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3 May 2006 : Column 1076
Missed NHS Appointments
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Watts.]
7 pm
Grant Shapps (Welwyn Hatfield) (Con): I rise to raise the issue of missed appointments in the NHS and the extraordinary cost and impact involved. The matter first came to my attention through one of my constituents, Mr. John Mitchell, who I am pleased to say is watching the debate this evening. Mr. Mitchell, who is from Welwyn, missed a hospital appointment. Being a public-spirited gentleman, he kindly took the decision to send the East and North Hertfordshire NHS Trust a cheque for £15, as he wished at least to make a gesture to make good following his missed appointment.
Imagine Mr. Mitchell's surprise when the trust, which is some £53 million in deficit, returned his cheque, saying that it did not need it or could not cash it, or something like that. Missed appointments cost the trust about £2.8 million a year. I pay tribute to John Mitchell for taking such a public-spirited approach. He had been to the dentist the previous week and seen a notice saying, "If you miss your appointment, there will be a £15 charge". He therefore thought that the NHS trust would accept the money, and that it might help to make up for his missed appointment.
That case sparked my interest in the subject, and the Minister will be interested to hear that I then fired off freedom of information requests to each of the 245 acute trusts in the country. I cannot reveal the details yet because I have not got all the information together. On Monday, however, I will have it, and I shall issue a report that I shall be happy to share. It does not take much to realise that if my medium-sized NHS trust is some £2.8 million adrift as a result of missed appointments, and if there are 245 acute trusts, including the ambulance trusts, in the country, we must be talking about a very large sum of money indeed.
I want to address the issue of missed appointments and to find out what the Government intend to do about it. I also want to call for much more action than is apparently on the cards at the moment. I know that the issue has been raised with Ministers in the past, and that they said that they would take measures to cut the number of so-called "no-shows". It is therefore a mystery to me that, two and a half years after they made that pledge, nothing has happened. I have the figures here for 2003, when there were about 5 million missed appointments, and 2004, when there were about 5.7 million. Despite the fact that we are only just into May, I shall be able to reveal the figures for 2005 on Monday, and I am afraid that they do not make good reading for the Minister.
The response so far has been to look for solutions that involve very large computer-oriented fixes. We are all familiar with the £6.2 billion project designed for booking appointments, the so-called choose and book system. We are also aware that the project has been mired in controversy, with backlogs, and with money going down the drain. It was supposed to be up and running by last year, but it was not. I would be interested to hear a progress report from the Minister on that system. An efficient choose and book system would of course make a great deal of difference in cutting the
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number of missed appointments. However, the Government seem to confuse spending vast sums of taxpayers' money on complicated computer projects with actually fixing the problem.
In the context of the pledge to try to reduce the number of no shows, and the reference to the new £6.2 billion computer system, does the Minister feel that that was money well spent? Has it lived up to expectations? Clearly it cannot have done so far. Will it live up to expectations, or will that money never be recovered? I ask that question for a very good reason: £6.2 billion is perhaps six times the deficit for this year alone in the NHS. That is an awful lot of money, and so far we have seen no benefits from the system. I have figures from August last year showing that if the system had been on target, 205,000 appointments should have been made. However, only 63 appointments were booked though the computerised system. I would be interested to hear an update on those figures from the Minister.
The NHS has a big problem of missed appointments, which is costing it a huge amount of money. I will have the figures for that on Monday, and I would not be surprised if the sum is the same as the total deficit in the NHS for last year. I hope that the Minister will accept that that is a huge issue, and I know that the Government have accepted previously that it is a problem. The proposed solution appears to be a very large computer project, which, according to the National Audit Office, has gone terribly wrong. I am keen to hear an update on that.
Simultaneously—let us not forget that this is at the heart of the problem—my East and North Hertfordshire NHS Trust, which serves perhaps 300,000 people in the Welwyn Hatfield area, while losing all this money through missed appointments and many other problems relating to its financing and running, is closing down children's services, the blue light accident and emergency department, the maternity department, elective surgery and many other services besides. We must get to grips with that problem, which has now spiralled out of control. I am pretty sure that the answer is not spending money. There must be solutions relating to the role of management and Ministers in the running of the NHS.
Before the Minister starts accusing me of wanting to charge all the patients who miss appointments, let me say that that is not what I am driving at. I use the NHS myself, and do not have any other kind of health cover. Indeed, my life was saved by the NHS in 1999–2000, when I was effectively treated for Hodgkin's lymphoma. I am indebted to the NHS. I do not want to hear anything about how, if the Conservatives got into power, we would start charging people for all their NHS services. That is not what this debate is about—I know that, because it is my debate. What I want to know is what will happen about missed appointments.
The Minister might try to tell us that these problems are much more complex than I am trying to represent them as, that the administration involved is somehow beyond our comprehension, that the £6 billion IT system might ultimately resolve the problems—although so far we have little to show for the expenditure—and perhaps that dark forces are at work that a mere Back Bencher cannot easily comprehend. I would point to research carried out by the NHS on why people are missing their appointments. What is the great
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reason behind more than one in 10 people missing their appointments, at huge cost to the NHS? According to that research, two thirds of those people simply forget.
I am not convinced that a £6.2 billion computer project is required to remind people of their appointments. I approve of spending on technology in the NHS and can see the worth of it. What worries me more than anything, however, is that where there is a problem there is a budget, that when that budget is broken, that does not much matter, and more will be spent until the problem is solved.
I do not think it is good enough to say that spending money on huge computer projects is a panacea that will solve a problem two thirds of which is due simply to the fact that an individual forgot to turn up for an appointment. There must be something else that we can do, and some of the solutions may be blindingly straightforward, as is the problem itself—the fact that people are simply forgetting about appointments.
Let me run a few of my ideas past the Minister. Perhaps I will receive a response. It seems to me that when my constituent Mr. John Mitchell, being a public-spirited gentleman, sent a £15 cheque to the NHS trust, it might have been better had it been cashable by the trust. That was, after all, my constituent's intention. I should have thought that if the trust did not feel that it could cash the cheque, it would have been appropriate to send it to the League of Friends of the QEII hospital.
What interests me is where the blockage lies. When the trust was asked about the matter, the head of communications, one Peter Gibson, told the local newspaper, the Welwyn and Hatfield Times, that it would be simply illegal to accept the £15. I ask the Minister this: is it illegal to accept a £15 donation, and if so, why? If it is not illegal, will the Minister undertake to drop a note to the chief executive of the East and North Hertfordshire NHS Trust, Nick Carver, explaining that it is not illegal? While she is at it, perhaps she will write to the other 264 trusts in England and Wales telling them that they can accept such donations.
On Monday, when I release a report containing all the data from all those 264 trusts, I shall be very surprised if other people do not come forward with exactly the same story. I am fairly convinced that a string of constituents from all over the United Kingdom will say, "That's funny: exactly the same thing happened to me."
I should have thought that in an age when people care passionately about the national health service and really want it to work, the Government and Ministers would want to do more to ensure that people who are generous in spirit, like my constituent, can make up for their error in forgetting to turn up for an appointment. I should have thought that there was sufficient good will throughout the nation for the establishment of a rather more formal arrangement.
Another solution might be to adopt the dentists' system. There might be a compulsory charge, or it could be suggested that those who missed appointments might like to make a payment. I would be surprised if that did not raise several million pounds a year.
There are practical solutions that the Minister could pledge to adopt this evening. She could write to all the chief executives reminding them of the legal position. If it is not the case that, as the East and North Hertfordshire NHS Trust claimed, it would have been
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illegal to accept the money, a letter to remind trusts of that would cost only 264 postage stamps and could save the NHS a fortune. The Minister could also consider whether it would be possible to introduce a scheme that would stop shy of compulsion, but would go as far as inviting public-spirited payments for missed appointments—if necessary, through a separate fund, or possibly to organisations such as the league of friends of the QEII hospital, which has equivalents throughout the country, or indeed to the main coffers of the trust itself.
I feel that my questions require answers. I hope that on Monday the Minister will be interested to see the results of the research that I have conducted throughout the country. I also hope that if I send her a copy of my report on the total cost of missed NHS appointments, she will tell me whether further measures could be taken to reduce the number of missed appointments—and I very much hope that the solution will not be purely and simply to rely on a £6.2 billion computer project that we all know has gone badly wrong.
7.14 pm
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