One of New Labour's promises to the electorate before it came to power in May 1997 was that it would cut the number of people on hospital waiting lists by 100,000 in the life of this Parliament.

Within a year, waiting lists had risen to an all-time record.

Since then the overall trend has been downwards, but doctors say that the number of people on waiting lists is not what counts - it is how long they wait.

And the latest flu crisis., leading to the cancelling of many non-urgent operations, seems certain to put a dent in Labour hopes of reaching the target quickly.

Labour has been attacked for its focus on waiting lists, which first became a government obsession under the Conservatives in the late 1980s.

Three main criticisms have been levelled at Labour's initiative:

• That it is unsustainable in times of increased emergency admissions;
• That it is a misuse of funds;
• That it has increased waiting times for NHS treatment.

Emergency issues

Carlos Perez-Avila, of the Association for Accident and Emergency Medicine, blamed the government's strategy for the 1998/9 Christmas and New Year crisis.

Labour has promised to cut numbers

He said: "This deplorable state of affairs in accident and emergency department throughout the United Kingdom is partly as a result of the government pressures on complying to waiting list initiatives."

The NHS Confederation, which represents health service managers, said the initiatives had collapsed altogether over the same period as demand for emergency care soared.

In a survey the confederation found that waiting lists are unlikely to fall significantly in December and January because hospitals are focussing on managing the winter emergency pressures.

The initial survey findings showed that:

• Most trusts (73%) think that emergency admissions are compromising their trust's ability to achieve waiting list targets;
• The majority are experiencing a rise in emergency admissions (97%); a rise in bed occupancy (77%) and unacceptable trolley waits for some patients (91%);
• 85% believe the current experience of winter pressures is worse than last year. The cause is given to be predominately the normal rise in activity over winter plus the increase in flu cases.

However, the government told health service managers in September 1998 that it would have to continue to reduce the size of NHS waiting lists while they cope with the winter surge in demand.

'Waste of money'

In anticipation of the government's announcement of extra cash for the NHS, the King's Fund said it should not be "frittered away" on waiting lists.

Rabbi Julia Neuberger, chief executive of the fund, which is a leading health research charity, said the money should be poured into areas like mental health and elderly care where it could make the most difference.

The fear is that concentrating funds in one area will lead to failings elsewhere in the health service.

In 1998, hospital performance tables showed that while the number of people in waiting for hospital treatment in England had fallen, the time they were waiting had risen.

That trend continued in 1999.

Doctors have argued since the waiting list policy was introduced that it does not matter how many people are on a waiting list if they are all treated promptly.

In December 1998, the British Medical Association proposed a new system of compiling waiting lists that it said would lead to the NHS treating patients according to clinical need instead of their position on a waiting list.

The system would indicate how quickly patients should receive surgery, but could also mean that some treatments might "never reach a high enough priority to get funded on the NHS".

The BMA wants the system to be national so that patients know they will be given the same priority for surgery wherever they live in Britain.