The nine-month waiting-time target expected in today's national plan can only be met if clinically defined referral and access thresholds are introduced, according to King's Fund fellow in health systems Anthony Harrison.

Although the government is expected to launch a massive overseas recruitment drive to help deliver 30,000 more nurses and 10,000 more doctors for the NHS, Mr Harrison said 'a sudden blip of operations' would not lead to significantly shorter waits because more people would simply come forward for treatment.

He said any new system of demand management would need to sort out the problems in the many areas in which access to treatment is poor, adding: 'We need more people being treated, but put a limit to it. It is a very difficult balancing act, and we have spent 50 years getting it wrong.'

He also said the NHS would need to use existing resources in a better way.

One example would be 'one-stop clinics, where people are assessed and treated on the same day'.

David Hunter, professor of health policy at Durham University, said delivering the waiting times would need a change in the culture of NHS working. 'Simply putting more doctors and nurses in will amplify the problems that exist.'

NHS Confederation policy director Nigel Edwards said encouraging recruitment from overseas would be good 'in the short term', but the success of the plan was crucially dependent on the ability to recruit nurses and get them trained and restarted.

In the longer term, success depended on the 1,000 extra medical school places believed to be in the plan, and substituting doctors for other types of staff.