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The Mystery of Waiting Lists and Waiting Times
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Commentary from Westminster The Mystery of Waiting Lists and Waiting Times THE Government is now making much of the reduction in hospital waiting lists achieved since it took office in May, 1979. But the reduction may not be quite as much of a success story as it appears to be on the surface. Superficially, a major turnround in waiting lists has been brought about. The month before the last General Election total waiting lists in England were 752 000, which the Health Minister, Dr Gerard Vaughan, points out was an all-time peak. In order to underline his criticism of the previous Labour administration, Dr Vaughan says "the length of time it takes to receive an operation on the N.H.S. is a disgrace to a civilised country." By March, 1980, the figure had fallen to 662 000. Now Dr Vaughan is glad to announce a further reduction to 630 000 by March, 1981. "In other words," he adds, "we have reduced the waiting lists by 122 000 in our first two years of Government." The latest figures, are a little higher than expected, "but the important thing is that the underlying trend is still downward." Politically, this is a useful point for the Government to score. Surveys conducted by private health companies
suggest that the most widespread criticism of the N.H.S. by the man in the street is that it takes a long time to have an operation in an N.H.S. hospital. The Health Minister could have developed his claim further. Figures for waiting lists from 1968 onwards suggest that they tend to shrink under Conservative governments. In December, 1969, waiting lists had risen from 505 107 the previous year to 532 037. After six months of Mr Heath’s Government they were down to 525926; a year later down to 493 731; in December, 1972, down to 479 199. In December, 1973, they had crept up to 508 617, where they hovered for a year. Then, coinciding with the change of Government, the size of waiting lists began an apparently inexorable climb each year to the March, 1979, peak so deplored by Dr Vaughan. But many independent researchers point out that waiting lists are in fact not an ideal indicator of how efficiently the N.H.S. is dealing with people who need operations. Mr Hugh Elwell, for instance, who has been examining the impact of waiting lists on behalf of private medical interests, is not particularly impressed with the apparently dramatic reduction. Mr Elwell is also a member of the working party set up by the D.H.S.S. earlier this year to search for alternative ways of financing the N.H.S., and has no political interest in denigrating Conservative achievements. Yet he says: "We actually know very little about waiting lists. We don’t know precisely why they occur, why they affect particular specialties in different areas, and nobody can say with confidence why they come down. We do know that the aggregate figures have a limited significance, since waiting lists vary tremendously from area to area." Recently Mr Elwell looked at two similar area health authorities with similar large waiting lists in similar specialties. One area was plainly very well managed, the other not so well. But when the efficient area, with great effort by all concerned, reduced its waiting lists the respite was brief. Patients from other areas’ waiting lists were soon being transferred onto the lists of the efficient authority. No doubt the net effect was beneficial; but the efficient area thereafter found it hard to keep up the impetus of effort which had reduced the lists in the first place. "Far too many superficial comments are being made about waiting lists," Mr Elwell declares. "But ifyou are
looking for a criterion of whether or not the N.H.S. is treating patients effectively it might well make more sense to look at waiting times." Looking at waiting times is easier said than done. Figures seem to be scarce. The D.H.S.S. only has complete figures for the position in 1978. Those show a mean waiting time of 3 5’33 weeks for operations on varicose veins; 33-44 weeks for joint replacement; and 18 weeks for inguinal hernia operations. These are the areas in which private medicine has, not surprisingly, found a licence to print money. But waiting times for more urgent operations can, according to the figures, average 20 weeks or more in some specialties. The Department also has more fragmentary statistics which, on the face of it, do show a decline in waiting times. In March, 1979, there were 34 907 people who waited more than a month for urgent operations; at the same time there were 185 195 people who had waited more than a year for nonurgent operations. In September, 1979, the first category had fallen
to 34 268, while the second category had risen to 197 842. In March, 1980, 31 397 people had waited more than a month for urgent operations, and 196 983 more than a year for non-urgent. In September, 1980, the first category was down to 28 062, while the second category was scarcely down at 187 993. If the figures do show a trend, which is hard to be sure of without a more comprehensive study, then it is that waiting times are falling for urgent cases but not for non-
Individual health authorities may have more on their own areas, but they do not seem to statistics complete be collated at the D.H.S.S. with much consistency. The B.M.A. can shed little light on the situation. "There do not seem to be very many statistics," a spokesman reported. It does seem, however, that in 1977-78 waiting times were rising for both urgent and non-urgent cases but, the B.M.A. points out, waiting lists were also rising then. Perhaps waiting times have declined since then, along with waiting lists. Nobody knows. urgent
cases.
Britain’s Medical Exports Dr Vaughan is now well on the way to realising one of his favourite schemes: a specially equipped hospital which can play a major part in boosting exports of British medical equipment and the sale of British medical expertise. By next Spring plans will be near fruition for the conversion of a hospital building to this purpose and the setting up of an independent "foundation". The foundation would offer scholarships to foreign doctors to do postgraduate training in the hospital, where it is hoped they would be impressed by the equipment used and take their enthusiasm back to their home countries. The foundation would also act like a Government agency, selling advisory services to foreign Governments and agencies on how to set up their own health-care systems. The move is hoped to put new life into sales of medical equipment which Ministers feel are not fulfilling their potential in the Middle East against European competition. No N.H.S. cash will be siphoned into the project. No final decision has been taken on how finance will be arranged, but there are hopes that equipment manufacturers and private health interests will play a major part in the financing. Nor has any definite site been selected for the hospital, although the Westminster Hospital has been mentioned as an obvious candidate. The hospital would be fully operational, treating the normal mix of N.H.S. and private patients. No cost has yet been estimated for the plan. RODNEY DEITCH
Commentary from Westminster The Mystery of Waiting Lists and Waiting Times THE Government is now making much of the reduction in hospital waiting lists achieved since it took office in May, 1979. But the reduction may not be quite as much of a success story as it appears to be on the surface. Superficially, a major turnround in waiting lists has been brought about. The month before the last General Election total waiting lists in England were 752 000, which the Health Minister, Dr Gerard Vaughan, points out was an all-time peak. In order to underline his criticism of the previous Labour administration, Dr Vaughan says "the length of time it takes to receive an operation on the N.H.S. is a disgrace to a civilised country." By March, 1980, the figure had fallen to 662 000. Now Dr Vaughan is glad to announce a further reduction to 630 000 by March, 1981. "In other words," he adds, "we have reduced the waiting lists by 122 000 in our first two years of Government." The latest figures, are a little higher than expected, "but the important thing is that the underlying trend is still downward." Politically, this is a useful point for the Government to score. Surveys conducted by private health companies
suggest that the most widespread criticism of the N.H.S. by the man in the street is that it takes a long time to have an operation in an N.H.S. hospital. The Health Minister could have developed his claim further. Figures for waiting lists from 1968 onwards suggest that they tend to shrink under Conservative governments. In December, 1969, waiting lists had risen from 505 107 the previous year to 532 037. After six months of Mr Heath’s Government they were down to 525926; a year later down to 493 731; in December, 1972, down to 479 199. In December, 1973, they had crept up to 508 617, where they hovered for a year. Then, coinciding with the change of Government, the size of waiting lists began an apparently inexorable climb each year to the March, 1979, peak so deplored by Dr Vaughan. But many independent researchers point out that waiting lists are in fact not an ideal indicator of how efficiently the N.H.S. is dealing with people who need operations. Mr Hugh Elwell, for instance, who has been examining the impact of waiting lists on behalf of private medical interests, is not particularly impressed with the apparently dramatic reduction. Mr Elwell is also a member of the working party set up by the D.H.S.S. earlier this year to search for alternative ways of financing the N.H.S., and has no political interest in denigrating Conservative achievements. Yet he says: "We actually know very little about waiting lists. We don’t know precisely why they occur, why they affect particular specialties in different areas, and nobody can say with confidence why they come down. We do know that the aggregate figures have a limited significance, since waiting lists vary tremendously from area to area." Recently Mr Elwell looked at two similar area health authorities with similar large waiting lists in similar specialties. One area was plainly very well managed, the other not so well. But when the efficient area, with great effort by all concerned, reduced its waiting lists the respite was brief. Patients from other areas’ waiting lists were soon being transferred onto the lists of the efficient authority. No doubt the net effect was beneficial; but the efficient area thereafter found it hard to keep up the impetus of effort which had reduced the lists in the first place. "Far too many superficial comments are being made about waiting lists," Mr Elwell declares. "But ifyou are
looking for a criterion of whether or not the N.H.S. is treating patients effectively it might well make more sense to look at waiting times." Looking at waiting times is easier said than done. Figures seem to be scarce. The D.H.S.S. only has complete figures for the position in 1978. Those show a mean waiting time of 3 5’33 weeks for operations on varicose veins; 33-44 weeks for joint replacement; and 18 weeks for inguinal hernia operations. These are the areas in which private medicine has, not surprisingly, found a licence to print money. But waiting times for more urgent operations can, according to the figures, average 20 weeks or more in some specialties. The Department also has more fragmentary statistics which, on the face of it, do show a decline in waiting times. In March, 1979, there were 34 907 people who waited more than a month for urgent operations; at the same time there were 185 195 people who had waited more than a year for nonurgent operations. In September, 1979, the first category had fallen
to 34 268, while the second category had risen to 197 842. In March, 1980, 31 397 people had waited more than a month for urgent operations, and 196 983 more than a year for non-urgent. In September, 1980, the first category was down to 28 062, while the second category was scarcely down at 187 993. If the figures do show a trend, which is hard to be sure of without a more comprehensive study, then it is that waiting times are falling for urgent cases but not for non-
Individual health authorities may have more on their own areas, but they do not seem to statistics complete be collated at the D.H.S.S. with much consistency. The B.M.A. can shed little light on the situation. "There do not seem to be very many statistics," a spokesman reported. It does seem, however, that in 1977-78 waiting times were rising for both urgent and non-urgent cases but, the B.M.A. points out, waiting lists were also rising then. Perhaps waiting times have declined since then, along with waiting lists. Nobody knows. urgent
cases.
Britain’s Medical Exports Dr Vaughan is now well on the way to realising one of his favourite schemes: a specially equipped hospital which can play a major part in boosting exports of British medical equipment and the sale of British medical expertise. By next Spring plans will be near fruition for the conversion of a hospital building to this purpose and the setting up of an independent "foundation". The foundation would offer scholarships to foreign doctors to do postgraduate training in the hospital, where it is hoped they would be impressed by the equipment used and take their enthusiasm back to their home countries. The foundation would also act like a Government agency, selling advisory services to foreign Governments and agencies on how to set up their own health-care systems. The move is hoped to put new life into sales of medical equipment which Ministers feel are not fulfilling their potential in the Middle East against European competition. No N.H.S. cash will be siphoned into the project. No final decision has been taken on how finance will be arranged, but there are hopes that equipment manufacturers and private health interests will play a major part in the financing. Nor has any definite site been selected for the hospital, although the Westminster Hospital has been mentioned as an obvious candidate. The hospital would be fully operational, treating the normal mix of N.H.S. and private patients. No cost has yet been estimated for the plan. RODNEY DEITCH