Aim
This guidance aims to ensure:
- there is consideration of why an adult with needs for care and support might fail to attend a health appointment
- they are individually assessed and managed with consideration to their welfare
Where an adult who does not have care and support needs may be at risk of domestic abuse, you should follow your organisation's policy for responding to concerns of domestic abuse.
If you believe that a crime has been committed and there is an immediate danger, call the police on 999 or 112. If there is no immediate danger, call the police on 101.
Introduction
Not all circumstances where an adult with care and support needs fails to attend a health appointment will raise concerns. In most cases there will be reasonable explanation. However, all clinical and non-clinical staff have a duty to safeguard adults by recognising abuse and referring onwards as appropriate.
A single missed appointment is unlikely to be a cause for concern. It will depend on the likely impact and other factors such as time since the person was last seen. However, numerous studies have shown that missing healthcare appointments is a feature in many Safeguarding Adult Reviews and Domestic Homicide Reviews and it can be a precursor to abuse. Therefore, for some adults, missing appointments may be an indicator that they are at an increased risk of abuse and, or neglect.
Within Health there is a move towards the concept of ‘Was Not Brought’ (WNB) rather than Did Not Attend (DNA) for children and young people. This guidance seeks to use this concept for adults but replaces the term 'Was Not Brought' with 'Was Not Supported to Attend'. Where an adult may rely upon a carer, family or friend to bring them to appointments due to their care and support needs, this should be considered in the context of 'was not supported to attend' rather than 'did not attend'.
For the purpose of this guidance, the failed appointment refers to any type of pre-arranged appointment, in any pre-arranged location where the adult (or carer) either:
- cancels the appointment
- fails to attend
- was not supported to attend, or
- the service provider cancels the appointment
Cancellation of appointment by the service
On any occasion that an appointment may need to be cancelled by staff within a service, then that service will be responsible for ensuring that prior to the appointment being cancelled:
- any risk to the service user is identified
- a further appointment is arranged as soon as possible
Cancellation of appointment by individual, carer, relative or friend
Where an appointment is cancelled it is good practice to attempt to understand the reason for the cancellation:
- If it is a regular occurrence, is the appointment usually rearranged and subsequently attended?
- Are they cancelling all future appointments for a service which is deemed necessary or where the adult is known to be at risk?
Where a person is cancelling for another person it can be important to speak to the person who the appointment is for, to clarify the above. Consideration should be given whether a carer, relative or friend may need:
- additional support
- appropriate advice and information
- onward referrals
All staff should use professional curiosity when people are cancelling services or appointments for a service which is deemed necessary for care, health and wellbeing.
Did not attend (DNA) or was not supported to attend (WNSA)
This guidance sets out three areas to consider if the adult did not attend or was not supported to attend:
- If this is the first time an appointment has been missed, there is no indication that the individual has care and support needs then the normal appointment DNA process should be followed.
- If the adult has been identified as having care and support needs and has not attended two consecutive appointments then this guidance should be followed.
- If, as a result of initial enquiries, there is a reasonable belief that the adult is at risk of, or may be experiencing abuse or neglect, then this guidance should be followed.
Eligibility criteria under the Care Act 2014
Staff will need to use their professional judgement in order to assess possible risks to the adult and apply the most appropriate and proportionate response.
Whilst the use of a letter is being cited as the standard form of communication with adults or carers, additional methods of communication may be used where inappropriate. For example, where there is:
- visual impairment
- learning disability
- low level of literacy
- other factors affecting an adults or carers ability to read or understand the letter’s instructions.
It is important to identify language barriers and recognise that English may not be the patient’s first language. Staff should always use appropriate interpreting services or literature in various languages.
Did not attend, was not supported to attend or appointment cancelled considerations
When the adult did not attend an appointment, was not supported to attend or the adult or their carer cancelled the appointment, please consider the following:
- Are the adult's circumstances known to be recently unstable?
- Are other services involved with the adult? Have you considered contacting these services?
- What are the adults needs and risks?
- What is the impact of the missed appointment upon the adult and their family?
- Is the missed appointment necessary for the physical or mental health of the adult?
- Does the missed appointment form a pattern of non-attendance?
- Does missing the appointment signify a risk of immediate harm to themselves or others?
- Are you aware of any current safeguarding issues?
- Immediate steps to be taken?
- How long is it since the adult was last seen by your service?
This is not an exhaustive list of considerations but is designed to support you in your thought process.
If an appointment has been cancelled, the individual did not turn up or was not supported to attend, consider the following actions:
First appointment missed
- If this is the first time an appointment has been missed, there is no indication that the individual has care and support needs then the normal appointment did not attend process should be followed.
- Follow your current did not attend process
Two consecutive appointments have been missed
If the adult has been identified as having care and support needs and was not supported to attend or did not attend two consecutive appointments then this guidance should be followed:
- Attempt to contact the adult or carer based on their individual communication needs.
- If contact is made, use professional curiosity to ascertain reasons for non-attendance. If no concerns identified, follow your current did not attend process.
- If contact is not made or contact has raised concerns and you are aware that they are known to other agencies, contact these agencies to share your concerns and agree an appropriate course of action.
- Record outcomes of attempted contact and discussions with other agencies and the agreed course of action.
Adult has been identified as having care and support needs and was not supported to attend or did not attend
If the adult has been identified as having care and support needs and was not supported to attend or did not attend and there are safeguarding concerns indicated for the adult, then this guidance should be followed:
- Attempt to contact the adult or carer based on their individual communication needs.
- If contact is made, use professional curiosity to ascertain reasons for non-attendance. If no concerns identified follow your current did not attend process.
- If contact is not made or contact has raised concerns and you are aware that they are known to other agencies, contact these agencies to:
- identify most recent contact
- share your concerns
- agree an appropriate course of action which may include making a safeguarding referral.
- Record outcomes of attempted contact and discussions with other agencies and the agreed course of action