(Title Image: Wales Audit Office, copyright free)

Public Accounts Committee

Management of follow-up outpatients appointments (pdf)

Published: 31st July 2019

“Patients in most instances are best placed to evaluate the level of pain, or whether they have any concerns – and we would like to see the NHS use this information to care for those with the greatest need first and minimise unnecessary appointments. “Often people are given follow up appointments because that’s the way it’s always happened. By listening to patients and using technology we can ensure that patients with the greatest need are seen first and that NHS resources are used the most effectively.”

– Committee Chair, Nick Ramsay AM (Con, Monmouth)

This inquiry was triggered by a report from the Wales Audit Office, which you can read here (pdf).

1. More than 1 million patients in Wales are on follow-up appointment waiting lists

As of April 2018, 1.06million patients were on a waiting list for a follow-up outpatients appointment – a 12% increase since 2015. Just under 255,000 of those were waiting longer than they should be, with Cardiff and Vale seeing the largest increase in patients waiting too long – though some patients may be on separate treatment pathways, making the lists look larger than they actually are in terms of people on the ground (i.e. a patient waiting for follow-up appointments in three different departments will be counted three times).

Aneurin Bevan and Hywel Dda health boards were the only health boards to see a decrease in delayed appointments since 2015.

There’s no target waiting time for follow-up appointments and the only target concerns the first hospital appointment, where 95% of patients should be seen within 26 weeks. The British Medical Association argued that this creates an incentive for health boards to prioritise the first appointment over necessary follow-ups.

2. Delays to outpatient appointments can put patients at risk

Delays in certain medical specialities, ophthalmology was picked out as an example, could result in patients suffering real harm, like sight loss or loss of hearing/balance in the case of ENT. Despite this, there was no formal process for accessing the clinical risk to patients waiting for follow-up care.

The Welsh Government have introduced a new £7million eye care system focused more on patient experience than traditional waiting times, meaning patients at greater risk of harm are treated sooner. The Welsh Government have also asked all health boards to ensure all patients on follow-up appointment lists have an agreed clinical review date – though the Committee were concerned about how this would be monitored.

3. Some outpatient follow-up appointments could be managed in a different way

It’s accepted that for many outpatients, they’ll still need to be in a hospital to access the right diagnostic equipment, but there will be cases where self-management and community management will be appropriate.

One relatively simple suggestion was for consultants to be given regular information on patients who don’t have follow-up appointments booked. Technological solutions include virtual imaging/distant review of new diabetic retina referrals, so unnecessary appointments aren’t booked (this resulted in 75% of patients being discharged in Swansea Bay).