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Select Committee on Public Accounts Minutes of Evidence


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 A).


    "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.

Antony Fletcher
Ethical Audit

November 2001

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