Outpatients: Missed Appointments and Cancelled Clinics

A report published today by John Dowdall CB, the Comptroller and Auditor General for Northern Ireland, examines missed outpatient appointments and cancelled clinics in the health service, against a background of efforts to reduce outpatient waiting times. In June 2006, the Department of Health, Social Services and Public Safety (the Department) announced a target that, by March 2007, no patient would be waiting longer than 26 weeks for a first outpatient appointment. On the basis of the information available to the Department at the beginning of April, the outpatient target has been achieved and all patients are now being seen with 26 weeks of GP referral. Given the scale of the challenge – with almost 74,000 patients waiting more than 26 weeks for a first outpatient appointment this time last year – this is a commendable performance by the Department.

However, the Report also shows that in line with the rest of the UK, at present, the only detailed information being collected is on attendances at clinics led by consultants. Systems currently do not identify information on the trend for other outpatient clinics to be led by other health care professionals such as nurses and physiotherapists. Such clinics do not currently fall within the remit of the Department’s published statistics on outpatient waiting but the Department plans to set targets for these groups in 2007-08. Based on the findings of a census by the Department, outpatient activity levels from both sources are about twice that officially reported, with around 345,000 clinics held each year and almost 2.7 million attendances (paragraphs 2.7-2.8).

The majority of people show a responsible attitude to attendance at outpatient appointments or notify the clinic if they are unable to do so. However, the Department’s census also showed that one in ten outpatients is “not seen”. These individuals are a combination of those who will either have had their appointments cancelled by Trusts, cancelled their own appointments and those who simply did not attend (paragraph 2.21).

The potential cost to taxpayers of outpatients who are not seen at clinics is estimated at around £11.6 million annually. On this basis, each one per cent reduction in outpatients not seen might generate an annual efficiency gain of £1 million (paragraph 2.23). In addition to the substantial financial costs for the health service, there may also be clinical implications for those not seen and other patients on the waiting list (paragraph 2.24).

Failure to attend outpatient appointments can waste valuable time and resources. A comparison with Great Britain shows that Northern Ireland has consistently had the highest overall rate of non-attendance (paragraph 2.19). The Report calls on Trust managers and clinicians to investigate further the factors influencing non-attendance at clinics to allow the planning of effective strategies to counteract these (paragraph 2.22).

The Department is tackling outpatient waiting times through a major programme of service reform. A significant element in this work is the introduction of partial booking of outpatient appointments (paragraph 3.3). Patients are advised of the probable wait for their appointment, shortly after their referral, and are then contacted six weeks prior to this date and invited to call the hospital to agree a convenient date (paragraph 3.4). In addition to reducing waiting times and improving the management of outpatient services, it is expected that this approach will also have a positive impact on the numbers of cancelled clinics and missed appointments (paragraph 3.2).

Another way in which the Department will continue to reduce waiting times for outpatient appointments is through the new range of Integrated Clinical Assessment and Treatment Services (paragraph 3.12). These services should further reduce outpatient waiting times by ensuring that all patients are referred to the most appropriate healthcare professional and referring to hospital only patients who will benefit from seeing a consultant. With the resultant reduction in waiting times, the Department considers that the scope for missed and cancelled appointments will be similarly reduced (paragraph 3.2).