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Switching from a traditional, letter-based appointment management system to a digital patient portal is saving one NHS trust in Lancashire over £120,000 a year – and freeing up 30,000 reusable appointments that would otherwise have been wasted.

The Envoy Messenger platform and patient portal were developed by Cheshire-based Healthcare Communications, and have been adopted by trusts across the country with the support of the Academic Health Science Networks including the Innovation Agency and Health Innovation Manchester.

The Challenge

Missed appointments cost the NHS around £1 billion a year. East Lancashire Hospitals NHS Trust processes 450,000 outpatient appointments a year across five hospitals and 17 community nursing locations in East Lancashire and Blackburn with Darwen. In 2016 the did-not-attend (DNA) rate across the trust was around 9.4 per cent, compared to a regional average of 9 per cent.

Outpatient appointments across the trust are managed by a team of 40 staff. The trust estimates that the team spends roughly 30 hours a week managing letters - printing them out, putting them in envelopes and posting them. The trust also serves a diverse local community where many groups need access to languages other than English.

Actions Taken

In summer 2017 East Lancashire Hospitals NHS Trust launched an appointment reminder campaign and introduced reminder prompt messaging software.

In July 2018 the trust expanded their digital service with the addition of a digital patient portal. The patient portal, which can be accessed via smartphones, tablets and desktops, gives patients appointment times and locations with the ability to confirm, rebook or cancel. Additional information including leaflets and pre-assessment instructions can be provided via the portal, and information can be translated into 99 different languages.


The trust introduced the reminder prompt messaging service in summer 2017. When comparing the calendar years of 2016 to 2017, there was a drop in the trust’s DNA rate from 9.4 per cent to 7.5 per cent, significantly lower than the regional average of 9 per cent and freeing up 10,000 additional appointments that would otherwise have been wasted. This reduction continues to be evident to date.

The Patient Portal was launched in July 2018 and by September, 54 per cent of patients had opted to receive their appointment letters and other information digitally, cutting the cost of appointment letters by 51 per cent.

The trust estimates that as of March 2019 their digital services have freed up 30,000 reusable appointments and saved £120,000.


Wendy Cowgill, who has used the Digital Patient Portal as a patient, said: “Before we had the portal you’d have to wait for your appointment letter to arrive and if the appointment was at an inconvenient time you’d have to ring to cancel, re-arrange a new appointment and then wait for the arrival of a new appointment letter.

“The portal delivers digital appointment letters via a single text. You can access all your appointment information anytime, anywhere, and you get an instant ‘confirm’, ‘rebook’ or ‘cancel’ option. You also get an interactive home to hospital map and directions.

“It saves time. You have all the information at hand if you need to plan any other events, and you avoid double-booking.”

Daniel Driver, a supervisor in the trust’s booking centre, said: “Prior to the digital portal we were printing off hundreds of appointment letters daily. Printers would break due to the volume being processed which would lead to delays, and staff time was spent matching leaflets with appointment letters. 

“The portal is a different way of sending appointment letters to patients along with any relevant information. It automatically matches up the relevant information leaflets required for specific clinics. We send new patients their appointment letters as soon as they are booked, even if this is weeks in advance, so that patients are aware of when they’re being seen. It reduces costs for us and confusion for patients.

“Patients can interact with the portal. They can confirm attendance, or rebook or cancel. We then act on the rebook or cancel responses at a time that fits in with our workload demands.”

Kenny Bloxham, Managing Director Healthcare Communications, said: "The Innovation Agency has been instrumental in increasing our northern footprint. Through their events, advisory meetings and ecosystem conferences, we’ve had access to key NHS decision makers to introduce our digital patient portal. East Lancashire Hospitals NHS Trust are now saving £120,000 a year in postal costs by adopting our solution and we are now in talks with several other northern hospital trusts thanks to the support of the Innovation Agency."

Photo: Wendy Cowgill using the digital patient portal

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