THE Government is on course to achieve its 18-week waiting time target for NHS hospital treatment by 2008, a report from an independent health body concluded.

But there could still be problems caused by increasing demand, staff shortages and the destabilising effects of new policies. Even if the target is achieved, the report from the King’s Fund said, it will not be “the end of waiting”.

The report questioned whether waiting times should remain the central policy issue, suggesting that inequities will increase as waiting times are reduced.

“There are tremendous variations between hospitals,” John Appleby, chief economist at the King’s Fund and co-author of the report, said. “There are dramatically different waits across London, for example, even between hospitals next door to one another.

“There are also differences between different social classes, with the middle class generally doing better than the working class, and between people whose first language is English and those for whom it isn’t.

“There are also people outside the system altogether because they are not registered with a GP. It may be time to look at these variations much more closely and try to narrow them.”

The report, The War on Waiting for Hospital Treatment, is the most detailed examination of how the Government has tackled what it identified in 1997 as the key NHS issue — long waits for treatment. It concluded that, in England, setting targets and penalising managers who failed to meet them has reduced maximum waiting times. But in other parts of Britain, change has been slower.

In 1997 1.3 million people were waiting for operations and the maximum waiting time was 18 months. Today 823,000 are waiting, for a maximum of nine months. The report said that the number of people actually treated since 1997 had fallen. Yet the number waiting also fell — explicable only by the fact that fewer people were listed for operations. Some operations were reclassified so that they were not included in the data.

These changes worked, at least in the sense that waiting times and, later, waiting lists were reduced. The new waiting time target is 18 weeks, from the time of GP referral to hospital treatment, to be achieved by 2008.

Policies such as patient choice and “payment by results” have been introduced to provide incentives to achieve the target.

But the report said that these policies were potentially destabilising. Payment by results is meant to encourage hospitals to compete for patients by paying them a fixed tariff for each procedure. But, if a hospital is unable to perform the procedure for the fixed amount, it will lose money on each procedure it performs and the incentive will be to do fewer rather than more operations, Mr Appleby said. Around half of hospitals will find it hard to work within the tariff.

Mr Appleby questioned whether further reducing waiting times was the best policy for the NHS. “The question is what patients value more,” he said. “If they value other things more than the shortest possible waiting time, then it could be time to reconsider.”

Andrew Lansley, the Shadow Health Secretary, said: “We need to know how the 18-week target is going to be measured before discussing if the target will be met. What we need is flexibility so that patients are treated according to need, not some political target. This would enable hospitals to fast-track more serious cases over non-urgent ones.”

The Department of Health said that the NHS was “more than capable” of meeting the new 18-week target.

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