In terms of throughput as measured by bed use waiting lists may be a more efficient way of admitting patients to hospital than a booked admissions system. But this ignores the costs of uncertainty borne by patients. These uncertainty costs may outweigh the costs of lost throughput and are anyway inconsistent with a consumer oriented health service where explicit decisions are to be made concerning the true intention to treat.Surgeons are clearly interested in the extension of booking systems despite past failures and present frustration. They are also very explicit about the facilities required to make booked admissions practicable. These facilities are those that permit elective surgery to be protected from the demands ofemergency and urgent cases. These predictable barriers have to be removed if any policy for introducing booking systems as a norm is to be successful.We thank the consultant surgeons of the South Western region for their help in completing the questionnaires and Mrs Fiona Braddon for her help in analysing the responses.