Adrian Double Space wrote

> Subject:       What are the merits of waiting lists?
Classsical queueing theory shows that queues (AKA waiting lists) 
develop whenever the load on a service temporarily exceeds the 
capacity of the service.  Classical theory also shows that if the 
load permenently exceeds the capacity, then the queue length will 
grow without limit.
> 
> Looking at an organisation which has 1-2 years work stacked 
> up ahead of it after 50 years it would seem likely that it 
> had been underfunded by 2%-4%
Not necessarily underfunded (puts on Devil's Advocate's Hat).  The 
service may have been adequately funded, but not operated as 
effectively as it should have been.  (For my part, I would guess that 
the underfunding has been more than the 2% - 4% suggested, and that 
the reason the wating lists are not longer is because all sorts of 
folk within the service have worked their arses off to keep the show 
on the road).  However, it is reasonably accurate to conclude that 
the work performed by the service is continually rather less than the 
load placed on it. 

> 
> The use of waiting lists, for surgical procedures at least, 
> is an implicit assumption that although we are busy now, 
> and short of money and other resources now, next year 
> things will be better.
> 
> I know of no pair of years in which this assumption has 
> been born out.
Agreed totally.   Where the service time for an item is small (ie a 
few days once the waiting period is over, incomparison with a total 
running time here of many years) and there is a permanent back log, 
then it is clear that the periods of light loading are not adequate 
to allow the service to clear off the outstanding backlog, and reduce 
the waiting time to zero.  There are two cures
	put less load on the system
	make the system more powerful
I am assuming the first is not really an option;  telling people to 
stop getting ill doesn;t usually effect many cures;  and if/when they 
get ill they are referred on for some form of further service, then 
they can reasonably expect to receive the further service at some 
point in the not too distant future.

> 
> Not only is it not easier cheaper or quicker to do work in 
> the future instead of now, it is in fact harder, costlier 
> and slower to put it off.
That sounds like common sense. It may even be true in terms of 
Evidence Based Medicine?  Can anyone point to a reference?

> 
> So, since we do this, there must be enormous compensating 
> merits to the waiting list for operation, and the 8-52 week 
> wait to be seen in outpatients.
> 
> But, I don't know what they are.  Can anyone suggest one?
The real point here is that the costs of waiting are NOT borne by the 
'service' side, but by the patient side.  (Is it an accident that the 
word patient can be used both as a noun and an adjective).  The costs 
are in terms of discomfort or incapacity, possibly leading to loss of 
earnings, and certainly to anxiety.  But the costs are borne by 
separate individuals, rather than by a single organisation.

Mike Wells


> 
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