Annex A > Chapter 12 - Waiting Lists > Effect of the waiting list on patients
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Effect of the waiting list on patients
53 Evidence on the possible effect on patients of the timing of surgery and delays in surgery generally is set out in Chapter 13 - Pre-operative Care.
54 As to any effect caused by there being a waiting list, Mr Wisheart said that, whereas some adult patients may have died while on a waiting list for cardiac surgery, he did not think that many paediatric patients, `if any', died while on the waiting list. [62]
55 However, he said it must be accepted that some paediatric patients were detrimentally affected by being placed on a waiting list. He said that it:
`... is really quite variable as to the effect of [being on a waiting list] would have on the child. The ones, of course, who wait are those who are in the elective group, and most of those who would wait longer are those for whom the timing is less critical, but I would be unable to say that that was the case entirely. In other words, I cannot say to you that there were not some children who would have suffered, for want of a better term, from the extra delay.' [63]
56 Mr Wisheart said that as at 1991 there was very limited knowledge available about the effect of keeping a given patient or patients in general on a waiting list in terms of morbidity or mortality:
`I imagine there was some published information by that time, but I think there was quite a lot more in the years that followed this, in the early 1990s.' [64]
57 Mr Wisheart said it was possible to say that:
`If we set aside those children who need urgent or emergency treatment and consider those who are not in immediate need of surgical treatment, the congenital abnormality which they suffer from will have an effect that secondary changes will develop in the heart and in the lungs, and possibly in other organs, but in most children, in all of them in the heart, in many in the lungs also, and in some, elsewhere.
`So that, if a child early in life has an abnormality of the heart but is relatively free of secondary effects, whereas N years later they may still be alive but in addition to the abnormality of the heart, they will have these secondary effects.
`The importance of this is that whereas in the 1970s, say, and also in the early 1980s, people, surgeons and cardiologists, preferred to delay operations because they felt children would be operated on more safely when they were a little bit older, people came to realise and accept that, indeed, they should be operated on sooner in order to prevent the development of these secondary effects which, in essence, were complications - additional complications.
`That, then, is the thinking underlying the trend towards earlier operating. ...
`So the effect of a child waiting, again, whether they are on a waiting list or not, is best understood within, I think, that set of ideas.
`So, for some children, an extra wait will be of very little significance; for others it will be of some; for some it may be quite important, but whether or not they are on the waiting list is not the crucial factor; the crucial factor is that time is passing.' [65]
`I think it was more obvious when you had a condition like VSD or AV canal, or similarly transposition, where the pulmonary or lungs are already subject to higher pressure. If you leave it longer, it could deteriorate. And of course, you know, I cannot prove it, but I had a feeling that the longer you leave it, post-operative recovery would be further prolonged.' [66]
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Footnotes
[66] T84 p.91 Mr Dhasmana. See Chapter 3 for an explanation of these terms