NHS staff are becoming disillusioned with the use of waiting-list data for political points-scoring. But John Yates says that the truth is there to be found

Published: 07/02/2002, Volume II2, No 5791. Page 22

Patients and hospital staff are becoming increasingly cynical about waiting-list numbers and waiting times. Confidence is undermined by politicians who appear to use the data for political ends. Both the recent publication of the National Audit Office report describing the 'fiddling' of waiting-list data and the Department of Health's exaggerated press releases leave many confused. Truth is lost between spin and scepticism.

Waiting lists and waiting-time statistics are dangerous areas. Seen by some as the litmus test for the NHS, politicians greet them with a mixture of fear and delight, depending on whether the lists are going up or down, and whether the politician is in government or opposition. Even innocuous figures can be given different interpretations, and are easily used to reach different conclusions. If February's figure is higher than January's, one side will use it as evidence of deterioration while the other will say that as it is lower than the previous February, the situation is improving.

A Sunday Telegraph article (20 January) made embarrassing reading for the Labour Party. The 'convenient timing of waiting-list announcements' was criticised because the large drop of 26,000 in the March figure was released right at the start of the election campaign. The day after polling it was announced that the April figure had bounced back by 17,000. When a Conservative spokesman called for an inquiry, the words pot, kettle and black came to mind for those who remember the 1992 election. Though monthly figures are usually released five weeks or more after the event, the DoH gathered and released information about long-wait patients within 48 hours for the first time.

The Daily Telegraph, at the height of the election campaign, declared: 'Two-year waiting list slashed.'

Such behaviour supports the suggestion that compilation of waiting-times data should be handed over to an independent agency. This sounds like a good idea, but it is naive. The tentacles of political power and funding are long. A secretary of state once reminded me about the 'King's shilling' - if I were to continue publicly discussing information about waiting lists my funding would be reviewed. I did continue, and it was.

Unfortunately, some of the genuine hard work by surgeons and managers is belittled by those who are understandably cynical of the data. While some of the reductions in waiting times are manipulated, much of the data published is accurate. It is honestly gathered by thousands of NHS secretarial and information staff and analysed by managers. The managers know that both clerical staff and clinical colleagues are watching their every move. The threat of whistleblowing undoubtedly ensures that the grossest fiddles are discouraged, and the figures published do offer a reasonable approximation of what is going on.

Monthly, rather than quarterly, publication raises the pressure. Monthly data that takes six weeks to surface suggests incompetent data-gathering systems, highly pedantic cross-checking procedures or a period to allow manipulation. Monthly data should be treated as control data - used for taking action - and it should be (in some trusts it is) examined within 48 hours.

Waiting six weeks before acting is no type of control.

Public and press would be more likely to accept quarterly publication if they could be sure the NHS was using monthly control data to reduce waiting times.

In advance of the release of the December 2001 figures (due six weeks after the date collected) it is safe to predict the following. Outpatients waiting over 13 weeks will remain above 300,000. Inpatients waiting more than six months for admission will be close to 250,000. If this is correct, it will mean that figures have changed little since the government's re-election or since the NHS plan. We have been promised that both figures will be reduced to nil by 2005. There are now only four years left to deliver that promise.

While the prime minister and the leader of the opposition argue over one poor lady's treatment and the press get excited about nine patients going to France for surgery, 500,000 long-wait English patients look on. These are the true waiting-time statistics.

Professor John Yates is director of Inter-Authority Comparisons & Consultancy at Birmingham University's health services management centre.