What’s happening to waiting times?BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1235 (Published 01 March 2011) Cite this as: BMJ 2011;342:d1235
All rapid responses
In John Appleby's otherwise perceptive analysis of NHS waiting times
he repeats the old myth that waiting times are a substitute for rationing
or prices. They are, many would argue, the natural consequence of
The truth is they are not a symptom of a shortage of capacity. Only
perpetually lengthening lists would signify a real shortage and even under
the Thatcher era they did not expand without limit. Nor are they a useful
mechanism to limit demand, as many NHS veterans (including some of the
Department of Health's own economists) asserted when the Labour government
decided to try and reduce them.
Those of us who have worked with the NHS on waiting list problems
have often found that they are as much a problem of badly managed
processes. Poor scheduling of capacity like operating theatres creates the
illusion of capacity shortage by wasting actual capacity. Then poor
organisation of waiting lists confuses providers about the real level of
demand and makes patients wait far longer then they need to for treatment.
In some lists the same patient appeared multiple times or patients were on
a list not because they had sought treatment but because they might at
some future point want treatment and would be able to get it faster if
they were already on the list.
The factor that best explains waiting lists was an NHS that didn't
put the patient first and organised itself for the convenience of the
providers not the patient. Let's hope we don't slide back to that.
Competing interests: No competing interests