Over a weekend the urology waiting list was
"reduced" by 340 patients.
On enquiry I was told that patients who required
operations/procedures that did not occupy a hospital bed were
no longer to be counted as on the waiting list. These patients
include those who would be waiting for diagnosis/treatment of
conditions such as bladder cancer and patients waiting for lithotripsy
treatment for their kidney stones. There can be no valid reasons
for excluding these patients from the list of those "waiting
for treatment," apart from cynical manipulation of the figures.
In addition, should additional resources become
available to further reduce waiting listsas sometimes happensthis
group of patients will no longer have access to these funds, because
they are no longer on the list. Thus they will have to endure
relatively longer waits.
There is absolutely no doubt that successive
government initiatives have distorted clinical priorities. Over
the years there has been great pressure to expand day surgery,
not only because it is efficient, but also because with simple
and short procedures large numbers of patients can be rapidly
removed from the waiting list. The result is that patients with
more complex problems have to wait considerably longer for their
treatment as there are less inpatient places on the operating
list, which are more expensive than day cases.
For example: if you have an inconvenient ganglion
on your wrist you will wait for three to six months, but if you
cannot walk properly because of a defective hip, you will have
to wait for one to two years. In my department, if you have an
irritable penis which requires circumcision, the average wait
is four months, but if you are over 65 and cannot get a night's
sleep because you have to get up four or five times, you will
have to wait an average of 14 months for your prostate operation.
It is not difficult to assess which of these deserves more rapid
Turning to the much vaunted two week wait for
patients with possible cancer, though we have to see these patients
within two weeks of referral from their GP, there have been no
additional staff or other funding to facilitate this. As a result
an 80 year old man with possible early prostate cancerlow
clinical priorityis seen very soon but a 40 year old with
a kidney stone causing potential long term kidney damagehigh
clinical prioritynow has to wait even longer to be seen,
because he or she does not have cancer!
In addition, even though we see cancer patients
quickly, it is seldom possible to make a firm diagnosis at the
initial consultation, so further tests are necessary. Because
of the shortage of pathologists and radiologists this part of
the process takes as long or longer than before, so there is no
overall benefit to these patients. Yet the Government can legitimately
claim that all patients with possible cancer are being seen within
two weeks, which makes for good public consumption.
There are several flaws in the new proposals,
particularly relating to the waiting times from referral to treatment.
At first glance these seem sensible, but generally they are thoroughly
impractical. For an easily identifiable condition such as a hernia,
it is simple to measure the time between the GP's initial diagnosis
and the operation. But for something more difficult to assess,
there can be many different circumstances that will affect the
time from referral to treatment, and this will distort the figures.
For difficulty in passing water, I might decide to operate and
will put the patient onto the waiting list; or I may want more
information and arrange tests. Then drugs might be tried, and
only if these fail will I decide to operate. There are innumerable
My latest problem describes just how little
control we have of clinical priorities. The Trust is overspent
and the telescopes which I use to remove kidney stones are broken
and will cost £3,000 to repair. I also have a patient who
has been waiting 17 months for a penile prosthetis which costs
£3,000. My clinical view is that the repair of the telescopes
should have priority, but this has been rejected because if the
penile prosthetis patient waits any longer he will slip over the
18 month wait limit and the hospital will be in trouble with the
Region. Once again clinical judgment is rejected by administrators.
Byron Walmsley FRCS
St Mary's Hospital