Labour's health policy could crumple under a culture of targets and centralised bureaucracy, the Audit Commission has warned.

The independent spending watchdog expressed its concern that progress in the NHS may not last.

Sir Nigel Crisp, chief executive of the NHS, said "This Audit Commission report provides another external commentary on achievements in the health service.

"I agree with its comments on the optimism and achievements of the NHS. However, it is a snap shot report and in most cases the NHS has moved on.

"The health service is turning the corner. The resources and reform are biting. The NHS Plan is well on track. It is becoming a reality across the country."

Forum Response: Epilepsy Action

A spokeswoman for Epilepsy Action told ePolitix.com: "The Audit Commission's report raises some serious concerns. In terms of targets, we can only comment from our experience with epilepsy and that experience shows that when a condition doesn¹t have any NHS targets, it effectively falls off priority lists and is forgotten.

"For people with epilepsy the lack of targets means that around 1000 people continue to die every year, when research has shown that 42 per cent of those deaths could be prevented through better quality health care. This is just one implication - misdiagnosis and inappropriate treatment are others. As Dr Gill Morgan states, targets appear to concentrate efforts and deliver results - something we would dearly love to see in epilepsy services.

"Dr Morgan goes on to state that a new approach is required and Epilepsy Action definitely agrees. One of the issues this audit report highlights is the amount of effort and money being spent on NHS bureaucracy and policing that bureaucracy.

"The recent government Action Plan for epilepsy not only failed to set measurable targets for epilepsy services, it didn¹t allocate any funds specifically to epilepsy services in the NHS. It is sad that even bureaucracy appears to have a higher spending priority than people's health."

Forum Response: Royal College of Nursing

A spokeswoman for the Royal College of Nursing, told ePolitix.com: "Waiting list targets have undoubtedly improved access to NHS services for some patients, but to be truly meaningful, targets have to reflect quality patient care. Quality must always be the bullseye at the centre of any target.

"Targets can place immense pressure on both staff and managers which can often force trusts to concentrate on achieving short-term goals at the expense of longer term improvements and less high profile services."

Forum Response: Institute of Directors

Geraint Day, health policy adviser at the IoD, told ePolitix.com: "The Institute of Directors has argued consistently over the last few years that there is a severe outbreak of 'targetitis' in the National Health Service.

"The Audit Commission's comments confirm this opinion. It is only through freeing up the management of NHS trusts, via self-governance initiatives like the government's foundation trust plans, that this case of severe chronic resource inefficiency will begin to be brought under control, to the benefit of patients and NHS employees alike."