As many appointments cancelled by hospital as patient no-shows?

CLAIM: Almost as many health appointments were cancelled by hospitals as were the result of patients not turning up.

CONCLUSION: ACCURATE WITH CONSIDERATION. In 2017/18, hospitals cancelled more appointments (175,428) than patients not showing up (139,351). However, in the same period, patients cancelled notably more appointments (207,960) than hospitals did. Hospitals account for 34% and patients 66% of all appointments scheduled but not held.

Are half of hospital appointment cancellations done by hospitals rather than by people not turning up?

On 12 March 2019, BBC Radio Ulster’s Nolan Show discussed whether people should pay to see their General Practitioner in order to reduce the number of no-shows. Presenter Stephen Nolan pointed out to guest Dr George O’Neill GP that people not turning up at their doctor’s appointments “ultimately costs the NHS millions of pounds a year”. Dr O’Neill, who argued against the suggestion, responded that in relation to hospital appointments, “almost as many appointments were cancelled by hospitals as were resulted by people not turning up” (01:46-02:10).

Northern Ireland hospital statistics

On 2 August 2018, the Department of Health published a report on Hospital Statistics for the period from 1 April 2017 to 31 March 2018. The report includes information about Patient Cancellations (CNAs), Hospital Cancellations, and Missed Appointments (DNAs). Data is given for Outpatient appointments — enabling patients to see a consultant — and Integrated Clinical Assessment and Treatment Services (ICATS) appointments — non-consultant outpatient appointments “provided by integrated multi-disciplinary teams of health service professionals”.

In total, 1,572,943 hospital appointments were held in 2017/18: 1,456,651 for outpatient services, and 116,292 ICATS.

Appointments cancelled by the hospital

In 2017/18, there were 175,428 (166,238 outpatient services + 9,190 ICATS) hospital cancellations (i.e., appointments cancelled by the Health and Social Care Trust provider).

Missed appointments

139,351 (128,407 + 10,944) appointments were missed, where a patient did not attend (DNA) an appointment. Missed appointments include cases where patients did not turn up without warning the hospital, and cases where patients warned the hospital on the same day as the appointment was scheduled.

Thus, there were even more cases were appointments were cancelled by the hospital than cases appointments not attended by the patient.

So Dr O’Neill’s claim is reasonably accurate in relation to hospital cancellations and patients not showing up.

Appointments cancelled by the patient

However, apart from DNAs, 207,960 (191,803 + 16,157) appointments were cancelled by patients who could not attend (CNA) an appointment. In these cases the hospital was warned in advance, “with the patient contacting the hospital no later than the day before the appointment is scheduled and informing the hospital that they are unable to attend the scheduled appointment”. Dr O’Neill further made the comment that patients often have “valid reasons” to cancel an appointment.

Taking into account all appointments that were intended to be held, but didn’t occur, a third (34%) were cancelled by the hospital. The remainder (66%) was 347,311 appointments where the patient cancelled or did not attend.

Hospital Cancelled Patient Did Not Attend Patient Cancelled Appointments Attended
Outpatient services appointments 166,238 128,407 191,803 1,456,651
ICATS appointments 9,190 10,944 16,157 116,292
All appointments 175,428 139,351 207,960 1,572,943

Cancelled and missed appointments over years

The graph below shows the number of appointments cancelled by patients, missed by patients, and cancelled by hospitals from 2010/11 to 2017/18, adding up data for outpatient services and ICATS.

Source data graph: https://www.health-ni.gov.uk/publications/hospital-statistics-outpatient-activity-statistics-200910-201617

(The decrease between 2013/14 and 2015/16 is due to the changes in the recording of ward attendances and virtual outpatient activity. Ward attenders no longer appear in outpatient attendance figures since 2014/15, nor virtual outpatient activity since 2015/16. Therefore, the Department of Health notes that “it is only possible to provide trend data on outpatient activity in HSC Trusts from 2015/16 onwards”.)

Conclusion

From 1 April 2017 to 31 March 2018, there were more hospital appointments cancelled by hospitals (175,428) than appointments where people did not turn up (139,351). However, including appointments that were cancelled by patients (207,960), hospital cancellations account for only a third of the total of cancelled or missed appointments.

Image source: “The Belfast City Hospital” licensed by William MURPHY CC BY-NC