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Health initiatives change the face of the NHS
Waiting lists have changed how hospitals operate
Successive governments' emphasis on reducing waiting lists has changed the way hospitals function, say health experts.

Waiting lists began to be a political hot potato in the late 1980s as a result of growing demands on hospitals and pressure to make "efficiency savings".

The Conservatives introduced the Chartermark which encouraged hospitals to keep within certain limits on waiting lists.

Then came league tables and finally Labour's election pledge to reduce waiting lists to below the levels they had inherited from the Conservatives.

This emphasis, combined with other factors such as growing pressure on budgets, has caused hospitals to gradually adapt the way they work.

Emergency cases

According to Tim Jones of the NHS Confederation, hospitals now plan carefully so that they do the more complex routine operations in the Spring and Summer, leaving them free to concentrate on day cases and the increased emergency cases in Winter.

In this way, they hope to have beds spare to cater for patients while also ensuring no-one waits longer than 18 months for an operation.

"It has been a slow process of change over a number of years," he said.

It is a delicate balancing act which does not always work - often because of other factors such as staff shortages, he added.

"The system demands the beds are full. It is not because there are not enough beds," he said.

He added that hospitals can also arrange their year so that they have the right type of staff available to cater to the particular operations they do at certain types of year.

For example, they can ensure there are extra occupational therapists on duty during the spring and summer when complex operations - usually involving the elderly - are more likely to be performed.

"Waiting list initiatives are part of the process of hospitals becoming more and more efficient," said Mr Jones.


The concentration of money on waiting list initiatives has been blamed in part for the emergency crisis seen this winter.

The British Association for Accident and Emergency Medicine says allocating more and more money to reduce waiting lists and stressing their importance has meant other areas, such as emergency beds, have suffered.

Many hospital trusts and health authorities have accumulated big budget deficits in the last few years.

This in turn leads to more cutbacks and other areas being affected even more.

The NHS Confederation says the fact that NHS trusts have had to spend more on the winter crisis than they may have bargained for could mean more cutbacks in the future - although the government's extra 21bn came online in April 1999.

The new health system demands maximum use of beds
Although hospitals plan for a certain amount of flexibility and the flu outbreak was not totally unexpected, other factors may cause hospitals to feel the squeeze in the coming months.

Nursing shortages and the need to hire agency staff - often at premium rates - will bump up hospitals' budgets.

The way to solve this, argue health managers, is to attract more nurses into the profession by increasing their pay.

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