The NHS in Wales should move towards a 'transparent and consistent' system of prioritising patients based on clinical need, according to a report endorsed last week by the Welsh Assembly's health committee.

An interim report from the group set up last year to produce a new strategy for managing waiting times in Wales suggests an initial target could be to put prioritisation systems in place for the five specialties with the longest waits by 2002.

In the long term, the strategy development group says all appointments and admissions should be prioritised and booked. It acknowledges that in some specialties this will require additional capacity, staff and information technology systems.

The report was warmly welcomed by the British Medical Association in Wales, which said: 'The BMA has always stressed that what matters to patients is not the numbers on waiting lists but the time the individual has to wait for treatment. 'The report paints a striking picture of a system battling to maintain elective activity against a rising tide of emergency admissions. It says the total number of inpatients treated in Wales has increased from 317,000 in 1970 to 870,000 in 2000.

Emergency activity doubled between 1975 and 1998 and the report says emergency pressures 'now stretch across the whole year, peaking in winter'. The report says services have responded well to increasing demand, pointing out that 75 per cent of outpatient appointments are made within six months and 85 per cent of inpatients are seen within 12 months.

However, it also says that at the end of July this year, 80,111 patients were waiting for inpatient and day-case treatment and 179,652 people were waiting for outpatient appointments.

The report calls for action to:

improve consistency and equity (proposals include prioritising patients, introducing booked admission systems and developing new primary care facilities);

produce additional capacity (proposals include a programme of 'specialty reviews' to find and remove bottlenecks, an expansion of day surgery and the development of ambulatory care units);

encourage innovation (the report highlights work done in Carmarthenshire, where a system has been set up using seven categories to 'score' patients' relative priority for surgery);

improve management and information.

Former BMA chair in Wales John Brym, a member of the strategy development group, warned that patients would have to realise 'there is no immediate solution to the problem of waiting lists'.

Waiting Times in Wales: a strategy for the future.