Betsi Cadwaladr University Health Board is one of the UK’s largest health organisations geographically, providing services across North Wales to a population of 660,000 in Welsh and English. In 2013, 50,000 outpatient appointments were missed at the Health Board. At up to £150 per slot this is at significant cost and greatly impacts on the ability to deliver an efficient service. Delays in patients care increase without reutilisation opportunities.

The most common reason for did not attends (DNA’s) is simply because the patient forgets the appointment. To overcome this issue and improve access, Betsi Cadwaladr decided to implement new communication technologies to remind patients of their upcoming appointments.

Blend of Communication Channels

In April 2014, Healthcare Communications were awarded the contract to deliver a blended, totally bilingual Appointment reminder solution. The team worked with the Health Board to develop sophisticated scripts in both languages across technologies enabling patients to respond and confirm, cancel or rearrange their appointment.

The first phase of the project introduced patient reminders via SMS and Interactive Voice Message (IVM) with the option to receive the message in either Welsh or English. Envoy messenger Appointment Manager collates and reports on outcomes, meaning cancelled slots are successfully reused, reducing waiting times and associated costs.

Phase 2. Agent Call Implementation

The Health Board is committed to making sure every patient benefits from a reminder. In December 2014 Agent calls were added to the communications portfolio with the following objectives:

  • Improve patients access to care by increasing slot utilisation using every means possible
  • A totally bilingual Agent call reminder service to follow up when other communication connections cannot be completed
  • Contact hard to reach patient groups and when land line only details are provided

Agent calls are now an essential part of the remind service. Of the 40,000 patients that are reminded monthly, up to 10% of these are delivered by agent calls. This is especially relevant when SMS or IVMs are not completed; an agent call will automatically follow to ensure every channel is used to reach the patient.


  • Successful implementation of our bilingual agent call facility to cater for the English and Welsh speaking population
  •  Up to 4200 patients a month now confirm their intentions through agent calls. Replies occur up to 7 days ahead of the appointment, meaning booking centres can re-use the slots for significant efficiency gains
  • Enhanced patient experience. In September 2014 a patient evaluation was undertaken for feedback on the reminder service. 88% of patients rated it Great, 8% good with the remaining 4% commenting on other elements of the healthcare
  • A reduction in DNA rate across departments

Award Nomination

Besti Cadwaladr University Health Board and Healthcare Communications commitment to providing a totally bilingual appointment reminder service has received recognition in the Welsh Language in Health Social Services and Social Care Awards. The Health Board was shortlisted in the IT and the Welsh and Language category in 2014 and won in 2015.

Measurable Results

Betsi Cadwaladr have sent over 350,000 reminders resulting in reutilisation of over 4600 appointments and a DNA reduction since implementation. 24 hour reminders have now commenced to further improve patient experience and financial efficiency.