NHS drive to reduce ‘no shows’ to help tackle long waits for care

The NHS has this week launched a major drive to reduce hundreds of thousands of missed hospital appointments every month, to help boost the recovery of elective services.

As part of the biggest and most ambitious catch-up programme in NHS history, hospitals have been asked to ensure they are sending timely appointment reminders, improving processes for cancelling or rebooking, and considering remote appointments where appropriate.

Trusts are also asked to consider implementing short notice lists, to contact patients last minute to help fill slots other patients cancel.

Over a fortnight (23 Jan to 3 Feb), NHS trusts will be looking at reasons why people miss their appointment and taking steps to address them, as often people can experience transport issues, difficulty taking time off work, or cannot arrange childcare for the time of the appointment.

Of the 122 million appointments booked last year (2021/22), around 6.4% were missed – around 7.8 million appointments a year and around 650,000 a month.

Every appointment freed up could be used to see other patients, including those who have been waiting the longest for an appointment or treatment.

Around four in five people on an NHS waiting list are waiting for an outpatient appointment which includes things like physio, dermatology, and minor procedures such as cataract surgery. Over three in five of outpatient appointments are follow-ups.

The NHS’ next elective recovery target is to eliminate waits of more than 18 months by April with 48,961 of the longest-waiters remaining as of November 2022, down two-thirds from a peak of 124,911 in September 2021.

Sir James Mackey, NHS National Director of Elective Recovery, said: “With NHS staff delivering more than two million outpatient appointments every week, and outpatients making up more than 80% of the overall waiting list, this drive to reduce missed appointments has the potential to make a huge difference in freeing up capacity and helping us deliver for patients.

“The reasons for missing appointments can vary hugely – which is why the NHS is aiming to make it easier for patients to cancel and rebook, offer remote appointments where appropriate and preferred and send more and better appointment reminders, while drilling down and tackling the root causes that lie behind non-attendances.

“We want to make the best use of every available slot we have – and that means more use of short notice lists, so that patients who are willing to be “on standby” can be ready to fill any empty appointment.

“With around one in 15 appointments missed it is important that where possible, patients let hospitals know as far in advance if they think they aren’t able to attend and share their experience with local NHS teams of any barriers impacting their ability to access care.”

Steve Barclay, Health and Social Care Secretary, said: “As we work to cut waiting times for patients and tackle the Covid backlog, it is vital the NHS does everything it can to address the 7.8 million hospital appointments that are missed every year.

“This new drive will reduce no-shows, fill last-minute cancellations and make it easier for patients to be assessed from the comfort of their home, where that is best for them.

“Every appointment freed up could be used for other patients, especially those who have been waiting the longest, helping us continue to make progress to reduce the longest waits.”

Chris McCann, Director of Communications for Campaigns and Insight at Healthwatch England, said: “Missing appointments is not something most people do intentionally; some people may miss appointments due to having caring responsibilities, work commitments or issues with travel.

“Our latest poll on the impacts of the cost of living crisis shows that out of 2,000 respondents, one in 10 said they had avoided an NHS appointment due to the cost of travel in December alone.

“It’s hugely important that the NHS is now looking at the reasons why people miss their appointments. We’ve welcomed changes to the NHS App which allow people to see when they have appointments coming up. We now look forward to more being done to make sure everyone can contact the NHS about their care.

“It’s vital that simple systems are put in place which help people attend, rearrange or cancel appointments in ways that suit them, be it via text message, letters, telephone or in person.”

As part of identifying health inequalities, a number of groups have been highlighted as needing particular consideration including those from deprived backgrounds, people who require carers, people with mental health conditions and vulnerable patients.

During a pilot, St Helens and Knowsley Teaching Hospitals NHS Trust were able to reduce missed appointments in their radiology department by 81%, after introducing text requests for patients to confirm in advance of booking in.

Sheffield Children’s NHS Foundation Trust reduced the amount of missed appointments, including phone call reminders a week beforehand and offering transport support like bus tickets or parking permits.

Sussex ICB reduced their missed appointment rate in September 2022 from 6.5% to 5.5% using telephone appointment reminders.

In 2016, a patient-led booking system at Guy’s and St Thomas’ saved the trust an estimated £2.6 million, with missed appointments reduced by 11% in six months. Patient satisfaction in the system was high, with more than nine in 10 recommending the new service.

By understanding the variety of causes behind missed appointments and working to reduce them, NHS teams can support patients to take control of their care and help reduce health inequalities. Evidence from Royal Cornwall Hospitals NHS Trust suggests that 10-20% of patients from the most deprived backgrounds were most likely to miss an appointment.

After the initiative, titled ‘Action on Outpatients – Reducing DNAs’, evidence will be gathered to assess which approaches had most impact and how these can be scaled up nationally.