Mortality statistics as measures of need for outpatient services.

The Report of the Resource Allocation Working Party' stated that "morbidity among non-psychiatric outpatients is just as likely to be reflected by standardised mortality ratios (SMRs) as it is among inpatients." It recommended that revenue allocations to regions for non-psychiatric outpatient services should be weighted by the all-causes SMR for each region. The report pointed out that it is not possible (through lack of routine data) to break down the use of outpatient services by clinical condition. It is, however, possible to break down the use of outpatient services according to clinical specialty and to consider the proposition that all-causes SMRs reflect the general need for outpatient services. Method Figures on the number of inpatient deaths and inpatient episodes-discharges and deaths-for each specialty in England and Wales in 1978 (the latest available year) were obtained from the Office of Population Censuses and Surveys. These were In this way specialties were categorised as those that are substantially concerned with conditions that lead to death and those that are not. National figures for outpatient attendances (from the 1978 Annual Hospital Return (Form SH3)) were used to calculate the contribution of each specialty to the work load of outpatient services. Results The 12 specialties with the highest number of outpatient attendances are ranked in order in the table. Geriatric medicine is also included because, though ranking low in outpatient attendances, it accounts for a substantial proportion of all inpatient beds used. Six specialties in which inpatient deaths were uncommon in absolute terms and in relation to the number and age of the patients they treated-ophthalmology, consultant dentistry, ENT surgery, gynaecology, dermatology, and venereology-accounted for 40"' of all outpatient attendances and for 45"(1 of all new outpatients nationally (table). General