We can't run away from a policy of reducing the length of time people wait - it's the right thing to do

Health minister John Hutton

Shadow health secretary Dr Liam Fox said doctors all around the country had been angered by the way clinical need had been "overtaken by political expediency".

And Liberal Democrat health spokesman Dr Evan Harris described the report as a "damning indictment" of government policy.

However, health minister John Hutton told the BBC that reducing waiting lists had a "beneficial" impact on the length of time patients had to wait.

'Explain'

Dr Fox said that patients all over the country deserved "nothing less than an apology from Tony Blair."

"Although [Health Secretary] Alan Milburn has been forced to abandon these nonsensical targets, the replacement waiting time targets are no better since they still take no account of clinical need.

"Until that happens, the sickest will not always be treated first in Labour's NHS - and we will still be no nearer the world class NHS that Tony Blair has promised the country," he said.

For the Liberal Democrats, Dr Harris said that ministers had a lot of explaining to do.

"They were warned that political posturing on waiting lists would lead to longer waits for seriously ill patients," he said.

"But they continued to deny it, even whilst consultants were being forced to treat less urgent cases first.

"This report is a damning indictment of government policy."

'Progress'

Mr Hutton told BBC Radio 4's Today programme: "The policy was not wrong. Reducing waiting lists has had beneficial impact on the length of time people wait.

Mr Hutton defended government policy

"There are some parts of the NHS which are making progress both in reducing the numbers of people on the list and the length of time they wait without distorting clinical priorities."

He said that the issue for the government was to make sure that the best standards in the NHS became common practice across the service.

But he added: "We can't run away from a policy of reducing the length of time people wait - it's the right thing to do."

Vasectomy

According to the report patients with bladder tumours have had their surgery delayed so that routine operations to reverse vasectomies could be performed on men coming up to the 18-month target.

The report said: "There is a risk that with pressure to reduce waiting times further, the failure to treat patients in accordance with their clinical priority will continue to be a problem unless waiting lists are managed effectively."

Former Tory leadership contender David Davis, who was chairman of the House of Commons, public acounts committee said: "The Department of Health must get a better grip on why patient waiting times differ so much across the country.

"Variations like this must be understood as a first step to doing something to solve them.

"There must be no backsliding from the fundamental principle that those in greatest need are treated first," he said.

A spokesman for the Department of Health said: "The NAO is right to underline the importance of treating patients according to their clinical priority.

"We expect the NHS to follow this principle and we have repeatedly made this clear."