Watchdog to expose 'manipulation' of NHS waiting lists

The Government's drive to improve the National Health Service will suffer a setback tomorrow when the Audit Commission publishes new evidence that waiting lists are being manipulated.

The official watchdog is to demand an explanation from the Department of Health for problems it uncovered during spot checks on the waiting lists at 41 NHS trusts in England.

Whitehall officials say the findings are so sensitive that there has been a game of "ping pong" between the Department of Health and the commission as the department tried to water down criticism. One source described the findings as very embarrassing.

Nigel Crisp, the NHS chief executive, is expected to announce tough measures to tackle the problems uncovered by the inquiry. They might include disciplinary action.

The report focuses on "outcomes" and does not identify why waiting list figures are being distorted. NHS managers have complained that they are under pressure to meet the main targets set by ministers. These include ensuring a maximum four-hour wait for accident and emergency care and a 12-month wait for clinical treatment by this spring. By 2005, the Government has pledged that no one will wait for more than six months.

In 2001, the National Audit Office found that nine NHS trusts had massaged their figures to mask their failure to hit targets. An official has resigned in South Manchester, while others have been suspended in Scarborough and East and North Hertfordshire after allegations that waiting lists were manipulated.

Critics claim that patients have been offered appointments when hospitals knew they were unavailable, that managers have delayed adding patients to lists and that records have been amended.

The tensions between the Health Department and the commission will fuel claims that the Government has tried to muzzle its watchdogs.

Sir Andrew Foster, the commission's outgoing controller, accused ministers, their advisers and officials last month of putting improper pressure on the watchdog body. He said the department tried to minimise the impact of a 2001 report on accident and emergency waiting times because Alan Milburn, the Health Secretary, was "very unhappy because it did not give a positive image".

Ministers deny trying to neuter the commission but are frustrated that media coverage of its reports focuses on the problems of improving services rather than the success stories.

Ministers are anxious to show the NHS is improving because a 1p rise in national insurance, to increase the health budget, takes effect next month.

Last night, Iain Duncan Smith stepped up the Tories' campaign against the increase, warning that Gordon Brown's "tax and spend gamble" had contributed to an economic "malaise".

The Tory leader told a City of London audience: "Over a million people are still on hospital waiting lists, waiting for treatment in a health service that has more administrators than it has beds. If you need an operation in France, the maximum wait is four weeks. If you need one in Britain, the average wait is 4.3 months."