What people told us about outpatient appointments

In 2023, NHS England made a commitment to improve outpatient appointments, which have changed little since the founding of the NHS in 1948. It committed to working with professionals and patient group representatives to come up with a new strategy, which will be published shortly.

So we’ve looked at our recent evidence on outpatient appointments to find out what people like about the current approach and what they’d like to change. During November 2023, we received 879 pieces of feedback from people about their experiences of outpatient appointments.

The stories people shared showed that people experienced issues the whole way through the process, from first trying to book all the way up to attending their appointment.

These are the key themes in the feedback we looked at:

Poor administration

We heard that administration of outpatient appointments was problematic. People found it difficult to get through to someone by phone who could deal with their query. In other stories, people were passed around from department to department before being able to talk to someone who could help them.

“The following has happened 3 times when I tried to call about my appointment or to cancel.

• The phone reception for the department I had the appointment with had to talk with another department which had booked the appointment.
• The main reception could see the appointment but couldn’t access the appointment to amend or see details because they didn’t book the appointment.
• I was given 2 phone numbers to ring:  one not answered, the other wasn’t right so given number for outpatients.
• Outpatients said they don’t deal with inpatients and gave number for main reception.
• I gave up and didn’t cancel the appointment.”

— Story shared by Healthwatch Sheffield

People also talked about experiencing difficulties when trying to move appointment dates and times. One person described not being able to arrange a new appointment over the phone. Instead the appointment had to be cancelled and rearranged.

We have done research in recent years to show the effects that poor administration can have on patients, and made recommendations for what good administration should look like. Read more about this work.

Waiting times for appointments

We heard about long waits for outpatient appointments (including initial consultant appointments before planned surgery) – including one of 47 weeks. People also told us about the hospital cancelling outpatient appointments, sometimes multiple times or at very late notice. Occasionally patients turned up at the hospital only to find the appointment had been cancelled without their knowledge.

While they wait for another appointment, people are experiencing anxiety and pain:

“The individual was suffering from respiratory issues and was referred to the respiratory service but did not hear back in which time their condition worsened. Following further referrals for more tests they were finally given an appointment with the respiratory service; however that appointment was cancelled and rescheduled over three weeks later. They have not had any treatment, they are still struggling with breathing, and have had to take considerable time off work. In order to help themselves they have gone private.”

— Story shared by Healthwatch Medway

NHS England is trying to meet a target of no people waiting over 65 weeks to start consultant-led elective treatment by March 2024 (except where patients choose to wait longer). But performance statistics show there were over 107,000 waits this long in October 2023. While slightly lower than the previous month, there has been no lasting improvement seen since March 2023.

Getting to appointments

In 2019, we raised concerns about how people get to healthcare appointments. In this report we highlighted that travel was a key issue, with nine out of 10 people in a survey telling us that convenient ways of getting to and from health services is important to them. Indeed, people put transport above other things, such as choice over where to be treated and improving digital access to services.

Four years later, we are still hearing similar concerns. We heard about people who rely on public transport being offered appointments at hospitals that were difficult for them to get to. We heard about long journeys that involved several changes of bus to get to an appointment, or the difficulty of getting to a very early or very late appointment. People have to resort to taxis, which are expensive.

We also heard that people reliant on patient transport to get to outpatients’ appointments found it could be difficult to book services. They faced long waits on the phone and staff insisting they had to book the service close to the appointment.

In contrast, where the NHS can support people to get to appointments, people are more likely to attend.

For example, Healthwatch Birmingham evaluated a service to support children and their families with transport to outpatients appointments. They found that affordability and reliability of travel, availability of parking and cost of parking and travelling through Birmingham’s clean air zone are among the barriers people face when attending their appointments. For the majority of participants, travel support made the journey affordable and helped reduce stress and anxiety.

Finding the right department

People attending an outpatients’ appointment for the first time need to know how to get to outpatient clinic location once they’ve arrived at the hospital. Clear and accurate signage is necessary to achieve this. We heard that poor signage leads people to get lost on their way to their appointment and doesn’t always indicate the safest most accessible route.

Mystery shopping by Healthwatch Southend found that a hospital undergoing refurbishment had particularly poor signage. The location of some departments had moved with limited or no signage, scaffolding obscured existing signage and there was insufficient temporary signage to outpatients’ clinic locations.

The importance of staff attitude

People told us about the attitude of healthcare professionals and reception staff that they encountered at their outpatient appointments. People reported poor experiences when staff were rude or abrupt, or had limited time to explain treatment to patients.

In contrast, good experiences involved healthcare professionals taking the time to listen to patients and explain treatment, medication and self-care:

“I just wanted to drop a note to commend X. She has always been so helpful in helping us navigate our daughter’s care at the paediatric allergy clinic. Nothing is ever too much trouble for her. If she can't help at the time she will always call back and help resolve any issues. She is always pleasant and empathetic on the phone. It makes a real difference to have someone on the other end who understands rather than making us feel like neurotic parents being a nuisance. X, you are a credit to the NHS. We are super grateful.“

— Story shared by Healthwatch Harrow

Service integration

Feedback also raised the need for better service integration. People described having to go to two different hospitals for their conditions and being asked to duplicate certain diagnostic tests as the two hospitals couldn’t share records. We also heard about delays in hospitals sharing test and scan results with GPs, and even losing samples and scan results:

“Client's daughter has had bowel issues since she was 5. In 2021 the hospital took bloods. In 2022 they did a stool sample. The hospital have now set up a new clinic and she got a call from them saying that they have seen red flags in the 2021 blood sample. She asked about the 2022 stool sample and they said they had no record of that. Her daughter has now been diagnosed as coeliac and is waiting to see a dietician. She is worried in case more damage has been done to her daughter's bowels from it not being spotted sooner.”

— Story shared by Healthwatch Liverpool

Our calls for change

We’re calling for:

• ICBs to support people waiting for NHS treatment, including support or signposting to help for their mental health.
• Services to improve communications with patients, so nobody feels forgotten or in limbo following delays and cancellations to outpatient appointments.
• NHS England and Integrated Care Boards to work together to ensure everyone choosing to travel for faster treatment is given support. This must include the costs of transport and accommodation. Otherwise, this option risks deepening health inequalities by only providing solutions to people who can afford to contribute towards the additional costs of travel.
• NHS England to restart their review of the Healthcare Travel Cost Scheme (HTCS). This must include work to reduce reimbursement time, improve usability, and support providers to offer to patients more proactively.
• NHS England and the Care Quality Commission (CQC) to restart their annual outpatient survey, so people’s experiences of appointments can be benchmarked year on year. Work should also be announced to collect, report, and analyse real-time experiences of NHS care.
• GP and hospital teams to give patients a real choice at the point of referral to appointment types and times.
• ICBs to hire care navigators in secondary care to help guide patients through their care journey, including booking and modifying appointments.