Waiting list and waiting time statistics in Britain: a critical review.

OBJECTIVES The measurement of access to health care in the National Health Service is dominated by waiting list and waiting time targets which depend on the collection and publication of a range of government statistics. The aim of this study was to describe the purposes for which waiting statistics are collected, and the different methods of data collection in the countries of Britain, in order to assess the extent to which published data meet their objectives. STUDY DESIGN Systematic review. METHODS A systematic evaluation of waiting statistics in England, Scotland and Wales based on official published data collections in each country, plus a review of the relevant literature. RESULTS Waiting statistics are collected for a number of purposes, but are primarily for performance monitoring against waiting time targets and for local planning. One method of data collection may not best serve all objectives, and there are differences in the practices of the countries of Britain. An important purpose should be to measure access to health care according to individual patient need, and limitations in the statistics were identified in this respect due to methodological issues, omissions and exclusions, hidden waits, the emphasis on achieving targets, and interpretation. CONCLUSIONS Although there are merits in maintaining the existing series, the use of waiting statistics as the primary method of measuring and monitoring access to services has limitations, not least because statistics do not contain the information required to assess whether time waited is appropriate to need.