Editorials

Queues for cure?

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6983.818 (Published 01 April 1995) Cite this as: BMJ 1995;310:818
  1. Harry Hemingway,
  2. Bobbie Jacobson
  1. Honorary senior registrar Director of public health Department of Public Health, East London and the City Health Authority, London E3 2AN

    Let's add appropriateness to the equation

    If waiting were a disease it would be one of the commonest and least studied diseases in England. There were 628800 people on an inpatient waiting list and 442300 people on a day case waiting list in England on 30 September 1994.1 Of these, 7% and 4% respectively had waited more than one year. The first assumption made by politicians—irrespective of political colour2—and therefore inherited by managers is that being on a waiting list is a measure of need. One study even defined need in such terms.3 The second assumption concerns a dose-response relation: the longer the wait the greater the need. Consequently, initiatives to reduce waiting lists tend to act as if it is the long wait itself that warrants treatment.

    The patient's charter enshrines the right to admission for treatment within two years of being put on a waiting list. It does not distinguish between the different procedures for which people wait, although since 1986 separate targets have existed for hip and knee replacement and cataract operations. The NHS Executive acknowledged that patients for whom “delay in investigation or treatment …

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