Key targets in the Welsh Assembly Government's flagship health plan have been missed, BBC Wales has learned.
Milestones in as many as 10 areas such as bed blocking, bowel cancer screening and reductions in waits for heart surgery, had not been met by April.
Launched in 2005, Designed For Life is a 10-year strategy with specific annual targets.
The head of the NHS in Wales said the overall picture was of major improvements in the health service.
BBC Wales' Dragon's Eye programme examined the targets set for the end of March and found that waits for heart surgery are currently 36 weeks, which is around nine months, when they should be three months.
This wait has been reduced from 72 weeks and is due to reach 26 weeks by December 2009.
Another target missed by the Designed for Life plan is that all heart patients should be seen by a consultant within 24 hours.
The assembly government said it was still working towards developing services that would deliver this.
There are targets in place according to the Welsh Assembly Government but they are a joke
Tim Madison, heart by-pass patient
All patients eligible for cancer screening should be offered a screening, according to the plan.
But it was found that although breast and cervical cancer screening programmes are in place and are almost on target, a bowel cancer screening programme is still only in the planning stages.
Bed blocking, which is also known as delayed transfers of care, also continues to be an issue.
According to the assembly government's target, bed blocking should have been reduced to 50% of the figure in September 2003.
Although there has been a substantial reduction, the target has not been met.
Tim Madison from Ystrad Mynach, who is due to have a triple heart by-pass, said he had been waiting for this operation for 18 months.
"It is devastating to learn first of all that you need very serious heart surgery," he said.
"But to then discover that the health service that you thought was there isn't going to give it to you and look after you as it should be is a double shock. It is a real problem for people.
"There are targets in place according to the Welsh Assembly Government but they are a joke.
"I have been on the website and checked on the waiting times figures. The last one I checked in February-March showed no-one was waiting more than 24/25 weeks. Here I am - 18 months."
On a number of fronts we have made extraordinary progress
Ann Lloyd, head of the NHS in Wales
Professor Gwyn Bevan from the London School of Economics, an expert in the use of targets in the English health service, said they succeeded because failing trusts were named and failing bosses lost their jobs, something that has not happened in Wales.
He said: "If you have a set of targets but some are missed and no one worries much about it...the whole thing loses credibility."
Ann Lloyd, the head of the NHS in Wales, acknowledged that not all the "very stretching targets" had been reached but that the overall picture was of major improvements in the health service which had been achieved in the face of rising demands.
She also insisted that the principles of Designed for Life still apply.
"I think you have to remember that Designed for Life was designed to improve health, improve services and the quality of care. On a number of fronts we have made extraordinary progress," she said.
'Screening saves lives'
But shadow health minister Jonathan Morgan AM, said Designed for Life was failing to meet targets in key areas.
"Heart disease, coronary disease, and cancer are very important, big health issues in Wales and if you cannot get that right then how on earth can people be confident that the NHS will be delivered in the right way?"
Ian Beaumont, of Bowel Cancer UK, said: "There is no excuse for the Welsh bowel cancer screening programme to be delayed, especially when its larger English and Scottish counterparts are rolling out so effectively.
"Screening saves lives and the quicker the programme rolls out in Wales the more people with the disease will be identified in time to be treated."
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