Surgeons have little control over general surgical waiting lists

This study describes changes in the general surgical waiting list over a 13-year period. We have also attempted to define the factors affecting the size of the waiting list.

The number of patients on the waiting list was obtained from Hospital Activity Analysis data. Available surgical beds and theatre sessions were recorded prospectively over 13 years.

As the number of beds and theatre sessions decreased, the general surgical waiting list increased. The total number of patients waiting rose from 301 in 1985 to 1,253 by 1990. The number of patients waiting for more than one year rose from 37 to 251. During that time the total number of available beds fell from 143 to 99 and theatre sessions from 21 to 17.5. Despite theatre sessions subsequently increasing to 21.5, the waiting list continued to rise, as these sessions were not matched with an increase in available beds. The introduction of a waiting list initiative that made extra resources available resulted in a fall in the number of patients waiting to 702 by 1993. Only 45 of those patients had been waiting for more than a year. When the waiting list initiative ended, there was a further steady rise in the waiting list, reaching 1,242 by the end of 1997. At this point, further waiting list initiative facilities were made available. We also noticed that during winter months there was a disproportionate number of patients added to the waiting list when surgical beds were 'blocked' by medical patients.

This study shows that external factors, particularly available resources, influence the number of patients on a surgical waiting list. The main factors are lack of beds and theatre sessions. Furthermore, an imbalance between them will result in insufficient beds being available to fill those theatre sessions that do exist. Surgeons have little control over their routine waiting lists.