KKLEIN wrote:There are schemes in the NHS that I would like to start seeing implemented - billing people that book appointments that then don't show up for a start. My Mum works as a receptionist for the NHS and the amount of people recently that don't cancel & then just don't show up is a bit ridiculous. Fine them for goodness sakes.
This sounds like a very logical and fair policy.
However, for me it very quickly starts to fall apart once you look a bit deeper. For one, it would be very difficult to implement fairly. I'm sure you would quite happily charge a feckless stoner who missed an appointment, but an A&E nurse who had a car crash come in ten minutes before their shift ended should be cut some slack, yeah? But who decides where the line is? Bus late - leave earlier, or blame Arriva? Get arrested - tough luck crim, or innocent until proven guilty? Who has an important enough job to miss an appointment?
The obvious answer to this is to have some form of appeals process, where someone can collect all the bus tickets and other excusing paraphernalia and decide who has a good enough excuse to be let off. But can you imagine the cost of checking up all these (potentially) shaggy dog stories? Would you want to be the member of the admin team who had to tell a patient they weren't depressed enough to miss their appointment, or that they could have rung
before the panic attack happened? There would also have to be an appeals process for the appeals process (or it could go to PALS). My GP surgery has a 95%+ attendance rate, and a fair penalty charge is generally thought to be about a tenner from most things I've read about the idea. How much money would you actually get, once you deducted the cost of actually extracting it from patients? Taking Squinty's 160 DNAs a quarter message - if you extrapolate that up to 640 DNAs a year and divide it by 250 (for a rounded approximation of working days in the year), you work out with, on average, around 2.5 missed appointments a day. That's £25 a day in £10 fines (assuming they're all eligible to be fined, less the administration of collecting it). Would that even keep the lights on in the surgery?
It could also lead to further disenfranchisement of society's most vulnerable. If you're living on JSA (or whatever it's called now...), where are you going to find the money for a fine from? Is the best way to promote healthy lifestyles to further demonise (and to all intents and purposes criminalise) people who are most on the edge of society? The people who are most engaged and most able will either pay their fine or kick up enough of a stink to get off (that includes all the naughty Jeremy Kyle Benefits Street dolescum lot that everyone hates). The patients who are less able to pay, cannot work the system as well, or have long term health conditions (reducing ability to attend whilst also increasing their need to do so), will either need to
pay money they cannot afford to access the NHS, or they will not bother going until they have a much more serious complaint which costs much more to treat in A&E, and could cost them their livelihood (probably putting them into the welfare system) or even their life.
I work in a screening programme. This means we see patients who are in an at risk group for a certain illness, but have not developed any symptoms that would make them seek help off their own back. The earlier you catch these problems, the better (and cheaper) it is for everyone. Our DNA rate is probably a little bit higher than a GP (obviously we'd like as many people to show as possible!) - as you may expect, people with no symptoms are less likely to turn up than those receiving effective treatment for a problem impinging on their life. We're all guilty of it - I was a bit lax booking my dental check up this year until my tooth started hurting! If we started charging patients who did not turn up, it would be the oldest, the frailest, the least engaged with their treatment - and therefore the most likely to need early detection and care - that would suffer.
That doesn't sound logical and fair to me.