Two strikes and you're off waiting list, NHS could tell patients who turn down appointments

Patients waiting for NHS treatment who refuse two appointment offers should be removed from the waiting list, new official guidance has suggested.

According to the NHS England document, if a patient declines two proposed treatment dates, then they should be moved on to a separate list, known as “active monitoring” – effectively removing them from NHS England’s official waiting list.

The guidance aims to “help hospitals to manage patient choice fairly and effectively” and came as the number of patients waiting to start treatment stood at 6.8 million, up from 4.4 million at the start of the pandemic.

NHS England said that the interim operational guidance for hospitals for managing patient lists was requested by individual trusts and agreed by the Department of Health and Social Care.

It is understood that trusts do not have to follow the guidance in its entirety and would be subject to “local implementation”.

In August, NHS England declared two-year waits for treatment were virtually eliminated. It has now moved on to the next phase of its recovery plan by focusing on patients waiting more than 18 months.

The Royal College of Surgeons told the Health Service Journal (HSJ), which first reported the guidance, that it could be positive if used “sensibly”.

However, if it was “used poorly, it could see patients lost in the system, or banished to waiting list purgatory”.

The guidance is intended for trusts who have a small number of patients who repeatedly refuse treatment offers, preventing others on the waiting list from starting treatment, it is understood.

Sir James Mackey, NHS England’s elective recovery adviser, told the HSJ: “Trusts will need to keep a grip on their lists so they know the status of all their patients – including those on active monitoring – and we will be monitoring this nationally.”

Miriam Deakin, the director of policy and strategy at NHS Providers, said: “We know it can be particularly difficult for people in precarious or low-paid jobs to take time off for a procedure and some people may not want to have those conversations without additional support.”

However, she added that there may be occasions where it is appropriate to move patients if they repeatedly turn down appointments following a clinical conversation and in agreement with the patient.

GP and mental health services face cuts

Elsewhere, officials at NHS England warned that cancer, mental health and GP services could face cuts unless the Government filled a £20 billion funding gap over the next three years.

Julian Kelly, the chief financial officer of NHS England, told its board meeting that rising inflation and the cost of this year’s pay award will force the health service to scale back services.

“If we had to manage it within the nominal budget that we have,” he said, “clearly you have to completely revisit investment in cancer, mental health, primary care, diagnostic capacity, and you would have to look at what it meant in total, or what the NHS could deliver.”

The NHS’s “one-stop shops” – offering MRI scanning, CT scanning and other services closer to patients’ homes – are expected to face cuts unless additional funding is found, it is understood. There are more than 90 already up and running, but 160 were expected to be up and running across the country by 2025.

Rachel Power, the chief executive of the Patients Association, said: “If NHS England has to save billions, then it can only be done by cutting services for patients, which is unacceptable given there are millions waiting for care.”

Matthew Taylor, the chief executive of the NHS Confederation, said it was a “sobering warning”, adding: “A financial hit of this magnitude will undoubtedly have a very real and hard impact on front-line patient care and needs to be urgently addressed.”

The NHS is facing a £7 billion funding gap for 2023-24, Mr Kelly said, but further pressures could increase this by an additional £14 billion over the next three years.

A government spokesman said that an extra £36 billion was added to NHS budgets over the past two years to fund the impact of Covid.

They added: “We recognise that public services are under pressure due to the global economic situation caused by the pandemic. The NHS resource budget in England is currently at £152 billion and will increase to over £162 billion in 2024-25 – the highest spend on health and care in any government’s history.”