479,000 outpatient no-shows last year

I heard this figure on the radio the other day, and I assumed that it was a mistake. But on checking it, I see that it's true.

Is there no penalty for not showing up for an appointment?

If I book a medical appointment privately and don't show, I presume I will be charged for it?

It's interesting to see how it was reported at the time:

The Irish Times:
Over 500,000 waiting for hospital out-patient appointment

You will have to wade through 13 paragraphs and 9 other figures before coming to the figure for missed appointments.

But at least, the Irish Times covered it.

I can't find any reference to it in the Indo. But they have covered the waiting lists frequently - for example:
10pc of population on waiting list to see a specialist




The Examiner is the only paper to highlight it:
479,000 outpatient no-shows last year

Is it any wonder? How many of the patients are still alive?

"A patient has received an appointment for New Year's Day 2024 after being referred to St Vincent's Hospital for neurology treatment."
https://www.independent.ie/irish-ne...s-hospital-appointment-for-2024-36626554.html

At the other extreme, a family member once received an appointment letter AFTER the date of the appointment.

Can be a nightmare trying to call through to reschedule or cancel or rebook or just get basic information on the appointment.

Obviously, there's an element of forgetfulness going on too.

We need a proper 21st century appointment management system that supports access by phone & internet.

The walk in clinics at places such as Beaumont Hospital for chest x-rays are very well run, may I add, without appointment.

If I had an appointment for a genuine illness which I had to pay for, I would not forget it, even if it were 6 years away.

This is just another case of people abusing a free system. They make appointments and don't care. Maybe they are no longer sick and feel that they don't need to bother cancelling the appointment.

How can it be a nightmare to cancel? Just write a letter.

Agree that rescheduling might be difficult because the hospital would have to know when they next have a slot.

And of course, the system could be more efficient.

I have booked blood tests online in St. Vincents and it's very efficient. They sent me reminders by text. And I presume I could have changed them easily online if I had needed to.

Brendan

I tried for weeks to cancel an appointment by phone in a public hospital. The appointment letter had a number to call for cancellations which I used. No one ever answered the phone - it just rang out every time. I first tried to contact them about six weeks before the appointment date, so they would have been able to schedule someone else in. The date passed and I heard no more........

Well known in medical circles. The funny thing is there is no penalty for not turning up even for private appointments. In practice this means (like Ryanair) they overbook a significant amount of people on the public/private waiting lists each day as they know about 15/20% do not show up. They have made some noises recently that they are 'automatically removed' but there is no central policy in the HSE. In some cases they are automatically re-booked. Seems like we could whittle down that list pretty quick if a sensible policy was put in place. No show without exceptional circumstance = auto removal from the list. Also automate appointments so you can cancel and re-book without penalty.

geri said:

No one ever answered the phone - it just rang out every time. I first tried to contact them about six weeks before the appointment date, so they would have been able to schedule someone else in. The date passed and I heard no more........

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Of course, they should have answered the phone, but why did you not just write to them?

Brendan

Brendan Burgess said:

Of course, they should have answered the phone, but why did you not just write to them? Brendan

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How do you have a two-way discussion about suitable dates for a reschedule via a letter?

What kind of organisation complains about lack of notifications for cancellations, but issues phone numbers on the appointments letters that are never answered except during hours they mysteriously do not disclose to patients? It's amateur stuff.

odyssey06 said:

How do you have a two-way discussion about suitable dates for a reschedule via a letter?

What kind of organisation complains about lack of notifications for cancellations, but issues phone numbers on the appointments letters that are never answered except during hours they mysteriously do not disclose to patients? It's amateur stuff.

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Exactly. I attempted to cancel by following the instructions in the letter. Why should I have to write a letter? Even if I could have emailed I would have. It's a long time since I've had to write a letter for anything.

geri said:

Why should I have to write a letter? Even if I could have emailed I would have. It's a long time since I've had to write a letter for anything.

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Because the tax payer is paying to treat you pretty much free of charge. The fact that it is not an efficient system means that you don't just not cancel.

It would help others and the smoother running of the system had you just written and cancelled.

Brendan

An elderly relative of mine took up getting various health checks as a kind of a hobby. It was part interest, part neuroses I suppose.

He would get an appointment to see a specialist, it might be years in the future. Then he would go to the specialists clinic a few days later and basically chat up the receptionist, he was really good at this, very pleasant, very affable, never said what he wanted until he was asked. Any cancellation appointments available. Here is my number give me a ring, I'm free anytime.

His record was getting a four year appointment down to 3 days.

I wouldn't say there are too many people posting letters to hospitals to cancel appointments.

What was the cost to the taxpayer of the missed appointments. There needs to be an efficient way to cancel or the problem will continue.

geri said:

I wouldn't say there are too many people posting letters to hospitals to cancel appointments.

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That is clear from the figures, but that does not make it right.

They should charge people a decent amount for the appointment, and refund half of it when they attend.

Brendan

To be honest, and maybe it was thoughtless of me, but it didn't cross my mind to write a letter. If it happens again, although hopefully I won't have any further need of appointment, I'll write if I have to cancel.

Could the HSE handle 479,000 letters?

I wish they could give accurate appointment times. I have memories of getting 11 am appointments for a children's eye clinic and not been seen until 2 pm. 2 hours off work turned into a half day. The waiting room was too small for the amount there, mostly young children. Stressed parents trying to feed small babies and keep other children entertained.

On another occasion we had a 9.50 am appointment. The clinic opened an 9.30. Speaking to the others in the waiting room, their appointments were 9.30, 9.40 and me at 9.50. All the appointments seemed to spaced by 10 minutes. The consultant arrives at 9.30 and sees the first person at 9.40. Each appointment took 15 - 20 minutes. By the time we were leaving the waiting room was overcrowded.

The whole process seems to be archaic. Why can't it be like the NCT site.

I have cancelled many outpatient appointments over the years and have always phoned to do so with no problem. I would never let an appointment go to waste.

The level of efficiency seems to vary widely.

I have a outpatients appointment every 6 months in the same public clinic. The admin staff are efficient, the appointment system works well 80% of the time. If I have to ring to move or cancel, they answer the phone on time.

I have also had the experience of losttheplot of waiting hours for an appointment in a clinic which was very badly run.

Or there's the case where you're given a time, and you think it's an actual appointment time, only to discover that it's a general clinic and that's the time it starts. So there you sit for half the day for 10 minutes in with the specialist.

Seagull said:

there's the case where you're given a time, and you think it's an actual appointment time, only to discover that it's a general clinic and that's the time it starts.

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Hi Seagull

I would say that is partly due to the no shows. If they think that they can handle 20 patients in a morning, they book in 25 as they can expect 5 no shows. As they don't know which ones will not show at what time, the easiest way is to schedule them all for the start.

But I agree that they could still stagger it with 10 at 8 am and 10 at 9 am.

By the way, I have suggested this to the Courts System as well. All 50 people in the Registrar's Court are told to appear at 10 am. It's a hot, noisy, stuffy, courtroom. They could easily schedule 25 cases at 10 and 25 cases at 11.15. It would be much easier for everyone.

Brendan

I attended a busy Fracture Clinic a few times this year. Patients were given different appointment times. But the receptionists ignored them - they recorded the order that patients arrived, and we were seen in that order. So as far as I recall on one day I arrived early at 7.20 for an 8.00 apt, the first appointment of the day. But the second lady to arrive knew the system and arrived a few mins after me, for an 11.00 appointment. She wanted to be seen early and leave before it got busy. I was seen first, she was seen second, ahead of all the other people who had arrived in plenty of time for their earlier appointments.

On a positive note, I received 2 reminders by text about each of my appointments, and had to reply with Yes or No to indicate if I’d be attending. So it would have been easy for me to reply No, and allow the appointment be given to someone else. However, I assume I’d have needed to ring if I wanted to reschedule.

There is huge variation not only between hospitals but also between specialties within hospitals. Having worked in both public and private, I have seen good and bad in both.

Let's round it up to 500,000 missed appointment. There are at least 50 acute hospitals, so that's 10,000 per hospital. If there are maybe 48 working weeks of the year, that's around 210 missed appts per hospital per week or about 40 per day. There can be 20+ clinics in some hospitals. So realistically it's only around 2 patients for a clinic of up to 40 patients, which doesn't sound so outrageous. I would like to know the total percentage of no-shows, as the relative number of missed appointments is the meaningful figure.

I ran a special clinic a few years ago, where I worked an extra half day each week (for free) and saw people who had been waiting for 2+ years. In each clinic, maybe 50% would turn up. I would always call the patient afterwards to find out why they didn't attend and they were typically deceased or occasionally had already been seen elsewhere. Of the patients who showed up, around 50% would have already gone private and just attended because they had been called - most said they wanted a check up, and a few wanted to meet me to give out about the delay which is understandable. Of the remaining 50% of attenders, most needed nothing done and were discharged. I sent maybe 2 for procedures/investigations, but that was out of dozens. I stopped doing the clinic as it was just excusing the hospital of its duty to properly plan and fund services.

Funny that people should mention writing a letter; I occasionally come across them in very old charts, lovely penmanship and always so polite, asking if they could change a date/time or apologising for missing an appointment. If you sent a letter now I don't think it would be very practical... could take weeks to get a response.

It would be very helpful if the HSE:
a) Undertook an exercise of finding out why people miss appointments; in my experience they are typically good reasons, e.g. patient has died, never got the appointment letter, patient is an in-patient elsewhere, etc.
b) Made it much easier to view, change, and cancel appointments, e.g. using an app, website, automated phone system, etc. We can do this for so many commercial services, it really is not acceptable that we don't have it in place for healthcare