Thousands of NHS patients accidentally removed from waiting lists, health watchdog warns

e-Referral Service design flaw causes referrals to disappear without warning

By LineZotpaper

Published22 October 2026

Read Time3 min

At least 2,000 NHS patients have been inadvertently removed from waiting lists for hospital care since 2018 because of a flaw in the electronic referral system, according to interim findings from the Health Services Safety Investigations Body (HSSIB). The system automatically deletes referrals after 180 days of inactivity without notifying patients or clinicians, leaving thousands unaware they have fallen off the list.

The Health Services Safety Investigations Body (HSSIB) has warned that the NHS e-Referral Service (e-RS) was not designed to manage the current volume of referrals, particularly since the pandemic. The system generates digital worklists for hospitals and automatically removes referrals when an appointment is booked or after 180 days with no action. While the 180-day function was intended to prevent large worklists from impacting performance, it has created a patient safety risk by removing referrals without alerting healthcare providers.

The watchdog’s investigation found multiple incidents since 2018. In 2018, 72 referrals disappeared from an appointment slot issue worklist. The following year, more than 1,000 patients potentially dropped off similarly. In 2023/24, approximately 1,000 patients were added back onto a worklist after dropping off at six months, having not been booked due to clinic capacity constraints. GP practices raised concerns when they noticed patients had not heard from the hospital.

Nick Woodier, senior safety investigator at HSSIB, said patients waiting for appointments are often “living with symptoms and the worry of not knowing when they will be seen. If a patient’s referral is removed from a list without warning, they may wait far longer than they should.” He added that while the risk is created by the system itself, it is an immediate safety risk, which is why the body published an interim report with practical steps for trusts.

Rachel Power, chief executive of the Patients Association, said the findings show how easily the system forgets patients. “Patients should be able to trust that when they are referred for care, their referral will be followed up. They should not have to worry that they have been lost in the system, or carry the responsibility for making sure the NHS does not lose track of them,” she said. She called for clear accountability, effective referral tracking and proper administrative support.

The HSSIB has called on hospitals and other providers to check they have reliable processes in place and ensure referrals are not removed from lists. NHS England is updating its national clinical risk documentation to recognise the hazard and will share this with trusts.

Analysis

Why This Matters

Thousands of patients could face extended waits without realising they have been removed from lists, increasing the risk of harm from delayed care.
The NHS is already under strain with over 7 million treatments waiting and more than 113,000 patients waiting over a year; systematic admin failures deepen the backlog.
HSSIB’s interim report identifies an immediate safety risk and demands urgent action from trusts to check and fix tracking processes.

Background

The NHS e-Referral Service (e-RS) is the electronic system widely used by GPs to refer patients for specialist hospital care. It was not designed to handle the volume of referrals now seen, especially after the pandemic. The system automatically removes referrals from worklists after 180 days of no action, a feature originally meant to prevent large worklists from affecting performance metrics. This function has not been formally documented as a patient safety risk until now.

Key Perspectives

[HSSIB]: The health watchdog warns that the 180-day removal function creates a hazard. It has called on all trusts to immediately check that no referrals are silently deleted and to implement reliable tracking. [Patients Association]: Rachel Power says the flaw undermines patient trust and places the burden of chasing care on patients. She urges NHS England and trusts to establish clear accountability and administrative support so no patient falls through gaps. [NHS England]: The national body is updating its clinical risk documentation to recognise the 180-day risk and will share this with trusts. However, HSSIB says immediate action is needed while that update is underway.

What to Watch

Whether NHS trusts successfully audit and recover patients who may have fallen off worklists.
NHS England’s updated risk guidance and how quickly it reaches frontline services.
Further interim or final reports from HSSIB’s broad probe of electronic patient record systems.

Sources

Thousands of patients accidentally removed from NHS waiting lists · The Independent UK

Checked

12 claims in this story checked against 1 source: 7 supported.

Show each claim

SupportedThousands of NHS patients were accidentally removed from waiting lists, the health watchdog warned.The Independent UK: “At least 2,000 patients have accidentally “dropped off” NHS waiting lists since 2018, according to a new report by the health watchdog.”
Partly supportedThe e-Referral Service design flaw causes referrals to disappear without warning.The Independent UK: “Its investigation found there were incidents where referrals disappeared from worklists without being flagged, both for unknown reasons and after 180 days of no action.”
Partly supportedAt least 2,000 patients were removed from waiting lists since 2018 because of a flaw in the electronic referral system.The Independent UK: “At least 2,000 patients have accidentally “dropped off” NHS waiting lists since 2018, according to a new report by the health watchdog.”
Partly supportedThe system automatically deletes referrals after 180 days without notifying patients or clinicians.The Independent UK: “Referrals are automatically removed when an action, such as booking a patient an appointment, is performed or when 180 days pass with no action”
Not in the sourcesThousands of patients were unaware they had fallen off the list.The Independent UK
SupportedThe e-RS was not designed to manage the current volume of referrals, particularly since the pandemic.The Independent UK: “The HSSIB highlighted that the e-RS system “was not designed to manage the current volume of referrals seen across the NHS”, particularly since the pandemic.”
SupportedIn 2018, 72 referrals disappeared from an appointment slot issue worklist.The Independent UK: “In 2018, some 72 referrals “disappeared” from an appointment slot issue (ASI) worklist”
SupportedIn 2019, more than 1,000 patients potentially dropped off the e-RS ASI worklist.The Independent UK: “The following year, more than 1,000 patients also “potentially dropped off” the e-RS ASI worklist.”
SupportedIn 2023/24, around 1,000 patients were added back to a worklist after dropping off at six months because clinic capacity had prevented booking.The Independent UK: “And in 2023/24, around 1,000 patients had to be added back onto a worklist after “dropping off” after six months. They had not been booked into an appointment because of “clinic capacity constraints””
SupportedNick Woodier said patients waiting for appointments are often living with symptoms and worry, and that an unannounced referral removal may make them wait far longer than they should.The Independent UK: “Patients waiting for a hospital appointment are often living with symptoms and the worry of not knowing when they will be seen. “If a patient’s referral is removed from a list without warning, they may wait far longer than they should.””
SupportedRachel Power said patients should be able to trust that referrals will be followed up and should not have to worry they have been lost in the system.The Independent UK: ““Patients should be able to trust that when they are referred for care, their referral will be followed up. They should not have to worry that they have been lost in the system, or carry the responsibility for making sure the NHS does not lose track of them.””
Partly supportedNHS England is updating its national clinical risk documentation to recognise the hazard and will share it with trusts.The Independent UK: “It also said that NHS England is updating its national clinical risk documentation to recognise the risk and will share this with trusts.”