Latest figures suggest the continuous fall in long waits for hospital admission cannot be sustained. John Appleby reports

The last two sets of waiting times figures from March and December 1997 seem to suggest that the continuous fall in long waits since 1987 cannot be sustained by the NHS.

By 1996 the NHS had managed to cut the number of people waiting between one and two years to just 2 per cent of the total waiting for admission. In many respects, and given the apparently inexorable upward historical trend, this was a major achievement; money, political will and hard management had combined to deal apparently once and for all with the NHS disease.

But figures from March last year - confirmed by figures for December - seem to reveal that the tide has turned: between September and December last year alone, the number of people waiting between 12 and 17 months jumped by over 18 per cent, and nearly 1,000 people were waiting longer than the Patient's Charter guarantee of 18 months. The problem is not just the result of a few aberrant regions either. Across the country the trends are more or less the same, with even the best performing region - North West, which had no one waiting more than a year in 1995 - now showing around 4 per cent of its lists waiting over a year, and total lists having grown by 2 per cent. So what's gone wrong?

Research associated with previous waiting times initiatives suggests that there are usually many reasons why waiting times (and lists) grow, and that the relative importance of these factors varies not just from authority to authority or trust to trust, but from consultant to consultant (the real 'owners' of waiting lists). If anything is to blame, it is probably that the NHS - from ministers down - took their collective eye off the ball.

But now, with typical tough talking from health secretary Frank Dobson, and with around three-quarters of the additional£500m announced in the Budget to be targeted at waiting times, there is the prospect of reducing them.

The target for March next year will be set at around 100,000 fewer people waiting than at March 1997 - one of Labour's manifesto pledges. Despite mention of waiting times by NHS chief executive Alan Langlands in a recent letter to the NHS, it would seem that these have been usurped by the length of the list as a political priority.

This appears somewhat 'Canutish' given past trends in the growth of numbers of people waiting.

To avoid any perverse incentives - such as the building up of lists over the next few months in order to secure a larger slice of the waiting list money - the government will need to be careful how it allocates the new funds.

HAs and trusts are going to have to work very hard to make a significant dent in the numbers waiting for admission if they are to meet the new targets. For example, every month around 200,000 to 300,000 people are admitted to hospital from the waiting list in England. With waiting lists having grown since last March, meeting the government's manifesto pledge over the next 12 months will require trusts to treat a similar number of people from the waiting list - in effect, 13 months' work in just 12.

All other things being equal, and if no other area of work is to be adversely affected, activity will need to rise by about 8 per cent this year - a frankly enormous increase compared with annual changes the NHS has achieved over the past 20 years.

Even after September 1996, when the health service treated a record number of people from the waiting list, the number waiting still went up by nearly 100,000 the following March.