8,550 people did not show up for their driving tests in the year to the end of November. They didn't cancel either so the slot could not be given to someone else on the waiting list.
In the article the RSA says that the 8,550 represents a no-show rate of 3.5% and that has reduced from a 2019 rate of 11%. Like unemployment figures, we are never going to get to 0% and we probably wouldn't want to because then we would have other negative effects.
Healthcare no-shows (Did Not Attend/DNA) present a highly complex problem in every country and every type of health system, public or private. I worked for a few years on patient flow projects with groups in Ireland, the UK, Australia, and the USA. This was in the heyday of nudge theory when governments all over the world were setting up behavioural science units to "nudge" people to make particular choices. Appointments were a big target.
We all originally thought that charging a refundable deposit or some sort of fee would improve attendance. There is some evidence that it can but it's single digit improvements at best and the cost of delivering such a system is high. You need a payment portal, you need admin staff to deal with queries/complaints/disputes/refunds/waivers, etc. It was just not cost effective.
But the main reason we still avoid financial penalties is that the unintended negative effects are unacceptable. Financial penalties make little difference to wealthier people but will absolutely prevent poorer patients from accessing care. They either do not have the money for the payment in the first place or they have the money but cannot risk losing it. Poorer patients already carry the highest health burden anyway (multiple conditions and more chronic diseases) so you are then punishing a sicker and more vulnerable population. When they finally attend they are sicker and require more treatment - perversely requiring even more appointments and making the original problem worse. This is bad for the individual patient and for the general taxpayer as we then have to spend far more resources than if we had seen them earlier and prevented the disease from progressing.
Rather than pushing the problem back onto patients, it's much more effective to improve booking and admin systems. One unit I worked in had self-service booking with a 24/7 online system that allowed you to select your own date/time. There was also a waiting list option. If you needed to cancel you could do it easily at any time and the system would tell you when the next available appointment would be. You could still call a human, for anyone who couldn't do it online for whatever reason. Our DNA rates were very low. You would still have people who were unwell on the day, train was cancelled, couldn't get childcare, etc. so it would never be zero DNAs but almost every clinic was overbooked anyway so it worked out.
Very efficient systems with short waiting lists bring problems too. I was involved in a clinic re-design years ago where we managed to cut waiting times from months to weeks. But DNA rates went through the roof. Patients knew that if they didn't show up they would be offered a new appointment quickly. And because the waiting list was so short the patients we were seeing were not as sick so they didn't put as much value on the appointments.
