wait watcher What can we make of the Department of Health's waiting-list statistics or, more specifically, their nonappearance? Professor John Yates asks whether it is a case of government spin or plain lies

There was a time when English spinners were deadly accurate - ask any older cricket enthusiast who can remember Laker and Lock.

Today's spinners in England's civil service and political system are, by contrast, either tame or woefully inaccurate.

Take a look at their output over the last few months. In July, it was said: 'It is common knowledge that waiting lists tend to rise slightly during the winter months, but historically they also tend to go up a little in the spring.'

Surely we are trying to change history and reduce waiting times - not make excuses about emergency admissions and the effects of CJD.

In August, the press release was headed: 'All aspects of NHS waiting improved since last year.' This conveniently ignores the accompanying data, showing that month-on-month waiting times were deteriorating.

In October, we were told: 'Figures published today highlighted progress towards cutting waiting times for patients.' But this month, as in all previous months, the Department of Health has failed to publish the data collected about the progress being made, or not made, towards the government's waiting-time targets.

Attention is deflected away from the clear promise made in the NHS plan, and reaffirmed by prime minister Tony Blair at the last election: waiting times will be reduced, and by 2005 no outpatient will wait over 13 weeks and no inpatient over six months. In the first five months of this financial year, surrounded by spin, we find ourselves unable to plot progress towards these goals (see table).

The so-called 'fast track' monthly returns for September were not available as HSJwent to press, and are not expected to be published until at least five weeks after the month end. Honesty and speed are both in short supply. So far this year, waiting times appear to be deteriorating, the control data is at times slow, or absent altogether, and its interpretation leaves something to be desired. Our attention is being directed towards irrelevant issues and less appropriate targets, while important information about waiting times is collected but not published.

Mr Blair assures us that public services remain high on his agenda, but the NHS is failing to respond as he would wish.

Despite substantial increases in investment and an increased number of consultant surgeon appointments, NHS activity this year has not increased. In some key specialties, productivity in terms of patients seen per consultant continues to fall.

Productivity is falling for understandable reasons, such as decreasing working hours for junior medical staff, pressure for consultants to limit their working hours, and some increases in case complexity.

Productivity is also falling because of policy decisions made with good intent, but with undesirable sideeffects. Stopping twin operating lists for safety reasons and demanding that increased consultant time be committed to audit, training and clinical governance all takes time away from other activities - including, all too often, treating patients.

Finally, productivity is falling for some less acceptable reasons. Many surgeons simply do not have the facilities to do a full week's work. In orthopaedic surgery, the specialty with the greatest waiting-time problems, we still find consultants with only two operating lists per week when the guidance of their professional body clearly states they should have a minimum of three lists per week.

Some of the more fortunate, and more committed, even have four or more operating lists per week. Simply appointing more and more surgeons without providing matching resources will only result in an even greater fall in productivity.

One of the traits of 'modernisation' in the NHS is experimentation with new and unproven methods. It is an exciting concept when it works, but can we afford to ignore old and proven methods? In the early 1990s, the waiting-list initiative saw long wait (over one year) patients reduce from 223,311 to 4,576 in six years. Most of that reduction occurred in the first two years and was secured not simply by studying monthly waiting-list statistics, but by securing the correct levels of resource input and ensuring appropriate levels of activity.

The latter was stimulated by a mixture of incentive payments, political pressure and a genuine desire to succeed. It was supported by monthly control data - not just about waiting times, but about activity and productivity.

If the government is to succeed in making radical reductions to waiting times, it is going to have to understand that without control data, there is no control.

The alternative is watch and pray. We await September's results. l Professor John Yates is director of inter-authority comparisons and consultancy at Birmingham University's health services management centre.