.
Bit easy whem someone pays for you isnt it ?

(Not aimed at u btw)

[Spijed]

Around 11 per cent of people who attend A&E are discharged without requiring treatment, and a further 39 per cent receive guidance or advice only (NHS Digital 2017). This does not mean that all these people are attending A&E unnecessarily or could be cared for elsewhere. For example, someone who leaves A&E without being admitted to a hospital bed may well have attended appropriately because they required assessment or clinical advice from A&E professionals.

I always think that if you are quite prepared to sit and wait for over four hours you are unlikely to require emergency treatment. Surely urgent care departments serve the needs of those people better.

[cricketfieldclarets]

So many inefficiencies within the nhs that need addressing before they start fining the patients.

[taio]

I always think that if you are quite prepared to sit and wait for over four hours you are unlikely to require emergency treatment. Surely urgent care departments serve the needs of those people better.

Bear in mind that about three quarters of emergency hospital admissions i.e. to a ward come through a&e.

But i certainly agree there are too many people getting treatment in the wrong place:

Going to ED when they could be treated at an Urgent Care Centre or a Minor Injuries Unit
Going to Urgent Care when they could wait to see their GP
Going to see their GP when then could go to a pharmacy

[BarstewardsEnquiry]

I agree. As long as I can also fine the NHS for every cancellation!

This
A big thanks to my G.P. for cancelling my 8-15am appoinment at 8-03am yesterday by text message "due to illness" as I was about to walk into the surgery.
My re scheduled appointment is now 19th January. Oh and 1 hours pay down.

[bob-the-scutter]

This
A big thanks to my G.P. for cancelling my 8-15am appoinment at 8-03am yesterday by text message "due to illness" as I was about to walk into the surgery.
My re scheduled appointment is now 19th January. Oh and 1 hours pay down.

Yep. It should work both ways!

[mdd2]

Make people pay for certain treatment

Eg. Prick decides to drink 54ltrs of vodka and needs stomach pumped. You pay prick.

Prick decides to wack someone with a weapon. You pay prick.

And prick who smokes -does he pay along with the 20stone prickette who wont lose weight and the speed merchant who wrecks his car and brain along with the rock climbing prick who falls off the rock and breaks his leg and so on ad infinitum.

The reason we have so much or an alcohol problem is due to its price and availability-the latter thanks to Tony Blair.

[Dyched]

And prick who smokes -does he pay along with the 20stone prickette who wont lose weight and the speed merchant who wrecks his car and brain along with the rock climbing prick who falls off the rock and breaks his leg and so on ad infinitum.

The reason we have so much or an alcohol problem is due to its price and availability-the latter thanks to Tony Blair.

I agree

[Lowbankclaret]

I missed two appointments at hospital last year because the wonderful post office didn’t deliver the letters. They now text me and email me.
pO also lost 3 eBay parcels, no more Post office for me.

Yes I agree in principle however it’s not always the patients fault.

[Roosterbooster]

Yep. It should work both ways!

????????

You want a hugely underfunded, overstretched, free service to pay you??? Which would further underfund it and lead to more cancellations??

Or just get rid of it entirely and then see how you like it...

[ClaretAL]

As long as we can charge the government for the amount of lives being lost due to paramedics being forced to wait in the corridors because it means the hospital then don't have to start the clock for the amount of time patients are waiting to be seen after they are handed over, which could mean they are fined? Which in the end falls down to the amount of hospitals closed down and the amount of people in this country who don't pay anything in tax or national insurance to keep them open.

RANT OVER.

[bobinho]

Availability of alcohol has always been widespread. Even more so years ago when we had pubs.

And as for price, I think £2.50+ for a pint is expensive. Keep putting the prices up and another industry will struggle, and those who are loaded are the only ones in A&E. Except those that fall down the stairs at home. Price increases will eventually see people making their own and thus the black market for dodgy alcohol is born. That then becomes taken over by the criminal element, who do God knows what to it to increase profit margins... Other taxes go up due to the loss of revenue...

Simply putting prices up solves nowt really, it's all a bit unimaginative.

[mdd2]

I think you are wrong there bobinho. The relative price of alcohol is lower than it has ever been since the 'gin palaces"-check it out. The last time it was as available as today (after Blair abolished licesning hours) was 1914 and since about the 1980's the ability to buy alcohol has become progressively more easy.
Pricing would affect consumption as would curbing advertising-just witness the fall in smoking rates with price advertising and other curbs

[ElectroClaret]

Availability of alcohol has always been widespread..

No it hasn't. Certainly not like today.
You couldn't even buy it in supermarkets once, never mind the local garage/newsagents/wherever.

Its new availability is the main factor with the problems we're now having.
The scrapping of the 11oclock last orders law was a disaster.

[dsr]

Around 11 per cent of people who attend A&E are discharged without requiring treatment, and a further 39 per cent receive guidance or advice only (NHS Digital 2017). This does not mean that all these people are attending A&E unnecessarily or could be cared for elsewhere. For example, someone who leaves A&E without being admitted to a hospital bed may well have attended appropriately because they required assessment or clinical advice from A&E professionals.

Even the 11% who didn't require treatment didn't necessarily attend inappropriately. How are they supposed to know they didn't require treatment? That's why they needed a doctor - because they didn't know whether they needed treatment.

In an ideal world, only those who require treatment would visit A&E, and while we're being unrealistic we might as well insist they have already correctly diagnosed their illness or injury too.

And a word of warning to those who want to stop the less seriously ill visiting A&E. I had a tummy ache for a couple of days before it got worse on Saturday - not unbearably bad, but bad enough so if I was sat down I wanted to be stood up and vice versa - I was persuaded to go to A&E. Within an hour of arrival I was in a hospital bed on a drip. I never did feel terribly bad, but the doctors thought I needed to be there. If you work too hard to keep the not-really-needing it people away, then you're also going to keep away some of those who do need it.

[Claretologist]

Some interesting opinions here and the fines can work in some patient pathways e.g GP and clinics. However we are missing the main point. Due to the massive cuts, which have forced services such as A&E departments down (like Burnley's), the A&Es that remain have to deal with a large workload. I work in the major trauma centre in London, where we act as the Trauma centre (such as Preston or Blackburn), accepting all the emergencies in our catchment area. This backlogs our A&E due to Trauma being treated instantly. As a result the surrounding minor injury units are full, due to the long waiting times at the trauma centres.

For example with the terror attacks, we shut down our services to cope with the demand. Think of the collection of trauma that occurs in a day, equating to the same amount of treatment required for the major incident event of an attack, but the services continue. They continue with the hardwork of the staff, but when numbers reach as high as they do now, it becomes an equation of staff numbers and resources as sadly hardwork is not sufficent to deal with the situation.

We should be talking about who will give the NHS what it needs? No party is free from mistake, as we are always in debt, but money needs to be spent where its needed and not being cut to help the men in suits. We all know the tories have done that, if not you need to wake up and smell the coffee.

[taio]

Even the 11% who didn't require treatment didn't necessarily attend inappropriately. How are they supposed to know they didn't require treatment? That's why they needed a doctor - because they didn't know whether they needed treatment.

In an ideal world, only those who require treatment would visit A&E, and while we're being unrealistic we might as well insist they have already correctly diagnosed their illness or injury too.

And a word of warning to those who want to stop the less seriously ill visiting A&E. I had a tummy ache for a couple of days before it got worse on Saturday - not unbearably bad, but bad enough so if I was sat down I wanted to be stood up and vice versa - I was persuaded to go to A&E. Within an hour of arrival I was in a hospital bed on a drip. I never did feel terribly bad, but the doctors thought I needed to be there. If you work too hard to keep the not-really-needing it people away, then you're also going to keep away some of those who do need it.

The point is a proportion can be advised whether they need to be treated but that doesn't have to be at an Emergency Department. But I get you point and sometimes people are advised to go to ED by NHS eg 111 when it's not necessary, so it's not even the person's decision.

[Claretologist]

Even the 11% who didn't require treatment didn't necessarily attend inappropriately. How are they supposed to know they didn't require treatment? That's why they needed a doctor - because they didn't know whether they needed treatment.

In an ideal world, only those who require treatment would visit A&E, and while we're being unrealistic we might as well insist they have already correctly diagnosed their illness or injury too.

And a word of warning to those who want to stop the less seriously ill visiting A&E. I had a tummy ache for a couple of days before it got worse on Saturday - not unbearably bad, but bad enough so if I was sat down I wanted to be stood up and vice versa - I was persuaded to go to A&E. Within an hour of arrival I was in a hospital bed on a drip. I never did feel terribly bad, but the doctors thought I needed to be there. If you work too hard to keep the not-really-needing it people away, then you're also going to keep away some of those who do need it.

Well said. Who knows a sprained ankle from a broken one without the clinical/diagnostic tests? I bet all of us have been there and been told to ice it and keep it elevated. That counts as no treatment too.

[jurek]

Although I can appreciate many of the points put forward - be it for or against fining
non attenders - I do end up thinking it might be impossible to actually collect and unless it was a significant amount
(£50 or more?) it may cost more to collect than it might actually bring in.

We need to educate the public to cherish our NHS and not abuse it and hope the majority
respond although, no doubt, there will always be some who deliberately don't 'give a toss'.

[bobinho]

No it hasn't. Certainly not like today.
You couldn't even buy it in supermarkets once, never mind the local garage/newsagents/wherever.

Its new availability is the main factor with the problems we're now having.
The scrapping of the 11oclock last orders law was a disaster.

I hear what ur saying, years ago we didn't have massive supermarkets selling it. What we DID have were loads of pubs and clubs everywhere. Once of a day you could start a pub crawl at The Alma on Accy road, and if you had one pint in every pub on your walk into town, you wouldn't make it. Now you could make it, then jump in a car and safely drive home. Don't forget the Off Licences which were also widespread.
With regards to the extension of the licensing hours, what we lost were gangs of lads ramming ale down their necks because they only had four hours to do it. What didn't help was our `conditioning`. We'd been drinking like that for generations and It's taken quite a while to realise the pubs don't throw us out at three anymore, so we can stay out a bit longer as opposed to going home stocious to beat our wives. We just beat each other instead I suppose. Maybe the `plan` is to end up with ALL the pubs and clubs closed, so there's no reason for us to be in town fighting and puking and putting a strain on the NHS. That'll save on policing costs as well. Win, win... but I just don't get it.

I do agree that pricing affects consumption... is the suggestion we increase the price to make it the pastime of the extremely rich? Like I say, it won't go away, it'll move it underground, so to speak. We still have dangerous, non genuine, non regulated tobacco on the streets, and it's a lot more dangerous than the normal stuff.

You have a point about smoking, price increases helped in reducing the numbers, but lets not forget about information we had rammed down our throats for years. Anyone can find out just how lethal smoking is, that's gotta help in keeping the numbers down more than any other factor, including the ban in public areas. And we also have a `safe` alternative now don't we? I'm wondering how we can get the message across to people that drinking is bad for your health, like we did with smoking, because I just don't see anyone buying it.

[bob-the-scutter]

????????

You want a hugely underfunded, overstretched, free service to pay you??? Which would further underfund it and lead to more cancellations??

Or just get rid of it entirely and then see how you like it...

Yes.
And it's certainly not underfunded it's just run with OTHER PEOPLE'S MONEY And a large percentage of that is wasted. It may have been a good idea in centuries past but It's a dinosaur in today's world which needs either scrapping entirely or rebuilding from the ground upwards.
You don't actually buy the bull$hit that's it's "Envied by the world" do you?
It's the largest employer on the planet outside the Chinese military. A money pit!

[Paul Waine]

Huge fan of our NHS, but a radio show on the way home from work got me thinking.

Each day, thousands of appointments are missed across the country, without cancellation.

If the NHS were to introduce a flat £10 fine for everyone who doesn't attend an appointment without prior cancellation, what would your thoughts be on this?

It would save the service an astronomical amount.

J

Hi jd, I'm not sure if I've got this right, I think it was reported that missed appointments cost the NHS £600 million per year (I don't know how the cost was calculated).

So, maybe everyone should be charged for their appointments and they can only recover the charge if they attend. Missed appointments = no recovery.

If overstaying in a carpark, or not having a valid parking ticket is charged at £50 and more, then shouldn't it be an even higher charge for an NHS appointment?

Re admin: the glib answer would be to get the guys who chase for unpaid NHS carpark charges to chase also for missed appointments. There's no reason why a charging system should be "impossible" or "too costly" for the NHS to implement. By all reports GPs, consultants and others are all very good at submitting their own charges and getting paid.

I received a postcard (when postcards existed) telling me to attend for an operation. The card was posted 2 days after the operation was due to take place. So, of course, I didn't attend. This was 1963. I never did have that operation.

Yes, I now get texts reminders of appointments. Technology is great.

[Spijed]

Well said. Who knows a sprained ankle from a broken one without the clinical/diagnostic tests? I bet all of us have been there and been told to ice it and keep it elevated. That counts as no treatment too.

Tbf, as this advertising campaign highlighted too many people are going to the A&E simply for stuff that they really should see a GP about.

https://www.door22.co.uk/work/nhs-accid ... -campaign/" onclick="window.open(this.href);return false;

[Sidney1st]

We've all seen people attend their GP's or A&E when they really don't need too.

The NHS hotline are also guilty of advising people to attend hospital when they don't need too, probably in fear of being punished if they get it wrong.

Today's society needs to toughen up a bit and understand that a GP or A&E aren't going to make you better when you've got a cold or the runs.

The government are possibly going to start trialling 'Drunk Tanks' so the morons who can't handle their booze/drugs have got somewhere safe to sleep it off instead of going to hospital etc.
That shouldn't really need to be implemented, but unfortunately its the side effect of the society we live in.

Charging people for missing an appointment carries the usual risks and there will be the usual complaints that those on benefits can't afford a fine etc.

[tybfc]

Huge fan of our NHS, but a radio show on the way home from work got me thinking.

Each day, thousands of appointments are missed across the country, without cancellation.

If the NHS were to introduce a flat £10 fine for everyone who doesn't attend an appointment without prior cancellation, what would your thoughts be on this?

It would save the service an astronomical amount.

J

Great thread and interesting replies and I can really see both sides of the discussion.

A fining system is an excellent idea in principle but as said by others would be costly to administer if patients just don't turn up for appointments without cancellation and probably ending up not benefitting the NHS as it be hard to enforce.

As others have said on the flip side there are the cancellations that the hospitals are making without recompense to the patients.

One of our kids was due an operation towards the end of last year that was cancelled. It was re-booked and that was cancelled. It was re-booked for tomorrow and has been cancelled and re-booked for next week. Following Jeremy Hunt's statement today that won't be happening any time soon.

Fair play to Burnley hospital that they do everything to me by text message but my wife still has to keep booking / cancelling days off work but I would never dream of wanting to fine them a penny as they are obviously stretched to their limit.

One suggestion I would make is that they make more use of texts / emails to make appointments and cancellations as surely a massively high percentage of East Lancashire use the internet and it is far quicker and easier than posting them to lowbank.

[Inchy]

I always think that if you are quite prepared to sit and wait for over four hours you are unlikely to require emergency treatment. Surely urgent care departments serve the needs of those people better.

Not always the case though. My dad recently had a stroke and had to wait 6 hours to see a doctor (was seen by a nurse fair quick). He was then wrongly told to go home, only to be admitted via the stroke clinic two days later.


Last winter we were very fortionate that we didn’t suffer from a major flu, norovirus, or any other virus outbreaks. I predicted then that next winter the NHS would massively fail. It appears that prediction is coming g true

[Inchy]

As long as we can charge the government for the amount of lives being lost due to paramedics being forced to wait in the corridors because it means the hospital then don't have to start the clock for the amount of time patients are waiting to be seen after they are handed over, which could mean they are fined? Which in the end falls down to the amount of hospitals closed down and the amount of people in this country who don't pay anything in tax or national insurance to keep them open.

RANT OVER.

The main reason patients are kept in an ambulance is because it’s safer there than in a and e where there is no one to see them. Not to prevent fines. Ambulances are separate trusts to hospitals

[CharlieinNewMexico]

Haven't read the thread but my eye specialist here charges $100 for a no call no show. Because it's about 20% of what he can claim from my insurance if i do show. Steep but it makes sense for both parties, right? I mean how hard is it to call and say "hey, I can't make it tomorrow".

[ClaretDiver]

Not always the case though. My dad recently had a stroke and had to wait 6 hours to see a doctor (was seen by a nurse fair quick). He was then wrongly told to go home, only to be admitted via the stroke clinic two days later.

This is truly shocking, when my wife had her stroke we were stroke to scan in 35 minutes.....this was in Thailand.

I hope your dad is ok mate!! My thoughts are with you!

I have heard stories like this in the UK and it is a definate problem of an overstretched NHS.

[ClaretDiver]

Maybe it's time to implement a similar scheme to the Aussie one where you pay for your GP appointments and then get to claim a good proportion back...Medicare

[wilks_bfc]

Hi jd, I'm not sure if I've got this right, I think it was reported that missed appointments cost the NHS £600 million per year (I don't know how the cost was calculated).

The £600 million will be made up from the what the Trusts have missed out in claiming for seeing the patient.

Depending on the specialty of the appointment and whether it was a new or follow up appointment would determine the cost.
A new attendance to urology would generate a tariff of around £142, a new to respiratory £208. Followups for these are £54 & £94.

It’s also worth noting that these are national tariffs so unless Trusts have local agreements with the CCGs are the same for everybody (although each Trust does have an uplift for Market Forces Factor).

Also need to point out that some clinics overbooked, to hopefully allow for that however that creates issue if nobody DNAs

[Barry_Chuckle]

Politicians continue to quote "The NHS is the envy of the world" they say it so often hoping we believe it, truth is, they say it because they know it no longer is.
Instead of spouting this bile, they should get on and fund the service to the level required to make it the envy of the world again!

[Chobulous]

Tbf, as this advertising campaign highlighted too many people are going to the A&E simply for stuff that they really should see a GP about.

https://www.door22.co.uk/work/nhs-accid ... -campaign/" onclick="window.open(this.href);return false;

The problem is that when you need to you can't actually get in to see your GP. I have just spent 20 minutes this morning ringing our local GP to try to get an appointment for my wife. When I finally got through I was told that all appointments were booked up until Monday. This is a common occurrence at Parkside surgery.

[Sidney1st]

Politicians continue to quote "The NHS is the envy of the world" they say it so often hoping we believe it, truth is, they say it because they know it no longer is.
Instead of spouting this bile, they should get on and fund the service to the level required to make it the envy of the world again!

Labour try to pour money into it and it doesn't really make massive amounts of difference because it's spent so poorly.

Tories swing the cutting axe to much the other way to compensate usually.

[Sidney1st]

The problem is that when you need to you can't actually get in to see your GP. I have just spent 20 minutes this morning ringing our local GP to try to get an appointment for my wife. When I finally got through I was told that all appointments were booked up until Monday. This is a common occurrence at Parkside surgery.

Monday?

I usually have to wait 2 weeks in Didcot, unless it's an emergency.
I just tend not to bother with the GP unless it's for my daughter or for my Asthma (usually see the nurse for this one).