BBC Health Correpondent James Westhead: Scoring system may make waiting lists fairer

In an overhaul of the current system, patients should be given a score when they are put on surgery waiting lists to reflect the severity of their condition, the association said.

This would indicate how quickly they should receive surgery and could mean that some treatments might "never reach a high enough priority to get funded on the NHS".

The BMA wants the system to be national so that patients know they will be given the same priority for surgery wherever they live in Britain.

The changes are put forward in a discussion paper called Waiting List Prioritisation Scoring Systems.

It looks at systems around the UK and the world, and is designed to provoke debate about the fairest way to ensure that patients who require treatment get it when they need it.

'Focus on need'

Dr Peter Hawker is chairman of the association's central consultants and specialists committee.

Dr Peter Hawker: "Patients would be reassured"

He said: "We must move away from the present focus this government has on total numbers waiting for surgery and look at the clinical priority of those waiting for surgery.

"I know that if patients understood why they were waiting - to let someone with a greater clinical need receive their surgery - then they would not mind the slightly longer wait they themselves may have to face.

"They would be reassured that if their need was greater, perhaps next time, then they would take priority on the list."

The BMA recommendations rely on co-operation between hospital doctors, health authorities and GPs in order to work.

The scoring system would be drawn up by royal colleges, the National Institute of Clinical Excellence and the Department of Health.

Hospital trusts would be responsible for implementing the system at a local level.

Scoring system

The scoring system would be based on several factors. The document examines a system developed at Guy's Hospital in London, where surgeons considered:

• The likelihood of the patient dying in hospital;
• The number of patients who failed to benefit from the operation in question;
• Life expectancy of the patient;
• Quality of life for the patient.

The system would be similar to that in Sweden which has a national maximum guaranteed waiting time of three months of cataract surgery.

Sweden's National Board of Health and Welfare and the Federation of County Councils agreed the new system which ensures that surgery for patients with 20/40 vision or less in their best eye.

They must also be defined as having an increased need for help or inability to work.

If the operation cannot be performed locally within the time frame then the patient is offered a different location for surgery to take place at no extra cost.

Overall reduction

Dr Hawker added: "Our long-term aim must be to reduce the size of the waiting lists so that everyone received their operation within one year."

"Even then we must ensure that patients receive their surgery according to their clinical need."

But it is how that need is defined which could raise ethical dilemmas.

In New Zealand, for example, the paper says prioritising according to clinical need has led to rationing for some people who are more likely to die following an operation and for those who bring "economic costs with inferior long-term quality of life".

Age Concern says it would be "wholly unacceptable" to treat the old differently to the young.

The Patients' Association, although welcoming moves to base treatment on clinical need, is also worried about factors like age being brought to bear.

And it is worried about whether it will be possible for doctors to agree on criteria for treatment.

A Department of Health spokeswoman said: "We all want a waiting list system which is as fair as possible to patients.

"The Waiting List Action Team is already funding 18 pilots around the country looking at scoring systems for patients and priority protocols for referring GPs and hospitals.