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Richard Motley's response assumes that, like supply, the demand for surgery is finite. This is clearly not the case. Despite a large increase in the number of surgeons, and a commensurate increase in the number of operations carried out in England over the past three decades, waiting lists have altered little. The phenomenon of the amount of supply being a key determinant of the level of demand can also be seen in comparisons with the US, where much higher provision of services results in surgical rates approximately twice those in the UK. This is why current initiatives to eliminate waiting lists through increased provision are doomed to have only a short-term, temporary impact. Our efforts should be focused on improving the efficiency of services so as to ensure we obtain best value for those who pay for the NHS.