Wednesday, February 11, 2009

Waiting lists

When it comes to health service politics and management one of the biggest issues is the length of time patients have to wait for treatment, and I understand why this is the case. The problem is that the issue is far more complex than managers and particularly politicians seem to understand.

For a long time in the UK waiting lists for appointments and surgery were far too long. It was a running joke in the NHS that you waited a year for an appointment, followed by 18 months for a scan and then a year or so for your operation. By spending huge amounts of money, which a number of my UK colleagues have spent on Lamborghinis and the like, the Labour government has brought waiting times for treatment down significantly. At least that's what we're told.

Short waiting times aren't necessarily a good thing. They can lead to overtreatment. A number of conditions will resolve or improve spontaneously with time. If I saw and operated on everyone with a slipped disc on day 1 I'd be doing 90% of the operations unnecessarily. They also lead to inefficiency. If patients know they don't have to wait long for treatment there is a tendency to cancel appointments at short notice for seemingly frivolous reasons. Thirdly, a short wait for a specialist appointment means the GP's threshold for referral decreases giving a reduced conversion rate in clinic and a loss of balance between inpatient and outpatient work.

There has to be a happy medium. The UK's 18 week limit from referral to operation is in my opinion too short and inflexible. If I made the rules they would be to aim to see patients about 3 months from referral, and to aim to operate on them within 3 months from the decision to do so.

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