Forum Topic

Fines for people who do not turn up to NHS appointments?

It seems that the race to the bottom between Sunak and Truss as to who can come up with the most barking right wing policies to ingratiate themselves into the party members has found new depths.Sunak's latest is fines for people who miss doctors' or hospital appointments.  How will that work?• Poor people who are struggling to get through the week will not make appointments at all, for fear of missing them and being knocked even further over the financial edge.  They will postpone treatment (consequentially potentially becoming more expensive for the NHS if their conditions deteriorate).  Contagious diseases will not be treated, and may spread throughout the population.  • Those who can afford it may see it as a “fee”, to allow them to miss an appointment without guilt. Sunak should read the Gneezy and Rustichini study (“A Fine is a Price”, Journal of Legal Studies 20.1 (2000) which found that when fines were imposed for parents who picked their children up late from day care saw the fine as a "fee" and actually encourage more parents to pick up their child late because they felt they had permission, and had paid for it.• How will the NHS collect the fine?  Prevent patients receiving any more treatment until they have paid?  Employ debt collectors?  Make it a criminal offence to not go to the doctor?• What about people who have a good reason for not being able to make the appointment (bearing in mind that we are talking about people who, by definition, are ill)?Only a person who has never been poor, or even (as he admits) even ever had any “working class” friends could come up with something so stupid.

T P Howell ● 1513d84 Comments

I wonder how many of the no-shows are dead?  A couple of days after MIL died a physio turned up at her home.  I can assure you we were in no state to deal with an appointment we had no idea about.How good is the communication between surgeries and hospitals nowadays?  And what happens if you die abroad?  Has this now been sorted so that the authorities including surgeries and hospitals are informed automatically as well as the DWP?I once had one of those missed hospital appointment letters.  It worried me as I wasn't aware of needing to go to hospital  and didn't have any appointments.  I phoned the hospital - it was their mistake.  There are lots of people with the same names and presumably occasionally similar numbers and I don't believe that computerisation always avoids these problems.  There used to be ward clerks who were more aware of what the TEAMS on wards were doing.  Cutting down on staff for the last 10+ years did us no favours when it came to a predicted sometime pandemic.People move home all the time and some more than others.All this computerisation has made it very difficult for those who are elderly with poor sight and hearing who are unable to come to grips with the ever changing technology of methods of doing things. A very organised elderly friend with sight and mobility problems often seems to turn up to hospital by taxi only to discover that the consultant isn't there for one reason or another and the appointment has been cancelled last minute.It would have been more interesting if he had plans to increase and ensure that we had enough medical cover in terms of NHS medical staff but you can bet that there is heavy lobbying of the private kind.

Philippa Bond ● 1512d

I wonder how much of this is about putting out a political narrative that the reason that the NHS is struggling is because "it's the patients' fault" (and not a fundamental problem of inadequate funding).Blaming the patient is a more simplistic and superficially attractive excuse (for a government that perfers soundbites and accepts responsibility for nothing) than the fact that UK public health funding falls far behind other comparable developed countries (although this funding gap is partly explained by the relative efficiency  NHS "free at the point of use" model, i.e. avoiding all the frictions and leakage of insurance companies, shareholder profits, payment systems, adminstration, etc. etc.).The UK falls behind France, Luxembourg, Australia, Ireland, Canada, Netherlands, Sweden, Denmark, Austria, Norway, Switzerland and the US.  https://data.oecd.org/healthres/health-spending.htmUK public health spending 2021 was $4,466 per head.  Netherlands  $5,256.  Germany $6,351.  So if we spent the same as Germany (42% more) or even the Netherlands (17.6% more) then I expect that we could sort out most of the problems in the NHS relatively quickly.(Although UK ONS shows the UK spend to be considerably lower - £2,647 per head, or 8% of GDP, compared with France £3,307 (9.3%) or Germany £4,131 (9.9%) and the G7 average (distorted by the US £6,782 (13.9%) of £3,524 (9.9%). But either way, the fact is that the UK spends considerably less than comparable countries).What would an extra, say, 20%, wisely spent on the NHS do for treatments, waiting lists, recruitment etc.?  I suspect that this would resolve most of the problems (once ramped up over a period of time in a managed way).This would require the overall amount of tax raised in the UK to increase from 33% to 35% of GDP.Would you be prepared to pay 6% more in taxes (overall - including indirect, e.g corporation tax, VAT, etc. etc) for a properly funded NHS? That's about 1.2p on the basic rate of income tax, 2.4p on the higher rate, or 1p on the rate of corporation tax.  Around £233 more tax a year for someone on the mean average salary for all workers in the UK of £31,447.Or put another way, about an additional £8 bn a year (for England). Or a quarter of the missing £32 billion that dissappeared on "track and trace".A junior doctor’s salary in the UK ranges between $29,000 to $40,000.  In Ireland, the same doctor earns between €43,000 to €51,000 (and the dollar and Euro now almost the same).  Nurse's average salary Ireland = £40,579.  UK = £33,305.  And the UK has a significantly higher cost of living than most other European countries.The US spend per head (public health / compulsory insurance) is $10,052 (more than two and a quarter times the UK), and total spend (i.e. including directly privately funded) is $12,318 (compared with $5,468 UK).  And yet this is the model (perhaps the most inefficient in the World - causing 62.1% of all personal bankruptcies in the US) that many in the Conservative party are advocating.  Yet another example of political dogma (or promotion of vested in interests) over evidence based policy making.

T P Howell ● 1504d

Re missed appointments: - I don't know much (well, anything really) about the NHS at an operational level (other than as a user).But it seems to me that for general appointments, provision for missed appointments can be (and indeed is) built into the system.  The NHS will have enough data to know how many appointments are likely to be missed, and arrange bookings accordingly. it's what the airlines, and most other service providers do. I.e. take account of predicted "no shows", and plan accordingly.I can see that "no shows" could be a real problem for major operations, etc. where resources (human and infrastructure) have to be booked out for a long period (hours - a day), so that if a patient does not show up, this is a serious waste of time and resources.  If this is a problem, then I am sure that there are more direct and effective ways to solve it.But beyond this - it is difficult to see how ad hoc no shows could be a material cost to the NHS.In any event, before presenting knee-jerk popularist "solutions", proper identification and analysis of the problem is needed first.  Intuitively, I think that a scatter-gun imposition of fines is unlikely to work, and is likely to have unexpected adverse consequences (poor people, or people on zero hours contracts who may be called into work at short notice, not booking at all for fear of missing an appointment and being fined, etc).For example, my recently late mother suffered dementia in the last years of her life.  The hospitals who were treating her for various conditions were supposed to notify me and her carers of appointments, but frequently did not. As a consequence, I am sure that she made a significant contribution to missed appointments statistics. Fining her would have made absolutly no difference (and indeed the prospect would have terrified her to the point that she would have refused any appointments at all).  I am sure that many "repeat offenders" will fall into similiar circumstances.  It seems unlikely that someone who has a medical condition that needs treatment would intentionally miss appointments - except in very rare cases where there is some wider underlying social, mental or medial issues.Which comes back to the fundamental points:1  Is this a real problem, or is it a smoke-screen?2  If it is a real problem, is fining people likely to be an effective solution?3  The real issue here (on objective comparative data) is that the UK underfunds its health system.

T P Howell ● 1504d

In fact the objective data shows that the NHS is relatively efficient.  4th out of 11 countries reviewed in the Commonwealth Fund analysis (with the US 11th out of 11 on all measures apart from "Care Process").The data published by the King's Fund "Health and social care in England: tackling the myths" makes good reading for anyone who has an interest in this subject (beyond simplistic sound bites).The nub of it is that we under invest in health care in the UK.  And the level of under-investment has got worse over the last decade under the excuse of "austerity".  The richest 1% of UK households now own 43% of all wealth, whereas the bottom half of the population hold only 9% (2018/2020).  We are the sixth richest economy in the World, and yet our government chooses to underinvest in health care.The reports support the views:1  That the NHS is relatively efficient; and2  That we spend less than comparable countries on health care (and that we are falling further behind).As the King's Fund report says:  "Compared to other countries, the UK does not spend a particularly high proportion of its national wealth on health care, while a decade of historically low funding increases has left services facing huge pressures and a workforce crisis. Like levels of taxation and public spending more generally, how much is spent on health is a political choice and politicians should be honest with the public about the standards of care they can expect with the levels of funding provided."So a bit more tax, and better health care, or continue to fall further behind comparable countries?  It's our choice.https://www.kingsfund.org.uk/publications/health-and-social-care-england-myths?gclid=CjwKCAjwi8iXBhBeEiwAKbUofQLdE0jdQ9RTIqs5Oj7JuoXhiIpHXB4RrW7W4Z2v-QQ6zo9n9sBcORoCabAQAvD_BwEhttps://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly#rank

T P Howell ● 1504d

" This is a bizarre thread."What may seem truly bizzare for somebody with fortunately limited experince of tne NHS (tonsils 1948) is that it was at any time standard practice within the NHS that if a patient failed to turn up on time for their appointment everyone sat around twiddling their thumbs in the hope of their eventually turning up Instead of immediately cancelling/delaying their appointement and dealing with the next patient instead.The NHS must be about the only organasation I can think of  - ( unlike say aitlines where it will actually cost passenfgers money if they fail to turn up) where no mechanism is desigbned into the appoinrments system to accomodate the inevitable no-showsPaediatrics is obviously somewaht different as the patients themselves aren't respomsible for making tneir own  travel arrangements, and so are possibly are desrving of a greater degree of laxityAs to fines there may be all sorts of legitmate reasons why patients fail to keep appointment and fail to cancle while some may be simply feckless; but  I can see no real evidence why feckles people should neceassarily be deterred by fines which many might not be able to afford to pay in the first place; and who possibly won't suffer the biggest impact of those fines as with others who are forced to rely on them - peadiatrics again,Basically it a management problem; to design an appointements system which can best accomnmmodate an ineviatble percentage of no-shows with the least disruption to the system overall.Blaming the customers as opportunistic Tory politicians or inneficient Practice Managers  are wont to do is simply a sign of poor management  IMOmichael adams

Michael Adams ● 1498d

This has been a complaint for years but obviously more and more people are now using mobile phones and computers.  People who can access the internet can also find much more info about their medical complaints including the relevant charities and telephone numbers and email addresses.Doctors' practices are supposed to be the gateway to referrals.  Some now don't even have a doctor and can be extremely difficult to get the appointment to get a referral.  An elderly friend who has poor sight and can't use her computer and mobile phone ended up sitting in a waiting room until she was seen so could be referred recently.  She has in the last year or so actually been by taxi to at least two hospital appointments which had been cancelled and she had not had the notification in time.I think everybody needs to check that they, their friends and relations update their addresses and telephone numbers with their doctors so that they are accessible.  Who tells the hospital when you move?  We should all know that there is a great digital divide which grows with a decline in hearing and sight and mobility and when any system eg a telephone needs to be replaced and the way the new one works has to be learnt.I think my MIL missed a hospital appointment when she was actually an inpatient in the same hospital.  We went to another later (two of us taking time off work and travelling across the country - one to park and one to accompany) and a long wait which was a waste of time because they had lost her notes.  A physio certainly turned up to see her a day or two after she died in hospital.I'd like to think that things have improved.  I certainly found my Moorfields @ Ealing visits to be well managed but I do worry about who you will be targeting with this.

Philippa Bond ● 1497d