Waiting lists

Why would we want to reduce waiting lists? Surely not. They serve so many in the NHS so well. Doctors like them because patients faced with a long wait will, if they can, go private.

Managers like them because they are a lever to get more money. A long list shows you are under undue pressure (never that you are a poor manager). This gives you power to fight other directorates.

Chief executives like them because they provide a means to put pressure on the health authority. Acute trusts like waiting lists a lot because few community trusts have Patient's Charter monitoring of waiting, so they can be easily out-argued in the competition for funding.

Even HAs can find them useful in arguing for more funds for their area. With a bit of luck there will be another waiting list initiative along to sort out the deficit if you have long enough lists.

So why change? It is, after all, only the patient who suffers, who waits in a haze of worry for weeks for their few minutes with the consultant. It is only the patient who waits, maybe in pain, for what others consider a non-urgent operation. We say there is nothing we can do: waiting lists have been part of the NHS since it began.

Has no one in the NHS noticed that we used to wait for interminable weeks for a new car, a carpet and other goods? Something has changed in industry. Now we have more choices, delivered more quickly and at lower prices than ever before. Industry has been learning from a man named Eli Goldratt. But keep us from using his ideas, please. They might work - and where would we be without our waiting lists?

Trust chief executive

(Name and address supplied)