I’m not sure why the views of a descendent of a politician who shepherded legislation creating the health service are worth reporting, esp when they involve speculating on what that politician would think, but here we are:
The Prime Minister who created the NHS would be “horrified” that patients “abuse” the health service by turning up drunk at A&E and missing appointments, his granddaughter has said.
Jo Roundell Greene, the granddaughter of Labour leader Clement Attlee, said when the health service was created people were “so grateful” but now some people take the system “for granted”.
The “for granted” is supposed to explain why people miss appointments or show up drunk at the A&E.
This is utterly ridiculous. Are people more likely to use NHS services now than when it started? I wouldn’t be surprised! Presumably when it started people didn’t know about it or were unsure about it or the range of services were less, etc. (Maybe not! But it’s plausible!) We’d need to know how the rates of “misuse” have changed over time and probably normalize it to the population. (We might just have a higher percentage of the sort of people who don’t keep appointments.)
Even instrumentally, I’m pretty skeptical that this scolding would have a beneficial effect.
And now a different bugaboo:
“But I think it’s like so many things, you sort of take it for granted,” she said in an interview with the Press Association. On people missing appointments she added: “I just think it’s a real problem.”
“So if you can address the cost problem at the front end it might help with the cost problem of these very expensive drugs. Because every time somebody misses an appointment it costs a lot of money.”
According to NHS Digital figures, patients in England did not attend almost eight million hospital outpatient appointments in 2016/17 – or 6.7 per cent of appointments.
NHS England has said because each hospital outpatient appointment costs the NHS around £120, that means almost £1 billion worth of appointments were missed.
This last bit is the most judicious phrasing I’ve heard. Usually, I get a text like:
We are expecting you at Wrightington Hospital, Wigan Tue xx Jun 2018 xx:00AM. Not attending costs NHS £150 approx.
Rheumatology APPT REMINDER: On xx/06/18 at xx:30 at DEPT OF RHEUMATOLOGY. No shows cost the NHS £160.
(I think it’s gone as high as £180.)
Does it actually cost the NHS anything in the typical case? All these people are in salary. (Well, not as much under Tory stupidity. Using locums could raise such costs.) The utilities must run the same anyway. There’s always a fair bit of non patient work to be done. Often you can slot a patient forward. Etc.
Missed appointments are annoying and probably have an associated cost (esp if they reach a certain level) but this “it costs X for an appointment thus each missing appointment wastes X”.
If the system were more appointment efficient, perhaps we could shrink staff a bit. That would save real money that could be used elsewhere. But afaict NHS staff are already working at a very high capacity. If you magically reduced the total number of appointments by 6% it’s not clear you’d be able to cut/reassign any staff.
Now, perhaps there’s some standard health economic analysis that shows I’m wrong. I’d love to see that. But I’m not putting forth these claims! The proponents and repeaters owe us at least a gesture of justification.
Finally, there is a natural rate of missed appointments. People get sick. Their car breaks down. Their kid gets sick. Their work prevents them. Etc. It’s unclear how many missed appointments are avoidable.
Follow up: After writing this I googled a bit and found a discussion about these estimates:
However, Andrew Street, a professor at London School of Economics, previously told BBC Radio 4’s More or Less programme that while missed appointments were a problem, solving them will not necessarily save as much money as has been suggested.
Responding to a previous NHS estimate which suggested the average cost of an appointment was £120, he said: “It’s a massive overestimate of the true cost… A missed appointment costs closer to zero.
“That is only the true cost of missed appointment if staff stand around doing nothing if a patient doesn’t turn up. Outpatients clinics tend to be overbooked.”
Missing surgeries seems potentially more servers as the opportunity cost is higher and the number of slots less elastic.
It seems reminder texts help:
Aneurin Bevan health board said its text reminder service, launched in 2016, proved effective with the rate of missed appointments dropping shortly afterwards from about one in 10 to one in 20.
Its did-not-attend appointments fell by 8,591 from 2015-16 to 2016-17 – a notional saving of about £1.17m.
I’m not sure what the marginal gain is of the cost scolding in these texts (it has no effect on me; the reminder itself does all the work and I’m had of them).
In general, 6% seems to be a fairly low rate. It doesn’t mean it’s minimal but it’s probably not going to be a major source of cost savings.