Patients in England cannot rely on information on waiting times for non-emergency operations, such as knee and hip replacements, a watchdog says.
The National Audit Office (NAO) found wrong and inconsistent recording after reviewing 650 cases in seven trusts.
The watchdog said it was unable to discern whether this was deliberate, but says it should be investigated.
The government says waiting times are "low and stable" but it will work with the NHS to ensure accurate reporting.
The NAO said that overall there was a tendency for the practices to conceal delays rather than over-record waits.
The NAO said that the lack of reliability, whatever the causes, was harmful to patients because it hampered their ability to make informed choices about where to choose to have their treatment.
It also called into question whether the NHS was actually meeting its waiting-time targets.
Greater scrutinyThere are more than 19 million referrals for elective operations each year.
Patients are meant to be treated within 18 weeks of a referral and the NHS is currently meeting its targets on this - but only just.
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NHS patient Sue Walker: "I had built myself up... and the plug was pulled in a few seconds"
The waits are monitored by hospitals, but they have the power to pause the clock if a patient is unavailable for appointments for personal or social reasons.
The patient can also be sent back to their GP - which means the clock starts all over again - if they fail to attend appointments.
But the watchdog said this leeway was being applied wrongly or inconsistently in 167 of the cases they looked at - just over a quarter of the total.
NHS patient Sue Walker was in an operating theatre waiting for a hip operation when she was told it had been cancelled because the hospital didn't have the right equipment.
"The registrar came along and said unfortunately, they didn't have the right cup for my hip," she said.
"It felt terrible because I had built myself up ready for that particular operation at that particular time.
"I had been through all the paperwork with everybody and had everything set up at home for when I returned home. The plug was pulled on that just in a few seconds."
End Quote Katherine Murphy Patients AssociationThe care and welfare of patients must always come first"
The NAO report reviewed 650 orthopaedic patient waiting times across seven hospital trusts, and found that more than half were "not supported by documented evidence or were incorrectly recorded".
- In 281 cases, waiting times had been correctly recorded and were supported by documented evidence
- In 202 cases, waiting times were not supported by enough evidence to say whether they had been correctly recorded
- In a further 167 cases, there was "evidence of at least one error, leading to under and over-recording of waiting time", with an overall under-recording of three weeks (mean) per patient
The NAO also highlighted other cases that were brought to its attention during the review.
These included North West London Hospitals Trust failing to record the waiting times of 2,700 of its inpatients, while Barnet and Chase Farm failed to properly monitor more than 2,000 patients. The problems have now been rectified.
There is also the well-publicised case of Colchester Hospital's misrecording of cancer waiting times.
'Deliberate manipulation'The report urged NHS England to apply greater scrutiny to waiting-time statistics to establish what was really happening.
NAO head Amyas Morse said: "Performance information should be reliable.
"However, we have found significant errors and inconsistencies in how trusts record waiting times, masking a good deal of variation between trusts in actual waiting times."
Katherine Murphy, of the Patients Association, said the findings were "concerning", accusing the NHS of deliberately manipulating the figures.
"The care and welfare of patients must always come first, and managers' efforts to try and 'fudge' their figures to meet targets will inevitably divert attention from providing high-quality care for the patients."
Continue reading the main storyThe association's Mike Smith told Radio 4's Today programme: "If you have arthritis, to wait 18 weeks is far too long. The limit has been being reached, but not in enough cases."
NHS England said action would be taken.
"We firmly believe it is essential to have accurate information provided in a timely way to ensure better care for patients," said NHS England's director of policy and strategy, Bill McCarthy.
Matt Tee, chief operating officer of the NHS Confederation, told Today: "Ninety per cent of people are being seen in the allotted time, when previously it would have taken 18 months to get an appointment.
"The NAO have pointed out that waiting times have increased a bit, and we will address that."
A spokeswoman for Health Secretary Jeremy Hunt said: "Overall waiting times remain low and stable, with the number of patients waiting longer than 18, 26 and 52 weeks lower than at any time under the last government.
"It's crucial that reporting is always accurate, and we will work with the NHS to make sure hospital staff get the support they need to get this right."
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