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Written on 7th May 2021 by Richard Money-Kyrle

Healthcare watchdog, the Healthcare Safety Investigation Branch or HSIB, has called for NHS trusts to improve the reliability of their systems for booking follow-up appointments for patients needing ongoing care.

HSIB’s national report, Outpatient Appointments Intended But Not Booked After Inpatient Stays, identified that booking failures commonly occurred for patients who need follow-up or review appointments as part of their ongoing care. Reasons for the failures included hospitals prioritising appointments for new patients to meet target timescales for first appointments, gaps in guidance and technology, and leaving patients responsible for accessing or chasing up follow-up care.  

Failure to follow up patients can lead to serious injury which would have been avoided with better care. We see this often in claims for devastating injury, such as those arising from cervical or ovarian cancer, tuberculosis and infection. HSIB’s investigation considered that NHS trusts need greater accountability and must ensure that their booking systems not only achieve national targets, but also maintain patients’ safety.

What are outpatient appointments?

When a patient visits a hospital for a consultation with a specialist, or for tests, scans or other treatment which does not require them to stay in hospital, this is known as ‘outpatient’ care.

A patient’s outpatient appointment may be their first hospital visit for their condition, or it may follow a period of inpatient treatment where they had to stay in hospital, such as for an operation or serious injury needing extensive medical or nursing care.

The timescales for new patients’ first appointments are set by the NHS Constitution. This gives patients with suspected cancer the right to a specialist appointment within two weeks of referral. Other new patients needing consultant-led treatment have the right to begin their treatment within 18 weeks of referral. NHS trusts are required to put systems and dedicated teams in place to track each new patient’s progress along the two-week or 18-week pathway. Audits must be carried out to ensure that these first appointments have been made.

Follow-up appointments for other patients are not subject to national targets. In these cases, the patient waits to receive an appointment for their follow-up treatment or review, which should be booked by the hospital within a timescale (or at intervals, such as every 3 months) which is appropriate for their condition and the plan for their care.

HSIB finds common failure of hospitals to book outpatient follow-up appointments

HSIB say that although there is no clear data to say how often intended outpatient follow-up appointments are not booked, its investigation suggests that this failure is common. They looked for possible gaps in the systems used by NHS trusts to book outpatient appointments. Their findings included:

  • limited assurance (ways of being sure) that intended follow-up appointments are booked for patients who are not on the two-week or 18-week appointment pathway, because:

    • there is no target timescale for these appointments;
    • there is no national guidance relating to follow-up appointments, each NHS trust has its own system;
    • new patients may be prioritised over follow-up appointments to meet targets, instead of patient need.
  • even the more certain outpatient appointment booking processes for new patients depend on resources, and the vigilance and diligence of staff;
  • some NHS trusts don’t know that an intended appointment has not been booked unless the patient tells them;
  • lack of data-sharing and communication between different NHS IT systems increases the risk of outpatient booking failures;
  • initiatives used to carry out the NHS Long Term Plan’s goal to remove 30 million outpatient appointments each year (before Covid-19) failed to build in ways of ensuring that intended appointments are booked, except for specific groups of patients;
  • digital transformation is giving patients more responsibility for their own healthcare but does not ensure that necessary appointments are made.

Compensation for injuries caused by NHS failures in follow up care

HSIB’s findings suggest that nationally and at individual NHS trust level, the NHS’s focus on new patient waiting list targets, cutting costs and shifting responsibility for accessing treatment to the patient, has led to dangerous gaps in the reliable provision of patient follow-up care. Regardless of other patients’ targets or the newness of their condition, all patients receiving NHS treatment and ongoing care have a right to reliable, planned and timely follow-up care. 

Where NHS system failure allows patients to fall through the gaps, the impact on the patient can be devastating. Where a patient suffers serious avoidable harm in these circumstances, they are entitled to compensation for the additional injury and its financial consequences that was caused by the negligent care.

Boyes Turner’s clinical negligence lawyers are experts in securing high value compensation settlements for individuals who have been harmed, and families who have been bereaved, by negligent hospital care.

If you or a member of your family have been seriously injured as a result of hospital negligence, you can find out more about making a claim by contacting our specialist lawyers, free and confidentially, via email at or call: 0800 124 4845.