Brian Davies: Quality, not quantity

The West Wales General in Camarthen uses a computer to determine which patients should be seen first.

Patients are scored according to the nature of their disease, the pain they are in, their disability, the effect an operation will have on their lives, and the time they have already been waiting.

The highest scores are seen first.

All patients would be assessed and scored under the Camarthen system

Deeply flawed

Current National Health Service (NHS) waiting lists are simply a measure of how long people wait. They have huge political significance, but as a true measure of what is going on in the health service they are deeply flawed.

The lists do not take account of the time people wait from going to see their GP to the time they get an appointment with a consultant who then decides if they should go on a list. This can add several months to the wait recognised in the official figures.

Government waiting list initiatives tend to target money at those who have been waiting longest, but these people are not always the most urgent clinical cases says Dr Laurence Buckman from the BMA.

"You can't compare ingrowing toenails and coronary artery bypass grafts; they're not all the same kind of patient. And patients who are waiting for coronary artery bypass grafting really should be seen as a higher priority."

Quality of the list

The Camarthen experiment, which is being used by the hospital's ENT (ear nose and throat) and orthopaedics departments, avoids this problem.

"What we are trying to do overall is, rather than look at the quantity of the list, that is the length of it, to look at the quality of it," says ENT surgeon Brian Davies.

"It is quite possible to have an 18-month waiting list with trivial cases on it, and a six-month list with very dire, serious cases on it. With our present system, the funding would tend to go to the 18-month list rather than to the six-month list with the serious pathology."

Time cannot be equated with need

The programme has been built on ideas developed in New Zealand and in Salisbury, Kent. Brian Davies says the impact of waiting list initiatives is eventually lost as waiting times climb back up after the extra funding has gone.

But he believes the Camarthen system would still allow ministers and the public to see improvements in the performance of the health service even when the crude figures rose or stayed the same.

"If patients are assessed and each had a score, we could look at the average score change during the period of a year; we may well find that the score has dropped by 25%. So although the list is the same length, we could say the patients served by the list are 25% healthier than they were a year ago."

Best practice

The government has employed a waiting list buster to gather ideas and spread best practice across the country.

Tim Jones: Some people may not need an operation anymore

Many hospitals are now writing to patients to see if they still wish to keep their names on a waiting list. It is a practice known as waiting list validation.

"It is an appropriate tool," says Tim Jones, the policy manager for the NHS Confederation which represents trust hospitals and health authorities.

"What it means is that we are writing to people to ask them if they still want their surgery. They may in the mean time, for example, have been having physiotherapy or other treatments which would mean they no longer require it.