Is there any substance to opposition claims that waiting lists are being 'fiddled' by the use of subsidiary lists? Laura Donnelly examines this and other accusations of manipulating waiting-list statistics
Frank's fiddles - six of the best' is the snappy title of shadow health secretary Ann Widdecombe's latest attack on waiting-list figures.
But have the Conservatives done their homework this time?
At the end of May, former shadow health secretary John Maples declared that 101 hospitals faced cuts or closure. But his figures were swiftly demolished, leaving a lingering suspicion that Tory rhetoric on waiting lists might lack firm foundations.
Ms Widdecombe says her six-pronged attack is backed by 'evidence pouring in from all over the country'.
'Frank's first fiddle', she claims, is the 'cunning ruse' of transferring patients to subsidiary waiting lists, so they 'do not appear in the waiting lists statistics'.
She cites the case of Bradford Hospitals trust, where a drop in waiting lists has 'coincided with the removal of certain patients from the main waiting list'.
Her evidence is an internal trust memo saying that under 'new NHS guidance' patients waiting for the removal of internal fixations should no longer be included in the list.
The snag? The NHS Executive knows of no such guidance and that procedure has never been included in waiting-list figures.
Conservative Central Office admitted it could not 'track down' the guidance referred to.
And as the Department of Health points out, the inclusion of 'planned procedures' (such as removing metal plates post-surgery) 'would be like putting all pregnant women on a nine-month waiting list'.
A spokesperson for Bradford Hospitals trust says that while the memo may have been 'badly worded', claims that figures had been manipulated are 'mischievous'.
Ms Widdecombe's second claim is that increasingly long waits for outpatient appointments are behind the apparent drop in waiting lists.
Her evidence is Frenchay Healthcare trust, in Bristol, where the average wait for a routine appointment with a consultant orthopaedic surgeon is between 92 and 102 weeks, compared with 74 weeks in May 1997.
A trust spokesperson says the 'huge jump' in the figures is simply a case of 'demand outstripping supply' in the wake of a 30 to 40 per cent increase in GP referrals between January 1997 and July this year.
The average wait for routine treatment has remained constant at 12 months.
Ms Widdecombe's claims mirror an allegation made by Liberal Democrat health spokesman Simon Hughes.
He claimed last week that South Devon Healthcare trust had created a 'pending list' of patients who weren't counted in waiting list figures. This met a swift rebuttal from both health secretary Frank Dobson and the trust's chief executive. Mr Dobson said the allegation was 'untrue' and a 'smear' on the success of staff.
The trust says that those waiting on 'pending lists' (since renamed) have always been included in monthly waiting statistics.
Chief executive Tony Parr says: 'It would have been helpful if Mr Hughes had contacted us before making this claim.'
King's Fund health policy analyst Tony Harrison says the 'folklore' of waiting-list manipulation remains hard to prove, while the government continues to publish outpatient and inpatient lists at different times and covering different periods. 'They need to show the full picture ,' he says.
Outpatient figures due out next week should give 'some indication' of whether falling outpatient lists are a result of increasing waiting times for initial appointments, he says.
Ms Widdecombe's third claim - that rationing routine operations is helping to keep waiting lists down - is hardly new.
But her evidence, that 'it is now well known' that routine operations are no longer available in 'many' health service regions, is hardly proof that waiting lists are being substantially affected.
Meanwhile, the DoH says health authorities have to set priorities 'from within the resources available' but 'we do not support blanket bans and GPs and consultants need to consider the clinical issues of each case'.
Health policy analyst Sean Boyle, also of the King's Fund, gives greater credence to 'Frank's fourth fiddle' - that reprioritisation is a factor in bringing
lists down. 'The emphasis on meeting targets is bound to mean an emphasis on 'lower-cost options',' he says.
'A system which encourages a focus on lightweight cases doesn't strike us as the way forward - and I think the government will come to recognise this.'
Ms Widdecombe also claims that trusts are setting targets
for administrative 'clean up' and that pressure is being placed
on GPs not to refer patients to hospital.
On the question of 'pruning', a spokesperson for the Radical Statistics Health Group is blunt: 'Really there's nothing wrong with removing dead people from the lists.'
And a spokesperson for the DoH points out that 'list validation' was introduced in 1991 by Conservative health secretary William Waldegrave.
But the DoH does not deny pressure on GPs to refer fewer patients, merely quoting Mr Dobson's statement in July that he aims to 'get more people treated, if appropriate, closer to home by their GPs, rather than, in some cases, going into hospital'.