£1m spent on NHS no-shows Borgen on the ridiculous

Nyborg would not put up with no-shows. Picture: Toby Williams
Nyborg would not put up with no-shows. Picture: Toby Williams
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SULTRY Danish Prime Minister Birgitte Nyborg from the hit TV drama Borgen would probably approve.

Patients who fail to turn up for their hospital appointments could be hit with fines under radical new proposals aimed at ending a multi-million pound drain on the NHS.

Picture: Ian Georgeson

Picture: Ian Georgeson

In a policy consultation paper published by the Scottish Conservatives, it is suggested that “punitive measures” including hitting timewasters in the pocket, could be introduced at Scottish hospitals.

While it is not yet firm party policy, it is understood the Tory top brass are keen on the idea, while the Labour Party said there “may be a case” for looking at penalties for repeat offenders.

A similar plan has been working successfully for a number of years in Denmark – where fictional drama Borgen starring Sidse Babett Knudsen, 44, as attractive PM Birgitte Nyborg, is set.

NHS Lothian said last year that there were 86,000 missed appointments in the region annually, also known as ‘did not attends’ (DNA), leaving the health board with a bill of £1 million. The Scottish Government ruled out bringing in charges for missed appointments, saying they would “act as a barrier to accessing health services”.

But the strong possibility of charging becoming Tory policy and tentative support from Labour means the fines could be introduced under a future Holyrood administration.

A spokesman for the Scottish Conservatives said the idea had been floated as part of an ongoing review of health policy and the views of party members would now be sought.

He added: “This is just one possible way of encouraging people to be more responsible with our National Health Service. There are lots of things to consider particularly with regard to reducing the number of DNAs, given the considerable cost to the health service and the unfairness to others waiting for appointments, for example the variable ways in which health boards currently notify patients of appointments.”

In a bid to lessen the number of missed appointments in the Lothians, a trial was introduced late last year which saw patients receive automated reminders by phone. An initial trial across six departments has been extended following promising results. It is understood that while more than nine per cent of patients failed to turn up over a one-week period before its introduction, the rate fell to 6.4 per cent in the same week this year.

Labour MSP Dr Richard Simpson, a former Lothian consultant and his party’s Public Health spokesman, said hospital no-shows “put a huge strain” on stretched NHS budgets and backed phone and text reminders.

He added: “There may be a case for looking at penalties for repeated offenders if this can be done without creating a significant administrative burden. However those who fail to attend hospital appointments are already penalised by being taken off the waiting list.”

Public health minister Michael Matheson said that charging would not be brought in under the SNP government. He said: “We are committed to a National Health Service free at the point of delivery and will never charge for missing appointments, which would act as a barrier to accessing health services. NHS Boards are implementing a number of ways to reduce missed appointments.”

For and against


Mark Brown, Capital Tory activist

I back calls to fine those patients who repeatedly miss appointments at hospital.

With some 86,000 folk not attending appointments – at a cost of around £1 million a year in the NHS Lothian region alone – this is wasting valuable time of doctors and nurses whilst also denying others vital medical care.

A levy of £10 for each missed appointment seems fair.

In fact, I would extend it to GP surgeries too.

The introduction of text message and automated service reminders could help reduce the stats, but it is the personal responsibility of the patient to ensure they attend.


Dr Andrew Buist, deputy chairman of the BMA’s Scottish GP Committee

The BMA would support measures to reduce the number of missed appointments in hospitals and GP surgeries.

However rather than introducing penalties, the BMA believes better education on the consequences of missed appointments that deprive others accessing the service would be more appropriate.

Charging patients to visit their GP would be a damaging and backward step that would undermine the very principles upon which the NHS was founded. We would be concerned that charging patients could undermine the doctor-patient relationship.

Denmark takes the initiative

FINES for patients who failed to turn up for hospital appointments were introduced in Denmark in 2004.

However, while the ability to fine was written into law, the legislation is not used to its full extent by local counties.

The Tory Party in Wales said this year that charging irresponsible patients should be considered. Critics branded the proposal “simplistic”.