Op-ed: Why Sajid Javid’s £20 fines are not the cure for NHS no shows

Helen is forty-two, works nights at a supermarket in Sunderland and juggles raising two kids on her own. 

When she woke up with chest tightness one morning, her GP surgery was still running the dreaded 8am phone scramble, so she queued on hold while making the school run. 

Luckily, she managed to grab the 10:40am slot the next day and crossed her fingers that the number 23 bus would show up to get her there on time. 

But the bus was cancelled, and a taxi costs half her shift’s pay. 

Back on hold to re-book, she waited thirty-five minutes before the line dropped. Helen missed the appointment. Under Sajid Javid’s proposal, she’d now owe the NHS £20. Plus a fine for the no-show. 

This is the latest from the former health secretary who was in post for about 12 months in the vaccination phase of the coronavirus crisis. 

Now, in the recent report published by think tank, Policy Exchange, Javid insists Britain is “long overdue” a conversation about NHS funding, noting that the service now “spends its original yearly budget every month” in a bid to justify the fines. 

Missed appointments cluster in the very communities already punished by poor health and poverty

Helen isn’t actually a real person. She’s an amalgam of different people whose stories I hear every single day. 

Instead of punishing patients for falling through the cracks of a broken system, we should get to the root cause of why the system is broken. The answer isn’t fines, it’s technology. AI-powered scheduling, automated rebooking, and better use of NHS capacity could mean no-shows, shorten waiting lists and ease pressure for staff.  

This is a progressive step forward. One that can save money and close the health inequality gap to ensure all patients have equal access to care. 

The human cost of a no-show

Helen is one of six million people waiting for a GP appointment - part of a wider crisis where eight million appointments vanish each year often because the system makes rescheduling so difficult. To fix this, we need to understand what missed appointments really mean.

A national data-linkage study found that patients with long-term health and mental-health conditions who miss more than two GP visits a year are more than eight times more likely to die within twelve months than those who attend. 

Missed appointments cluster in the very communities already punished by poor health and poverty. If you’re a man and live in one of the 20% poorest neighbourhoods you die on average, 10.7 years earlier than those in the richest neighbourhoods. That’s one of the worst gaps in Western Europe. 

Charging Helen £20 does not close that gap; it widens it.

Billing patients for no shows adds bureaucracy, not capacity 

Under Javid’s proposal, practices would need card machines, invoicing software and debt collection staff. This is admin the NHS can’t afford. What does this mean for low income families? An upfront fee, which is a huge deterrent, yet simply pocket change for high earners.  

This policy punishes those who have the least control over the things that cause no-shows in the first place: shift work, childcare and transport. 

Javid says that switching to a largely insurance-funded NHS would halve the tax burden paid by the public by around £2,400 a year - but at what cost? This fuels a system where money decides who gets care, and who goes without.