Health bosses are deliberately making patients wait for treatment so they will remove themselves from waiting lists by either going private or dying, a report has suggested.
Some Primary Care Trusts (PCTs) are refusing to operate before 15 weeks in a bid to save money, an independent agency that advises the Department of Health has discovered.
The tactic was employed by PCTs after they found that if patients were made to wait longer "some will remove themselves from the list or will no longer require treatment when it is finally offered.
"A PCT may therefore save money overall by increasing waiting times," the report said.
"We understand that patients will 'remove themselves from the waiting list' either by dying or by paying for their own treatment at private sector providers," the report by the Co-operation and Competition Panel (CCP) said.
The terms of the NHS Constitution states that patients should be seen within 18 weeks, but the panel has been told by some PCTs that they are imposing minimum waiting times of up to 15 weeks. The DoH guidance is to treat patients within 18 weeks but there is no specific guidance on a minimum waiting time.
Some PCTs said that increasing waiting times had the potential to save money, but the authors of the report pointed out that when treatment is delayed, more complex and expensive care can be required so money may not be saved in the long run.
The report said: "At an individual level, making patients wait longer than necessary for treatment is likely to impose greater pain and inconvenience than is necessary on patients."
However, not all trusts impose minimum waiting times and provide care "as soon as a provider can safely deliver".
The Patients Association said that the "cynical manipulation" of waiting lists should not be tolerated.
Katherine Murphy, chief executive of the Patients Association, said: "It is outrageous that some PCTs are imposing minimum waiting times of up to 15 weeks.
"This is unacceptable and aside from the worry and inconvenience it may cause for patients, we are concerned that it will put patients' health at risk.
"The suggestion that it could save money because patients will remove themselves from the list by going private or dying is a callous and cynical manipulation of people's lives and should not be tolerated.
"What right do they have to say people should wait longer for treatment just because it might save money? We are deeply disappointed in those PCTs allowing this conniving behaviour.
"We urge the Department of Health to take a firm stand on this issue, clearly demonstrating to PCTs that this deplorable practice has no place in the NHS."
CCP chairman, Lord Carter of Coles, said: "Commissioners have a difficult job in the current financial climate, but patients' rights are often being restricted without a valid and visible reason. Crucially, it is the lack of transparency that surrounds certain restrictions on patient choice that is of real concern."
Care Services Minister Paul Burstow said: "This report illustrates exactly why we need to modernise the NHS and increase choice for patients.
"PCTs will want to take a hard look at practices in light of this report and ensure they are always in the best interest of patients and the taxpayer.
"Under our plans to modernise the NHS we are extending choice for patients and making sure they are at the heart of our health system. We are also creating a dedicated organisation to protect and promote patient interests."
Health Secretary Andrew Lansley said: "This is exactly why we need to put patients' interests first. Too many PCTs have been operating in a cynical environment where they can game the system - and in which political targets, particularly the maximum 18 week waiting time target, are used to actually delay treatment.
"When GPs, specialist doctors and nurses are making the decisions, as they will under our plans, they will plan care on the basis of the clinical needs of patients and their right to access the best service, including the least possible waiting time."
Andrew Taylor, the CCP's director, told BBC Radio 4 Today's programme greater transparency was needed when it came to telling patients how long they would have to wait for operations.
He said by delaying operations, trusts could only save money for a financial year. "It does delay the treatment into the next financial year for that patient so it is not really a long-term cost-saving," he added.
David Stout, director of Primary Care Trust network in the NHS Federation, also told Today that patients needed more information from their doctors about how long they would have to wait.
He said: "Firstly, I think you need to put it in context, so 10 years ago people were waiting longer than 18 months. Now we have an average waiting time from referral to treatment of about eight weeks so we have improved performance very, very significantly over the last few years.
"These are routine cases in some cases, we are not delaying emergency treatments. These are cases which aren't emergencies. I am not saying they are not serious, of course they are and that's why we have made such an effort with waiting times over the years.
"It saves money only in the financial year that we are talking about. The NHS has to live within its budget. Activity and demand is rising faster than the available cash and obviously NHS organisations have to find a way of managing within their available resources."