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Wednesday, 19 December, 2001, 11:30 GMT
How the figures were fiddled
Couple in hospital
The inquiry found long waits had been disguised
The nine hospitals named and shamed in the National Audit Office (NAO) report used varying tactics to camouflage their bulging waiting lists.

Some cases were more severe than others - at University College London, for example, only five patients had their records altered, and there was judged to be no impact on care.

However, at South Warwickshire General Hospital, between May and September 2000, there were 500 patients at any one time involved - and an estimated total of 2,000 over that period.

Suspended operation

One of the key methods used by hospitals to get their lists down, or disguise the fact that patients were waiting beyond the 18-month maximum, was simply to suspend them from the waiting list.

This is normally done when the patient cannot have their operation for reasons beyond the control of the hospital.

This would happen if the patient became too ill for their operation, or if they could not have the operation for their own reasons, such as holidays.

However, in the case of many of the hospitals named in the NAO report, patients were suspended for no valid reason.

While this was the most common technique in the problem hospitals, a variation on the theme was also used in others.

Plymouth Hospitals NHS Trust set up an inappropriate separate "planned" list for some patients - thus moving them out of the reckoning of the main list.

But perhaps the most cunning method of getting people shoved off the list in this way was carried out at Surrey and Sussex Healthcare.

Staff wrote to patients, and asked them when they were going on holiday.

They then offered them surgery during these weeks - meaning they could suspend them from the list when the patient was forced to turn it down.

Keep them off the list

Another technique was to delay putting patients on the list in the first place - thus making it look as if they had waited for a shorter period.

At Surrey and Sussex Healthcare, for example, it was found that not only were large numbers of patients nearing the 18-month limit inappropriately suspended from the lists, but others were not being added.

This also happened at Stoke Mandeville Hospital, while at South Warwickshire General Hospitals, chief executive Andrew Riley actually set up a mechanism which meant only urgent cases were added.

Alter patient records

The third technique was simply not to tell the NHS about how many patients the hospital had on its lists.

Elderly people in nursing home
No-one is supposed to wait more than 18 months
At Barts and the London NHS Trust, which controls two major teaching hospitals, the Admissions Department Manager, Jan Rice, "deliberately and systematically" altered patient records so that the regional NHS office did not find out about those waiting more than 18 months, the report said.

She altered the "decision to admit" date on patient records to shorten the apparent length of waiting time.

She also changed admission dates on patient records so it looked as if they had actually had their operations - when in fact they were still waiting.

Ms Rice employed the full range of other crafty methods of "shortening" the waiting lists.

She inappropriately suspended patients, moved them to another "planned" list - or simply deleted them from the list altogether.

'Potentially dangerous'

Even her own trust board did not get to hear about 18-month plus waiters.

However, the scams came to light when a health authority stepped in to ask why a patient on the trust's waiting list had been waiting nearly 20 months - despite being classed as an "urgent" case.

The enquiry said that the manipulation of lists had been "potentially dangerous" to patients, as there was a risk that some would be "inadvertently denied" treatment.

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