THIS WEEK

Health service managers may be able to celebrate this week as Labour's long-discredited waiting-list target looks set to bite the dust.

The subject of so much controversy, the Labour Party's 1997 manifesto pledge to cut hospital waiting lists by 100,000 is likely to be dumped and future targets are expected to focus on the length of a patient's wait rather than the numbers waiting.

University College London Hospitals trust chief executive Robert Naylor - a member of the Department of Health's performance taskforce - said: 'I would be very surprised if there wasn't a move away from waiting numbers to waiting times.'

It is a move which Mr Naylor describes as 'long overdue', though he believes a new system would also present challenges. 'Waiting lists are relatively easy to manage. . .

managing waiting times is more difficult and more sensitive because you wouldn't set a general waiting time for all types of patients.Waiting-time standards have to be sensitive to the different types of patients we treat.'

And he added: 'We should be looking at waiting time from the point of GP referral.'

NHS Confederation policy director Nigel Edwards said politicians would be as relieved as managers to see the end of the waiting-list initiative: 'They've been trying to get themselves off that hook for a while.'

But future time-based targets would need to be subtle, he argued. He suggested there might be a national time target for the 'end-point', but local targets should be agreed 'based on where they are starting from and whether trusts redesign services or increase capacity'.

Redesigning services might mean times 'get worse for a short while, but then exponentially improve', he said. 'The performance management approach to that will need to be subtle or it will demotivate people.'

King's Fund fellow in health systems Anthony Harrison said politicians had 'realised numbers are not the thing - they will try to go for maximum waiting times'.

But he added that, the government would have to look at three aspects together - trusts' activity levels, referral criteria and how waiting time is measured.

'At the moment, waiting time at the outpatients stage is not linked with times for inpatients. You do not have patients' total experience, ' he said.

And he added: 'You have got to look at management in a broad sense - referrals and thresholds as well as activity. There are not any agreed clinical priorities. It hasn't been sorted out who is urgent.'

The waiting-numbers pledge dogged the government throughout its last term, with managers under huge pressure to meet the crude numbers targets.

A scandal at Plymouth Hospitals trust over accusations of fiddled figures brought the resignations of its chief executive and director of operations last year, while a review is still under way at Stoke Mandeville Hospital trust , where 135 patients were wrongly placed on the 'suspended' list.

And the final NHS election row centred on claims in the BBC's Panorama that the government had not fulfilled its waiting-list pledge.

This was followed by press reports that a National Audit Office investigation had found that trusts 'massaged' waiting-list figures under pressure to meet the targets. The NAO refused to comment on the claims, saying its report was a leaked draft. The final report is expected in the summer.