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Most patient contacts with hospital services are as outpatients and paediatricians spend a great deal of their working lives in outpatient clinics. Yet this work has a low profile in comparison to other areas of clinical practice, is usually poorly organised and managed, and is often provided in outdated and unsuitable facilities. As a consequence it attracts poor support in terms of clinical and other staff. Since 1991, new appointments in the NHS have increased overall by 4.8% per year and in paediatrics the rise is greater than this. A new report from the Clinical Standards Advisory Group (CSAG),Services for outpatients,1 has identified current problems and suggests ways of tackling them. The report considers the whole range of outpatient services for adults and children—medical, surgical, and specialist—but has important implications for the provision of children's outpatient services.
Clinical Standards Advisory Group
CSAG was set up in 1991 as an independent source of expert advice in order to address concerns about access to and availability of specialist services following the NHS reorganisation which introduced the purchaser–provider split. Early reports included studies on neonatal intensive care,2 cystic fibrosis,3and childhood leukaemia,4 and more recently back pain, clinical effectiveness, and cleft lip and palate.5 The report on hospital outpatient services, together with others on depression, epilepsy, and pain concludes the work of CSAG which was abolished in November 1999. Its work has been subsumed under the remit of the Commission for Health Improvement. However, it seems increasingly unlikely that the new Commission will undertake clinically based topic reviews in the style of the CSAG.
The main strength of CSAG lay in its membership, which was senior and multidisciplinary, backed by academic support and commissioned research. CSAG was never given a remit to implement its findings, but recent reports have helped …