Missed NHS appointments - to fine or not to fine?

[beddie]

The problem with that is how do you get the money if they don't pay. Do you then not allow them another appointment? It's a tricky situation.

[smudge]

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.
Rr 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.

Just curious how you identify these people that we've all seen.
Do you ask them,do you ask the doctor,or is it by just looking at them.

[Inchy]

I think asking drunks to pay for their care could cost more to implement than its worth.

Imagine the increased number of security needed to deal with the issues caused by asking a drunk Yorkshireman for money.


The NHS is going to massively fail this winter. Its going to be make or break and at the end of it serious decisions will be made. With this government I can only see this heading towards a more private system. I am not necessarily saying that's a bad thing but the way in which the Tories have forced this issue is sickening. IMO the Tories have purposely underfunded the NHS and purposely made it more difficult to train nurses with the ultimate intended outcome of making the NHS not fit for purpose, therefore requiring drastic action.

People state it wasn't much better under Labour but I read the other day that 8 years ago hardly any trusts were in debt. Now pretty much all trusts are in debt.

IMO the NHS should be run by a cross party committee made up by politician with relevant skills e.g. Doctors, successful businessmen. Personally I wouldn't mind pay 5% more tax to fund the NHS if it was ring fenced for specific areas e.g. Cancer care, urgent care. And not spent on more cosmetic treatments

[Roosterbooster]

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!

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!

Whilst the NHS is the envy of many, having worked in more than one health care system, I can speak from experience when I say that there are other publicly funded health care systems which are better.

Studies suggest the NHS is the most efficient health care system in the world (politicians often quote this as meaning it is the best in the world), and this may be so. But efficient doesn’t mean best. I can buy a Chomp for 10p. That’s excellent value for money. But I wouldn’t serve a Chomp for dessert on Christmas Day.

As a proportion of GDP we actually spend less than most comparable countries. We get a huge amount out for what we put in, mainly because of the generosity of the staff working in it, and the volunteers and charities supporting various causes. I won’t say there isn’t wasted money in the NHS, of course there is, and in reality it needs a huge overhaul to cope with the modern world. It has been too slow to evolve since it was set up nearly 70 years ago. But to argue it isn’t underfunded is just plain ignorant. This last week has seen a service in crisis, despite an almost “bailout” sum of money being used to try and avoid the winter pressures. We have lost hospitals, wards, beds, A&Es, nurses, doctors... the list goes on. A winter bailout won’t solve this.

[Firthy]

The problem with that is how do you get the money if they don't pay. Do you then not allow them another appointment? It's a tricky situation.

People who miss appointments will not pay the fine and it would cost more to collect than the fine is worth. Guess the ethics committee would have a field day if you refused them another appointment so not practical either.

Easiest way would be to charge for any following appointments. It's a penalty rather than a fine and you aren't refusing to treat them.

Miss one appointment and you have to pay £10 for another appointment.
Miss two appointments and you have to pay £20 for another appointment.

And so on as a rising scale.

[ClaretDiver]

The flip side is that a friend of mine needs a minor op, he works away a lot and can't choose his surgery day, because the last three dates he has been sent weren't suitable he has now been referred back to his GP....he will now go through the same rigmarole as before....could they not just give him an option??

[Lancasterclaret]

As an ex-NHS worker who worked at the end of the last Lab govt to the Con/Lib Dem coalition I can only say two things.

1) it was better under labour, but only because the trusts were allowed to do whatever they wanted. One ward in our hospital had all its staff nurses on holiday at the same time and just paid for the O/T and agency staff to cover it

2) As soon as the Cons/Lib Dems changed things, Trusts had to justify their expenditure and I remember the e-mails from frantic people who hadn't been doing their job properly for years asking for stuff from years ago as they were suddenly asked to justify their position.

But it went too far (as it always does)

There has to be a balance somewhere and it has to be found, or we won't have an NHS.

Against charging for missed appointments btw, as I'm not sure it would come out as even cost neutral at best.

[Sidney1st]

Just curious how you identify these people that we've all seen.
Do you ask them,do you ask the doctor,or is it by just looking at them.

Are you telling me you haven't seen someone with just a cold at their doctors?
I've heard the idiots telling their mates they've got a cold and that's why they're there.

I've also seen numerous people going to various hospitals pretending to have whiplash for their dodgy insurance claims, which is something else that needs putting a stop too as it's a waste of time and money.

There is lots of stuff that goes on and consumes much needed time and resources in our hospitals/GP's when really it shouldn't.

[Sidney1st]

As an ex-NHS worker who worked at the end of the last Lab govt to the Con/Lib Dem coalition I can only say two things.

1) it was better under labour, but only because the trusts were allowed to do whatever they wanted. One ward in our hospital had all its staff nurses on holiday at the same time and just paid for the O/T and agency staff to cover it

2) As soon as the Cons/Lib Dems changed things, Trusts had to justify their expenditure and I remember the e-mails from frantic people who hadn't been doing their job properly for years asking for stuff from years ago as they were suddenly asked to justify their position.

But it went too far (as it always does)

There has to be a balance somewhere and it has to be found, or we won't have an NHS.

Against charging for missed appointments btw, as I'm not sure it would come out as even cost neutral at best.

Great comment and something that lots of Labour supporters aren't willing to admit was happening.
They just claim Labour was better because it just poured money into the NHS.

Does happen across numerous sections of the Public sector, not just the NHS.

[Firthy]

The flip side is that a friend of mine needs a minor op, he works away a lot and can't choose his surgery day, because the last three dates he has been sent weren't suitable he has now been referred back to his GP....he will now go through the same rigmarole as before....could they not just give him an option??

He's been given three options. Sorry but he should be working round them if he wants the op. Not the hospital working round him.

With the NHS as stretched as it is he's going to have fit in with them. Imagine the mayhem if every patient was given an option.

[Tall Paul]

Whilst the NHS is the envy of many, having worked in more than one health care system, I can speak from experience when I say that there are other publicly funded health care systems which are better.

Studies suggest the NHS is the most efficient health care system in the world (politicians often quote this as meaning it is the best in the world), and this may be so. But efficient doesn’t mean best. I can buy a Chomp for 10p. That’s excellent value for money. But I wouldn’t serve a Chomp for dessert on Christmas Day.

As a proportion of GDP we actually spend less than most comparable countries. We get a huge amount out for what we put in, mainly because of the generosity of the staff working in it, and the volunteers and charities supporting various causes. I won’t say there isn’t wasted money in the NHS, of course there is, and in reality it needs a huge overhaul to cope with the modern world. It has been too slow to evolve since it was set up nearly 70 years ago. But to argue it isn’t underfunded is just plain ignorant. This last week has seen a service in crisis, despite an almost “bailout” sum of money being used to try and avoid the winter pressures. We have lost hospitals, wards, beds, A&Es, nurses, doctors... the list goes on. A winter bailout won’t solve this.

This post raises a very important question.

Where can you get a Chomp for 10p these days?

[ClaretDiver]

He's been given three options. Sorry but he should be working round them if he wants the op. Not the hospital working round him.

With the NHS as stretched as it is he's going to have fit in with them. Imagine the mayhem if every patient was given an option.

I don't agree, my friend is a a top leader in internet security worldwide, why can't the NHS give him options of times and dates???

[ClaretDiver]

I don't agree, my friend is a a top leader in internet security worldwide, why can't the NHS give him options of times and dates???

Why don't they utilise the phone and call him and say, ok Mr x, we have several options available, which would you prefer! Rather than arbitraly sending a date that might not be suitable.

We have had the same issue with my wife who is a stroke survivor, they send appointment dates out according to their schedule with no consultation of whether it is a suitable appointment....

Ok, she can make that appointment, can you provide transport...no, well it's not suitable due to other commitments....

[Firthy]

This post raises a very important question.

Where can you get a Chomp for 10p these days?

That question could be answered in so many ways

[Roosterbooster]

This post raises a very important question.

Where can you get a Chomp for 10p these days?

Excellent question!

Buy in bulk from shops that sell items that are nearly out of date. Try Nelson Arndale (or whatever it is called now). Bargains to be had...

Which raises another important point actually. bob-the-scouter mentions the NHS employs a huge number of people. It’s a mammoth organisation. But different parts are completely isolated from each other. The NHS spent club together and buy everything in bulk to save money. Individual trusts etc negotiate their own deals. Such a waste.

[Sidney1st]

Haven't they done the bulk buying thing before and got ripped off?

We know the Public sector is guilty of over paying for goods/services, so whatever works to stop that is great.

[bobinho]

The flip side is that a friend of mine needs a minor op, he works away a lot and can't choose his surgery day, because the last three dates he has been sent weren't suitable he has now been referred back to his GP....he will now go through the same rigmarole as before....could they not just give him an option??

Seems to me he needs to work out what’s more important to him. He needs an operation? He tells his employer he needs time off when the date comes through. I’m just a little confused as to what the NHS can do here other than refer him back to his GP.

[ClaretDiver]

Haven't they done the bulk buying thing before and got ripped off?

We know the Public sector is guilty of over paying for goods/services, so whatever works to stop that is great.

Look at their failed attempt at a centralised computer system....

[tybfc]

This post raises a very important question.

Where can you get a Chomp for 10p these days?

How much a twix?

[bob-the-scutter]

This post raises a very important question.

Where can you get a Chomp for 10p these days?

Certainly not in the hospital foyer, they are at least a pound!

The NHS is NOT underfunded, it`s just funded incorrectly with far too much money wasted and that`s why it needs completely dismantling and rebuilding for this century. You can throw as much money as you want at it, (As labour will no doubt do) but it will make no difference, just make a lot more managers richer!
It`s high time politics was taken out of the equation and handed over to people who actually have an idea how it should be run.

[houseboy]

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.

What if he actually pricks someone?

[ClaretDiver]

Be afraid as I believe Richard Branson has just won the contract for Lancashire NHS Trust!!!

[Sidney1st]

Look at their failed attempt at a centralised computer system....

I'm not allowed to mention that, upthebeehole get's upset because it's true and he doesn't like to admit Labour messed that one up.

[houseboy]

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

Agree in principle with the following caveats:
A: I can fine them every time I call my GP and I can't get an appointment.
B: I can fine my GP every time I call and it's engaged until all the appointments are gone.
C: I can fine them if I am kept waiting in the surgery or hospital till 1pm for a 10am appointment.
D: I can fine them if I need urgent A&E and am kept waiting for 8 hours.
E: I can fine them for waiting an hour for an ambulance to turn up.
I'm sure if we could all fine each other every thing would be just.....fine.

[boatshed bill]

What about charging £10 for every appointment made, and then giving it back when they attend...simples

[Inchy]

Excellent question!

Buy in bulk from shops that sell items that are nearly out of date. Try Nelson Arndale (or whatever it is called now). Bargains to be had...

Which raises another important point actually. bob-the-scouter mentions the NHS employs a huge number of people. It’s a mammoth organisation. But different parts are completely isolated from each other. The NHS spent club together and buy everything in bulk to save money. Individual trusts etc negotiate their own deals. Such a waste.

Trusts bulk buying is something which is being brought into effect as we speak. The problem is for large trusts like Manchester. For example they might pay £1 for a syringe where Airdale pay £1.50 because they don't buy as many. The Carter report recommended bulk buying so the NHS is now tendering for certain products to be provided by 1 or 2 suppliers. Issues have arisen because only 1 company can meet that demand. It also creates a monopoly where the smaller suppliers stop making the products so the tendered supplier can bump their prices up once the tender is finished as they have the market. Also trusts like Manchester will be out of pocket whist Airedale will save money. However, there is no way suppliers will let their profits slip so they will manipulate pricing to ensure this.

Why would a trust like Manchester want to have their costs increase? Its one of the problems with having separate budgets for separate trusts

[aggi]

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;

Good in theory, the difficulty being trying to see your GP. Last time I phoned mine I was in pretty much constant pain, couldn't walk, couldn't even sit down comfortably and was offered an appointment in two and a half weeks (which is fairly standard). I opted to go private but for someone who couldn't afford that option you can see why they'd head for A&E.

[HatfieldClaret]

I don't agree, my friend is a a top leader in internet security worldwide, why can't the NHS give him options of times and dates???

I've seen this scenario quite a few times before. With reasons for the date not suitable as being "I'm due to go on holiday" to "Having my hair done that day". Referred the patient back to the GP saying please re-refer when the patient is ready for treatment.

The numbers are just too great to make it convenient for everyone. If I need a back operation because of the pain then the op comes before my foreign holiday.

It's not just a case of throwing money at it though, it needs a shake up. A case yesterday the elderly patient had an appointment to review the MRI scan. the scan had been delayed a fortnight but the clinic didn't rearrange the orthopaedic appt. Transport collected the patient for him to be told there was no appointment and transport to take him home again. A single instance but often enough is costly poor administration.

[Tall Paul]

I don't agree, my friend is a a top leader in internet security worldwide, why can't the NHS give him options of times and dates???

If he has such an important, and presumably very well paid job why doesn't he go private?

[Sidney1st]

If he has such an important, and presumably very well paid job why doesn't he go private?

It's free, that's why.
As such many people will use it and complain about it when they could easily afford to go private.

[Rick_Muller]

Be afraid as I believe Richard Branson has just won the contract for Lancashire NHS Trust!!!

It is scary to think that Virgin will be involved in healthcare. I saw the below picture in the lift when I went for my routine blood test at Bedford Hospital on Tuesday... It is an amateur attempt at an information sheet, but not actually passing on any information. I had to go and google to understand what the cr@p attempt at an information sheet was telling me. The next image shows what I was presented with when I clicked the link. If anyone is under the illusion that this government isn't trying to privatise healthcare - WAKE THE F#CK UP....! Its happening right now under your very noses.

[Firthy]

Be afraid as I believe Richard Branson has just won the contract for Lancashire NHS Trust!!!

Will he have beans on the lunchtime menu?

[Sutton-Claret]

This.

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

Agreed. Sounds likes a good idea but common sense must prevail.

I prefer the 3 strikes and out idea

[Hipper]

I've not had a hospital appointment for years but it used to be that specialists/surgeons would over book appointments because they knew a percentage would not turn up. The point was to make sure the doctor was continually active and not wasting valuable time waiting for clients. That makes sense but of course if those estimated to not turn up actually do, it often meant long waiting times for those that turn up at the appointed time. Which is very irritating for those who responsibly attend as agreed. Therefore if these practices are still carried out the issue needs to be resolved not only for NHS efficiency but also for those NHS clients who reliably turn up.

Do doctors still over book these days?

On cosmetic surgery, one could argue that some is medically necessary. For example, Down's Syndrome people often have an extended tongue which makes them look odd. Surgery used to be one solution although I don't know if it's still considered. Large noses and small breasts can also be psychologically damaging.

[Roosterbooster]

Its one of the problems with having separate budgets for separate trusts

I think this last sentence summarises my issue perfectly. We could still buy from different suppliers, but if it was done centrally then the NHS could control the market better. Rather than the suppliers controlling the NHS.

I’ll give you a perfect example. There is a prostate cancer drug. The supplier provides this for free to hospitals. So the hospital provides this drug to start with when the patient is discharged. The GP is then forced into providing the same drug longer term. But the supplier charges the GPs a huge whack for it. Meanwhile, another prostate cancer drug, which does exactly the same thing, is much cheaper, but isn’t provided to the hospitals for free. Hence fewer patients are on it. Overall.... The NHS loses out!

[Rick_Muller]

It's free, that's why.
As such many people will use it and complain about it when they could easily afford to go private.

Sid - we all know its not free, it is funded by taxes and NI. I would welcome an increase to both to ensure that it remains a good service. I agreed with you before about governments of both colour degrading the NHS, and I think previously we agreed that the NHS needs managing outside of the 4-5 year cycle of government via cross party control and management.

In terms of going private - thats all well and good as long as you dont actually get ill, if you do, your premiums go up massively and you'll be back on the NHS waiting lists before long - of course as long as the NHS is there. The big picture is that this is social cleansing, those who can afford healthcare will get it, those who cant wont and the consequences will dire.

[Roosterbooster]

Do doctors still over book these days?

I can’t remeber the last clinic I did which wasn’t overbooked. It does mean patients are often waiting way beyond their allocated time, but they are also probably seen 3-4 weeks earlier than they otherwise would have been. Extra patients also get booked in last minute, just because they NEED to be seen urgently.

There will always be no shows, and sometimes this helps, but usually it just wastes resources.

[bobinho]

Why don't they utilise the phone and call him and say, ok Mr x, we have several options available, which would you prefer! Rather than arbitraly sending a date that might not be suitable.

We have had the same issue with my wife who is a stroke survivor, they send appointment dates out according to their schedule with no consultation of whether it is a suitable appointment....

Ok, she can make that appointment, can you provide transport...no, well it's not suitable due to other commitments....

Maybe i'm misunderstanding - if I am, apologies. But...

Is the NHS now into transportation of people to and from appointments? I don't know because i'm lucky enough to be one of those people who just pay into the system, and i'm not in need of their services - yet. If we have `service users` who require a lift to make appointments, and can't get there themselves due to mobility issues, or family members can't help, then lets help them. That's the right thing to do, but if we are asking for a lift because "i'm doing something else on that day, at that time" then we really HAVE lost sight of why it was invented in the first place. Seems like a question of priorities. I know what i'd do if I needed an appointment for my health issues - there wouldn't be other commitments. Sometimes, we just need to help others, help us.

[Roosterbooster]

Governments of both colour degrading the NHS

The NHS needs managing outside of the 4-5 year cycle of government via cross party control and management.

If you (get ill) your premiums go up massively and you'll be back on the NHS waiting lists before long

All excellent points, bang on the money

Politicians are such short term thinkers that they should be pawns only when it comes to managing such a complex service

Look at how travel insurance costs go up if you are ill. It’s extortionate. A private scheme works only for the über-rich, or the perfectly healthy

[smudge]

Are you telling me you haven't seen someone with just a cold at their doctors?
I've heard the idiots telling their mates they've got a cold and that's why they're there.

I've also seen numerous people going to various hospitals pretending to have whiplash for their dodgy insurance claims, which is something else that needs putting a stop too as it's a waste of time and money.

There is lots of stuff that goes on and consumes much needed time and resources in our hospitals/GP's when really it shouldn't.

There are many reasons for people to visit the doctors.
The elderly perhaps because they are lonely and frightened.
Young mothers concerned for their children.
Neither you are I have a right judge these people.

[wilks_bfc]

Be afraid as I believe Richard Branson has just won the contract for Lancashire NHS Trust!!!

Not entirely correct.

Virgincare have won the contract for the county’s “Healthy Child Programme”, which was previously held by Lancashire Care NHS Foundation Trust

[Inchy]

I agree Rooster. Certain products like syringes and needles are used in every trust in the country and each trust spend part of their budget on them. They all want the best price but of course that depends on buying power. Those products should be procured centrally.

The problem is all NHS England are doing is saying "this is what you have to buy at this price" That price maybe more for Manchester and it negatively effects their budget. They don't get any of that money back so as always there is a knock on effect and money has to be cut from somewhere.

Another example like yours is Catheters which my trust get for pennies but in the community the gubbins needed for the Catheter cost community trusts a fortune. My trust wont take the financial hit to save the communities budget. Its all too disjointed and of course suppliers know how to exploit it

[Guich]

Whilst the NHS is the envy of many, having worked in more than one health care system, I can speak from experience when I say that there are other publicly funded health care systems which are better.

I won’t say there isn’t wasted money in the NHS, of course there is, and in reality it needs a huge overhaul to cope with the modern world. It has been too slow to evolve since it was set up nearly 70 years ago. But to argue it isn’t underfunded is just plain ignorant. .

I agree Rooster, but it'd be far better to sort out the inefficiencies and waste before increasing the funding, otherwise we'd risk going back to an over-funded, inefficient NHS. Problem is, staff morale is low and departments and external partner services work in silos. Work together and patient flow would speed up rapidly.

Back to the original question, fines might work, but some trusts I know have put a clinical doctor as a gate-keeper in A and E and that made a huge impact, 50 per cent and more people being redirected or sent home quickly. These are trusts where morale is relatively high.

[Sidney1st]

There are many reasons for people to visit the doctors.
The elderly perhaps because they are lonely and frightened.
Young mothers concerned for their children.
Neither you are I have a right judge these people.

I'm not judging those people you've mentioned, I've taken my kids to the doctors when I'm not sure what's up.

I'm talking about people who visit the NHS is it's many forms for simple things they could sort out themselves, from the common cold to a minor graze.
Unfortunately it happens when it shouldn't.

Lonely elderly people need better care etc and this was mentioned on the radio yesterday.

Various parts of the NHS and social care chains need sorting out so it all runs in a more efficient and productive manner.

[Inchy]

Surely all we need to do is look at other countries who have a better universal healthcare system and a better social care system and copy them?

Am I right in thinking most Scandinavian countries are good on both fronts? I wonder what their spend is compared to ours

[Spijed]

Do doctors still over book these days?

Every six weeks I have my haematology consultation at the hospital to review my blood tests and unless I get an early appointment it means I can wait between 2-3 hours to be seen because there are too many patients for the number of slots available.

Even more frustrating when I get told my blood results are normal. I've even asked why the just don't call people in who have abnormal results but I was told they like to see each patient in person!

[Rick_Muller]

... but I was told they like to see each patient in person!

thats to ensure that they get the funding for your treatment

[Sidney1st]

Surely all we need to do is look at other countries who have a better universal healthcare system and a better social care system and copy them?

Am I right in thinking most Scandinavian countries are good on both fronts? I wonder what their spend is compared to ours

I suppose a lot would depend on whether or not governments in different countries feel the need to use their health system in a game of political football...
That's our biggest issue in the UK.

[Inchy]

I suppose a lot would depend on whether or not governments in different countries feel the need to use their health system in a game of political football...
That's our biggest issue in the UK.

or the fact that most of the public don't seem to care that politicians do this.

Someone like myself who is young and fit, very rarely needs to use the NHS is a prime example of the demographic who don't care that its abused in a political way. However recently I had to use it because my dad had stroke symptoms on XMAS day. Even if I was loaded there is no private hospital A and E departments, and I very much doubt any private CT scanners were in use on XMAS day. Its when something like this happens makes you realise how important a decent NHS is, particularly in the acute phase of care. There are no other options

[Sidney1st]

So the younger people don't worry about the political football until they or someone they care about needs the NHS in an emergency?

That would be the same generation who believe that it was better under Labour I suspect.

Hope your dad's ok.