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The NHS in England has been ordered to prioritise patients who have endured long waits for routine treatment.

Ministers want to see more than 100,000 procedures carried out during the summer on those who have waited longer than 18 weeks - the official target.

There are nearly 200,000 in that situation - 65,000 of which have been waiting for more than half a year and over 500 for more than a year.

Those who have waited longest will be prioritised for treatment.

But ministers conceded it may mean performance against the waiting time target slipping in what they said would be a "managed breach".

They said the patients who have waited the longest tend to be the most "complex and difficult" to treat.

The NHS is meant to see 90% of patients who need non-emergency operations, such as knee and hip replacements, within 18 weeks.

The target was missed marginally in February and March, but has been met by and large since it was introduced in 2008.

However, the Department of Health said it was likely to be missed for a few months while the patients with the longest waits were dealt with.

It said the situation would return to normal by the end of the year.

Those who have been waiting the longest are sometimes called the hidden list.

That is because as the NHS is judged against the 18-week target there is less incentive to treat patients once the mark has been passed.

However, the numbers facing long waits has been falling after it was first identified as an issue in 2011.

'Ration care'

Those waiting more than 52 weeks topped 18,000 in May 2010, but had dropped to 574 in May this year, the latest month for which the data is available.

But now ministers want the NHS to make another push to treat those who have been waiting for a year - unless it is clinically necessary.

Hospitals have already been given an extra £250m earlier this year - and that will now be used to fund these extra procedures.

Health Secretary Jeremy Hunt said: "No-one - except in exceptional circumstances - should have to wait for more than a year.

"We need targets that help patients get treatment when they need it - not targets followed blindly with no regard for the impact on individuals."

But Dr Mark Porter, of the British Medical Association, said: "It is right to prioritise patients who have had to wait the longest for treatment, but this announcement tries to wash over the fact that more patients will have to wait longer for an operation because the government, in effect, is having to ration care.

"This is yet more evidence that the NHS is buckling under extreme pressure and that patient care is being compromised."