Two-tier waiting lists to go

An end to two-tier waiting lists for hospital care was announced by the Government yesterday. But the move drew immediate charges from the opposition that it would lead to a levelling down of services to patients.

Frank Dobson, the Secretary of State for Health, said that NHS trusts would be required to operate common waiting lists for non-urgent patients from next April, regardless of whether they were referred by fundholding or non-fundholding GPs. In addition, health authorities will be required to set maximum waiting times common to all their residents.

Official figures show that in 60 per cent of health authorities in England, patients of fundholding GPs get faster hospital treatment than those of non-fundholding GPs. A health department spokesman confirmed that yesterday's announcement would mean waiting lists for patients of most fundholders would rise.

Mr Dobson said: "Today is the beginning of the end of the two-tier NHS. This is good news for patients. It is also good news for doctors and other NHS staff, many of whom have found the unfair two-tier system repugnant to administer".

Faster hospital treatment has been touted as one of the main advantages to patients of joining a GP practice that holds its own budget for hospital care. Almost 60 per cent of patients are now covered by GP fundholders who have been able to negotiate "fast track" deals with NHS trusts anxious for their business. But in some cases, GP fundholders who have overspent their budgets have instructed trusts to delay hospital treatment to the maximum allowed under the Patient's Charter - 12 or 18 months. In this minority of cases, fundholding patients can expect a better service.

Dr Rhidian Morris, chairman of the National Association of Fundholding Practices, said that, far from achieving equity in the NHS, the measure would simply push inequity up from the level of the local practice to the level of the trust or health authority. "We will still have a multi- level waiting list. If you live on the border of a health authority, a person two streets away could have a totally different waiting list," he said.

He said the move could also add to the financial pressure on hospitals as a doubled waiting list would halve the income from a fundholder. "I don't think any fundholder is going to be happy about increasing their waiting lists. There is a possibility of chaos and discord."

Other bodies welcomed the move. The NHS Confederation said the principle of fair and equitable treatment for all patients was "clearly the right one" but the British Medical Association warned that equity for all "must not mean equity at a lower level".

John Maples, the Tory health spokesman, said the move amounted to "a levelling down of services to patients who need access to hospital care ... it is a clear admission that Frank Dobson cannot deliver the improved health service which only a few weeks ago he was billing as a racing certainty".