Published: 24/01/2002, Volume II2, No. 5789 Page 93

Why is it so difficult to get waiting lists down and keep them down? We seem to have had successive waiting-list purges for the last 20 years, but they keep creeping up again. What will this mean for the NHS plan ?

Sleeper, Ashridge The real problem with waiting lists is patients.

The way it works is this: first, you get a long waiting list because local managers are useless, then you get rid of them and the waiting lists fall. The local population see that waiting times are less and so they choose to become ill because they know they can get treatment and. . voilà! The lists go up again. I have suggested to Mr Milburn that we should stop telling everyone what the waiting lists are doing; I believe he is quite interested in this idea. As for the NHS plan, everything is ticketty-boo and on track. It might be necessary to adjust a few minor details and ways of counting things from time to time, but you can rest assured that the targets in the NHS plan will all have been achieved by 2004.

Is it me, but I seem to be seeing quite a lot of media comment about the number of NHS managers who leave their post? Is this really happening and what is the cause?

Worried, Coventry Well I am afraid it is happening quite a lot and There is a simple reason for it. The NHS is sending all its work to the private sector. As a result, private hospital managers are sending out loads of begging letters seeking provider contracts. The poor old NHS managers are overwhelmed by this build-up of bumf and their in-trays are groaning under the weight of it. So they just leave it alone and do not deal with any post at all. It is a bit like waiting-list management. Unfortunately, post which is left untouched doesn't go away at the next election, and of course if you ignore your post you're likely to miss Mr Milburn's latest instruction. This would be very bad news indeed and is likely to lead to the managers concerned leaving their post for rather longer than they had intended. One solution would be to delegate everything to the medical director; everyone knows they never leave their post.