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I seem to be doing this more frequently than I would like.
It’s not what I want to do but I’m going to make another exception this morning.
I don’t like linking to stories that are behind a paywall.
First, I’m not sure about copyright issues and second, when I’ve linked to columns in the past, people complain they can’t open the originals to see for themselves, what’s what…
… there is always the whiff that ‘Lilley is exaggerating’… heaven forfend.
Anyway, as you’ve probably guessed… I’m going to do it again this morning.
Former Prime Minister Rishi Sunak has a new column in the £walled Sunday Times.
This week, his topic is the NHS. He has a pop at the striking doctors, tells us the NHS is under-managed, productivity is down and harks back to the time he introduced patient choice and payment by results.
Prevention, obesity and workforce plan and all the usual tropes get a mention, and…
… he reminds us; every year the NHS haemorrhages time, money and patience through the 8 million hospital appointments that people simply don’t turn up for.
It’s a lot of people but boils down to one in sixteen outpatient slots. Each missed appointment costs roughly £160, that adds up to more than £1.2bn a year…
… you could run a mid-sized hospital for that.
By the way no-shows in hospitality doubled from 6% to 12% in 2023 costing bars and restaurants around £17.6 billion a year.
Sunday-Sunak’s suggested remedy (pinched from Sajid Javid) is… ‘fine the no shows’.
Charge people a tenner, twenty quid, whatever plus a spot on the naughty step. It’s the sort of idea that Times readers might like but wilts the moment you shine a bright light on it.
There is no evidence fines change behaviour, but since when has political policy been evidence based?
There’s nothing to suggest the chronically chaotic, the overstretched carer, the person juggling two jobs, or the confused elderly patient will suddenly become punctual because a bill will arrive, and …
… the NHS would have to chase the fines. Court action? Debt collectors? It collapses under its own administrative weight before it even begins, and…
… you can see the Red-Top headlines;
‘war hero jailed for forgetting his bunion appointment…’
If we’re serious about reducing missed appointments … and we should be… we need to stop looking for someone to blame and start looking at what works.
We know behavioural nudges and operational tweaks work. Without legislation. Easy to do from tomorrow… three easy things.
Reminders.
Not the anodyne ‘You have an appointment on Tuesday’, or worse some months away.
Behavioural-science crafted messages that make the reality visible. Send a reminder that says, ‘Your appointment costs the NHS £160 if you miss it...’
It works because it taps into personal responsibility without wagging a finger, and…
… the timing matters, message a week before, a day before and critically, the morning of the appointment. Costs pennies and saves pounds.
Make cancelling easy.
Often, people try to cancel but it's a palaver. Make it easy… text ‘C’ to cancel or click a link. By introducing simple cancellation pathways, DNAs can fall by up to a third. No drama, no punishment, no headlines… just operational competence.
Flexibility.
Life isn’t tidy. Appointments often are. People working shifts, people caring for relatives, people with unpredictable health… they miss slots not through neglect but through circumstance.
Offer evening and weekend appointments, one-stop clinics where patients can do several things in one visit and real-time rebooking. Bring services closer to where people live.
Every time you fit the system around real life rather than the other way round, attendance improves.
Fines are a distraction. The NHS doesn’t need a punishment regime; it needs a user-friendly one. Smarter reminders, easier cancellations and flexible scheduling…
So, Mr Sundyak that’s how you turn 8 million missed appointments into something more manageable than a billion-pound write-off.
My worry is he and other politicians make similar dopey decisions in other policy domains we don’t know much about and then we're left to wonder...
... why Britain is run by numpties, but...
... he is supporting prostate screening, so he can't be all bad!
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