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Lord Hardy of Wath: My Lords, does my noble friend agree that a problem clearly continues? Does she further agree that it is a surprising problem, given the huge expansion of NHS bureaucracy under the previous administration? Since a large wastage of NHS resources clearly applies, would it not be advisable for good practice to be encouraged across the country in order to ensure that some of the criticisms offered by noble Lords no longer apply?

Baroness Jay of Paddington: My Lords, I certainly agree with my noble friend that the figures I have mentioned represent a considerable waste of resources within the NHS. It is difficult to calculate why appointments are missed. It may be that people simply forget; or it may be for administrative reasons, as my noble friend suggests. Frankly, it is difficult to calculate precisely what loss of resources it represents. An out-patient appointment at a clinic may be for some very simple matter, or for a complicated procedure. If we take as an average £61 for each out-patient appointment,

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the NHS could be losing as much as £360 million a year on missed appointments. It is certainly a matter that needs to be actively considered.

Baroness Gardner of Parkes: My Lords, can the Minister confirm that many hospitals have taken into account the number of patients who fail to arrive? In my experience as chairman of the Royal Free, we found that 15 to 17 per cent. of out-patient appointments were not kept. Do other trusts, as we have done, factor that in, in the way in which airlines tend to over-book? Although that may represent a large saving to the National Health Service, it could present great difficulties if all the patients turned up. Is the Minister aware of that?

Baroness Jay of Paddington: My Lords, I am aware, to use the noble Baroness's analogy, that some hospital trusts are "over-booking". Perhaps it would be even better if they offered people large sums of money to get off aeroplanes or out of health service clinics if they were there when there was a surplus! I understand that some trusts, including one in Burnley, have set up a reminder system for patients. Although it was concerned that that might lead to a rather unwelcome influx of people who had been, as it were, built into the system as not attending, in fact it was able to cut the rates of "do not appear" people, as they are called, in some clinics by one-third. So it was clearly worth doing.

Lord Kennet: My Lords, may we hear more about the £360 million lost by people missing appointments? It is a common experience--certainly it is mine--that, whatever the nature of the appointment, it always runs late because the staff concerned do not have a minute off between one appointment and the next. That being so, they are always, by definition, usefully employed. Where is the £360 million going?

Baroness Jay of Paddington: My Lords, I cannot speak for the noble Lord's personal experience. It is calculated that the real wasted costs are in, for example, writing to patients who do not appear and rebooking their appointments, as well as the extremely important loss of time by highly paid and very highly skilled members of staff within the clinics who, contrary to the noble Lord's experience, are often sitting around waiting for people to appear. I spoke today to a consultant in what one would have thought was a very oversubscribed, busy London clinic who said that six of his 10 booked appointments in the previous clinic had just not turned up.

Baroness Masham of Ilton: My Lords, does the Minister agree that it is possible that some patients who are to have an investigative procedure panic at the last minute? It might be helpful if the procedure and its importance were to be explained to them, either by the GP or in writing by the hospital.

Baroness Jay of Paddington: My Lords, the noble Baroness has made an important and sympathetic point. A great deal can be done. I am looking at the issue carefully in terms of preparing people for appointments,

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as well as doing the simple, courteous, administrative things such as reminding people who may have been sent an appointment some weeks ahead and may therefore just forget it.

Lord Avebury: My Lords, does the Minister agree that, because of the length of time it takes to get appointments in some disciplines, a few of the no-shows that she mentioned may have died?

Baroness Jay of Paddington: My Lords, that is always possible. But perhaps I may quote the latest figures for out-patient appointments in England for the last quarter, which show that 81 per cent. of those waiting for appointments waited under 13 weeks and 96 per cent. waited under 26 weeks. Those waiting times conform with the Patient's Charter standard set by the previous administration.

Lord Dixon-Smith: My Lords, does the Minister have any information on what happens to the patients who fall out of the system by not attending an appointment? Do they subsequently reappear for a later appointment--in which case they perhaps ought to have a black mark against their name--or do some fall out altogether and simply do a runner?

Baroness Jay of Paddington: My Lords, I am afraid I cannot give the noble Lord a universal answer to that question, because I suspect there is not one. He talks about people having a black mark against their names. One has to remember that, as I said when replying to the noble Baroness, Lady Masham, people can genuinely forget an appointment. When we raised some concerns about this matter publicly a few months ago, I had several rather pathetic letters from people, particularly older people who had been waiting months for a cataract operation, who simply forgot on the day and then found themselves back again at the beginning of the queue. This is something that needs to be addressed, both sympathetically and administratively.

Baroness Thomas of Walliswood: My Lords, does the Minister have figures for cancellations of appointments which had been organised--or disorganised--by the hospitals themselves and for the percentage of appointments that represents?

Baroness Jay of Paddington: My Lords, the most recent figures show that there were 50,000 cancelled appointments in 1997-98, which is a lot; but that compares with the 156,100 patients who failed to turn up.

Viscount Addison: My Lords, can the Minister say whether there is any analogy in this matter with private healthcare and whether those who pay a higher premium for their healthcare turn up on a regular basis for treatment or appointments with doctors compared with those who pay through the National Health Service?

Baroness Jay of Paddington: My Lords, I am afraid that I do not have any comparative figures with the private sector, but perhaps the noble Viscount has a point.

The Earl of Lauderdale: My Lords, will the Minister look into the matter of reminders for older people? I find

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that, at the age of 87, I cannot read my diary, anyway. I have several diaries and miss my appointments simply through inadvertence. Old people do need to be reminded.

Baroness Jay of Paddington: My Lords, I am grateful to the noble Earl for reinforcing the point I made more generally in my earlier answer when I said that I had received some concerning letters from people who had had exactly that experience. It is clearly a matter which needs to be addressed. A possible solution is answering machines, which would enable people who found at the last minute that they could not attend to leave messages; but that would not address the noble Earl's problem.

The Countess of Mar: My Lords, is it possible that, where a GP knows that a patient may forget or not understand an appointment, the hospital could also notify the GP of the appointment so that his staff could ring and remind the patient of it on the day beforehand or early on the day of the appointment?

Baroness Jay of Paddington: My Lords, I am grateful to the noble Countess for that useful suggestion. With modern technology--and, after all, the telephone is not very modern--there must be systems to enable people to be reminded and prompted to take up appointments which may have been set some weeks or months in advance.

Baroness Oppenheim-Barnes: My Lords, has the Minister considered whether patients--apart from elderly, forgetful patients--who miss their appointments should have to pay some form of penalty before another appointment is granted?

Baroness Jay of Paddington: My Lords, I have seen that suggestion.

Manufacturing Industry: Interest Rate Increase

3.25 p.m.

Lord Evans of Parkside asked Her Majesty's Government:

    What estimate they have made of the effect on employment in the manufacturing sector of the Bank of England's decision to raise base rates to 7.5 per cent.

Lord McIntosh of Haringey: My Lords, the Monetary Policy Committee raised interest rates in order to ensure that the Government's inflation target is met. I am sure that the House, manufacturers and businesses generally will agree that we must avoid the boom and bust policies of the past, since higher inflation today results in fewer jobs, lower growth and higher interest rates tomorrow.

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