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.

It warns that the government's "targets culture" could affect clinical decision making.

But the commission found that the focus on waiting times in the 10-year NHS Plan is "beginning to pay off".

Key improvements highlighted include the ability to see a GP within 48 hours, the reduction of outpatient waiting times to a 21-week average and a fall in waiting times for operations to a maximum of 12 months.

The findings confirm claims from the Department of Health that its plan remains on course.

But news that there are more accountants and support staff than clinicians will raise alarm at the growing bureaucracy.

The commission also highlighted incidences of corner cutting and inaccuracies in information.

It said these have led to doubts about whether the quality of care is being maintained.

Auditors believe that some health trusts are "finding short term solutions" to meet targets at the expense of the long-term modernisation of the NHS.

Trusts have been found to divert money away from IT, buildings and equipment funds towards short-term staffing costs and are paying for an increasing number of private treatments for NHS patients.

While this may satisfy politicians' promises, the commission argued, it does nothing to increase the capacity of public hospitals.

Commission chairman James Strachan said that real progress could only measured by the general standard of public health, not Westminster-generated targets.

"The NHS is improving as measured by waiting list targets in the NHS Plan, but while important, waiting lists do not equal the health of the nation," he said.

"Furthermore, in addition to inaccuracies in the data, the improvements that have been achieved are too often the result of short-term fixes.

"While setting national standards and developing action plans are powerful tools for improving services, having too many targets risks obscuring where the real priorities lie.

"It would be better to focus on a few major targets, such as reducing deaths from cancer, and then allow local health services to tailor plans to local needs."

The government believes targets help focus minds and measure progress towards more holistic goals.

NHS chief executive Sir Nigel Crisp told the BBC on Thursday that public goals were the aim of target setting.:

"He [Strachan] doesn't seem to understand that one of our major targets is to reduce death rates from cancer and another is to reduce death rates from coronary heart disease over a period between now and 2008," he said.

"To do that you have to do a whole range of things like cut waiting times for coronary heart disease at all stages of the patient journey, which incidentally he says we are 100 per cent successful at.

"Our targets are about waiting times, but they are also about improving services in priority areas like cancer, coronary heart disease, mental health and care of older people."

And responding to the report the chief executive of the NHS Confederation, which represents health trusts, agreed.

"We believe that many of the targets have helped to concentrate efforts and that genuine improvements have been delivered as a result," Dr Gill Morgan said.

"But we do need a new approach to setting and measuring targets to ensure we encourage real innovation and a focus on long term sustainable change."

But Conservative health spokesman Liam Fox said that the government would be wrong to ignore the Commission's warnings.

"Ministers should be alarmed when an organisation as reputable as the Audit Commission says 'there is a lot to be done, both nationally and locally, to make the improvements sustainable and permanent'," he said.

"Ministers must now surely tackle such problems as care for the mentally ill and the elderly, the widespread damage caused by the obsession with targets and the financial crisis gripping organisations throughout the NHS."