Waiting list dynamics and the impact of earmarked funding

Abstract Objective: To determine how changes in the number of admissions from waiting lists and changes in the number of additions to the lists are related to list size and waiting times, in the context of local waiting list initiatives. Design: Review of national and Korner statistics. Setting: England (1987-94) and districts of the former Oxford region (1987-91). Main outcome measures: Correlation of quarterly changes in the number of admissions from waiting lists in England with changes in total list size, numbers of patients waiting one to two, or over two years, and number of additions to the lists; examination of changes in waiting list statistics for individual district specialties in one region in relation to funding for waiting list initiatives. Results: Nationally, changes in the number of admissions to hospital from lists closely correlated with changes in the number of additions to lists (r=0.84; P<0.01). After adjusting for changes in the number of additions to lists, changes in the number of admissions correlated inversely with changes in list size (r=-0.62; P<0.001). Decreases in the number of patients waiting from one to two years were significantly associated with increases in the number of admissions (r=-0.52; P<0.01); locally, only six of 44 waiting list initiatives were followed by an increase in admissions and a fall in list size, although a further 11 were followed by a fall in list size without a corresponding increase in admissions. Conclusions: An increase in admissions improved waiting times but did not reduce list size because additions to the list tended to increase at the same time. The appropriateness of waiting list initiatives as a method of funding elective surgery should be reviewed.