THE National Health Service of today faces huge challenges.

In many ways, it is the victim of its own success. Improvements in treating disease and illness have helped to create an ageing population which means more people than ever before now need its services.

It does such a brilliant job that many people now expect it to solve all their problems, eating, drinking and smoking too much as well as failing to exercise enough in the belief that, if they’re ill, the NHS will sort it out later.

Our expectations have increased in other ways, too: we demand faster treatment, instant access to emergency care and support for all sorts of health issues which were not part of the service’s original remit of tackling disease.

Add to that the rising cost of new and advanced treatments and medicines, equipment, technology, energy, buildings and simply keeping up with that increased demand and its easy to see why it is predicted by some that there will be a shortfall in funding of £30 billion by 2020.

All of which is nothing new. You would have to be living on Mars not to be aware that the NHS is struggling for cash, with almost daily reporting of its plight across the press and media.

It would seem to be a completely natural reaction, therefore, for most people to want to do their bit to protect this incredible asset.

And yet millions of people every year contribute to a staggering waste of NHS resources, apparently without considering the consequences of their actions.

Figures released this week by NHS Digital, which collates and analyses vast amounts of data about the service to help it work more efficiently, show that more than one in five hospital outpatient appointments were missed in England last year.

That figure has substantially worsened on a decade ago, when the number of unattended appointments was one in six.

Of the 21 per cent of appointments unattended in 2016/17, about a third (nearly eight million) were due to patients simply not turning up, with another third due to patients cancelling them. The remaining shortfall was due to cancellations by the hospitals.

The figures for Bradford Teaching Hospitals Foundation Trust followed roughly the same trend, with non-attendances rising from 19.4 per cent in 2015/2016 to 20.4 per cent a year later.

Overall, the number of outpatient appointments at Bradford hospitals rose from 481,958 to 484,194, with unattended appointments increasing from 119,002 to 124,720.

The North of England generally, however, had the best record for patients turning up at 80.9 per cent, compared to London, which had the lowest attendance rate of 77.3 per cent.

Nationally, the total number of outpatient appointments has nearly doubled since 2006-07, rising from 63.2 million appointments to 118.6 million in 2016-17.

Older patients, between the ages of 60 and 79, accounted for 31.5 per cent of all attended appointments. Women accounted for a greater proportion of those who attended appointments (57.8 per cent), compared with men (42.2 per cent). Young men aged 20-24 were the worst group for not turning up.

The increase in missed appointments, at both hospitals and GP surgeries – which also cost the NHS around £162 million every year – comes despite a drive launched by the NHS in 2014 to tackle the problem by targeting patients with e-mail messages and text reminders.

The NHS has also been rolling out systems which allow patients to check, book and cancel appointments at their own convenience and order repeat medication online while more GPs have been using smartphones and tablets to connect with patients, with outpatient consultations via Skype becoming increasingly common for patients who don’t need a physical examination.

At the launch of the technology-driven initiative, Beverley Bryant, of NHS England, said: “It’s important that people realise that not turning up to appointments can have a big impact on the care and treatment we are able to give other patients. It wastes doctors’ and nurses’ time too, which costs taxpayers money.”

A spokesman for Bradford Teaching Hospitals Foundation Trust said: “The reasons behind these statistics are multifactorial. Work to improve access to outpatient services has been ongoing for some time.

“We have improved our administration processes and now give patients much more notice of appointments. SMS text reminders have been introduced and we have robust mechanisms in place to minimise the risk of hospital cancellations.

“Missed appointments are monitored and a reduction has been seen this year due to the implementation of the SMS text service. We continue to work with the Clinical Commissioning groups (CCGs) looking at demographic areas to see if further work is required within communities to improve the rate of missed appointments.”

He said failing to show up to appointments had an impact on hospitals’ capacity but constant efforts are made to mitigate the effects.

“Empty appointment slots are re-utilised to minimise waste in the system,” he said. “Patients who continually cancel their appointments will delay their treatment and this could impact on their clinical outcome, so it is important to attend appointments.

“Patients can help play their part by simply advising us that an appointment date is no longer suitable as this means other patients can be offered earlier appointments and doctors’ and nurses’ expertise isn’t wasted.”

A study of 20,000 NHS patients in 2015 found that adding a message to texts and e-mails setting out exactly how much money would be wasted by failing to turn up for their specific appointment was likely to have a bigger impact.

The study tested a variety of ways to encourage patients to keep or reschedule their appointments and it found asking patients to behave decently – such as a plea to be fair to others by cancelling or re-arranging – or just stating that not showing up would cost the NHS money, made little difference.

Lord Darzi, director of the Institute of Global Health Innovation which carried out the study, said: “The NHS is busier than ever and hospitals need to make every single penny count for patients. But we all have a role to play in keeping the NHS sustainable for the future, and it’s clear that people feel a sense of responsibility. Telling patients the cost of missing an appointment shows clear benefits by filling more appointment slots while saving money.”

The increase in non-attendances in the latest figures, however, suggest the message still isn’t getting through to a huge number of people.