Stemming the flow: Counting the cost of missed NHS appointments

Topic: Healthcare
illustration of a calendar and a doctor with a clock to represent the cost of missed NHS appointments

Esendex research has revealed the true cost of missed NHS appointments. Based on FOI data from NHS trusts across the UK, the findings show how simple solutions like SMS reminders could help reduce the burden.

Anyone working in healthcare understands the frustration when a patient misses an appointment and new research by Esendex has revealed the huge cost to the NHS of ‘DNAs’ (did not attend).  

There are many reasons why someone would fail to attend their scheduled appointment and these factors vary hugely, depending on the type of healthcare setting, organisation and region. 

Among the most common reasons for patients to miss an appointment are difficulty in arranging carers at the time of the appointment, transport issues, and difficulty taking time off work. 

These issues all highlight the complexity of getting people to the right place and at the right time, which is often beyond the control of the organisation and patient. 

Other common factors are far more frustrating for all parties. Many patients report being unaware of an appointment, or to have simply forgotten about it, while some also point to unclear or incorrect information and even difficulties cancelling or rescheduling. 

At Esendex we work with healthcare providers, from private and public hospitals to dentists, physiotherapists and GPs, to implement automated SMS solutions which have huge potential to drive down the number of missed appointments. 

The cost of missed appointments

To uncover the true cost of missed appointments across the UK, our team issued requests to all NHS trusts across the UK under the Freedom of Information Act, asking how many scheduled appointments were missed or DNAs at their hospital sites since 2019. 

The NHS’s data shows that every missed hospital appointment costs £160, so we combined the data to reveal the overall cost to the health service. 

Missed NHS appointments in 2024

New analysis by the Esendex team shows that in 2024, each NHS trust had an average of 51,168 DNAs.

This number actually fell by a marginal 3% compared to 2023, but still represents a cost of more than £8.2 million per trust from missed appointments alone. 

For the 144 trusts that responded to our FOI requests, this totalled 7.4 million missed appointments. Across all NHS trusts, this would represent 11.8 million NDAs and a total cost to the health service of £1.9 billion

Average DNA per NHS trust – 2019 – 2024

YearAverage DNA per Trust
201953,669
202042,653
202150,616
202254,599
202352,700
202451,168

Despite the small overall dip in missed appointments in 2024, the data revealed that some NHS trusts saw a much bigger impact as a result of missed appointments. 

Guy’s and St Thomas’ NHS Foundation Trust reported 321,351 missed appointments in 2024 – almost double the number the trust saw in 2023 – representing a financial cost of £51.4 million last year alone. 

Manchester University NHS Foundation Trust, Barts Health NHS Trust and King’s College Hospital NHS Foundation Trust also reported more than 200,000 DNAs in 2024. 

The NHS trusts with the most missed appointments in 2024

Hospital TrustDNA:2024Cost
1Guy’s and St Thomas’ NHS Foundation Trust.321,351£51,416,160.00
2Manchester University NHS Foundation Trust250,845£40,135,200.00
3Barts Health NHS Trust250,338£40,054,080.00
4King’s College Hospital NHS Foundation Trust218,432£34,949,120.00
5University Hospitals Birmingham NHS Foundation Trust187,895£30,063,200.00
6Royal Free London NHS Foundation Trust167,909£26,865,440.00
7Cumbria Northumberland Tyne and Wear NHS Foundation Trust166945£26,711,200.00
8Imperial College Healthcare NHS Trust133,016£21,282,560.00
9Liverpool University Hospitals NHS Foundation Trust132,871£21,259,360.00
10University College London Hospitals NHS Foundation Trust129,380£20,700,800.00

Guy’s and St Thomas’ NHS Foundation Trust wasn’t the only trust to report significant increases in missed appointments last year. 

Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust saw the biggest rise in DNAs, with a staggering 389% increase, from 9,443 in 2023 to 46,129 in 2024. 

The NHS trusts that saw the biggest increase in missed appointments in 2024

Hospital TrustDNA: 2023DNA:20242024 YoY change (%)
1Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust9,44346,129388.50%
2Countess of Chester Hospital NHS Foundation Trust11,85331,878168.94%
3Norfolk and Suffolk NHS Foundation Trust11,78326,627125.98%
4Whittington Health NHS Trust52,785113,305114.65%
5Guy’s and St Thomas’ NHS Foundation Trust.162,007321,35198.36%
6King’s College Hospital NHS Foundation Trust119,951218,43282.10%
7Sussex Community NHS Foundation Trust12,19820,30066.42%
8Sheffield Children’s NHS Foundation Trust20,59530,43747.79%
9Royal Orthopaedic Hospital NHS Foundation Trust7,80711,13742.65%
10George Elliot Hospital NHS Trust17,14323,95339.72%

Analysis of 2019 – 2023 data 

This isn’t the first time we’ve analysed this data around missed appointments in the NHS. We followed the same approach to compare 2023 data, as well as looking back at the previous five years of DNA records. 

Our analysis of 2023 data shows that, on average, each NHS trust had recorded more than 250,000 missed appointments over the last five years. For the 102 NHS Trusts who responded to our FOI request issued in 2024, this totalled more than 25 million appointments. 

The cost of these missed appointments was almost £41 million per trust. Across the trusts we surveyed, this was a total cost of £4.1 billion for the NHS. 

When we extrapolated this research across the 229 trusts in the NHS, missed appointments have cost the health service a total of £9.3 billion over the last five years. 

The NHS trusts with the most missed appointments 2019 – 2024

Hospital TrustRegion DNA: 2019DNA: 2020DNA: 2021DNA: 2022DNA: 2023Total DNATotal Cost of DNAs
Mersey Care NHS Foundation TrustNorth West England271,916219,195241,436238,069225,9981,196,614£191,458,240
Manchester University NHS Foundation TrustNorth West England235,251172,551220,539223,285232,8381,084,464£173,514,240
Barts Health NHS TrustLondon208,620154,911190,360241,242229,8121,024,945£163,991,200
University Hospitals Birmingham NHS Foundation TrustWest Midlands233,684192,678182,984203,897206,6731,019,916£163,186,560
Guy’s and St Thomas’ NHS Foundation Trust.London203,625166,129168,901203,081162,007903,743£144,598,880
King’s College Hospital NHS Foundation TrustLondon156,401127,679155,423167,706119,951727,160£116,345,600
Northern Care Alliance NHS Foundation TrustNorth West England168,849111,785121,598125,322118,033645,587£103,293,920
Mid and South Essex NHS Foundation TrustSouth East England119,18381,22199,982118,547122,564541,497£86,639,520
Liverpool University Hospitals NHS Foundation TrustNorth West England36,79099,235130,539117,132121,711505,407£80,865,120
Leeds Teaching Hospitals NHS TrustYorkshire and the Humber108,20376,393107,114106,854100,237498,801£79,808,160
Nottingham University Hospitals NHS TrustEast Midlands84,46374,08296,132107,713115,358477,748£76,439,680
Sandwell and West Birmingham Hospitals NHS TrustWest Midlands84,04682,28992,91197,803104,036461,085£73,773,600
London North West University Healthcare NHS TrustLondon97,20671,28286,66891,31394,691441,160£70,585,600
St George’s University Hospitals NHS Foundation TrustLondon84,43763,45375,37094,41093,665411,335£65,813,600
Barnet, Enfield and Haringey Mental Health NHS TrustLondon97,63851,46774,96790,26694,584408,922£65,427,520
Barking, Havering and Redbridge University Hospitals NHS TrustLondon86,10457,78180,66588,66594,769407,984£65,277,440
Chelsea and Westminster Hospital NHS Foundation TrustLondon94,43861,51775,02088,28388,546407,804£65,248,640
University Hospital of Derby and Burton NHS Foundation TrustEast Midlands90,93461,30675,35684,66283,672395,930£63,348,800
Lewisham & Greenwich NHS TrustLondon93,58763,64870,72376,16584,359388,482£62,157,120
The Royal Wolverhampton NHS TrustWest Midlands79,69258,88569,87281,26390,811380,523£60,883,680
University Hospitals of North Midlands TrustWest Midlands81,03766,26077,91778,57870,407374,199£59,871,840
South Tees Hospitals NHS Foundation TrustYorkshire and the HumberNot providedNot providedNot providedNot providedNot provided360,161£57,625,760
Hull University Teaching Hospitals NHS TrustYorkshire and the Humber55,48054,75074,27381,92970,926337,358£53,977,280
University Hospital Southampton NHS TrustSouth East England60,64553,86769,63469,07167,037320,254£51,240,640
East Kent Hospitals University NHS Foundation TrustSouth East England66,33852,03758,50368,16466,135311,177£49,788,320
University Hospitals Bristol and Weston NHS Foundation TrustSouth West England61,54951,13164,39768,43665,284310,797£49,727,520
Coventry and Warwickshire Partnership NHS TrustWest Midlands69,33664,19260,85646,01953,619294,022£47,043,520
East Suffolk and North Essex NHS Foundation TrustEast of England58,26946,41958,28356,54853,273272,792£43,646,720
Bolton NHS Foundation TrustNorth West England58,62043,84149,17158,64255,474265,748£42,519,680
Royal Berkshire NHS Foundation TrustEast of England53,88545,32353,21356,49754,334263,252£42,120,320
Tees, Esk and Wear Valleys NHS Foundation TrustNorth East England55,52351,47853,52048,34452,633261,498£41,839,680
East Lancashire Hospitals NHS TrustNorth West England49,26443,81854,32858,96150,658257,029£41,124,640
Homerton Healthcare Foundation TrustLondon54,71240,07650,77657,87153,296256,731£41,076,960
Gloucestershire Hospitals NHS Foundation TrustSouth West England48,97142,65152,93356,48051,460252,495£40,399,200
North West Anglia NHS Foundation TrustEast of England55,78643,15447,08455,73148,707250,462£40,073,920
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation TrustYorkshire and the Humber55,29039,11648,66352,75053,697249,516£39,922,560
Lancashire Teaching Hospitals NHS Foundation TrustNorth West England47,80243,22946,80952,86356,783247,486£39,597,760
North Bristol NHS TrustSouth West England49,83441,22251,48554,04447,720244,305£39,088,800
St Helens and Knowsley Teaching Hospitals NHS TrustNorth West England49,87939,16942,66652,80353,880238,397£38,143,520
Rotherham Doncaster and South Humber NHS Foundation TrustYorkshire and the Humber53,28239,42344,69946,87051,697235,971£37,755,360
Sussex Partnership NHS Foundation TrustSouth East England45,02244,73448,16847,98548,198234,107£37,457,120
Croydon Health Services NHS TrustLondon43,40239,80056,11648,54645,513233,377£37,340,320
Berkshire Healthcare NHS Foundation TrustSouth East England51,07441,92345,00346,95246,848231,800£37,088,000
University Hospitals Dorset NHS Foundation TrustSouth West England54,84336,80242,68348,57642,025224,929£35,988,640
Whittington Health NHS TrustLondon49,67034,00639,41847,62152,785223,500£35,760,000
University Hospitals Of Morecambe Bay NHS Foundation TrustNorth West England48,35031,76046,21146,48244,946217,749£34,839,840
West Hertfordshire Teaching Hospitals NHS TrustEast of England39,63335,43846,08547,34240,506209,004£33,440,640
Bradford Teaching Hospitals NHS Foundation TrustYorkshire and the Humber46,42930,26036,21147,42546,342206,667£33,066,720
Wrightington, Wigan and Leigh NHS Foundation TrustNorth West England40,21930,02942,73749,12341,580203,688£32,590,080
Northampton General Hospital NHS TrustEast Midlands42,66533,96244,37942,29538,248201,549£32,247,840

Mersey Care NHS Foundation Trust was found to have the most DNAs of those who responded to our Freedom of Information request. 

In 2023, it recorded 225,998 missed appointments and more than 1.1 million since 2019. The cost of these DNAs is calculated to be more than £191 million. 

Barts Health NHS Trust and University Hospitals Birmingham NHS Foundation Trust were the organisations with the next highest level of missed appointments, with more than one million each. 

How do different regions compare?

NHS trusts in the West Midlands have faced the highest cost of missed appointments, with almost £86 million generated between 2019 and 2024. 

The West Midlands was closely followed by the capital, with trusts in the capital facing costs of more than £79 million due to missed appointments. 

Trusts in London saw a significant increase in missed appointments, with 108,732 in total in 2024, an increase of 34% on 2023. 

The North West and Yorkshire both saw even bigger increases in DNAs, with the number of missed appointments up by 116% and 62% respectively.

By contrast, the East Midlands and West Midlands both saw a substantial drop in the number of no-shows, with DNAs down by 28% and 53% respectively on 2023 figures.

2019 – Missed appointments per trust2020 – Missed appointments per trust2021 – Missed appointments per trust2022 – Missed appointments per trust2023 – Missed appointments per trust2024 – Missed appointment per trust2019 – 2024 – Missed appointments per trustTotal cost of missed appointments per trust
East Midlands50,43639,98750,52054,64455,23239,984290,804£46,528,624.00
London84,44662,33974,91185,75980,981108,732497,167£79,546,792.00
West Midlands107,72189,09295,46599,819102,43948,487543,022£86,883,529.41
East of England35,49728,27235,05337,70735,44239,312211,282£33,805,167.06
North East England37,15229,59534,94635,96232,97349,221219,849£35,175,885.71
North West England21,63117,41220,89122,34421,72546,827150,830£24,132,778.18
South East England25,61022,89225,98534,37935,85240,565207,846£33,255,320.00
South West England and Gibraltar39,05732,01738,10239,70736,98237,515223,379£35,740,608.00
Yorkshire and the Humber27,50119,50623,61525,81424,85240,178161,467£25,834,760.00

What can healthcare organisations do to reduce missed appointments? 

There’s no doubt, given the huge costs of missed appointments, that healthcare providers need to find new ways to make sure they are reducing no-shows. 

Research shows that SMS open rates are as high as 98%, with the average response time of 90 seconds, and 90% of people read a text message within the first three minutes of receiving it. 

All of this research shows that SMS appointment reminders are a vital tool for healthcare providers to deliver the vital information patients need and reduce the risk of no-shows. 

While letters and emails are easily lost or left unread, automated SMS reminders can alert patients about upcoming appointments, scheduled tests or prescription collections, and give them the option to reschedule or cancel ahead of time. 

SMS surveys can also enable healthcare providers to gather invaluable feedback to inform planning and improve patient experiences. By sharing test results, after-care support and other reminders, healthcare organisations can also offer further support to their patients while reducing overheads. 

Commenting on the findings, Chris Gorman, Head of Commercial Transformation at Esendex at Esendex, said: 

“Missed healthcare appointments are hugely frustrating for everyone in healthcare – not least for organisations like the NHS which have to shoulder the financial and administrative burden of no-shows. 

“There are a huge number of reasons which might explain why someone misses a healthcare appointment, whether that’s difficulty in taking time off work, being unable to arrange care at the time of the appointment, or transport challenges that prevent people from getting to the healthcare setting. 

“Perhaps the most frustrating factor is when patients are unaware of a scheduled appointment, have the wrong information, or simply forget about it. While many healthcare providers rely on letters or emails to update patients about their appointments, these can easily be missed, lost or left unread, so it’s clear providers need to find new ways to reduce no-shows. 

“With data showing that most people read a text message within the first three minutes of receiving it, SMS solutions have a huge potential to drive down the number of missed appointments across the NHS. Rich messaging also enables providers to support two-way conversations on devices most of us carry with us at all times, making it a convenient and reliable method of contact.”

Find out more about our SMS and messaging solutions for the healthcare industry here.

Methodology

Esendex issued FOI requests to hospital trusts asking how many missed scheduled outpatient appointments or ‘DNAs’ (did not attend) there were at their major hospital sites across the past five years. With every missed hospital appointment costing the NHS £160 (own NHS data), we then calculated the total DNA figure by £160 giving us the total cost of missed appointments to each NHS hospital trust.

Author Avatar
Emily Herbertson

Emily is a marketing executive for Esendex UKI and has worked in a variety of content creation and strategy roles in both B2B and B2C.