Leading Article: Labour's hospital numbers game doesn't add up

LABOUR HAS lost no time in greeting the first fall in NHS waiting lists since it came to power. Frank Dobson, the Health Secretary, could not disguise his glee - and relief - at this "massive achievement" by NHS staff. Doctors and nurses do indeed deserve our praise as they work ever harder to meet the Government's targets. And its figures do superficially appear convincing; numbers waiting for treatment have fallen.

Unfortunately, Mr Dobson's case does not stand up to critical analysis. The real outlook is far less rosy than he would have us believe. Waiting lists are still longer than they were in May 1997, and there are more fundamental problems than simply that of numbers. Labour has made far fewer changes to the NHS than it likes to pretend. The main components of the Conservatives' internal market, including the division between "providers" of services, such as hospitals, and their "customers", such as GPs, have been retained. This means ministers have fewer means of controlling the direction of the service than the public have been led to believe.

In an increasing number of health authorities the Private Finance Initiative contracts out control of hospital care to private companies, which will demand rising profits over the medium to long term. NHS Trust status gives power over care in individual hospitals and GPs' surgeries to management, and takes it away from local health authorities that governments used to be able to pressurise in order to achieve results. We should be suspicious of ministers who trumpet results over which they have less and less power. Even Labour's "extra" funding amounts only to providing enough money to plug the gaps and return to the levels of funding increases associated with the early Major years.

But we should be wary of these waiting-list figures. The misuse of government statistics is nothing new, as Labour never failed to remind us when unemployment figures were meddled with by the Tories in the Eighties. Hospital managers, rather than government agencies, are the original source for the figures that ministers are citing. They have an incentive to make themselves appear more "competitive" inside the internal market; their reports should be treated with caution. Many patients have to wait months to see a consultant, which delays their appearance on waiting lists at all.

Even worse, the setting of regional, national and local targets themselves is another example of the adoption of management consultancy methods, which are quite inappropriate in the public services. Fetishes for single indicators, as economists have known for years, distort the very problem they are intended to solve. In their efforts to prevent any patients waiting more than 18 months for care, ministers have ensured that the numbers of patients waiting 12-18 months are still rising.

The culture of "throughput" - treating patients ever more quickly - is the main means being used to shorten waiting lists. This bolsters the managerial culture in which patients are seen as problems rather than people. Bigger hospitals are being built, to meet unrealistic targets for the bed numbers per year; patient care will be further neglected. More local hospitals will close.

Waiting lists are not the be-all and end-all for heath care; one compelling reason for the existence of the NHS is that it ensures there are waiting lists, to ration care and prevent health costs from burdening the rest of the economy, as they do in the US. Ignoring the quality of the NHS, in order to increase the quantity of care provided, is one way to undermine public confidence.

Mr Dobson's case is that the "supertanker" of NHS decline has been turned around. Opinion poll results undermine his argument; public confidence in Labour's ability to change the NHS is still falling. The public are more realistic than their government; this ship is still steaming into dangerous shallows.