'We have discovered that waiting lists to see hospital consultants are subject to the power laws of complexity. . . ' So begins a report in Nature (410: 652). For the odd reader who may, inexplicably, be unfamiliar with power laws in mathematics, they are used to describe the behaviour of systems that are semi-chaotic. The report's authors, Drs Smethurst and Williams of Nottingham's University Hospital, offer a few examples: sandpile avalanches, forest fires and disease epidemics.
A bit of academic esotericism without much bearing on waiting lists in the real world? Think again. The second half of Smethurst and Williams' opening sentence continues: '. . . and so are likely to be an essential symptom of an efficient healthcare service'.
Elsewhere in the piece they repeat it: 'A paradoxical feature of waiting lists that conform to a power law is that they represent the most efficient configuration for that organisation. '
So do NHS waiting lists 'conform to a power law'?
The lists studied by the Nottingham chaps - those of four dermatologists recorded over a period of six years - apparently do. Rejoice! Efficiency has been achieved.
Space prevents me delving more deeply into the intricacies of power laws and exactly why NHS lists seem to obey them. So let's stick to the two main conclusions: lists self-regulate to buffer against differing levels of demand, thereby creating bottomless pits that absorb all resources made available; and instead of judging a health system by the length of its lists we should be measuring the overall quality of care provided. Curiously, I suspect that even managers who can't lay claim to a GCSE in maths would say much the same.