Waiting lists provide an 'inefficient, obscure and unaccountable' method of rationing care and should be scrapped, according to the King's Fund.

In its annual health policy review, King's Fund fellow Anthony Harrison and health policy analyst Bill New also say the government's election pledge to cut waiting lists by 100,000 is 'arbitrary and has no justification in its own right'.

They argue that waiting for access to elective care 'performs an essential rationing function, by deterring some potential users from seeking treatment or professionals from offering it'.

But they warn that lists can be inefficient 'in the sense that they do not necessarily lead to the best possible m ix o f elective care being provided' - particularly if they are combined with maximum waits that take no account of condition - and they can lead to inequalities between people in different areas and with different conditions.

Writing in Health Care UK 1999/2000 , the authors suggest defining thresholds and times for treatment for 'important and common' conditions such as cataracts and joint replacement or supporting local experiments in prioritisation.

They say: 'Currently, primary care groups are charged with adhering to national waiting-list targets. Our proposal would be that these should be rejected in the present form entirely.

'They should be replaced by a mixture of national thresholds for specific conditions and local choice over precisely what waiting -time targets should be met and what level of activity should be funded, for other conditions'.

A more radical approach is already used in New Zealand which employs a system of clinical and financial thresholds which a patient must 'jump' before gaining access to publicly funded care.

But Mr Harrison and Mr New say there are problems with the system, including an incentive for politicians to move the thresholds in line with the economic climate.

King's Fund chief executive Rabbi Julia Neuberger said the NHS would never be able to offer an equal level of service around the country until the government 'grasped the nettle of rationing'.

Health Care UK 1999/2000 . King's Fund bookshop, 0171-307 2591.£14.99.