Grant Shapps (Welwyn Hatfield) (Con): I rise to raise the issue of missed appointments in the NHS, and the extraordinary cost and impact involved. The matter first came to my attention through one of my constituents, Mr. John Mitchell, who I am pleased to say is watching the debate this evening. Mr. Mitchell, who is from Welwyn, missed a hospital appointment. Being a public-spirited gentleman, he kindly took the decision to send the East and North Hertfordshire NHS Trust a cheque for £15, as he wished at least to make a gesture to make good following his missed appointment.

Imagine Mr. Mitchell's surprise when the trust, which is some £53 million in deficit, returned his cheque, saying that it did not need it or could not cash it, or something like that. Missed appointments cost the trust about £2.8 million a year. I pay tribute to John Mitchell for taking such a public-spirited approach. He had been to the dentist the previous week and seen a notice saying, "If you miss your appointment, there will be a £15 charge". He therefore thought that the NHS trust would accept the money, and that it might help to make up for his missed appointment.

That case sparked my interest in the subject, and the Minister will be interested to hear that I then fired off freedom of information requests to each of the 245 acute trusts in the country. I cannot reveal the details yet, because I have not got all the information together. On Monday, however, I will have it, and I shall issue a report that I shall be happy to share. It does not take much to realise that if my medium-sized NHS trust is some £2.8 million adrift as a result of missed appointments, and if there are 245 acute trusts, including the ambulance trusts, in the country, we must be talking about a very large sum of money indeed.

I want to address the issue of missed appointments and to find out what the Government intend to do about it. I also want to call for much more action than is apparently on the cards at the moment. I know that the issue has been raised with Ministers in the past, and that they said that they would take measures to cut the number of so-called "no-shows". It is therefore a mystery to me that, two and a half years after they made that pledge, nothing has happened. I have the figures here for 2003, when there were about 5 million missed appointments, and 2004, when there were about 5.7 million. Despite the fact that we are only just into May, I shall be able to reveal the figures for 2005 on Monday, and I am afraid that they do not make good reading for the Minister.

The response so far has been to look for solutions that involve very large computer-oriented fixes. We are all familiar with the £6.2 billion project designed for booking appointments, the so-called choose and book system. We are also aware that the project has been mired in controversy, with backlogs, and with money going down the drain. It was supposed to be up and running by last year, but it was not. I would be interested to hear a progress report from the Minister on that system. An efficient choose and book system would of course make a great deal of difference in cutting the

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number of missed appointments. However, the Government seem to confuse spending vast sums of taxpayers' money on complicated computer projects with actually fixing the problem.

In the context of the pledge to try to reduce the number of no shows, and the reference to the new £6.2 billion computer system, does the Minister feel that that was money well spent? Has it lived up to expectations? Clearly it cannot have done so far. Will it live up to expectations, or will that money never be recovered? I ask that question for a very good reason: £6.2 billion is perhaps six times the deficit for this year alone in the NHS. That is an awful lot of money, and so far we have seen no benefits from the system. I have figures from August last year showing that if the system had been on target, 205,000 appointments should have been made. However, only 63 appointments were booked though the computerised system. I would be interested to hear an update on those figures from the Minister.

The NHS has a big problem of missed appointments, which is costing it a huge amount of money. I will have the figures for that on Monday, and I would not be surprised if the sum is the same as the total deficit in the NHS for last year. I hope that the Minister will accept that that is a huge issue, and I know that the Government have accepted previously that it is a problem. The proposed solution appears to be a very large computer project, which, according to the National Audit Office, has gone terribly wrong. I am keen to hear an update on that.

Simultaneously—let us not forget that this is at the heart of the problem—my East and North Hertfordshire NHS Trust, which serves perhaps 300,000 people in the Welwyn Hatfield area, while losing all this money through missed appointments and many other problems relating to its financing and running, is closing down children's services, the blue light accident and emergency department, the maternity department, elective surgery and many other services besides. We must get to grips with that problem, which has now spiralled out of control. I am pretty sure that the answer is not spending money. There must be solutions relating to the role of management and Ministers in the running of the NHS.

Before the Minister starts accusing me of wanting to charge all the patients who miss appointments, let me say that that is not what I am driving at. I use the NHS myself, and do not have any other kind of health cover. Indeed, my life was saved by the NHS in 1999–2000, when I was effectively treated for Hodgkin's lymphoma. I am indebted to the NHS. I do not want to hear anything about how if the Conservatives got into power we would start charging people for all their NHS services. That is not what this debate is about—I know that, because it is my debate. What I want to know is what will happen about missed appointments.

The Minister might try to tell us that these problems are much more complex than I am trying to represent them as, that the administration involved is somehow beyond our comprehension, that the £6 billion IT system might ultimately resolve the problems—although so far we have little to show for the expenditure—and perhaps that dark forces are at work that a mere Back Bencher cannot easily comprehend. I would point to research carried out by the NHS on why people are missing their appointments. What is the great

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reason behind more than one in 10 people missing their appointments, at huge cost to the NHS? According to that research, two thirds of those people simply forget.

I am not convinced that a £6.2 billion computer project is required to remind people of their appointments. I approve of spending on technology in the NHS and can see the worth of it. What worries me more than anything, however, is that where there is a problem there is a budget, that when that budget is broken, that does not much matter, and more will be spent until the problem is solved.

I do not think it is good enough to say that spending money on huge computer projects is a panacea that will solve a problem two thirds of which is due simply to the fact that an individual forgot to turn up for an appointment. There must be something else that we can do, and some of the solutions may be blindingly straightforward, as is the problem itself—the fact that people are simply forgetting about appointments.

Let me run a few of my ideas past the Minister. Perhaps I will receive a response. It seems to me that when my constituent Mr. John Mitchell, being a public-spirited gentleman, sent a £15 cheque to the NHS trust, it might have been better had it been cashable by the trust. That was, after all, my constituent's intention. I should have thought that if the trust did not feel that it could cash the cheque, it would have been appropriate to send it to the League of Friends of the QEII hospital.

What interests me is where the blockage lies. When the trust was asked about the matter, the head of communications, one Peter Gibson, told the local newspaper, the Welwyn and Hatfield Times, that it would be simply illegal to accept the £15. I ask the Minister this: is it illegal to accept a £15 donation, and if so, why? If it is not illegal, will the Minister undertake to drop a note to the chief executive of the East and North Hertfordshire NHS Trust, Nick Carver, explaining that it is not illegal? While she is at it, perhaps she will write to the other 264 trusts in England and Wales telling them that they can accept such donations.

On Monday, when I release a report containing all the data from all those 264 trusts, I shall be very surprised if other people do not come forward with exactly the same story. I am fairly convinced that a string of constituents from all over the United Kingdom will say, "That's funny: exactly the same thing happened to me."

I should have thought that in an age when people care passionately about the national health service and really want it to work, the Government and Ministers would want to do more to ensure that people who are generous in spirit, like my constituent, can make up for their error in forgetting to turn up for an appointment. I should have thought that there was sufficient good will throughout the nation for the establishment of a rather more formal arrangement.

Another solution might be to adopt the dentists' system. There might be a compulsory charge, or it could be suggested that those who missed appointments might like to make a payment. I would be surprised if that did not raise several million pounds a year.

There are practical solutions that the Minister could pledge to adopt this evening. She could write to all the chief executives reminding them of the legal position. If it is not the case that, as the East and North Hertfordshire NHS Trust claimed, it would have been

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illegal to accept the money, a letter to remind trusts of that would cost only 264 postage stamps, and could save the NHS a fortune. The Minister could also consider whether it would be possible to introduce a scheme that would stop shy of compulsion, but would go as far as inviting public-spirited payments for missed appointments—if necessary, through a separate fund, or possibly to organisations such as the league of friends of the QEII hospital, which has equivalents throughout the country, or indeed to the main coffers of the trust itself.

I feel that my questions require answers. I hope that on Monday the Minister will be interested to see the results of the research that I have conducted throughout the country. I also hope that if I send her a copy of my report on the total cost of missed NHS appointments, she will tell me whether further measures could be taken to reduce the number of missed appointments—and I very much hope that the solution will not be purely and simply to rely on a £6.2 billion computer project that we all know has gone badly wrong.

7.14 pm
The Minister of State, Department of Health (Jane Kennedy): I must confess that when my private office approaches me and says "You must respond to an Adjournment debate", my heart often sinks. On this occasion, however, I must compliment the hon. Member for Welwyn Hatfield (Grant Shapps) on the entertaining way in which he presented his case, and the industry that he displayed.

I was aware that the hon. Gentleman had made requests under freedom of information legislation to various health organisations, and I compliment him on his industry. He is right that this is an important issue: we take it seriously and acknowledge that it is problem.

I shall not adopt a political position and say how much better things are under this Government. That would not be appropriate, but it is important to set the context for the debate and make it clear that our investment and reforms are having an impact on waiting times. In the past four years, waiting times for a first out-patient appointment have halved, falling from 26 weeks to 13. The maximum waiting time for an operation is now six months—and the average is even lower—compared with the two years or more that some patients used to endure.

I do not pretend that the new connecting for health computer system will be the panacea that resolves all problems. I shall detail what I expect will happen in a moment, but our investment means that the NHS will have a proper IT system that is able to track patient progress. That will make it much easier for patients to contact their GPs and the consultants dealing with their cases than has been the case in the past.

In addition, we are enabling patients to choose where they will go for treatment. The connecting for health system does much more than allow hospitals to track people who do not turn up for appointments. The hon. Member for Welwyn Hatfield referred to the electronic booking system that we are putting in place. That will enable patients to select the time and date, as well the place, for their treatment.

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On top of that, our financial reforms are developing incentives in the NHS to tackle the problem locally. Payment by results should mean that hospitals will no longer be able to pass the costs of missed appointments on to their commissioners. I understand that a figure of £100 per missed appointment is being bandied about. It is not one that I recognise: I think that it overstates the cost by quite a large amount, although I accept that missed appointments are a cost to the NHS.

Grant Shapps: That figure is based on Government estimates in the past, although I admit that I have only seen it quoted in various articles and do not know its precise source. However, I have much more detailed information about the actual cost of each missed appointment. I assure the Minister that my estimates will be based not on the £100 figure but on independent health trust statistics.

At the beginning of her speech, the Minister reeled out some information about how appointments were being speeded up. Does she agree that that makes little difference to people in Welwyn Hatfield, given that the QE2 is all but being closed down?

Jane Kennedy: Clearly, I do not accept what the hon. Gentleman says about his local hospital, and I shall speak in a moment about the efforts being made by the local health organisation to reduce the number of occasions on which appointments are missed and the cost that flows from them.

Where missed appointments are a particular problem, NHS trusts already have the devolved power and the incentive to tackle them locally. Hospitals know their rates of failed attendances. Those figures are predictable, and NHS trusts are dealing with the problem. For example, it is likely that two patients out of 20 will not turn up to a clinic. When a patient does not show up, doctors do not just sit on their hands: they get on and see the next available patient.

Like other NHS trusts, East and North Hertfordshire is taking action locally to reduce the number of missed appointments. That goes beyond merely spraying money at the problem, but includes improving the quality of the trust's communication with patients. Reminders are sent out, and the trust also follows the matter up with those who fail to attend. In addition, it contacts the GPs of people who frequently miss appointments. That generally makes clear what the problem is, and I assure the House that it is not the same for all patients. I shall be interested in what the hon. Gentleman's research uncovers in that regard.

The hon. Gentleman referred to his local newspaper. His local trust uses the media to explain how important it is to keep appointments or, if that is not possible, that the trust is contacted to change the appointment. That has enabled the trust to reduce missed out-patient appointments by nearly 10 per cent. this year and it is planning action to reduce them even further next year.

The hon. Gentleman said that his constituent, Mr. Mitchell, had offered a contribution towards the cost of his missed appointment. I understand that his contribution was not accepted because it was offered as a payment. As I hope we all accept, the health service does not make charges to patients, so it cannot accept payments. However, had the contribution been offered

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to the League of Friends of the hospital, as the hon. Gentleman suggested, it would have been in order for the friends to accept it. A donation is different from an offer of payment, which was, I understand, the context of the offer.

The issue of missed appointments is important and I thank the hon. Gentleman for raising it and allowing me the opportunity to explain the work that the Government and the health service are doing to reduce that extra burden and cost to the NHS. One of the reasons that the issue is so important is that the NHS is treating more patients than ever. In the last year, 9 per cent. more patients were seen in out-patient clinics and 6 per cent. more as in-patients than under the previous Government. Despite that, the proportion of missed out-patient appointments is coming down—from 13 per cent. last year to 12 per cent. for the first three quarters of 2005–06.

Grant Shapps: I want to check some of those figures, to make sure that I heard them correctly. The number of missed appointments is not coming down for the year as a whole, so will the right hon. Lady undertake to ensure that there is some feedback on those figures when the report is submitted? The numbers mean nothing to me in the context of the research that has been carried out, so I suggest that they may be wrong.

Jane Kennedy: The Government will receive the hon. Gentleman's report with interest when it is ready for publication.

The electronic booking system to which the hon. Gentleman referred earlier should allow patients to see all available dates and times. They can then book an appointment straight after seeing their GP, or at their own convenience after checking with friends and family. We have been testing the system and we know, from pilot sites, that it has a strong, positive impact on missed appointments. The hon. Gentleman may be interested to learn that in one pilot scheme, the out-patients manager reported that none of the patients who had been electronically booked failed to turn up for their appointment. In another pilot, cardiology missed appointments dropped to 10 per cent. for electronically booked appointments, compared to 30 per cent. for traditionally booked appointments. At the Good Hope Hospital NHS Trust, the first two years of electronic

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booking helped to reduce missed appointments from 16 to 2 per cent. There is still further work to do and further improvements to be made, but we are making progress.

The investments we have made mean that now almost every out-patient appointment is booked in consultation with the patient, which is a massive improvement on the take-it or leave-it approach of the past. Although we do not collect figures on missed appointments with GPs, we know that it is an issue. That is why the Department of Health is funding the "Keep it or cancel it, but don't forget it" campaign to raise awareness among patients of the impact of their missed appointments. The campaign provides GP practices and primary care trusts with examples of best practice from other areas, as well as tools to help them to address missed appointments.

Finally, may I return to the point about charging patients for missed appointments? I do not believe that it would be right to charge for missed appointments. First and most important, we remain committed to an NHS that is free at the point of delivery, and I welcome the hon. Gentleman's generous comments about his gratitude to the NHS in his case. Charging for missed appointments would be not only wrong in principle, but uneconomic. Unless the fines were very large, it would cost more to collect them than it would bring in revenue. We are not sure how effective that would be. We know that many of the people who fail to attend are elderly or suffer from mental illness. Would it not be a cruel policy that punished the very people most in need of care and least able to pay?

We see a national health service that is treating more patients than ever before, treating them more quickly and reducing missed appointments. We are introducing systems that will allow patients for the first time to choose where and when they will be treated, and we are enabling local NHS organisations to tackle missed appointments at the grass roots. I accept that the problem is not resolved, and that there is still a way to go. I anticipate that the hon. Gentleman's report will enable us to consider further what more can be done to help local NHS organisations to reduce the cost to them of missed appointments.


Adjourned accordingly at twenty-six minutes past Seven o'clock.
 

Promoted by Amanda Perkins on behalf of Grant Shapps, both of Maynard House, The Common, Hatfield, AL10 0NF