Could NHS have been doing more operations?
The number of patients waiting longer than 18 weeks for routine operations such as hip and knee replacements is rising year on year in England.
The total waiting list of more than 4.1 million is up more than 10% over 12 months.
But now a leading health regulator says hospitals could treat more patients if they planned use of operating theatres more effectively.
A report by NHS Improvement say at least 291,000 more non-urgent operations and procedures could be carried out each year at 92 hospital trusts in England.
This is based on a study of 1.72 million surgical cases at those trusts in 2017.
The regulator says hospital facilities could be used more efficiently and intensively.
The report found that a third of operating lists - the schedule for each theatre for the day - started 30 minutes or more late and nearly 40% finished half an hour or more early.
The time lost to late starts, early finishes and delays between operations could, according to NHS Improvement, have been used to carry out the extra 291,000 operations.
The report says delays in patients arriving in theatre from wards or admission units and incomplete pre-surgical checks waste time.
And it urges hospital managers working with senior medical staff to analyse how facilities can be used more effectively.
One example given is better planning of the availability of senior doctors and surgeons.
Surgical staff, says the report, should be required to give more notice when booking annual leave and to agree lists of patients for operations four weeks in advance.
Sounds familiar? Well, yes it is. That's because BBC News was shown a similar analysis by NHS Improvement back in the autumn of 2017 and reported it.
This concluded that an extra 280,000 non-urgent operations and procedures could be carried out each year if delays in operating theatres were to be minimised.
I was told at the time that the full report would be out imminently. But it has only now finally appeared, in February 2019.
So what happened? Why was there a delay of more than a year for a report on delays in operating theatres?
There have clearly been differences of opinion over what could be achieved through higher productivity.
It is understood the Royal College of Surgeons did not receive the full analysis with all the number crunching until the summer of 2018.
Health service leaders and ministers were focused on the NHS 70th birthday celebrations and perhaps decided that improving hospital efficiency was not an appropriate message at that time.
The Royal College of Surgeons has given a guarded welcome to the NHS Improvement report, noting that there is an opportunity to improve the scheduling of operating lists.
But a college official added there were wider issues that should be tackled, including inadequate numbers of hospital beds to accommodate patients needing an overnight stay after their operations.
The problem, says the college, "is compounded by workforce shortages".
Andrew Haldenby, director of the public services think tank Reform, said: "What is striking is that neither the NHS authorities nor hospitals themselves are doing very much to improve the situation.
"It is possible that the way the government runs the NHS, hospitals are still not under enough pressure to strive for value for money every day."
So what happens next? NHS Improvement says all hospitals will be encouraged to adopt best practice already in evidence in some trusts.
But as yet there is no detailed plan for implementation of the report.
Patients might wonder why if the analysis was carried out in 2017 and proposed straightforward solutions there was not more effort on this front in 2018.
Perhaps hundreds of thousands more operations could have been carried out by now, relieving patients of the pain and inconvenience associated with long waits.
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