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The Minister of State, Department of Health (Jane Kennedy): I must confess that when my private office approaches me and says "You must respond to an Adjournment debate", my heart often sinks. On this occasion, however, I must compliment the hon. Member for Welwyn Hatfield (Grant Shapps) on the entertaining way in which he presented his case, and the industry that he displayed.

I was aware that the hon. Gentleman had made requests under freedom of information legislation to various health organisations, and I compliment him on his industry. He is right that this is an important issue: we take it seriously and acknowledge that it is problem.

I shall not adopt a political position and say how much better things are under this Government. That would not be appropriate, but it is important to set the context for the debate and make it clear that our investment and reforms are having an impact on waiting times. In the past four years, waiting times for a first out-patient appointment have halved, falling from 26 weeks to 13. The maximum waiting time for an operation is now six months—and the average is even lower—compared with the two years or more that some patients used to endure.

I do not pretend that the new connecting for health computer system will be the panacea that resolves all problems. I shall detail what I expect will happen in a moment, but our investment means that the NHS will have a proper IT system that is able to track patient progress. That will make it much easier for patients to contact their GPs and the consultants dealing with their cases than has been the case in the past.

In addition, we are enabling patients to choose where they will go for treatment. The connecting for health system does much more than allow hospitals to track people who do not turn up for appointments. The hon. Member for Welwyn Hatfield referred to the electronic booking system that we are putting in place. That will enable patients to select the time and date, as well the place, for their treatment.
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On top of that, our financial reforms are developing incentives in the NHS to tackle the problem locally. Payment by results should mean that hospitals will no longer be able to pass on the costs of missed appointments to their commissioners. I understand that a figure of £100 per missed appointment is being bandied about. It is not one that I recognise: I think that it overstates the cost by quite a large amount, although I accept that missed appointments are a cost to the NHS.

Grant Shapps: That figure is based on Government estimates in the past, although I admit that I have only seen it quoted in various articles and do not know its precise source. However, I have much more detailed information about the actual cost of each missed appointment. I assure the Minister that my estimates will be based not on the £100 figure, but on independent health trust statistics.

At the beginning of her speech, the Minister reeled out some information about how appointments were being speeded up. Does she agree that that makes little difference to people in Welwyn Hatfield, given that the QE2 is all but being closed down?

Jane Kennedy: Clearly, I do not accept what the hon. Gentleman says about his local hospital, and I shall speak in a moment about the efforts being made by the local health organisation to reduce the number of occasions on which appointments are missed and the cost that flows from them.

Where missed appointments are a particular problem, NHS trusts already have the devolved power and the incentive to tackle them locally. Hospitals know their rates of failed attendances. Those figures are predictable, and NHS trusts are dealing with the problem. For example, it is likely that two patients out of 20 will not turn up to a clinic. When a patient does not show up, doctors do not just sit on their hands: they get on and see the next available patient.

Like other NHS trusts, East and North Hertfordshire is taking action locally to reduce the number of missed appointments. That goes beyond merely spraying money at the problem, but includes improving the quality of the trust's communication with patients. Reminders are sent out, and the trust also follows the matter up with those who fail to attend. In addition, it contacts the GPs of people who frequently miss appointments. That generally makes clear what the problem is, and I assure the House that it is not the same for all patients. I shall be interested in what the hon. Gentleman's research uncovers in that regard.

The hon. Gentleman referred to his local newspaper. His local trust uses the media to explain how important it is to keep appointments or, if that is not possible, that the trust is contacted to change the appointment. That has enabled the trust to reduce missed out-patient appointments by nearly 10 per cent. this year and it is planning action to reduce them even further next year.

The hon. Gentleman said that his constituent, Mr. Mitchell, had offered a contribution towards the cost of his missed appointment. I understand that his contribution was not accepted because it was offered as a payment. As I hope we all accept, the health service does not make charges to patients, so it cannot accept payments. However, had the contribution been offered
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to the League of Friends of the hospital, as the hon. Gentleman suggested, it would have been in order for the friends to accept it. A donation is different from an offer of payment, which was, I understand, the context of the offer.

The issue of missed appointments is important and I thank the hon. Gentleman for raising it and allowing me the opportunity to explain the work that the Government and the health service are doing to reduce that extra burden and cost to the NHS. One of the reasons that the issue is so important is that the NHS is treating more patients than ever. In the last year, 9 per cent. more patients were seen in out-patient clinics and 6 per cent. more as in-patients than under the previous Government. Despite that, the proportion of missed out-patient appointments is coming down—from 13 per cent. last year to 12 per cent. for the first three quarters of 2005–06.

Grant Shapps: I want to check some of those figures, to make sure that I heard them correctly. The number of missed appointments is not coming down for the year as a whole, so will the right hon. Lady undertake to ensure that there is some feedback on those figures when the report is submitted? The numbers mean nothing to me in the context of the research that has been carried out, so I suggest that they may be wrong.

Jane Kennedy: The Government will receive the hon. Gentleman's report with interest when it is ready for publication.

The electronic booking system to which the hon. Gentleman referred earlier should allow patients to see all available dates and times. They can then book an appointment straight after seeing their GP, or at their own convenience after checking with friends and family. We have been testing the system and we know, from pilot sites, that it has a strong, positive impact on missed appointments. The hon. Gentleman may be interested to learn that in one pilot scheme, the out-patients manager reported that none of the patients who had been electronically booked failed to turn up for their appointment. In another pilot, cardiology missed appointments dropped to 10 per cent. for electronically booked appointments, compared with 30 per cent. for traditionally booked appointments. At the Good Hope Hospital NHS Trust, the first two years of electronic
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booking helped to reduce missed appointments from 16 to 2 per cent. There is still further work to do and further improvements to be made, but we are making progress.

The investments we have made mean that now almost every out-patient appointment is booked in consultation with the patient, which is a massive improvement on the take it or leave it approach of the past. Although we do not collect figures on missed appointments with GPs, we know that it is an issue. That is why the Department of Health is funding the "Keep it or cancel it, but don't forget it" campaign to raise awareness among patients of the impact of their missed appointments. The campaign provides GP practices and primary care trusts with examples of best practice from other areas, as well as tools to help them to address missed appointments.

Finally, may I return to the point about charging patients for missed appointments? I do not believe that it would be right to charge for missed appointments. First and most important, we remain committed to an NHS that is free at the point of delivery, and I welcome the hon. Gentleman's generous comments about his gratitude to the NHS in his case. Charging for missed appointments would be not only wrong in principle, but uneconomic. Unless the fines were very large, it would cost more to collect them than it would bring in revenue. We are not sure how effective that would be. We know that many of the people who fail to attend are elderly or suffer from mental illness. Would it not be a cruel policy that punished the very people most in need of care and least able to pay?

We see a national health service that is treating more patients than ever before, treating them more quickly and reducing missed appointments. We are introducing systems that will allow patients for the first time to choose where and when they will be treated, and we are enabling local NHS organisations to tackle missed appointments at the grass roots. I accept that the problem is not resolved, and that there is still a way to go. I anticipate that the hon. Gentleman's report will enable us to consider further what more can be done to help local NHS organisations to reduce the cost to them of missed appointments.

Question put and agreed to.

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