Points for pain: waiting list priority scoring systems

May be the way forward, but we need to learn more about their effects

Doctors have long worried that the British government's emphasis on the number of people on waiting lists, and the time they spend there, obscures the need to treat patients according to clinical urgency. This concern has been voiced most recently in a report from the BMA,1 2 though others have gone further and pointed to the futility of pursuing policies to reduce, or even abolish, waiting lists.3 4 The BMA warns that additional funds earmarked for reducing NHS waiting lists and waiting times will provide an incentive for operating on large numbers of minor cases, leaving more urgent cases and potentially cost effective treatments to wait. The danger with such initiatives is that they provide only temporary relief and do not address the underlying problem of ensuring that waiting lists operate as an efficient and equitable non-price rationing mechanism. The BMA paper argues in favour of priority scoring systems, such as those developed for elective health care in New Zealand, Canada, and Sweden. 5 6 7 The success of such systems seems, however, to be mixed.

In New Zealand an evaluation of the generic surgical priority criteria at Auckland Hospital showed wide variation and poor agreement between the surgeons' clinical judgment in assessing priority and the score patients obtained on the priority score.8 In Sweden a central …