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Continuous lumbar epidural analgesia for labour and delivery.

NHS and private patients to start this month. The Government's political efforts to introduce a common waiting list have always seemed disproportionate to any practical advantage for NHS patients. Consultants have generally admitted acutely and seriously ill patients according to medical priority, regardless of their origins, and the extent of so-called queue jumping by non-urgent private patients is exaggerated by politicians. Indeed, such patients have often been more interested in fixing a definite admission date some months ahead than in demanding an early bed. But the political deed has been done and so far as consultants are concerned the important part ofthis agreement between the Joint Consultants Committee and the Secretary of State is that waiting lists remain the individual consultants' responsibility. The consultants' leaders have done well to stick to their guns on that principle. Discussions are to continue, with local investigation and consultation, on extending the common waiting list to patients with non-urgent conditions. Consultants should make sure that their views are made known locally so that their representatives have full support in the discussions with health authorities. The importance of consultants making their voice heard locally is also emphasised by Mr D E Bolt, chairman of the Central Committee for Hospital Medical Services' Negotiating Subcommittee, in a letter to consultants about the programme for withdrawing private beds. Referring to serious disquiet in the profession about the way the Health Services Board is conducting the withdrawal exercise, he reminds consultants of the importance of challenging the Health Services Board's proposals for withdrawing beds where satisfactory non-NHS private beds are not available. Mr Bolt warns that: "A stage has now been reached at which the beds under attack are not, in any way, surplus to the requirements of private practice, but are essential-particularly for the conduct of serious cases requiring the full range of hospital facilities. The failure of Government to fulfil its side of the Goodman agreement by implementing Section 59 of the Act,' which would ensure access to hospital facilities for private patients needing specialised facilities, is making a bad situation worse. However, successful defence of these vital remaining beds demands local knowledge, and that can be provided only by the consultants on the spot. It is our view that, when the board comes to consider the evidence which you have submitted, it will be quite impossible for it to reach a fair conclusion without direct discussion with informed consultants from the districts concerned."