Guilty trusts

Barts and the London Guy's and St Thomas's, London Plymouth General Hospital Redbridge Health Care Salford Royal South Warwickshire General Stoke Mandeville Surrey and Sussex Healthcare University College London

Staff at some hospitals failed to add patients to waiting lists, others were deleted and in some cases medical records were adjusted to suggest patients had been treated on time.

In all, at least 6,000 patients were affected.

The NAO report suggests that while some patients may have been unaffected by the actions, the conditions of others "may have deteriorated during the longer wait".

Government response

However, some managers found guilty of fiddling the figures have since been re-employed elsewhere in the health service - and Health minister John Hutton said this would not be tolerated in future.

He told the BBC: "Anyone anywhere in the health service who breaches a fundamental principle of good faith and trust doesn't deserve to be employed by the health service."

It's your [Tony Blair's] culture of deceit that has forced the health service to manipulate these figures

Iain Duncan Smith

The prime minister told MPs at Commons question time that any manipulation of the figures was "entirely unacceptable" and that waiting lists were down by 100,000 since Labour swept to power.

But Mr Duncan Smith said that Mr Blair's "culture of deceit" had put pressure on health service staff.

"No one is going to believe a word you say about waiting lists, or anything else, when the NAO report today shows that you have put systematic pressure on doctors and hospital managers to fiddle the waiting list figures.

"You are to blame for all of this report and all those waiting lists going up."

'Spot checks'

Earlier, Nigel Crisp said measures would be put in place to make sure that the manipulation of lists could not happen again.

"We're putting in place spot check arrangements for trusts, and we're also making sure that we tighten up our procedures to deal properly with it when it does happen," Mr Crisp told the BBC.

Guy's was one of nine trusts criticised

The checks are set to be carried out by the Audit Commission from next year, said the Department of Health (DoH).

Waiting times for all NHS consultants will also be published on the internet for patients to check.

Medical records changed

The NAO report highlights a record of "deliberate manipulation" over a period of up to four years at some hospitals:

• Surrey and Sussex Healthcare NHS Trust only put urgent patients on waiting lists and offered appointments at short notice or when patients were on holidays.
• Plymouth Hospitals NHS Trust put patients on waiting lists just one month before they were treated.
• Stoke Mandeville Hospital NHS Trust failed to put patients on the list at all and took others off without good reason.
• St Bartholomew's and the London NHS Trust amended patients' medical records to make it look as if they had been treated on time.
• University College London NHS Trust also altered patient records.
• Salford Royal Hospitals NHS Trust excluded patients waiting more than 18 months from its "official" list and out-patients were only included one month before their appointments.
• South Warwickshire General Hospitals NHS Trust delayed adding people to its waiting lists
• Redbridge Health Care NHS Trust and Guy's & St Thomas's Hospital Trust took patients off waiting lists inappropriately

Condemned

There was widespread condemnation of the practices.

Shadow health secretary Dr Liam Fox said: "The NAO report makes it clear that these fiddled figures are only the tip of the iceberg."

Lib Dem spokesman Dr Evan Harris criticised ministers. "Fiddled figures are the result of New Labour's obsession with performance targets in the NHS."