Child outpatient non-attendance may indicate welfare concerns

Editor—Much effort has been put into reducing the high rates of non-attendance at outpatient clinics.¹,² Currently there is a drive to improve the quality of outpatient services, which in itself will improve attendance rates. The laudable recommendations of the Clinical Standard Advisory Group approach the problem from a health perspective.³ Sharp and Hamilton's editorial rehearses some of these strategies and highlights the magnitude of the problem in deprived populations.⁴ Social circumstances are a major influence on health, and we explored this in an audit of outpatient paediatric non-attenders.

We performed a retrospective audit of all paediatric outpatients attending a district general hospital in a deprived area of London over six months from January to June 2000. Of 2183 appointments, 685 were missed. Altogether, 589 were for children living in the local borough. Of these, 218 were for patients known on the social services database (157 were themselves on the database, while in the remaining 61 cases other family members were listed). Of the 157 patients, 38 were listed on the child protection index, of whom eight were on the current child protection register.

Thus we found that one third of the outpatient non-attenders were known to social services. Our audit illustrates why we must consider non-attendance within the wider social context and the importance of close liaison with social services. Medical staff must recognise non-attendance as a possible indicator of child welfare concerns and make contact with social services. This audit shows that good interagency working (encouraged by the Health Act 1999, the NHS Plan, and the Department of Health) is justifiably a high priority.