Cut queues, but rationing will remain

Diane Coyle, Economics Editor, explains why her pregnancy has convinced her that there is no need for waiting lists

FOR some conditions there is no NHS waiting list at all. Birth is one of them. I'm seven months' pregnant and happy to report that I will get a hospital bed and midwife when I need them in July, and not a year later.

Nor is this the only list-free area of health care. For all the horror stories about patients being ferried from one hospital to another in search of treatment, accident and emergency care is almost always there on demand. So is treatment for acute illnesses.

This just goes to show that there need be no waiting lists at all. They are only one of many possible indicators of excess demand for health care.

But equally, making people queue is sometimes the best way of parcelling out scarce resources. The Government has got itself hung up on a single sound bite indicator that fitted nicely on its pledge card but is not the only or even best way of easing rationing in the NHS.

For the bottom line is that, despite the extra cash wrenched out of the Chancellor for health spending, there is still going to be rationing. In my case, it takes the form of tediously long visits to a dilapidated ante-natal clinic with too few doctors. For the unfortunates waiting in a busy casualty department it might mean lying on a trolley in the corridor, and for others it means waiting six months for an operation.

Frank Dobson's waiting list war is dishonest as long as he does not acknowledge the hard arithmetic that underlies health policy. It is not that it is a completely misguided target. After all, 1.3 million people, 2 per cent of the population, are waiting for hospital treatment. No doubt he will get these numbers down, too, if that is where the new money is directed.

But the Government should acknowledge that other indicators of the quality of NHS treatment matter too: the length of wait for different conditions, for example, or the quality of care received, or the end results such as mortality rates and the general health of the population.

To focus on the size of the lists alone will produce the kinds of skewed results that are typical of bureaucratic planning. Just as the fact that output in the Soviet Union was measured by the weight of goods produced meant radios were manufactured with a brick in the middle, measuring NHS success by cutting waiting lists will push the rationing elsewhere in the system, such as even shorter stays or admitting fewer patients on to hospital waiting lists.

The real policy issue is how much more the Government is willing to cut from other expenditure or raise through taxation to finance a big increase in NHS resources. Growth in demand for health care outpaces incomes: the technology improves in more and more expensive ways, people's expectations rise and the ageing of the population imposes additional burdens.

As a result, real spending on health grew 3 per cent a year on average for 18 years under the Conservatives. It would take a very generous increase in the NHS budget - well over pounds 10bn in cash terms - for the next three years just to match the Tory pace of growth, and even that was not enough to keep voters happy.

Until the Government admits this, and stops pretending that lopping 100,000 off the numbers waiting for treatment is a cure-all for the ills of the NHS, those who can afford it will continue taking out private medical insurance or paying for routine treatments. If we fall for the pretence that getting waiting lists down will mark the end of rationing by numbers, we will just end up with rationing by price instead.