The government's new waiting list initiative received a strong thumbs down at a national conference on day surgery last week.

'Permanent funding is what is needed, not crisis money that will result in short term solutions, ' Sarah Penn, president of the British Association of Day Surgery, told delegates.

And Tees health authority commissioning director Harper Brown warned that the system would reward 'poor performance if more money is thrown at trusts with long waiting lists'.

Both were speaking at the fourth annual conference on managerial and professional issues in day surgery organised by the Journal and Nursing Times .

The conference heard that day surgery was being cut back as trusts fought financial pressures. But that was increasing waiting lists and demoralising staff.

At King's Healthcare trust, London, the proportion of elective surgery carried out by day care has dropped from 63 per cent to 50 per cent since 1995-96.

Service manager Jill Solly said the result was an increase in the waiting list, large numbers of patients waiting more than 18 months, and more complaints from patients waiting at home.

Cutting day surgery contradicted the strategy of using theatre space designed for large volumes and fast throughput safely and efficiently.

Mark Hitchcock, day surgery director at Addenbrooke's Hospital, Cambridge, said purchasers were disinvesting in day surgery because of cash shortages. 'We have been the victim of our own success. Advances in technology that used to be done in day surgery are now carried out in outpatients, ' said Dr Hitchcock.

David Ralphs, day procedures clinical director, Norfolk and Norwich Hospital, said practitioners were being demoralised because day surgery units were not used to full capacity. Day surgery staff were being moved to other parts of the hospital, undermining the dedicated unit.

Simply to throw money at waiting lists made a lottery of NHS funding, Dr Ralphs said. 'We need to have the advantages of day surgery properly represented in the way the waiting list money is going to be spent.'

Dr Ralphs said that making waiting lists a political issue was unhelpful. It would distort practice and undermine the development of co-operation across primary and secondary care.

'We shall find inevitably that the inefficient practitioner, who is not making best use of day surgery, is going to be bailed out by this money, ' he said.