PATIENTS who refuse hospital appointments without a good reason will pay the penalty of being placed at the end of the waiting list.

The new policy has been devised by Andy Kerr, the health minister, as part of the Scottish executive’s drive to reduce NHS waiting times.

Some patients routinely turn down appointments because they clash with birthdays, weddings, football matches or because of problems arranging childcare. Thousands more fail to turn up for appointments, costing the NHS up to £10m every year.

From 2007, anyone who is deemed not to have a valid reason for not attending a hospital appointment will lose their place in the queue and could face a lengthy delay before they can obtain treatment.

“Patients who refuse a reasonable offer of an appointment or admission cannot expect the same waiting time guarantee and they will be returned to the end of the waiting list queue,” said Kerr.

“No patient will return to the end of the waiting list if there are clinical or other compelling reasons for treating them more quickly. I think that the vast majority of the public will accept this, particularly as it means we will be able to treat more people more quickly. Patients should start to see the benefit of this new approach as soon as it is introduced.”

The same punishment will be given to patients who agree to a hospital appointment but fail to turn up. About 11% of patients failed to turn up for hospital appointments last year. In total more than 156,000 people did not show up. But while the executive says missed appointments waste NHS resources and penalise other patients, critics say long waiting lists for procedures mean patients often forget the date of an appointment.

“Missed appointments can cost the NHS millions of pounds each year and place additional pressures on staff,” said Dr Bill O’Neill, Scottish secretary of the British Medical Association.

“However, patients are not solely to blame for the problem. NHS administration systems are cumbersome and appointments are often made months in advance. Without a mechanism where patients can be reminded of appointments, it is highly likely they may be forgotten.”

The BMA is also concerned about what will constitute a “reasonable offer” under the executive’s guidelines. It alleges that some NHS managers offer patients appointments during periods when they know they will not be available, such as the summer holiday season, in order to meet targets on offering treatment.

“We would hope that ‘reasonable’ is clearly defined to ensure patients do not pay the price for the bureaucratic ‘gaming’ that goes on within NHS services as managers try to achieve targets,” said O’Neill.

Shona Robison, the SNP shadow health minister, said the new strategy could adversely affect the vulnerable, adding that patients should be given a right of appeal.

“We need clarity on what will be accepted as a reasonable reason not to attend. Would a mother with four children who is having trouble with child care arrangements be sent to the back of the queue? We do need to tighten up the appointments system to ensure it is as efficient as possible but we must not punish people who are elderly or vulnerable.”

Critics believe the reforms are a desperate attempt to mask the scale of the waiting times crisis in the NHS.

The Sunday Times reported last month that ministers are preparing to adopt a management system used by Starbucks, the coffee chain, to serve customers faster in order to speed up hospital waiting times.

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