Thousands of patients awaiting operations missing out on 18-month time limit pledge

Health analysts praise the progress the Government has made towards the manifesto pledge that "by the end of 2008, no NHS patient will have to wait longer than a maximum of 18 weeks from the time they are referred for a hospital operation by their GP until the time they have that operation".

Rates have risen sharply, from the target being achieved in less than half of cases nearly three years ago to well over 90 per cent now.

In Yorkshire and the Humber in October, 97.9 per cent of non-admitted patients – and 93.2 per cent of admitted patients – were seen within the time. Yet critics point out that given those figures cover more than 120,000 patients, thousands are still waiting longer.

Ruth Thorlby, a fellow in health policy at the King's Fund, said the NHS deserved "real credit" for its progress but the "world has moved on" from targets which can distort performance.

"The thinking is that there should be a legal right for patients to be treated within a certain timeframe," she said. "But if there's only a legal right and no target or performance management, the pressure might come off the hospitals and waiting times might creep up.

"How the NHS should be performance managed without targets is a bit vague at the moment".

Cancer czar Professor Mike Richards has also admitted the NHS will not meet its target that all women with signs of breast cancer should be seen by a specialist within two weeks. The

target has already been pushed back from 2008 to the end of

last year (2009) but Prof Richards has admitted it will still not be hit.

The Government has lived up to promises on giving patients more choice, and hospital infections have also come down, so Ms Thorlby says Labour has fared well on its main pledges, but the big question is what happens when the axe is taken to public spending.

"No one's really sure what's going to happen from 2011 – the Government's gamble is that enough investment went into the right things during the time of plenty," she said.

Meanwhile, on education the manifesto promised personalised learning "not back to mass failure", yet critics will point out that this year the proportion of 11-year-olds in England reaching the standard expected of them in English national curriculum tests fell.

Recent criticism from business leaders about the standards

they see in young recruits also raises questions about whether every child is getting the "good education" the manifesto promises.

Promises of more new school buildings have been kept, although concerns remain over the costs of the Building Schools for the Future programme, and catch-up support has also been put in place.