As waiting times hit an all-time low in the NHS, anecdotal evidence suggests a need to revise the view that waiting continues to be a substitute for prices as a rationing mechanism.
Otherwise, what to make of stories of some outpatient clinics facing a rise in patients failing to turn up for appointments as waiting times fall? Is the NHS on the verge of solving what has traditionally been the public's number one complaint about the service? If so, it has taken a lot of time, effort, money, an understanding of the phenomenon of waiting and a realisation that long waits are not an inevitable price to pay for a zero-priced health service.
In 1948 the NHS took on a waiting list of over 476,000 patients but no mention of waiting was made in the Ministry of Health annual reports until 1951, when an increase in the number of patients waiting was reported, up to nearly 504,00 on 31 December 1951. The report for that year saw the problem primarily as a function of limited investment in facilities such as beds.
Subsequent reports began to grapple with the underlying cause of waiting lists. In 1952 it was noted that ear, nose and throat had the longest waiting list of any specialty, despite an increase of 26 per cent in the number of ENT beds since 1949. The 1952 report noted with approval an increase in the use of beds - up by 15 per cent to 11.2 patients per bed.
By 1953 the waiting lists were up again, after falling for three years in a row, leaving officials puzzled: "When it is realised that the number of available beds, the number of patients treated in each bed and the total number of patients treated have all increased between 1952 and 1953, it is not easy to explain the sharp increase."
Greater efficiency in the use of hospital beds was seen as the solution: not just length of stay but the length of time that beds stood empty between patients (nearly three days for surgery). The Ministry of Health in 1953 reported that "if with one in every seven patients admitted, hospitals had saved one day on the turnover interval, the waiting list would, on the face of it, not have increased between 1952 and 1953".
By 1956, a policy of using hospital beds more intensively appears to have paid off, as the annual report announced that the waiting list had fallen to the "lowest number since the beginning of the National Health Service" - a false dawn as the figures for the next few decades show.
It was not until the mid 1950s that data became available on waiting times. In 1956 the inpatient waiting time for ENT was "four and a half months at non-teaching hospitals and provincial hospitals and some three months at London teaching hospitals" - around double the median wait today.
No data on waiting times was collected for outpatients until the 1990s. But reports from the 1950s express concerns about the length of time patients waited on the day. In 1956, hospitals were reminded of the criticisms, which included "late arrival of consultants in charge of clinics and badly organised appointments systems".