Four million patients who failed to attend
Authors: W. Russell
Journal: BMJ (1984)

The problem of the patient who wastes everybody's time by failing to keep an appointment is a common one throughout the National Health Service, causing as much irritation to doctors as waiting for hours causes some of those patients who do appear.The need for hospital patients to recognise their moral responsibility to turn up on time for appointments in order not to waste valuable NHS resources was stressed by Mr John Patten, Under Secretary of State for Health, in the Commons last week in reply to a call by Dr Brian Mawhinney, Conservative MP for Peterborough, a medical lecturer, for priority to be given to the introduction of computers in the NHS.Dr Mawhinney claimed that the cost of unkept outpatient appointments alone could be between £85m and £266m a year-the disparity is because of the lack of information on exactly what is happening-and that the latest available figures for 1982 showed that between 4-25 million and 5-33 million appointments were not kept.He argued that there was no point in a commitment by ministers to cost effectiveness in the NHS if the new Griffiths managers were not given the technology to enable them to do the job.Priority had to be given to computerising the districts and the regions and a little more money spent in the short term.As to why so many patients did not show up, he suggested that some might not do so because they were already dead, some because they were already better, and some because the consultant had put them on the waiting list in order to get them out of his clinic or surgery and had no real intention ofever giving them any treatment.Dr Mawhinney said that he had written to 14 regional health authorities asking them whether they could give him numbers and percentages of non-attendance over the past five years, and 12 had replied saying they did not have any figures, nor did any of the districts.The huge gap in the knowledge ofwhat was going on in the NHS was "very worrying."Mr Patten was sympathetic, and said that the government had asked health authorities to implement the first report by the Korner committee-set up to report on NHS information services-by April 1987.That had recommended all districts to collect informa- tion showing the number of patients with an appointment who did not attend."For inpatients who were to be admitted from waiting lists, the report recommends that all districts collect information showing the number of patients for whom arrangements to admit were made, but who were not admitted, distinguishing those who were not admitted because they failed to attend," he added.Mr Patten said that by 1987 the government expected at least one third of all districts to have a computerised patient administration system, and most would have the facility to monitor waiting lists to provide doctors with information about non-attenders.But as always it boils down to a question of cash.Mr Patten said that the computer systems available or under development at present would cost a district between £O-Sm and £5m to install, and that this was an investment nationally of about £50m or more.The money would