The two tier syndrome behind waiting listsBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7245.1349 (Published 13 May 2000) Cite this as: BMJ 2000;320:1349
- Donald Light, fellow
- Center for Bioethics, University of Pennsylvania Health System, Philadelphia, USA
The Labour government is making a serious effort to shorten the waiting times for specialist assessment and treatment. But if real progress is to be made it must tackle the two tier syndrome.
Past governments have formally sponsored private practice as a second tier by assuring long waits for NHS services and by writing contracts that provide consultants with incentives and ample time to induce patients to pay high fees for the treatments they should receive free.
Waiting lists have been attacked piecemeal and it is a pointless effort. Charges that lists are artificially reduced by pressurising general practitioners not to refer, or removing people from the lists, or by making more serious cases wait longer, are shuffling exercises that leave underlying causes untouched.
This is a blatant conflict of interest, an invitation to mischief
The two tier syndrome has six elements that have reinforced each other so well that the public and doctors think that long waits are as much a fact of life as waiting nine months for a …