The government is expected to announce by Christmas that patients who have been waiting the longest for operations will be able to get treatment outside their own area, in a further effort to ensure the 15-month waitingtime target is met by next March.

The announcement is expected to resolve funding rules so that a trust treating patients from outside its own area will receive payment quickly. The present out-of-area transfer system rules mean that payments are delayed by two years.

The announcement is likely to be the first step in giving patients greater choice in where they are treated, although there are serious problems with IT which may well delay any roll out.

The intention is that primary care trusts should be able to negotiate block contracts with trusts outside their own area, allowing them to offer long waiters the choice of being treated elsewhere more quickly.

King's Fund health systems programme director John Appleby said the biggest problems with waiting times seemed to be in the South East.

He said: 'I have heard some people from the Department of Health say there is quite a geographical issue involved. Outside the South East there are many hospitals which will not have trouble meeting the 15-month targets.

There seems to be a two-speed system, in which case if you give people the choice of where to go, you could start to even out that sort of variation.

'In that circumstance, you could find that waiting times even out below the 15-month target.'

But he warned that it was not certain the initiative would work and argued that it should be piloted. 'I think it is still an open question. One of the issues is:

what is the evidence that the waiting-list initiative has had that much of an impact? I think it will have some sort of impact, but it may not be cost-effective.'

York University health economist Professor Alan Maynard said: 'It may help at the margins, but the real problems right across the system are bed-blocking and capacity. But every little helps.'

NHS Alliance chair Dr Michael Dixon said the changes could deliver the targets, but had to be properly funded and overseen by primary care trusts: 'It could give patients some sort of guarantee they will get treated in that time. . . and give a boost to the local NHS.'

But he said: 'This has to be a PCT decision, otherwise we have no assurance of quality. Clearly the big hold-up is PCT funding.'