- Since the Labour government came to power in 1997, waiting lists have attracted unprecedented attention. For a time, the number of patients recorded as waiting for hospital treatment fell, but at the same time, numbers waiting more than 13 weeks for an outpatient appointment rose. This outcome had been anticipated in an earlier King's Fund paper (Hamblin et al., 1998) which argued that not only was the government pursuing the wrong objective, but also that the policies it adopted to achieve that objective were misconceived. This report builds on the earlier framework but extends it in four main ways: it considers all the stages through which NHS patients must pass to gain access to elective care; it expands the empirical description of how the elective care system works; it considers the role of waiting in the elective care system, specifically how it functions as a rationing device; and it sets out in more detail two broad policy options for 'solving' the waiting list problem. It describes how policy towards elective care has developed over the years and sets the scene describing the numbers waiting, the times they wait and recent changes in both. The report then considers a number of issues raised: why the numbers of patients waiting rise even when activity increases, why waits vary between different patients, why waits matter to the system and to the individual, and why waits vary from one area to another. The report goes on to consider how the broad objectives of any area of public policy - efficiency, equity and accountability - apply to elective care, and concludes by examining a range of policy options.