We have a situation that is costing patients' lives

Evan Harris, Lib Dem health spokesman

More than half of consultants surveyed in the report said they had been forced to treat less urgent cases at the expense of more seriously-ill patients in a bid to meet targets on reducing hospital queues.

Twenty per cent said they frequently treated patients in a different order to their clinical need to meet targets.

Dr Ian Bogle, chairman of the British Medical Association, said his members had long warned of the problems that waiting list targets were causing.

He said: "Understandably the government has tried to do something about the time patients wait for treatment, but wrongly they have focused on the actual size of the list, rather than looking at the time people wait and the condition they have got."

System flawed

Speaking on BBC Radio 4's Today programme, Evan Harris, Liberal Democrat spokesman on health said the NAO report showed the pressure on doctors to meet waiting lists was so strong that patients' lives are being put at risk.

Highest numbers waiting over 13 weeks for inpatient treatment (per 1,000 people)

North Cheshire - 29 East Kent - 27 Isle of Wight - 27 South Lancashire - 27 St Helen's and Knowsley - 26

He condemned the current system as having no redeeming features.

And he said cardiac surgeons had told him that urgent cases, that needed to be done in four to six weeks, could take four to six months because the top priority is patients, who though more stable, are waiting 18 months.

"We have a situation that is costing patients' lives."

"I don't think doctors can ethically co-operate with such a system now." he said.

Minsiters have said that in future they will focus on waiting times, rather than waiting lists.

Health minister John Hutton defended the government's record on pushing waiting lists down.

But he added: "I'm not going to justify anyone waiting longer than they need for treatment, and if that's happened its a matter of serious regret and we'll take action to put it right."

Shadow health secretary Dr Liam Fox earlier said: "All around the country doctors have been angered by the way clinical need has been overtaken by political expediency."

Reform

The NAO also says there are wide variations in how long patients wait around the country.

Highest numbers waiting over 13 weeks for outpatient treatment (per 1,000 people)

North Staffordshire - 14.2 Wirral - 12.6 Redbridge & Waltham Forest - 11.6 Liverpool - 11.5 Enfield and Haringey - 11.4

It said the way waiting list figures are compiled is riddled with inaccuracies and discrepancies and that hospitals do not even collect data in a comparable way.

The NAO is calling on the government to reform and standardise the system for collecting statistics, so patients get a truer picture.

Its report is an embarrassment for the government, which last year set targets of a maximum three-month outpatient appointment wait and a maximum inpatient wait of six months, to be met by 2005.

The report also criticises the way the NHS has concentrated on the wait to see a consultant for the first time and the wait for an operation, while ignoring "waits" for tests and further consultations.

Individual need

Waits around the country ranged from Dorset, where less than one per cent of patients on the inpatient waiting list waited longer than six months, to West Sussex where 37% did.

Martin Pfleger, deputy auditor general, said: "From the patient's point of view, they want to know how long it's going to take from first being aware they have a problem to being treated for it."

Mike Stone, director of the Patients Association, told BBC News Online: "We're meant to live in a country with a national health service. Whether you live in Newcastle or Truro, you should be receiving the same service."