So, the year-end RTT performance was released and performance continues to deteriorate as the waiting list increases. It’s interesting to see that the number of 52-week patients has risen significantly to 2,755, not surprising when looking at the February data and seeing how many patients are 48 weeks and above. As we know a drop in activity isn’t easily recovered from, compounded by the complexity of patients who are often those longest waiting means a long hard slog for those trusts to deliver the NHS guidance of reducing 52-week waiting patients in 2018- 2019. I must admit I do get frustrated at the ever-increasing focus on RTT waiting lists, while our planned and follow up patients get left behind. These patients’ are at risk of clinical harm and whilst the policy published in 2011 – Gateway 16994 Policy for patients who require appointments for assessment, review and/or treatment - use of planned (pending or review) lists- advises that patients passed their due date should have an RTT clock start, in view of the increasing size of the RTT PTLs , I’m not sure that this would mean the patients would be seen any sooner. Ever the optimist I would like to think that RTT waiting lists have grown as trusts have focused on treating their planned patients and seeing their overdue follow-up patients using their limited capacity – but until we routinely report on these patients, we will never know. Talking with a colleague recently around PTLs and waiting lists, he made reference to George Orwell’s Animal Farm – “All animals are equal but some animals are more equal”. Is this the case for our waiting lists? Every waiting list is equal but RTT (and Cancer) seem to be more equal than the others, leaving our planned and follow up patients being left behind or indeed forgotten.