Waiting list backlogs, A&E delays and strikes have put the NHS under huge pressure, and missed GP appointments are adding to the burden. Amid calls for a drastic reform of the service we ask whether charging no-shows should be part of the solution.
No
Wes Streeting, the shadow health secretary and Labour MP for Ilford North
Charging patients for missed appointments may be superficially attractive but it can’t be justified for a number of reasons. I worry that fines are a slippery slope. The Conservatives have long wanted to introduce charging for the NHS. The former health secretary Sajid Javid recently advocated for patients to be charged to see a GP or go to A&E. There are many things wrong with the NHS, but the fact that you never have to worry about the bill is its biggest strength.
The blame for missed appointments often lies with the outdated way the NHS communicates with patients. Many patients have not had their letter until after the date of their appointment. Others will have tried to cancel because of an emergency but been unable to get through to anyone to do so. The NHS should get its own house in order before dishing out punishments to patients.
Restaurants text customers a reminder of their reservation and ask for confirmation of the booking. When one NHS trust trialled this, missed outpatient appointments were cut by a third. If this was rolled out on a wider basis it could save the NHS an estimated £300 million a year. Labour would go further and reform the NHS app. We organise so much of our lives on our phones. We should be able to book and rearrange appointments, self-refer to specialist services where appropriate and check our health records on our phones too.
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Crucial to Labour’s reforms will be fixing the front door to the NHS. GPs spend too much time box-ticking and form-filling and not with patients. This would become ten times worse if they had to administer and enforce fines. Labour will cut the red tape that ties up GPs and train thousands more of them, so patients can see their family doctor when they need to. The agenda of the next Labour government will be about reaching patients earlier, to keep them well and out of hospital. Putting up barriers for patients would be a backwards step.
Yes
Sean Phillips, head of health and social care at Policy Exchange, a think tank
Roughly 20 million GP and hospital outpatient appointments are missed each year, costing the NHS an estimated £600 million.
Penalties in the private and public sector for no-shows, such as not turning up for a restaurant booking or unauthorised school absences, are now accepted as the norm. More than half the people surveyed in a poll last year were in favour of a £10 fine for a missed medical appointment as a means of raising revenue. The sentiment echoed a proposal made by the prime minister during his campaign to become leader of the Conservative Party. It taps into a sense of fair play, and there would probably be more public support if penalties were focused on repeat offenders.
Based on last year’s figures, £10 charges for missed appointments would have generated £200 million — enough to pay the salary of 6,000 nurses.
We would have international precedents to draw on. Norway introduced non-attendance charges in 2001, and a hospital in Telemark had a drop of 26 per cent in non-attendance fines when the penalty was doubled between 2014 and 2015. France is considering a €5 fine for no-shows from 2025.
There would need to be caveats to make such a policy fair. Healthwatch England, the patient watchdog, suggested that “more than two million people may have missed appointments in 2022-23 due to late delivery of letters”. Clearly patients should not face a charge for the administrative failures of NHS organisations or Royal Mail.
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We know from the evidence that missed appointments most often occur because of inflexible appointment times clashing with work patterns or caring responsibilities, or because of long waits. If the aim of penalties is to reduce missed appointments, efforts should be made to improve how the NHS communicates with patients.
If patients are given more choice about the time and type of their appointments, if they are given options to reschedule, if they are reminded then fail to attend, the case to introduce fines for non-attendance would be stronger still.
