Agenda item

16.1     The Committee considered a report from NHS Sussex on work being undertaken to minimise missed appointments in secondary care (hospitals) across East Sussex. An update on missed appointments in primary care was included in the report on agenda item 6, Access to General Practice in East Sussex.

16.2     The Committee raised a concern that often people would call East Sussex Healthcare NHS Trust (ESHT) and their calls would not be answered, which was a barrier for some people cancelling appointments they could not attend.

16.3     David Garrett, ESHT Divisional Director for Core Servicesaccepted that at certain times of day it was difficult to get through on the phone lines. He added that very few members of the booking team worked remotely, with call handlers based at both Eastbourne and Conquest hospitals. Teams had information on how many people were waiting and how long they had been waiting for, so it was possible to get more staff to answer phones as required. There were periods of high traffic and ESHT was considering implementing a semi-automated switchboard for the booking team which would allow people to cancel appointments without needing to have someone answer the phone.

16.4     The Committee commented that sometimes patients were unable to attend appointments as hospital transport required advanced booking which could not always be arranged in time.

16.5     Ashley Scarff, NHS Sussex Director of Joint Commissioning and ICT Development (East Sussex) commented that communication between patient transport and hospital trusts should be improved to avoid missed appointments. If there were issues with providing patient transport for a patient to get to their appointment, then a link back to the hospital or service should be made so that the appointment can be rearranged for a time when the patient would be able to attend.

16.6     Cllr Turner commented that if a patient missed an appointment because of a lack of available transport, then there was a risk they could go to the back of a waiting list through no fault of their own.

16.7     The Committee asked what the cost to the NHS was of missed appointments.

16.8     David Garrett explained that it was difficult to quantify the cost of missed appointments, as all clinics were booked based on a model of likely attendance to that particular clinic. This meant that if everyone booked in attended their appointment, then the clinic would likely overrun. Where clinics regularly underran then the model would be reviewed, and additional appointment slots would be added. Did not attends (DNAs) added some unpredictability to the running of a clinic that meant while every effort was made to try and adjust for them, it could only be determined on the day whether a clinic would over or under subscribed. Ashley Scarff added that the key cost would be the opportunity cost of having staff present at a clinic without anyone to attend to.

16.9     The Committee asked whether patients were able to request specific times for appointments to avoid having to pay for peak travel fares.

16.10   David Garrett explained that there would have to be a dialogue with patients to understand their travel needs, and they should be given two reasonable time offers for an appointment. Patients had to inform whoever was booking appointments of times at which they could not attend, and there was a function on the patients’ notes system where important patient information could be logged that would support discussions with patients on these issues.

16.11   The Committee asked what was meant by stricter policies in reference to repeat non-attendees of appointments.

16.12   David Garrett responded that ESHT had a Patient Access Policy which stated that if a patient did not attend an appointment twice then consideration would be given to discharging them back to their GP, subject to the advice of clinicians. There were a very small number of difficult to engage patients where a disproportionate amount of time was spent trying to contact and arrange suitable appointments, and so a process was required for dealing with patients that did not respond to any communication.

16.13   The Committee asked for more information on how short notice appointments were taken up.

16.14   David Garrett explained that short notice appointments lists had been introduced across a number of specialities to avoid clinical time not being utilised. Staff in the booking team had short notice lists of patients by speciality which allowed them to fill appointment slots that became available with less than 24 hours notice. Appointments that became available with more than 24 hours would be filled according to clinical need as usual.

16.15   The Committee asked if there was a link between DNAs and the number of times appointments were rearranged.

16.16   David Garrett commented that there can be a correlation between a DNA and a patient having their appointment rearranged. ESHT tried to set clinics six weeks ahead of time in order to give patients 4-6 weeks’ notice of their appointments. The exception to this was for urgent suspected cancer patients who were given appointments within seven days, which meant that it was not uncommon for patients to agree to an appointment without realising that they cannot actually attend and then have to have their appointment rearranged. ESHT was aware that sending patients different appointment letters could be confusing and tried to avoid it where possible.

16.17   The Committee commented that some communications to patients on long waiting lists suggested that they should consider being seen privately.

16.18   David Garrett explained the appointment validation process, whereby patients on long waiting lists were contacted to confirm whether they still needed an appointment. ESHT had found that a significant proportion (around 10-15%) of patients would respond that they no longer needed the appointment. The wording of communication may ask whether the patient has had their issue resolved privately, which was helpful information for understanding why a patient no longer needed their appointment. However, communications from the hospital should not be suggesting people be seen privately and if there were examples of that taking place David agreed to investigate.

16.19   The Committee RESOLVED to note the report.