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NHS deficit last year twice as high as expected, say sources

Hospitals in England ended last year with twice as big a deficit as expected, according to sources, in another illustration of the NHS’s fragile finances.

NHS Improvement (NHSI), the health service’s financial regulator, will reveal the overspend when it releases full details on Thursday of how the NHS performed in 2017-18. Sources close to the publication of the annual health check confirmed NHS trusts ended 2017-18 “about £1bn” in the red.

The likely overspend, double the £496m expected, will fuel claims that the government is underfunding the NHS, given the sharp increase in the number of people needing care.

It would show the health service has been unable to regain the spending discipline the Treasury demanded after years of steadily worsening finances. But critics will blame the deficit on the NHS experiencing the seventh successive year of a budget squeeze and hospitals having to staff thousands of extra beds as a result of the worst winter crisis in its history.

The deficit would be significantly higher than the £791m overspend in 2016-17, but less than the record £2.45bn the NHS ran up in 2015-16.

Jeremy Hunt, the health and social care secretary, is pressing Theresa May to honour her pledge of a long-term finding deal by giving the service a budget increase of between 3% and 4% a year at least until the end of the parliament in 2022.

Simon Stevens, the NHS England chief executive, wants a 10-year commitment to 4% annual rises. However, Philip Hammond, the chancellor, is privately warning that anything above 2.5% is unaffordable.

A report last week from the Institute for Fiscal Studies, the NHS Confederation and the Health Foundation warned people would have to pay more tax in order to give the NHS enough money in the years ahead to ensure it can provide care to an ageing population.

NHS finance experts claimed service’s deficit is much worse than the £1bn NHSI will admit to this week, because trusts also received £1.8bn from the sustainability and transformation fund, and £337m to help them cope with extra demand over winter.

Sally Gainsbury, a senior policy analyst at the Nuffield Trust, a thinktank, said: “NHS providers started the financial year 2017/18 with a £4bn black hole between their underlying costs and income that was deepened further over the year.

“So while hospitals and other NHS services did make efficiency savings over the year, the vast bulk of those savings were needed just to stop the black hole getting any deeper. Essentially, services are having to run to just stand still, or even move slightly backwards.

“The real underlying deficit is likely to remain very similar to where it was at the start of the year – at around £4bn, which is inevitable as long as we continue to systematically pay hospitals and other services less than the cost of actually delivering care.”

In March, the public accounts select committee said NHS finances “remain in a perilous state”.

“The NHS is still very much in survival mode, with budgets unable to keep pace with demand. The NHS has a long way to go before it is financially sustainable,” the committee said.

In February, NHSI disclosed that 107 of 136 hospital trusts providing acute care in England were in the red.

Niall Dickson, the chief executive of the NHS Confederation, said: “[Trusts] are at the end of their tether. It’s simply not realistic or reasonable to expect the NHS to go on delivering a comprehensive universal service with inexorably rising demand and demonstrably inadequate funding.”

He urged ministers to abandon a short-term approach by which the NHS “lurches from budget to budget, with one futile bailout after another”.

Record number of NHS operations cancelled at last minute

The number of operations cancelled at the last minute by NHS hospitals in the first quarter of the year was the highest since records began in 1994, official figures show.

There were 25,475 such cancellations in the first three months of 2018, equating to 1.3% of all admissions, the highest proportion since 2005.

The Royal College of Surgeons blamed the increase on “extreme pressures” on A&E departments and delayed discharges.

Its vice-president, Ian Eardley, said: “Patients are being forced to wait too long for planned surgery and an unacceptable number have suffered the stress of having their operation cancelled at the last minute. It is very distressing for patients who are often in pain or immobile, and the delay could mean that their condition deteriorates.”

Cancelled ops

The last-minute cancellations were on top of the large number postponed in advance. Over the winter NHS England told hospitals to cancel tens of thousands of planned operations in order to free up beds.

The statistics published on Thursday also show that 11.6% of patients who had their operation cancelled did not have their treatment rearranged within 28 days – again the highest percentage since 2005.

The number of patients waiting more than 18 weeks to start planned treatment was 491,102 in March, up 35% on a year ago. Only 87.2% of patients were seen within 18 weeks; the government’s 92% target has not been met since February 2016. The number of patients having to wait more than a year for treatment rose to 2,755, up 80% on a year ago.

The shadow health secretary, Jonathan Ashworth, described the record number of cancelled operations as “a badge of shame for ministers”, blaming a lack of investment.

The proportion of patients at hospital A&E departments treated within the government’s four-hour target was 82% in April, well below the 95% standard but an improvement on the historic low of 76.4% in March.

The regulator NHS Improvement said: “Too many patients are still waiting too long in A&E and for planned surgery.” NHS Providers, which represents hospitals, said services were clearly overstretched.

Record number of NHS operations cancelled at last minute

The number of operations cancelled at the last minute by NHS hospitals in the first quarter of the year was the highest since records began in 1994, official figures show.

There were 25,475 such cancellations in the first three months of 2018, equating to 1.3% of all admissions, the highest proportion since 2005.

The Royal College of Surgeons blamed the increase on “extreme pressures” on A&E departments and delayed discharges.

Its vice-president, Ian Eardley, said: “Patients are being forced to wait too long for planned surgery and an unacceptable number have suffered the stress of having their operation cancelled at the last minute. It is very distressing for patients who are often in pain or immobile, and the delay could mean that their condition deteriorates.”

Cancelled ops

The last-minute cancellations were on top of the large number postponed in advance. Over the winter NHS England told hospitals to cancel tens of thousands of planned operations in order to free up beds.

The statistics published on Thursday also show that 11.6% of patients who had their operation cancelled did not have their treatment rearranged within 28 days – again the highest percentage since 2005.

The number of patients waiting more than 18 weeks to start planned treatment was 491,102 in March, up 35% on a year ago. Only 87.2% of patients were seen within 18 weeks; the government’s 92% target has not been met since February 2016. The number of patients having to wait more than a year for treatment rose to 2,755, up 80% on a year ago.

The shadow health secretary, Jonathan Ashworth, described the record number of cancelled operations as “a badge of shame for ministers”, blaming a lack of investment.

The proportion of patients at hospital A&E departments treated within the government’s four-hour target was 82% in April, well below the 95% standard but an improvement on the historic low of 76.4% in March.

The regulator NHS Improvement said: “Too many patients are still waiting too long in A&E and for planned surgery.” NHS Providers, which represents hospitals, said services were clearly overstretched.

Record number of NHS operations cancelled at last minute

The number of operations cancelled at the last minute by NHS hospitals in the first quarter of the year was the highest since records began in 1994, official figures show.

There were 25,475 such cancellations in the first three months of 2018, equating to 1.3% of all admissions, the highest proportion since 2005.

The Royal College of Surgeons blamed the increase on “extreme pressures” on A&E departments and delayed discharges.

Its vice-president, Ian Eardley, said: “Patients are being forced to wait too long for planned surgery and an unacceptable number have suffered the stress of having their operation cancelled at the last minute. It is very distressing for patients who are often in pain or immobile, and the delay could mean that their condition deteriorates.”

Cancelled ops

The last-minute cancellations were on top of the large number postponed in advance. Over the winter NHS England told hospitals to cancel tens of thousands of planned operations in order to free up beds.

The statistics published on Thursday also show that 11.6% of patients who had their operation cancelled did not have their treatment rearranged within 28 days – again the highest percentage since 2005.

The number of patients waiting more than 18 weeks to start planned treatment was 491,102 in March, up 35% on a year ago. Only 87.2% of patients were seen within 18 weeks; the government’s 92% target has not been met since February 2016. The number of patients having to wait more than a year for treatment rose to 2,755, up 80% on a year ago.

The shadow health secretary, Jonathan Ashworth, described the record number of cancelled operations as “a badge of shame for ministers”, blaming a lack of investment.

The proportion of patients at hospital A&E departments treated within the government’s four-hour target was 82% in April, well below the 95% standard but an improvement on the historic low of 76.4% in March.

The regulator NHS Improvement said: “Too many patients are still waiting too long in A&E and for planned surgery.” NHS Providers, which represents hospitals, said services were clearly overstretched.

The last decade of health and social care in the UK – in 10 charts | Lord Ara Darzi

This year is one of anniversaries. It’s 70 years since the NHS was created and 10 years since my last review of the service, which focused on the quality of healthcare. It seems, therefore, like the perfect moment to step back and reflect on where we find ourselves today.

With this in mind, I recently launched another review, commissioned by the Institute for Public Policy Research (IPPR) and with analytical support from management consultancy Carnall Farrar. The review aims to assess the progress we have made and the challenges we face in the future. Telling the story of the last decade in the NHS, our interim findings are both interesting and important.

Quality has improved

It is impossible to pick up a newspaper without seeing a story about the crisis in the NHS. But behind the headlines resides a fascinating story. Despite the gloom – and ever rising numbers of patients – the quality of care has improved, from cancer to trauma, stroke to diabetes, mental health to maternity.

1. Despite higher numbers of stroke patients, mortality rates have gone down

Stroke mortality in the NHS


Illustration: HES, Carnall Farrar Analysis

2. Cancer survival rates have improved – albeit from a low base

Cancer mortality rates


Illustration: NHS England, Carnall Farrar Analysis

Yet we must not get complacent. There is still too much variation in the quality of care: the distance between the best and the rest remains far too wide. And in too many areas – cancer and mental health services, in particular – progress has been from a low base while other countries perform significantly better. High quality care for all is still not a reality.

Focusing on patient safety has paid off

In the wake of a number of high profile patient safety controversies in recent years, the health secretary has rightly made patient safety a priority. This would appear to be paying off: harm free care is increasingly the norm, instances of pressure ulcers are down, and most healthcare-associated infections are falling. While we can still do better, we have made progress.

3. Harm free care is increasingly the norm

harm-free care


Illustration: NHS Safety Thermometer, Carnall Farrar Analysis

Rationing has returned

If quality has been maintained or improved, the same is not true for access to services. In the NHS, the timeliness of everything from ambulance response times, to A&E waiting times, to getting a GP appointment has deteriorated. But the most shocking example is in social care where, despite a significant increase in the number of people in need of care, there has been a decline in the number of people accessing the support they need, with a corresponding rise in informal care.

4. The proportion of patients waiting for more than four hours in A&E has increased

a&ewait


Illustration: NHS Digital, Carnall Farrar Analysis

5. The number of people stuck in hospital beds (delayed transfers of care) has increased

delayed-transfers-of-care


Illustration: NHS Digital, Carnall Farrar Analysis

6. There has been a steep decline in the number of people receiving state funded adult social care

socialcareusers


Illustration: NHS Digital, Carnall Farrar Analysis

Public satisfaction is declining

Patient satisfaction in the NHS has held up well over the last decade but public satisfaction has started to fall. Just 57% of the population is satisfied with the NHS – down 6% since 2016 – and just 23% are satisfied with social care, according to King’s Fund analysis of the 2017 British Social Attitudes survey. This is probably partly a reflection of ongoing media coverage of the so-called crisis in health and care.

7. Public satisfaction with the NHS has started to fall

public-satisfaction


Illustration: British Social Attitudes Survey, Carnall Farrar Analysis

The most austere decade

It has been a decade of austerity for healthcare: the service has had to make do with slower funding growth – or cuts in the case of social care – despite a growing and ageing population. This has put huge pressure on the frontline.

8. In real terms, NHS funding growth has been the lowest on record since 2010

fundinggrowth


Illustration: IFS, Office for Life Sciences, Carnall Farrar Analysis

The NHS has, somewhat successfully, tried to manage this through increased efficiency

9. NHS efficiency has been significantly higher than in other periods

productivityvsfudninggrowth


Illustration: IFS, Office for Life Sciences, Carnall Farrar Analysis

The NHS has tried to manage this slow-down in funding growth by delivering “more for less”. This has – to some degree – been successful: efficiency in the NHS is higher than its historic rate, achieved by holding down costs – such as staff pay – and by reforming the way the service works – particularly a focus on prevention, and the integration of health and social care.

Running out of road

However, there is growing evidence that the sources of efficiency the NHS has relied on over the last decade are unlikely to yield the scale of gains needed in the future. The most significant of these is staff pay, which will rightly start to grow again after seven years of the public sector pay gap. Another source of efficiency has been the reduction in the amount of money paid to hospitals for each procedure they undertake, which is now resulting in significant deficits.

10. Net staff satisfaction with pay and rising inflation has put an end to the public sector pay cap

staff-satisfaction


Illustration: NHS Staff Survey, IPPR Analysis

A long-term funding and reform plan

The pressures we have seen in health and care over the last decade – in particular, an ageing and growing population – will continue over the years to come. But the 2020s will also be a decade of opportunity, with technology opening up exciting new possibilities for human health. However, the health and care system can only run if it is able to walk. In its current state, we risk the opportunities of the 2020s passing us by.

The time has come for the government to abandon austerity and put forward a long-term funding plan for health and social care. But money alone will not be enough; we will need a bold reform plan for the NHS and social care to be fit for the 21st century. With this is mind, we turn our attentions to the future in the form of detailed funding and reform plan, which will be published in the coming months. On its 70th birthday, the gift the NHS needs most is a pragmatic plan to secure it for future generations.

  • Lord Darzi is the Paul Hamlyn chair of surgery at Imperial College London and a surgeon working in the NHS. He was a health minister from 2007 to 2009

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Good news at last: the world isn’t as horrific as you think | Hans Rosling

Things are bad, and it feels like they are getting worse, right? War, violence, natural disasters, corruption. The rich are getting richer and the poor are getting poorer; and we will soon run out of resources unless something drastic is done. That’s the picture most people in the west see in the media and carry around in their heads.

I call it the overdramatic worldview. It’s stressful and misleading. In fact, the vast majority of the world’s population live somewhere in the middle of the income scale. Perhaps they are not what we think of as middle class, but they are not living in extreme poverty. Their girls go to school, their children get vaccinated. Perhaps not on every single measure, or every single year, but step by step, year by year, the world is improving. In the past two centuries, life expectancy has more than doubled. Although the world faces huge challenges, we have made tremendous progress.

The overdramatic worldview draws people to the most negative answers. It is not caused simply by out-of-date knowledge. My experience, over decades of lecturing and testing, has finally brought me to see that the overdramatic worldview comes from the very way our brains work. The brain is a product of millions of years of evolution, and we are hard-wired with instincts that helped our ancestors to survive in small groups of hunters and gatherers. We crave sugar and fat, which used to be life-saving sources of energy when food was scarce. But today these cravings make obesity one of the biggest global health problems. In the same way, we are interested in gossip and dramatic stories, which used to be the only source of news and useful information. This craving for drama causes misconceptions and helps create an overdramatic worldview.

We still need these dramatic instincts to give meaning to our world. If we sifted every input and analysed every decision rationally, a normal life would be impossible. Just as we should not cut out all sugar and fat, we should not ask a surgeon to remove the parts of our brain that deal with emotions. But we need to learn to control our drama intake.

It is absolutely true that there are many bad things in this world. The number of conflict fatalities has been falling since the second world war, but the Syrian war has reversed this trend. Terrorism too is rising. Overfishing and the deterioration of the seas are truly worrisome. The list of endangered species is getting longer. But while it is easy to be aware of all the bad things happening in the world, it’s harder to know about the good things. The silent miracle of human progress is too slow and too fragmented to ever qualify as news. Over the past 20 years, the proportion of people living in extreme poverty has almost halved. But in online polls, in most countries, fewer than 10% of people knew this.

chart

Our instinct to notice the bad more than the good is related to three things: the misremembering of the past; selective reporting by journalists and activists; and the feeling that as long as things are bad, it’s heartless to say they are getting better. For centuries, older people have romanticised their youths and insisted that things ain’t what they used to be. Well, that’s true. Most things used to be worse. This tendency to misremember is compounded by the never-ending negative news from across the world.

Stories about gradual improvements rarely make the front page even when they occur on a dramatic scale and affect millions of people. And thanks to increasing press freedom and improving technology, we hear about more disasters than ever before. This improved reporting is itself a sign of human progress, but it creates the impression of the exact opposite. At the same time, activists and lobbyists manage to make every dip in an improving trend appear to be the end of the world, scaring us with alarmist exaggerations and prophecies. In the United States, the violent crime rate has been falling since 1990. But each time something horrific or shocking happened – pretty much every year – a crisis was reported. The majority of people believe that violent crime is getting worse.

Vaccination session Mali


A vaccination session at the Baraouéli health centre in Baraouéli, Ségou region, Mali. Photograph: Unicef/UN/Keïta

My guess is you feel that me saying that the world is getting better is like me telling you that everything is fine, and that feels ridiculous. I agree. Everything is not fine. We should still be very concerned. As long as there are plane crashes, preventable child deaths, endangered species, climate change sceptics, male chauvinists, crazy dictators, toxic waste, journalists in prison, and girls not getting an education, we cannot relax. But it is just as ridiculous to look away from the progress that has been made. The consequent loss of hope can be devastating. When people wrongly believe that nothing is improving, they may lose confidence in measures that actually work.


It is just as ridiculous to look away from the progress. The consequent loss of hope can be devastating

How can we help our brains to realise that things are getting better? Think of the world as a very sick premature baby in an incubator. After a week, she is improving, but she has to stay in the incubator because her health is still critical. Does it make sense to say that the infant’s situation is improving? Yes. Does it make sense to say it is bad? Yes, absolutely. Does saying “things are improving” imply that everything is fine, and we should all not worry? Not at all: it’s both bad and better. That is how we must think about the current state of the world.

Take girls’ education. When women are educated, the workforce becomes diversified and able to make better decisions. Educated mothers have fewer children, and more survive. More energy is invested in each child’s education: a virtuous cycle of change. Ninety per cent of girls of primary school age attend school; for boys, it’s 92%. There are still gender differences when it comes to education in the poorest countries, especially in secondary and higher education, but that’s no reason to deny the progress that has been made.

Remember that the media and activists rely on drama to grab your attention; that negative stories are more dramatic than positive ones; and how simple it is to construct a story of crisis from a temporary dip pulled out of its context of a long-term improvement. When you hear about something terrible, calm yourself by asking: if there had been a positive improvement, would I have heard about that? Even if there had been hundreds of larger improvements, would I have heard?

This is “factfulness”: understanding as a source of mental peace. Like a healthy diet and regular exercise, it can and should become part of people’s daily lives. Start to practise it, and you will make better decisions, stay alert to real dangers and possibilities, and avoid being constantly stressed about the wrong things.

Hans Rosling was a Swedish physician, academic and statistician, who died in 2017. This is an edited excerpt from his posthumously published book Factfulness: Ten Reasons We’re Wrong about the World (Sceptre)

My mental illness has always affected my work, but at last I feel supported

With public support from figures like Prince William and Prince Harry, there is a growing public acknowledgement that mental illness is nothing to be ashamed of. But it doesn’t always feel that way. Even in the charity sector, mental health conditions aren’t often well understood.

That’s despite the evidence that they are becoming more common. According to the mental health charity Mind, one in four people experience a mental health issue each year. In other words, up to a quarter of the voluntary sector workforce may be affected. Many people – regardless of their profession – deal with their mental illness behind closed doors, afraid that talking about it with their manager or colleagues could put their career at risk.

Certainly, this is how I was made to feel. I have been diagnosed with bipolar disorder, with emotional instability personality disorder, and faced extreme mood swings. The first psychiatrist I saw told me I’d never be well enough to live “a normal life”. He was one in a long line of people who told me not to expect too much from my career. I was young, my confidence was low and, naturally, I started to believe they were right. But I wanted so much to live an independent life.

When I started working – first in retail and then sales – life was very difficult. I tried to be honest and talk to my manager early on but his reaction stunned me: “Everyone gets sad,” he said. He didn’t give me any additional support and expected me to pull myself together. My colleagues also didn’t understand and began to comment on the amount of time I had to take off. They started calling me “sick notes”.


My colleagues didn’t understand and ​​began to comment on the amount of time I had to take off

Working in this environment inevitably worsened my condition and I was signed off work for about six months. I felt shaken by the experience and it was incredibly hard to build up my confidence to the point where I felt ready to give work another shot. Eventually I did, but when I took on another sales role with a different company, the same thing happened.

Having spent some time volunteering for Rethink, I applied for a position in the charity sector with HOME Fundraising. I knew that knocking on people’s doors to collect money for charity wasn’t going to be easy, but I wanted to do something positive at work.

I had intended to keep my concerns about my mental health to myself but found the culture was entirely different. At the start of my second week, I had severe anxiety and had to take a day off. Rather than the usual brush-off I’d experienced from past managers, my manager asked questions and sounded as if he cared.

From the start I was encouraged to share how I was feeling and to take time off when I needed to. I’m able to talk about changes in my mood and medication, and my line manager and I plan coping strategies together. I also get plenty of support from my team. They know if I say I need to go off for a few minutes that I just need a bit of space. It’s made a huge difference to what I feel I can achieve.

This doesn’t mean that life is easy. Mental health will always be a big part of my life and impact on my work. At times, depression can get the better of me and I have to work from home or in a quiet room at the back of the office. Manic episodes can also be hard to deal with, and I have to make an effort to slow down when talking, especially when discussing charitable beneficiaries. But I don’t have to brush my symptoms under the carpet. That is such a relief.

Mental health is a daily battle for many, but it shouldn’t define us. Being able to do my job – and being recognised for being good at it – has given me confidence to develop a career in fundraising. I’ve been promoted and now manage teams of fundraisers in Norwich.

All employers have a responsibility to make that a possibility for people living with mental health conditions. They need to prioritise creating a culture of understanding that provides support, rather than focusing on limitations. Until that’s commonplace, many people will never reach their potential. And that would be a waste of the huge amount of talent that makes our sector a diverse, creative and wonderful place to work.

  • Fran Holland is the deputy fundraising manager of HOME Fundraising’s Norwich office

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Patients missing their appointments cost the NHS £1bn last year

As the NHS struggles with budget cuts, soaring demand and staff shortages, almost £1bn is being wasted annually by patients missing appointments, figures reveal.

In response, England’s chief nurse has urged patients to cancel their NHS appointments in good time if they are not able to attend, in order to free up resources for those who need them.

The money wasted could fund 1m more cataract operations or 250,000 hip replacements, said Prof Jane Cummings, chief nursing officer for England.

Data released by NHS Digital revealed that in 2016/17 almost 8m hospital outpatient appointments were missed due to patients not attending, compared with 7.5m in 2015/16.

Jane Cummings, chief nursing officer for England.


Jane Cummings, chief nursing officer for England. Photograph: Christopher Thomond for the Guardian

With each hospital outpatient appointment costing the NHS approximately £120 in 2016/17, it means almost £1bn worth of appointments were missed.

In addition, more than 9 million people were sent home from A&E in 2016/17 with just guidance and advice, which could have been obtained more conveniently from a pharmacist or by calling 111.

As the NHS celebrates its 70th year, Cummings is urging the public to rethink how they use it in the face of a growing funding crisis. Honouring appointments was a “small but effective way” to help, she said.

“With the NHS coming under pressure as never before, we are asking patients and the public to use the health service responsibly to help ensure that care is readily available for everyone who needs it,” she said.

“There are now more doctors, nurses and other clinicians available at the end of a phone to give advice and guidance to users of the 111 service.”

Some in the NHS believe that patients should be charged for missed appointments and Jeremy Hunt, the health secretary, hinted this was a possibility in 2015 before David Cameron, then prime minister, ruled it out.

However, steps were taken to inform patients of the cost to the NHS of missing their appointments after a study by Imperial College London showed that fewer appointments would be missed if people were given this information.

Simon Stevens, the head of NHS England, recently said its £110bn budget is not enough and called for an increase in funding.

His comments were backed up by the Health Foundation, the King’s Fund and the Nuffield Trust, who – following a joint analysis of NHS finances in England – calculated that the NHS needs £4bn more in 2018 to prevent patient care from deteriorating.

Patients missing their appointments cost the NHS £1bn last year

As the NHS struggles with budget cuts, soaring demand and staff shortages, almost £1bn is being wasted annually by patients missing appointments, figures reveal.

In response, England’s chief nurse has urged patients to cancel their NHS appointments in good time if they are not able to attend, in order to free up resources for those who need them.

The money wasted could fund 1m more cataract operations or 250,000 hip replacements, said Prof Jane Cummings, chief nursing officer for England.

Data released by NHS Digital revealed that in 2016/17 almost 8m hospital outpatient appointments were missed due to patients not attending, compared with 7.5m in 2015/16.

Jane Cummings, chief nursing officer for England.


Jane Cummings, chief nursing officer for England. Photograph: Christopher Thomond for the Guardian

With each hospital outpatient appointment costing the NHS approximately £120 in 2016/17, it means almost £1bn worth of appointments were missed.

In addition, more than 9 million people were sent home from A&E in 2016/17 with just guidance and advice, which could have been obtained more conveniently from a pharmacist or by calling 111.

As the NHS celebrates its 70th year, Cummings is urging the public to rethink how they use it in the face of a growing funding crisis. Honouring appointments was a “small but effective way” to help, she said.

“With the NHS coming under pressure as never before, we are asking patients and the public to use the health service responsibly to help ensure that care is readily available for everyone who needs it,” she said.

“There are now more doctors, nurses and other clinicians available at the end of a phone to give advice and guidance to users of the 111 service.”

Some in the NHS believe that patients should be charged for missed appointments and Jeremy Hunt, the health secretary, hinted this was a possibility in 2015 before David Cameron, then prime minister, ruled it out.

However, steps were taken to inform patients of the cost to the NHS of missing their appointments after a study by Imperial College London showed that fewer appointments would be missed if people were given this information.

Simon Stevens, the head of NHS England, recently said its £110bn budget is not enough and called for an increase in funding.

His comments were backed up by the Health Foundation, the King’s Fund and the Nuffield Trust, who – following a joint analysis of NHS finances in England – calculated that the NHS needs £4bn more in 2018 to prevent patient care from deteriorating.

Patients missing their appointments cost the NHS £1bn last year

As the NHS struggles with budget cuts, soaring demand and staff shortages, almost £1bn is being wasted annually by patients missing appointments, figures reveal.

In response, England’s chief nurse has urged patients to cancel their NHS appointments in good time if they are not able to attend, in order to free up resources for those who need them.

The money wasted could fund 1m more cataract operations or 250,000 hip replacements, said Prof Jane Cummings, chief nursing officer for England.

Data released by NHS Digital revealed that in 2016/17 almost 8m hospital outpatient appointments were missed due to patients not attending, compared with 7.5m in 2015/16.

Jane Cummings, chief nursing officer for England.


Jane Cummings, chief nursing officer for England. Photograph: Christopher Thomond for the Guardian

With each hospital outpatient appointment costing the NHS approximately £120 in 2016/17, it means almost £1bn worth of appointments were missed.

In addition, more than 9 million people were sent home from A&E in 2016/17 with just guidance and advice, which could have been obtained more conveniently from a pharmacist or by calling 111.

As the NHS celebrates its 70th year, Cummings is urging the public to rethink how they use it in the face of a growing funding crisis. Honouring appointments was a “small but effective way” to help, she said.

“With the NHS coming under pressure as never before, we are asking patients and the public to use the health service responsibly to help ensure that care is readily available for everyone who needs it,” she said.

“There are now more doctors, nurses and other clinicians available at the end of a phone to give advice and guidance to users of the 111 service.”

Some in the NHS believe that patients should be charged for missed appointments and Jeremy Hunt, the health secretary, hinted this was a possibility in 2015 before David Cameron, then prime minister, ruled it out.

However, steps were taken to inform patients of the cost to the NHS of missing their appointments after a study by Imperial College London showed that fewer appointments would be missed if people were given this information.

Simon Stevens, the head of NHS England, recently said its £110bn budget is not enough and called for an increase in funding.

His comments were backed up by the Health Foundation, the King’s Fund and the Nuffield Trust, who – following a joint analysis of NHS finances in England – calculated that the NHS needs £4bn more in 2018 to prevent patient care from deteriorating.