No-show patients cost NHS pounds 500m a year

Careless patients who fail to keep hospital appointments are costing the National Health Service pounds 500m a year, ministers disclosed yesterday.

The huge drain on the NHS's hardpressed budget was revealed as ministers published the fourth annual set of performance tables for the service which show pressures growing.

The total number of starred ratings indicating good performance is down on last year and cancelled operations not re-scheduled within a month - a sensitive indicator of hospitals in difficulty - are up almost 40 per cent.

Launching the tables, which are to be extended to include death rates and other clinical measures, Baroness Jay, the health minister, said she had been shocked by the number of patients who missed hospital appointments. They average 11 per cent across the NHS, but rise to more than one-third in some hospitals.

She said 1.3 million first out-patient appointments were missed each year at a cost of almost pounds 200 each, equivalent to pounds 250m. In addition, 250,000 patients failed to turn up for booked operations or day case surgery at an average cost of pounds 1,000 each, worth another pounds 250m. "We are seeing enormous sums being lost to the service," she said.

Some of the no-shows were accounted for by patients who died, got better or whose circumstances changed. Alan Langlands, chief executive of the NHS, said hospitals that phoned patients the week before they were due to come in improved attendance.

"There is a responsibility on patients to keep appointments and an important job for hospitals to ensure patients are reminded," he said.

Lady Jay said the existing performance tables, which assess hospitals across more than 70 indicators including waiting times, day surgery and cancelled operations, measured the quantity, but not the quality of treatment. She announced trials of 15 clinical indicators including deaths in hospital within 30 days of admission with a heart attack, infection rates and readmission rates. Some existing measures would be replaced including how rapidly patients are assessed in accident and emergency departments by what is disparagingly referred to as the "hello nurse".

The new clinical indicators, which were piloted last year under the Tory government, would be introduced as soon as possible, probably by next year, Lady Jay said.

Medical organisations welcomed the move, but warned that like must be compared with like. The NHS Confederation said: "The current tables lack credibility because they fail to give the public any indication of the success of their local hospital."

One of the most improved NHS trusts, which increased its star rating in 23 categories, is Redbridge in east London, which runs the 450-bed King George hospital and three other smaller hospitals. The trust attributed its success to hard work in areas identified in previous tables as weak, such as out-patient waiting times.

Health check

GOOD PERFORMERS Most improved NHS trusts which have performed well across the range

Redbridge Healthcare NHS Trust

Mid-Essex Hospital Services NHS Trust

Wiltshire Healthcare NHS Trust

Stockport Acute Services NHS Trust

Mid-Staffordshire General Hospitals NHS Trust

City Hospitals Sunderland NHS Trust

Southend Healthcare NHS Trust

South Warwickshire Healthcare NHS Trust

Heathlands Mental Health NHS Trust, Surrey.

North Hampshire Loddon Community NHS Trust

POOR PERFORMERS

NHS trusts and health authorities with poor records on certain measures

Newham Healthcare NHS Trust

Royal Hospitals Trust, east London

Royal Liverpool and Broadgreen NHS Trust

Northwick Park and St Mark's NHS Trust

Bournewood Community and Mental Health NHS Trust, Surrey

South Yorkshire Ambulance Service

Lewisham and Guy's Mental Health NHS Trust

BHB Community Mental Health Trust, Essex

Kensington and Chelsea Health Authority

Lambeth, Southwark and Lewisham Health Authority