Open letter to Royal Mail about the delivery of NHS letters

Healthwatch and national organisations representing patients and NHS leaders express concerns over Royal Mail plans to delay bulk mail of NHS appointment letters.
A female patient in the background waits by a lift. In the front is hospital signage with arrows and an information screen.

To: Martin Seidenberg, Chief Executive Officer, Royal Mail

CC: Dame Melanie Dawes, Chief Executive Officer, Ofcom. Amanda Pritchard, Chief Executive, NHS England. Rt Hon Victoria Atkins MP, Secretary of State for Health and Social Care. Kevin Hollinrake MP, Minister for Enterprise, Markets and Small Business, Department for Business, Energy and Industrial Strategy.

Re: Royal Mail delivery of NHS letters

Dear Martin

As national organisations representing patients and NHS leaders, we are writing to publicly express concerns following recent media reports that, subject to Ofcom approval, Royal Mail plans to delay bulk mail of NHS appointment letters from two days to three days. 

Late delivery of letters 

Our organisations have heard from patients who have experienced delayed delivery of letters containing vital information about their conditions, upcoming appointments, and treatment plans. 

This includes NHS letters being delivered after the scheduled appointment date and has on occasion included separate letters notifying cancellations and missed appointments arriving at the same time as the initial appointment letter. 

For those that receive letters ahead of the appointment date, delays can still make it difficult for patients to make necessary arrangements in time to enable them to attend appointments. This could be arranging childcare, time off work or transport, for example. 

This particularly affects those without internet access or mobile phones. These individuals don’t receive any information via alternative communication methods such as email or text, and are reliant on letters arriving on time. 

The result is a huge amount of confusion for patients who need absolute clarity following a referral for more specialist treatment. 

Impact of missed appointments on patients and NHS teams 

When appointment letters and other communications from the NHS are delayed, patient safety is put at risk, while NHS teams must deal with the fall-out of missed appointments. 

It widens existing health inequalities in the health system, as those most reliant on post due to being unable to afford or use digital communication channels are also likely to be on lower incomes. 

For the patients themselves, we know that the impact of missing appointments can include ongoing pain, worsening symptoms, poor mental health, and disrupted sleep.

 Missed appointments, lost referrals and other communication failures can also lead to people losing their place on NHS waiting lists, often having to go back to square one. 

Next Steps 

We recognise that the NHS must play its part in ensuring letters are sent out in a timely way. Getting correspondence to patients on time requires a partnership with the postage system. 

Yet plans to further delay posting of letters will undoubtedly make the issues highlighted in this letter more widespread. We ask that the proposals are scrapped and priority is given to ensuring that patients letters already delayed arrive on time. 

If our own organisations can be of assistance in this endeavour, then do not hesitate to let us know. 

We will be conveying our views above through Ofcom’s consultation on the future of the universal post service and encouraging others to do the same.

Yours sincerely, 

Louise Ansari, Chief Executive, Healthwatch England 

Jacob Lant, Chief Executive, National Voices  

Rachel Power, Chief Executive, The Patients Association

Sir Julian Hartley, Chief Executive, NHS Providers