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I contest Professor Black's conclusion that surgical waiting lists are inevitable (April 2004 JRSM1). Waiting lists are purely a function of an imbalance between supply and demand. If the availability of surgery, in terms of facilities and surgeons, exceeded demand, there would be no waiting list. Admittedly, a minority of patients might then undergo surgery for conditions which would have resolved spontaneously, but the majority would be appropriately treated and without delay. The proposal that surgeons with private practice contrive to maintain long NHS waiting lists is offensive to hard-working members of the medical profession. By what mechanism does Professor Black propose that these surgeons keep a long NHS waiting list? Do they not turn up for work when expected? This hackneyed explanation of long waiting lists is simply a political excuse for failing to provide adequate capacity in the NHS. However, in a publicly funded health service, few taxpayers would countenance a surplus of NHS surgeons sitting around waiting for patients. Far better the alternative—a reasonable wait for publicly funded surgery, and for those who wish to be treated at their convenience, a privately funded option.