Understanding Waiting Lists Pressures

NHS waiting lists currently sit at record lengths due to a combination of the immediate impact of the pandemic and, as well as, long-run pressures requiring investment on NHS resources. These factors have left managers and clinicians with increasingly complex decisions when scheduling elective operations. It is imperative that managers understand the basic dynamics, tradeoffs, and pressures when managing waiting lists. Queueing theory is a key part of operational research, extensively used throughout manufacturing, retail, information technology and other sectors. This article provides an exposition of the theory of queues within the context of the current NHS backlog. With this information a manager will be able understand the demand, queue size, waiting times, capacity requirements and trade-offs for different waiting lists. We describe the metrics and a reporting system developed to understand waiting list pressures in a large NHS trust. Our aim is to enable managers to better understand their waiting lists, to achieve targets and improve health outcomes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present work are contained in the manuscript.