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One in 50 outpatients who miss an appointment fail to attend three or more further appointments within three months

June 25, 2014: Hospitals in England recorded that one in 50 patients (65,590 of 3.5 million) who missed an outpatient appointment failed to attend three or more further appointments within three months (4).

*HSCIC must be quoted as the source of these figures

*Regional figures are available

The latest report from the Health and Social Care Information Centre (HSCIC) shows that in the 12 months to March 2014 over 4.3 million patients accounted for 6.8 million missed outpatient appointments (these appointments are known as Did Not Attends, or DNAs)7. The Department of Health has estimated that the average outpatient attendance costs £1088.

Today's figures are part of a special topic on outpatient data, presented alongside the monthly provisional Hospital Episode Statistics publication released today. This publication provides new analysis that examines the scale of missed outpatient appointments.

The report also looks at the subsequent use of other services following outpatient DNAs by monitoring what happens in the three months afterwards4.

Of the 3.5 million patients that missed an appointment in the period April 2013 to the end of December 2013, in the three months that followed:

  • One in six patients (566,040) failed to attend one other appointment, one in 25 (136,710) failed to attend twice and one in 50 (65,590) failed to attend three or more times.
  • Over half of patients (53.5 per cent, 1.8 million) attended a subsequent one within three months5.
  • 13 per cent of patients who did not attend an outpatient appointment (448,710) went on to have an unplanned A&E attendance6. This compares to 8.4 per cent (1.1 million patients) who attended an appointment within the same time period.
  • 6.5 per cent of patients who did not attend an outpatient appointment (223,110) went on to have an emergency admission to hospital. This compares to 3.8 per cent (510,710 patients) who attended an appointment within the same time period.
  • The highest percentage of outpatients who did not attend their appointment and then went on to either attend A&E or to be admitted to hospital as an emergency within three months were for the outpatient specialties of geriatric medicine and medical oncology (25.5 per cent and 24.6 per cent respectively).

Provisional data for the year to March shows:

  • Overall, 8.1 per cent of outpatient appointments were missed in England.
  • The Merseyside Area Team has the highest percentage of DNAs at 11 per cent, whereas the Bath, Gloucestershire, Swindon and Wiltshire Area Team had the lowest at 6.3 per cent.
  • Women aged 20 to 29 missed 10 per cent of their booked outpatient appointments (629,640 of 6.3 million) accounting for the highest number of DNAs for any age group.
  • Men aged 20 to 29 had the highest percentage of missed appointments at 17.4 per cent (405,560 of 2.3 million).
  • Female patients missed 3.6 million (7.5 per cent) outpatient appointments overall, whilst male patients missed 3.2 million (9.0 per cent).

Chair of the HSCIC, Kingsley Manning said: "This new analysis looks at the journey of outpatients and how they access services, such as Accident and Emergency, after missing an appointment.

"The fact that over eight per cent of outpatient appointments in England end up as a DNA is striking and really gives food for thought to patients and health professionals alike.

"It is hoped that this data can help to shape changes in policy that will educate patients on the benefits of re-arranging their outpatient appointments if they can't make them."

You can view the full report here: http://www.hscic.gov.uk/pubs/hesapr13mar14.

ENDS


Notes to editors  

  1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.
  2. Counts of figures over 1,000 have been rounded to the nearest 10, figures over 1 million have been rounded to the nearest 100,000. Percentages have been rounded to the nearest decimal point.
  3. Hospital Episode Statistics (HES) are compiled from data sent by more than 300 NHS trusts and Area Teams in England and from approximately 200 independent sector organisations for activity commissioned by the English NHS. The HSCIC liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies. While this brings about improvement over time, some shortcomings remain. Figures refer to recorded admissions and are reliant upon the accurate and complete recording of cause of hospital admission. Submissions from the independent sector in particular have improved significantly in recent years.
  4. Note that analysis of subsequent hospital activity is of patients who did not attend in the period April to end December 2013. Activity is measured up to 90 days (described as three months above) following their first did not attend in this period.
  5. Note that a number of patients neither had a subsequent attendance nor a subsequent non-attendance. No information is held as to whether the patient was offered a further appointment following the DNA.
  6. This analysis provides no information about the reason for the subsequent activity, e.g. subsequent A&E attendance may not be related to the original outpatient appointment.
  7. Did not attend is characterised by the patient failing to turn up to a planned appointment without any notice. This may be due to the patient being too ill to attend, forgetting their planned appointment or a failure in the appointment process, for example where a patient has been admitted to hospital but the appointment has not been reallocated.
  8. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/261154/nhs_reference_costs_2012-13_acc.pdf
  9. The Area Team (AT) within which the organisation providing treatment was located. In April 2013 changes to the structure of the NHS came into effect (http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx). Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) were abolished and were replaced with organisations such as Clinical Commissioning Groups (CCGs) and NHS England Area Teams (ATs). In addition there are now four NHS England Regions above the Area Teams in the structural hierarchy.
  10. For media enquiries please contact media@hscic.gov.uk or 0300 303 3888.
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