Reducing missed appointments in health visiting

Health visitor with a young child

A staggering 2,500 health visiting appointments are missed every month at Kent Community Health NHS Foundation Trust – and a chance is lost to help a family who might need us. 

We’ve probably all done it, missed an appointment, but the reasons why appointments are missed are often more complex than simply forgetting.

Making our services accessible for everyone is important if we are going to tackle health inequalities – the reasons why people have different or poor experiences of care – and reduce waiting lists so we can help people faster.

That’s why our Health Visiting Service, which has about 24,000 contacts each month, is trying to understand why people might miss an appointment – and what we can do about it. 

In response, we are sending letters or text reminders to parents and carers, and making it easy to cancel or re-book. We’ve reviewed clinic times and venues, we’re not booking appointments too far ahead and have launched short-notice lists, to quickly fill slots others cancel.

Evidence shows 10 to 20 per cent of patients from the most deprived backgrounds are most likely to miss an appointment. As part of identifying health inequalities, we’ve been making sure people from deprived backgrounds, those who need carers, people with mental health conditions and vulnerable patients are contacted and booked into last-minute slots.  

Health Visiting Programme Manager Sonia Hedegaard, who is leading the work, said: “Improving outcomes for children is what is most important. Early intervention can make a big difference, so we needed to look at why so many appointments are not attended.

“Missing appointments is not something most people do intentionally; some people may miss appointments due to having caring responsibilities, forgetting their appointment, work commitments and for many other reasons.

“Every appointment freed up could be used to see other clients, but only if we know about it in advance. This work has the potential to make a huge difference freeing up more time to care and helping us deliver for families.”

Our Health Visiting Service delivers the Healthy Child Programme, which includes antenatal, new birth, a six-to-eight week review and development checks at the ages of one and two. Our health visitors work with children aged up to five. 

Senior Engagement and Partnership Manager Juliette Wales is part of the team looking into why families might not attend or take their child to an appointment. 

She said: “Reasons for missing appointments can vary hugely – which is why we want to dig deeper to tackle the root causes. By understanding these, we can support people to take control of their care and help reduce health inequalities.”

This new drive is already reducing no-shows and seeing last-minute cancellations filled, meaning other families have appointments quicker. 

In health visiting, we’ve managed to reduce ‘do not attends’ and ‘was not brought’ from 11.5 per cent to 7.7 per cent, something we want to replicate in other Kent Community Health NHS Foundation Trust services.

A quality improvement (QI) approach was used to carry out this work. Below is the project on a page:

The reducing missed appointments in health visiting project on a page