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Waiting lists have been a cause of concern since the inception of the NHS. Many theories have been put forward to explain their existence and there have been many proposals to reduce their length. With the current changes in the NHS and the introduction of the Patient′s Charter has come a renewed emphasis on reducing waiting lists and waiting times. However, analysis of incentives within the new system suggests that waiting lists may be reduced by limiting access rather than by increasing treatment rate. Further, not only GP Fundholding, but also the contractual relationships between District Health Authorities and hospitals may lead to two‐tier systems, with admission priorities based on source of funding rather than clinical urgency. Overall, it is concluded that the NHS Review may result in fewer people obtaining treatment, but with shorter waits for those who do receive treatment.

To develop propositions on why public policies towards decreasing waiting list in health care can be expected to be unsuccessful.

On the basis of a case study of public policies directed towards the reduction of the waiting lists in health care a number of propositions are formulated explaining why this policy has turned out to be ineffective. The propositions are based on theoretical insights form the field of organizations studies about the behavior of organizations and professionals.

It is demonstrated that public policies on reducing waiting lists in the Dutch health care system are likely to be ineffective because the policy‐making strategies used are based on unrealistic assumptions about the behavior of organizations and professionals who are expected to reduce the waiting lists.

Although the propositions are based on established organization literature, empirically they are only based on one case study.

In order to develop effective policy interventions it is important to be realistic about the behavior and strategies of the actors towards which the policy is directed. Moreover, rather than directing exclusive attention to those waiting, it is important for policy makers to address the interdependencies of the organizational field in which waiting lists occur.

This paper gives directions to policy makers who need to deal with complex and interdependent problems.

Hospital waiting lists are a feature of publicly funded health services that result when demand appears to exceed supply. While much has been written about surgical waiting lists, little is known about the dynamics of radiology waiting lists, which is surprising given that rational treatment, and indeed the medical profession's claim to expertise, rests on establishing a diagnosis. This paper reports the findings of a case study of a problematic ultrasound waiting list. In particular, this paper highlights how the management of the ultrasound waiting list served to subordinate the needs of waiting patients and their general practitioners to the interests and values of radiologists. Radiologist concern to protect specialist expertise from encroachment by outpatient clinicians and sonographers is implicated in the growth of the ultrasound waiting list. It is argued that an adequate understanding of ultrasound waiting lists depends on grasping how radiologists are successful in structuring problems of access in ways that enhance radiologist control over ultrasound imaging. The case study reported helps to shed light on why increasing funding to clear waiting lists proves ineffective.

The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them.

IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned.

There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning.

This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research.

To the best of the authors’ knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally.

A study comprising both questionnaire and interview of patients waiting for general surgery revealed that the majority of patients suffer from relatively few clinical conditions, that more than three‐quarters had been on the in‐patient list for over a year and that they suffered significant pain while waiting. Patients added to long lists with initially non‐serious (non‐life‐threatening) conditions may be overlooked, yet their clinical and associated social conditions may deteriorate. Since treatment for these conditions is generally effective, many patients would benefit from more organised queue management and earlier surgery.

The purpose of this research is to focus on a hospital Division of Diagnostics and Clinical Support (150 medical, 1,975 non‐medical staff) and how systems were enhanced through lean principles application to facilitate quality and performance improvement.

An action research methodology was adopted. The research involved: review of available performance and quality improvement literature; identification of the systems that required improvement; adoption and implementation of new working methods.

The results were recognised as being beneficial to all parties, especially the patients! Staff recognised the need for change; the process transformation was actually welcomed. Patient waiting times reduced from 26 to 13 weeks. Fast‐track/“query cancer” service for out‐patients now within ten days; the majority of in‐patients receive imaging within 72 hours. Ultimately, patients are diagnosed faster and treatment commences earlier. Departmental managers can effectively manage capacity to meet demand because they now understand the waiting “profile”.

The methodology applied was appropriate, generating data to facilitate discussion and from which to draw conclusions. A perceived limitation is the single case approach; however, Remenyi et al. argue that this can be enough to add to the body of knowledge.

Guidelines indicating “What went well?” and “What could have gone better?” were produced. These centred on the practical application aspects. The implementation methodology developed is being used elsewhere within the same hospital group.

The paper demonstrates that the application of improvement techniques, such as “Lean”, can focus efforts to improve performance. This is of value to those working in the UK healthcare and wider public sector.

The allocation of resources is a complex problem in health care. In Finland there has been an effort to solve the problems with a program called “Securing the Future of Health Care”. The main focus of this research is on assessing how managers view the health care policy called guarantee of care from an ethical perspective.

The theoretical basis of the research covers theories regarding rationing, prioritization, as well as the ethics of health care. The empirical data were gathered through an internet questionnaire. The questionnaires were sent to the top managers in all Finnish health care districts (20 in all). The data were analyzed qualitatively.

According to respondents, ensuring access to treatment partially fulfilled the ethical principles of the right to good care, respect for human dignity, fairness, and co‐operation and mutual respect quite well. On the other hand, trust, impressiveness, non‐partiality in decision making and the right of self‐determination were not as well realized. The shortening of waiting lists had caused exhaustion and motivation problems among personnel and in addition, staff shortages were being experienced.

The administrators of the hospital districts agreed that centralizing resources as a reconstructive action is ethically wrong for the whole health care system. There is a great need for an ethical discussion concerning the choices made in health care policy. Long‐term results need sustainable solutions.

This paper sets out to investigate whether demand for gynaecological theatre time could be described in terms of the time required to undertake elective operations booked for surgery, and so help match the capacity to this.

A questionnaire assessed the estimates for total operation time for seven common operations, sent to surgeons, anaesthetists and nursing staff in one tertiary referral and one district general hospital (total 49 staff; response rate 58 per cent), and estimates were obtained from theatre computer logs. Average timings for each operation were then applied to cases added from clinics to the waiting list at the district general, to yield the mean demand for elective surgery, and were also applied to emergencies to estimate emergency workload. Finally these demand estimates were compared with the theatre capacity available.

The paper found no difference between the estimates of the three staff groups or between these and the theatre logs (p=0.669), nor did it find that estimates differed between the two centers (p=0.628). Including emergencies, the mean (95 per cent confidence intervals) demand at the district general was 2,438 (1,952‐2,924) min/week.

Although the paper modelled the variation in demand using the relevant variation in operation times, any additional variation caused by differences in booking rates from clinics over time was not nodelled. The minimum period over which data should be collected was not established.

The paper finds that the existing capacity of 1,680 min/week did not match these needs and, unless it was increased, a rise in waiting lists was predictable.

The paper concludes that time estimates for scheduled operations can be better used to assess the need for surgical operating capacity than current measures of demand or capacity.

This paper aims to show the results from a pioneering primary care‐based extended scope physiotherapist (ESP) led service, which placed patients directly onto the surgical waiting list of secondary care orthopaedic consultants over a two‐year period.

A retrospective data review was performed on all referrals from community‐based ESPs for direct listing at the secondary care hospital between 2 January 2008 and 31 December 2009.

A total of 130 referrals for direct listing were made by the ESP team during the two‐year period. Of these, 127 (98 per cent) went on to undergo a THR. Three patients (2 per cent) did not ultimately have a THR.

This process has continued over the two years of the direct listing service, with ongoing evaluation and refinement of the pathway, so referral criteria and clinical/administrative pathways have been changed in the light of experience.

Patients who were directly listed did not require a hospital orthopaedic outpatient appointment until attendance at preoperative assessment clinic shortly before their surgery. In addition to the reduction in inconvenience and travelling costs incurred by patients, there was an approximate saving of £145 to the primary care trust per directly listed patient.

The authors believe that this service evaluation is the first publication to show that direct listing by primary care based ESPs is a safe and effective process for some patients requiring primary THR.