Entering the Lobby: Access to Outpatient Assessment

Abstract

Outpatient activity offers one of the most graphic examples of the extent to which the balance of NHS activity may elude any simple criteria of rationality. Large numbers of people are seen in outpatient clinics each year. During the financial year 1989–90, 36 262 539 outpatient attendances were recorded in England, equivalent to some 75% of the population (Government Statistical Service 1991a). Some 15% of the overall hospital budget is absorbed by outpatient activity. However, the evidence suggests that whatever rationality informs what comprises one of the major components of health care provision in Britain, the distinctive advantage in terms of care or cure to those selected for attendance may not be apparent. While large numbers of people are occupied in attendances that maybe burdensome to both patient and doctor, other patients seeking urgent assessment may languish on waiting lists. The evidence for this assertion is the subject of this chapter. The changing perceptions of the nature of the problems surrounding outpatient assessment over the last century offer a graphic illustration of the ways in which professional concerns can take precedence over public preferences in debates of health policy.