Correspondence from Mr Antony Fletcher,
Chairman, Ethical Audit, to the Chairman of the Committee
For some time we have been attempting to draw
attention to the mismanagement of surgical waiting lists, and
hoping to persuade the three Royal Colleges to bring them back
under Consultants' control.
I enclose our Audit Report on this, together
with a startling account of one surgeon's recent experience (Annex
"Patients should be selected for admission
from the waiting list by the Consultant or his nominee."
"No patient should be removed from the waiting
list without the permission of the Consultant."
From "Guidelines for the Management of
Surgical Waiting Lists" issued by the Royal College of Surgeons
in June 1991. The College say that there is nothing more on this
topic issued since then.
It is obvious common sense, as well as proper
clinical practice, that medical consultants should have total
control of their waiting lists, and take full responsibility for
the patients listed. Only they can make a fully informed medical
assessment of each patient's condition and needs. Such decisions
should never be taken by someone without medical qualifications.
If through pressure of work the consultant needs to delegate these
decisions, this responsibility must be delegated to a medically
qualified assistant who will now which cases need to be discussed
with the consultant, who ultimately is always responsible.
Inevitably financial and other resources of
the NHS are limited, and decisions regarding medical priority
need to be taken in the light of resources available both now
and later. Here hospital management has the responsibility to
negotiate with consultants as to how the hospital budget should
be apportioned. Then it will be for the consultant to decide on
the priorities appropriate for each patient's condition.
All these self-evident points, laid down 10
years ago in consultation with the Department of Health, have
been slowly eroded. In many instances consultants have lost control
of their lists, which have been manipulated by administrators
without the consultant's approval. The consultants have been obliged
to treat or operate upon patients produced in the order laid down
without their control. They may disagree strongly with the priority
decided by others, but if this is challenged there may be repercussions.
There is plenty of evidence that waiting lists
are being influenced by political considerations so that the Government
can claim that lists have been reduced without revealing that
this is not because patients have been treated but because their
priority has been "adjusted" by the Health Authority,
under pressure from the Department of Health. This is a disgraceful
form of window dressing, which, far from helping patients, can
only act to their disadvantage.
It is proposed that the Royal Colleges of Surgeons,
Physicians and Gynaecologists should be asked to provide an up-to-date
comment on whether they agree with this derogation of medical
responsibility and, if not, what action they will take to return
it to that described in the 1991 Guidelines.