479,000 outpatient no-shows last year

I’ve had quite a lot of out patient appointments in the last few years, all public and most in Beaumont.
Only once have I had to cancel, a few years ago and I just rang the clinic and cancelled with the receptionist. Some of these clinics only operate once a week so maybe that’s why people can’t get through.

Anyway, for the last couple of years I get sent a text message from Beaumont reminding me of my appointment and asking me if I still want to attend and then a day or so beforehand another text where I have to reply yes or the appointment will be cancelled.

I’ve also been on some very long waiting lists(waiting 18 months for an appointment with no date, they ring you when they have a space a few days beforehand rather than a letter) and they have actually rang me after a year to ask if I still want to be on the waiting list or if I want to be taken off.

I don’t think I would ever not attend without letting them know. The backlogs in waiting lists are bad enough as it is and I think I would actually feel guilty addding to them by being too lazy to cancel.
 
arbitron said:
it's only around 2 patients for a clinic of up to 40 patients,
Click to expand...

Hi arbitron

Excellent post, so that is just 5% of appointments. I would guess that the private system has a no-show rate of 5% as well.

Do we really have 10m appointments a year in the public health system? It seems a lot, but maybe we do.

Brendan
 
I have attended an awful lot of outpatients appointments over the last four year, and have had amazingly good experiences to terrible experiences. I have not shown to two of those due to illness, one I was able to give 24 hr notice, the other I was only able to tell them the morning of the appointment. Not much either party can do when you are an inpatient in another hospital.

I like the hospitals with the text alert system. It shows that they are expecting you, that they have your contact details correct and that they give themselves enough time to offer the appointment to someone else if you realise that your appointment was in error or some other reason.

I have had appointments before my scheduled “checkup” and the scheduled appointment was never cancelled, which is frustrating to both sides, especially if it was discussed with the desk clerk. I find most clinics are happy to change appointments if needed, most run on a weekly cycle, and are good to phone or call if things change from their side.

One clinic we attend they cancelled at the last minute their side, a few weeks later a new appointment came and again they cancelled last minute their side. So I phoned to get the new appointment since we could not wait the few weeks to hear. Oh you go to the back of the queue when cancelled I was told. But the cancellations were all on your side. Very well they said but we will have to cancel a newborn baby for you. Pretty grim the mental torture of that. All things being equal what did the age of my girl and a newborn matter, clearly my girl had been waiting months at this stage. If the kid with the clinically greater need was prioritised, the the clerk making the appointments would not be in a position to make that judgement!

I have had many situations where once we arrived at the appointment in the hospital clinic we queue jumped to the front of the queue, from simply the consultant spotting us in the queue as he walked to the clinic and being called in moments later, by-passing many many other people who arrived ahead of us to the trainee doctors being so fascinated with the girls file calling us in early so they can know all about her interesting illness (I very kindly remind these that it is not “interesting” to the girl and please don’t use that phrase around her).

And then I have sat waiting in clinics where they have clearly forgotten us and people who arrived before us and those who arrived an hour after us have all been seen and still we sit there. I have been in a clinic where we drove 3 hours to get there, waited 4 hours and in the 5th hour of waiting were asked if another family could go ahead of us as they were concerned about being late home (the other family, not us). And once I had the consultant step out to check something and never ever come back... his parting words being I will be back in a few minutes.

And sometimes clinics go all pear shaped for the consultant as they deal with emergencies in their own or another hospital. It can very much depend on the speciality. I have had two outpatient appointments the same day with two different specialities in one hospital and the staff worked to make it seamless. One doctor had 8 kids to see in the morning, the other 40. One gave us all the time we needed, the other you need to start asking you questions immediately or he is off to the next patient.

One out patient clinic we attend have a large photo with a picture of the clinic empty and the comment “We were here, where were you.” I laugh whenever I see it, I have never seen the room empty, and on average we wait two hours to be seen, despite everyone having individual appointment times.

I think the news headlines are unhelpful, make the system work better for the patient and the doctor, make it pleasant, give staff and patient time, don’t make people wait weeks and months for the first appointment, look at the workflows and improve them and then measure the don’t shows. Work with the don’t shows individually and understand the reasons they don’t show up, then work on the reasons so other potential don’t shows improve attendance.
 
Brendan Burgess said:
Hi arbitron

Excellent post, so that is just 5% of appointments. I would guess that the private system has a no-show rate of 5% as well.

Do we really have 10m appointments a year in the public health system? It seems a lot, but maybe we do.

Brendan
Click to expand...

I don't think there are 10m, probably closer to 4m. It's hard to quantify as HSE data are not transparent. In my experience, a well-managed appointments system can get it down to below 10% no-shows, but you will always have some.

The irony is that if we saw all of those on waiting lists tomorrow it would cause even greater chaos for surgical waiting lists as we would have hundreds of thousands of new patients booked for surgery. It's all put on the long finger, trying to rob Peter to pay Paul.

The very unpopular and politically poisonous truth is that we need to downgrade or close most hospitals. We must move a lot of services into GP/primary care and then make the large university hospitals centres of excellence where we can maximise efficiency and quality. We need to give nurses and pharmacists bigger roles and it should be consultants seeing patients rather than juniors/trainees. We also need to either completely split public and private (incredibly expensive) or have a money-follows-the-patient insurance system like the Netherlands (also expensive but fairer).

This is all in train for years but HSE is painfully obstructive, TDs won't go against local lobbies, unions are paretic and paranoid, and patients are not yet organised or vocal enough. People need to be more demanding really.
 
This is an absolute disgrace:
http://www.thejournal.ie/rte-lost-money-4129921-Jul2018/

The HSE has been contacting patients across the country by post to ask them to confirm whether they still require an appointment.
However, those who don’t reply in writing within 10 days are deemed to no longer require their appointment, and their doctor informed that they have been removed.

There's 700,000 people on waiting lists. An Post lose 50,000 letters a week. This means that thousands of people will be dropped off the waiting list purely because either they didn't receive the letter OR HSE didn't receive their letter.
And that's not accounting for people who might be in nursing homes, or holidays and could experience a delay in receiving post.

They've learned absolutely nothing from the cervical cancer scandal.
They can't even setup a phone line.
This is a cynical exercise in abandoning patients.
 
When I read the press coverage of this issue, I feel sorry for the HSE. No matter what they do, they will be savaged for it. I would say that the temptation is to do nothing. And it probably discourages competent people from applying to work in the HSE.

We know that 500,000 people did not show up for outpatient appointments in 2017. That wastes a lot of resources, resources which could be used to treat other people sooner.

It's perfectly reasonable to ask people to confirm in writing that they still require an appointment. Of course a few people will miss the letter, but the HSE will inform their doctor and so it can be rectified.

And 10 days is about the right time to put in a letter. If they put in 30 days, then people would delay responding. By putting in 10 days, most people will realise that it is urgent. I would imagine that although they say 10 days, the HSE gives longer than that or reinstates appointments when people or their doctors reply late.

Brendan
 
Brendan Burgess said:
When I read the press coverage of this issue, I feel sorry for the HSE. No matter what they do, they will be savaged for it. I would say that the temptation is to do nothing. And it probably discourages competent people from applying to work in the HSE.
Click to expand...

I have to disagree strongly. Not setting up a phone line to me says this is a cynical exercise in massaging the waiting list figures.
This has nothing to do with what is best for patients.
The reason why the HSE is savaged is that they consistently get things wrong for patients because they don't see them as human beings. They are a bother, an expense, something that makes them look bad. We saw this attitude time and time again during the cervical check scandal and it continues to this day.
 
Hi Odyssey

Are you happy for the current situation where 500,000 people don't show up for appointments?

Do you accept that many of these no longer need these appointments?

Do you accept that many people who no longer need appointments don't bother informing the HSE?

Do you think that the HSE should do something to try to identify the ones who no longer need appoitments?



Brendan
 
Brendan Burgess said:
Hi Odyssey
Are you happy for the current situation where 500,000 people don't show up for appointments?
Do you accept that many of these no longer need these appointments?
Do you accept that many people who no longer need appointments don't bother informing the HSE?
Do you think that the HSE should do something to try to identify the ones who no longer need appoitments?
Click to expand...

The HSE should setup a proper central process for appointment management. If it's a once off exercise, setup a phone line. If it's an ongoing issue, setup an IT system.
It's 2018 not 1928.
It should be a patient first process.

Relying on post in a country when tens of thousands of letters go missing a week is a joke.

After everything we have seen of the HSE in recent years, they don't get the benefit of the doubt from me.
This has nothing to do with improving patient outcomes.
This is a cynical exercise in getting people off the waiting lists regardless of their need.
 
I'd be much happier to get electronic notification, but 50,000 mails (2% of all mail) do not get "lost" every week. That would be the number of items an post can't deliver due to incorrect or unclear addresses. https://www.irishexaminer.com/lifes...undelivered-by-an-post-every-week-266442.html

I'd assume HSE letters will make a good attempt to get a correctly printed or at least carefully handwritten address, so the percentage of their letters undelivered by an post would be close to zero.

On the other hand it's routine deflection that in house mistakes that result in someone not receiving a letter (e.g. forgetting to create or send an appointment), are blamed unverifiably on the final link of the chain - sure didn't someone say they "lose" 50,000 mails a week.
 
odyssey06 said:
Relying on post in a country when tens of thousands of letters go missing a week is a joke.
Click to expand...

Odyssey

I meant to ask you about this statistic. Have you any evidence for it apart from a once-off occurrence covering 8,000 items in September 2016?

Brendan
 
Brendan Burgess said:
Odyssey
I meant to ask you about this statistic. Have you any evidence for it apart from a once-off occurrence covering 8,000 items in September 2016?
Brendan
Click to expand...

Ashambles linked to this, it quotes 50,000 items that are 'undelivered' but the article describes them as 'lost'.
https://www.irishexaminer.com/lifes...undelivered-by-an-post-every-week-266442.html

These are the ones An Post knows about because they are undelivered.

Unless something is sent by registered post, the thing about lost post is how do you know you didn't get a letter you should have? And how are An Post tracking it?

We all have experience I'm sure of receiving post for the wrong address. I live in an apartment and I have received several letters addressed to blatantly wrong locations i.e. my door number but for a different apartment complex on my street with a very different name.
I sent a letter to a friend recently with a printed address. It never made it. God knows where it ended up.
I sent another one and it was received so there was no issue with the address used.
That doesn't show in any An Post statistic.

Standard post is an inherently unreliable mechanism without confirmation of receipt or possibility of realtime comfirmation.
It should not be the sole mechanism used for tracking medically necessary appointments or alerting of essential information.
 
Hi Odyssey

So, you are now quoting a 2014 article?

50,000 a week = 2.5m items a year.

That is just nonsense.

If the HSE sent emails to people, you would complain that some people don't check their emails.

The most appropriate way of dealing with this is the post.

But it's much better fun to vent anger at the HSE and none at all at the people who no longer need appointments, but don't have the manners to notify the HSE.

Brendan
 
Brendan Burgess said:
Hi Odyssey

So, you are now quoting a 2014 article?

50,000 a week = 2.5m items a year.

That is just nonsense.

If the HSE sent emails to people, you would complain that some people don't check their emails.

The most appropriate way of dealing with this is the post.

But it's much better fun to vent anger at the HSE and none at all at the people who no longer need appointments, but don't have the manners to notify the HSE.

Brendan
Click to expand...

If you have more up to date or accurate figures from An Post please circulate them, otherwise it is the figure that stands.
It is from an article reported in a national newspaper.
In the absence of such figures being readily available, what should we assume is the An Post successful delivery rate?
And why aren't such figures readily available?

If the HSE only sent emails, of course I would complain, and rightly so. This should be a co-ordinated managed effort. Sending out fire and forget letters by post or by email notifications is not a managed process.

An email is not an IT system. It's 2018 and the HSE can't setup a phone line or use an off the shelf IT customer relationship \ workflow \ appointment tracking package.

If this is about improving patient outcomes, it would have a proper team, proper phone and IT systems back up.
If you actually cared about patient outcomes, you don't issue press releases giving out about patients, you put proper processes into place to manage appointments.

This is not about patients. This is about reducing the waiting lists by hook or by crook.
 
Brendan Burgess said:
But it's much better fun to vent anger at the HSE and none at all at the people who no longer need appointments, but don't have the manners to notify the HSE
Click to expand...

What if they are dead? In a nursing home?
You seem to be assuming a lot of these people with zero evidence which seems more like venting to me than anything I have said.
 
odyssey06 said:
In the absence of such figures being readily available, what should we assume is the An Post successful delivery rate?
And why aren't such figures readily available?
Click to expand...

Because based on my own experience, I get all properly addressed letters sent in Ireland, the following day or a day after.

The only evidence I see of non-delivery is people who didn't receive their parking fine or other court proceedings.

An Post does a very good job. It is and should be the basis of any system of notification.

Brendan
 
odyssey06 said:
What if they are dead? In a nursing home?
Click to expand...

What are you suggesting? Dead people can't respond so they should not be taken off the waiting list? Eh, if they are dead, they won't need the appointment and this is exactly what the system is trying to identify.

If they are in a nursing home, it is very likely that their post will have been redirected or someone else will be checking their post.

Brendan
 
Brendan Burgess said:
What are you suggesting? Dead people can't respond so they should not be taken off the waiting list? Eh, if they are dead, they won't need the appointment and this is exactly what the system is trying to identify. If they are in a nursing home, it is very likely that their post will have been redirected or someone else will be checking their post.
Click to expand...

I'm suggesting that there are lots of good reasons why appointment cancellations don't get notified to the HSE that have nothing to do with 'manners'.
 
Last edited:
Brendan Burgess said:
Because based on my own experience, I get all properly addressed letters sent in Ireland, the following day or a day after.
The only evidence I see of non-delivery is people who didn't receive their parking fine or other court proceedings.
An Post does a very good job. It is and should be the basis of any system of notification.
Brendan
Click to expand...

Why do we have registered post if standard post is so reliable?

And if your registered post item goes missing, there is a contact phone number you can ring!

Even if standard post gets there 99.5% of the time, that still leaves thousands of post undelivered or lost. It's not than An Post don't do a good job, it's that it shouldn't be the sole means of communication. Even registered post items, courier items get lost. It cannot be, nor is it intended to be, 100% reliable, and should not be treated as such.
 
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