Cambridge Hospitals NHS Trust is one of the largest and well-known hospitals in the UK with approximately 750,000 outpatient visits last year. Although digital innovator’s in many ways, their appointment management system was cumbersome, and the Trust was not capitalising on technology to improve patient engagement and drive cost efficiencies.

The issues

Cambridge relied solely on Interactive Voice Messaging (IVM) to remind all patients of upcoming appointments. Mobile texting is the most popular form of UK communications, yet it was not deployed as part of the patient
communications strategy.

  • The Trust’s Did Not Attend (DNA) rate was low at 5.5%, however this had stagnated for some time and the current solution could not reduce DNA’s any further.
  • The reminder process was disjointed with minimal automation built in to work flows. Staff were required to ring patients individually about cancelled clinics or to fill last minute slots; hugely time consuming, archaic and expensive, which diverted staff from optimising clinics.
  • The system received high levels of complaints from patients who were suspicious of its origin and wary of phone scams; older patients were particularly concerned about this.
  • Text reminders are now common place for a range of appointments in our everyday life. Delivery is instant and 95% of SMS messages are read! The channel is not susceptible to spammers, so it’s a trusted mode to engage patients.

The solution

Text reminders are now common place for a range of appointments in our everyday life. Delivery is instant and 95% of SMS messages are read! The channel is not susceptible to spammers, so it’s a trusted mode to engage patients. However, not all patients can be reached this way and Healthcare Communications worked with the Trust to ensure reminders were inclusive to all patient groups whilst improving on service quality.

The communications plan

  • A conversational reminder text is sent enabling patients to digitally respond to confirm, cancel or rebook, without the hassle of phoning in to the hospital.
  • If the SMS is not delivered, or no mobile number is held for the patient, the Envoy platform automatically generates an IVM call at the best time to reach patients.
  •  48 hours prior to the appointment, a one-way reminder text message or IVM is sent to patients.

An extra nudge

  • If a reply to the first message is not received within 48 hours, another text is sent to ‘nudge’ the patient to communicate intentions. The Envoy platform automatically triggers a second message only to those that have not responded.
  • In the month of July 2018, 218 patients responded ‘cancel’ to the second message, equating to £34,880 potential income and a net gain of 14-18 clinics.
  • 571 patients also ‘rebooked’, opening up slots for waiting list patients with a net gain of 38-47 clinics.
    Without the second message prompt, potentially 789 appointments may have been wasted.


  • DNA drop: within 1 month, DNA’s dropped by 1% and have since lowered even further from 5.5% to 4% – overall a 27% decrease in missed appointments.
  • Cashable efficiencies: The Trust were previously experiencing around 3,000 DNA’s a month. From the reduction in missed appointments, Payment by Results (PbR) income has increased by £40,000 a month.
  • Improved patient experience: Patients can now respond at their own convenience and digitally, without the time and effort to phone the hospital to reschedule.
  • Measurable service quality improvements: there were concerns about the previous system and patients mistaking communications as fraudulent. Complaints around this have since stopped.
  • Improved ROI: the solution is more cost effective than the previous system and achieves higher patient contact outcomes increasing income potential.

Top ranking

Cambridge recently took part in NHS England’s DNA benchmarking where the average DNA rate was 8.9%. Cambridge on the other hand sits at 4%, less than half the average of the 68 hospitals that took part. It now has the  fourth lowest DNA rate in the country! (KPMG, 2018).

Resource efficiencies

  • The platform is data driven and automated, freeing staff from repetitive, manual tasks to focus on clinic efficiencies.
  • The booking team can send a single text blast to 100’s of patients to fill short notice clinics, rather than attempting to contact 150+ patients, which generally takes all day. Using the bulk send, a clinic can now be filled within 60 minutes.
  • Last minute clinic cancellation notification has improved too. A single text message can be sent to all patients and received instantly to ensure they do not attend unnecessarily.

Next steps

The next stage of the roll out is day case and whilst the Trust already has one of the lowest DNA rates in the country, the aim is to get this below 3.9% to achieve the most efficient service possible.