Consultants are fitting people with hip replacements that have not been fully tried and tested, a report says.
Many people require new hips
The study, by the National Audit Office (NAO), found that 10% of consultants are said to be using prostheses which have not been approved by the National Institute for Clinical Excellence (NICE).
It estimates that there are 64 different types of hip prostheses on the UK market. For many, there is no evidence of long-term effectiveness, often because they had only recently been developed.
In some cases, says the report, the choice of prosthesis may be influenced by incentives offered to trusts and consultants by manufacturers.
It says two-thirds of these incentives - mainly overseas training trips - were not properly registered.
Four out 10 of the 24 consultants who accepted overseas trips did not go through an approval process.
The report highlights the case of one surgeon who works at the East Sussex hospitals trust, which covers Eastbourne and Hastings, who receives royalties for his involvement in the development of a hip prosthesis.
According to the report, he uses the product in 90% of the hip replacements he undertakes.
Mr Hugh Phillips, vice president of the Royal College of Surgeons, said incentives were a matter for individual trusts, and that the money was spent on training and education.
He also defended consultants who accepted foreign trips.
"There is a lot of hard work involved and they are not swanning around sight-seeing," he said.
Too few operations
The report also warns some surgeons do not carry out enough operations to maintain their level of expertise.
One in 10 - 130 consultants - carried out fewer than 10 operations a year.
Waiting list targets, it says, are forcing one in 10 consultants to operate on patients who have been waiting the longest - at the expense of more clinically pressing cases.
Public Accounts Committee chairman Edward Leigh said: "This practice is in flagrant disregard of the fundamental principle that those in greatest need should be treated first - and it must stop."
Dr Evan Harris, for the Liberal Democrats, said: "Ten per cent of consultants are saying that their decisions are now made on the need to meet government political targets rather than on clinical priority.
"This means that around 5,000 patients have their medical needs subordinated to those of politicians."
The NAO report, which was a follow-up to the April 2000 report, that more than 43,000 hip operations are now carried out each year.
It found that the average waiting time for an operation, once a patient had been assessed by a consultant, remained unchanged at an average of eight months, compared with the NHS maximum target of 12 months.
However, the report did praise the fact that patients were now kept in hospital for a shorter time - a move which could result in more patients being treated.
It also found that 90% of hip replacements reached standards approved by the NICE. Overall, the service had improved over the last three years, it concluded.
A Department of Health spokesman said an investment of £50m in orthopaedic services had been announced just last month.
But he added: "We recognise that more needs to be done to provide patients with better choice and quicker access to surgery."
Gordon Lishman, Director General of Age Concern England, said hip operations were hugely important for elderly people.
He said: "Hip replacements can help individuals live in their own homes and communities for longer in later life.
"Much more needs to be done to ensure all patients get access to this life-transforming surgery when they need it."
The NAO report recommends the development of new guidelines to minimise the inequality in access to treatment by NHS consultants.
It also recommends NHS trusts develop protocols to ensure replacement joints conform to the National Institute for Clinical Excellence guidance, and a policy for trials of prostheses.