title: NHS waiting lists and evidence of national or local failure: analysis of health service data.
abstract: OBJECTIVE
  To investigate the national distribution of prolonged waiting for elective day case and inpatient surgery, and to examine associations of prolonged waiting with markers of NHS capacity, activity in the independent sector, and need.
  
  
  METHODS
  NHS hospital trusts in England.
  
  
  METHODS
  People waiting for elective treatment in the specialties of general surgery; ear, nose and throat surgery; ophthalmic surgery; and trauma and orthopaedic surgery.
  
  
  METHODS
  Numbers of people waiting six months or longer (prolonged waiting). Characteristics of trusts with large numbers waiting six months or longer were examined by using logistic regression.
  
  
  RESULTS
  The distribution of numbers of people waiting for day case or elective surgery in all the specialties examined was highly positively skewed. Between 52% and 83% of patients waiting longer than six months in the specialties studied were found in one quarter of trusts, which in turn contributed 23-45% of the national throughput specific to the specialty. In general, there was little evidence to show that capacity (measured by numbers of operating theatres, dedicated day case theatres, available beds, and bed occupancy rate) or independent sector activity were associated with prolonged waiting, although exceptions were noted for individual specialties. There was consistent evidence showing an increase in prolonged waiting, with increased numbers of anaesthetists across all specialties and with increased bed occupancy rates for ear, nose and throat surgery. Markers of greater need for health care, such as deprivation score and rate of limiting long term illness, were inversely associated with prolonged waiting.
  
  
  CONCLUSIONS
  In most instances, substantial numbers of patients waiting unacceptably long periods for elective surgery were limited to a small number of hospitals. Little and inconsistent support was found for associations of prolonged waiting with markers of capacity, independent sector activity, or need in the surgical specialties examined.
authors.affiliation: Department of Social Medicine, University of Bristol, Bristol BS8 2PR.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Martin
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
authors.forename: Shah
authors.initials: S
authors.lastname: Ebrahim
authors.forename: George
authors.initials: G
authors.lastname: Davey Smith
authors.forename: Stephen
authors.initials: S
authors.lastname: Frankel
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D001847:Bone Diseases / Q000601:surgery; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D004739:England; D005128:Eye Diseases / Q000601:surgery; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity; D006760:Hospitalization / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D010038:Otorhinolaryngologic Diseases / Q000601:surgery; D012044:Regression Analysis; D013222:State Medicine / Q000458:organization & administration / Q000706:statistics & numerical data; D014600:Utilization Review; D014850:Waiting Lists; D014947:Wounds and Injuries / Q000601:surgery