Waiting time for cardiac surgery in Scotland is relatively short

Editor—According to the results of Pell et al's study,¹ the main reason why patients from lower socioeconomic groups are disadvantaged is because their cases are characterised as urgent less frequently than are those of affluent patients. Theoretically this effect is maximised the longer the waiting time; when waiting time is relatively short the effect is attenuated.

The authors, who work in Scotland, give a mean overall waiting time of 143.7-158.2 days (depending on the age group); this is relatively short compared with waiting times for heart surgery in England, which commonly exceed 12 and sometimes 18 months. For this reason one would expect a much greater differential in the waiting time between socioeconomic groups in England than the one evidenced in Scotland. Hence the true level of inequalities in waiting times for heart surgery in the United Kingdom is likely to exceed the one calculated in this study.

Prolonged waiting for lifesaving surgery, not surprisingly, is associated with risks. According to one recent study, a median waiting time of about 146 days for coronary artery bypass grafting was associated with general mortality of 2.6% a year, or 0.28% per month of waiting.²

Hart's criticism of therapeutic nihilism in his commentary on Pell et al's paper is entirely appropriate. Unfortunately, according to the present dogma health care is not a matter of health, merely a matter of political demagogy and media sensationalism. Whoever believes that this is the case should pay attention to this article.