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ONE in three national health service trusts is deliberately distorting hospital waiting list figures, an investigation has found. The scale of the systematic fiddling uncovered by the Audit Commission throws into disarray a key government pledge on public services. The inaccuracies were exposed when Audit Commission teams carried out unannounced spot checks at 45 of the 186 acute and specialist trusts in England which are covered by the targets. Health service insiders say that thereport will reveal that up to a third of trusts were found to have made “inappropriate adjustments” to waiting lists. A further third had made unintentional mistakes. Directors at some trusts found to have manipulated their figures, including hospitals in Greater Manchester, North Yorkshire and Hertfordshire, have been suspended or sacked. Further disciplinary action is expected following the report’s publication next month. Hospitals have been under severe pressure since Labour came to power in 1997 with a manifesto pledge to cut waiting lists by 100,000 within four years. The Government’s NHS Plan stipulated that no one should wait more than 18 months for an operation, with the target time falling to 15, 12 and six months by 2005. Trusts that fail to make the grade suffer severe financial penalties. A range of techniques have been used to distort waiting times including, in one case, offering appointments to patients only on days when they were known to be on holiday. Managers have also deliberately delayed adding patients to lists and medical records have been altered. In one incident, dozens of patients were removed from a hospital’s official records at the touch of a computer button. The fiddles have forced some patients to suffer longer while their condition becomes worse. The commission’s findings will also provide further evidence of the intense pressure — there have been allegations of intimidation and bullying — facing hospital managers as they attempt to meet the targets. In a recent anonymous survey of 400 NHS managers, 10 per cent admitted deliberately filing inaccurate reports on waiting lists and more than half said they were afraid to raise concerns with senior colleagues for fear of reprisals. Mike Stone, director of the Patients’ Association, described the new findings as highly disturbing. “If the figures are being massaged, then a patient waiting in daily pain for a hip replacement may find that the operation is put back. “Psychologically, that can have a hugely detrimental effect on people. I can sympathise with the financial pressures that trusts are under but that is no excuse,” he said. Nigel Edwards, policy director of the NHS Confederation, which represents NHS managers, said he was surprised at the scale of the abuses. “If these figures are true, then the problem runs much deeper than the behaviour of individual managers,” he said. “We shouldn’t be talking about individuals behaving badly; we should be focusing on the flaws in the system as a whole,” he said. Andrew Whitley, finance director of the South Manchester University Hospitals Trust, resigned in October after auditors found that Wythenshawe Hospital’s figures had falsely suggested that no one had waited more than 18 months for inpatient treatment. Earlier this month, Simon Meddick, director of information, planning and performance management at the East & North Hertfordshire Trust, was suspended and an investigation started into the manipulation of its waiting lists.
Patients given dates for operations were allegedly removed from the list if they did not reply quickly enough to letters asking whether they still wanted surgery. Three directors of the Scarborough and North East Yorkshire Trust were suspended two weeks ago and an external inquiry team is being appointed after the Audit Commission uncovered widespread discrepancies with its waiting lists. Evidence that the system for recording hospital waiting numbers has been subjected to such widespread abuse comes one year after the National Audit Office named nine trusts found guilty of massaging their figures to cover up their failure to meet increasingly tough government targets.
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