A new report from the Health Foundation has explored how realistic the government’s plan to reduce NHS waiting times to 18 weeks is.
This comes only weeks after the Prime Minister published the government’s Plan for Change, which brought a commitment to ending hospital backlogs and reducing the amount of time that patients will have to wait for elective treatment. As part of this month’s elective care reform plan, the government has now outlined how it will achieve this by March 2029, including through increase used of the private sector, less follow-up appointments, and a reduction in the number of unnecessary referrals being made.
In October 2024, 20.8 million patients were referred to the waiting list, a figure projected to rise to 22.4 million by July 2029. To meet the 92% standard, treatments must increase from 20.8 million to 23.5 million annually, equating to an additional 2.6 million treatments per year. This would reduce the waiting list from 7.6 million to 4.4 million.
Recent growth in treatments (4.8% in the year to October 2024) was influenced by industrial actions and pandemic recovery. However, sustaining such growth rates is unlikely. The government estimates a 2.4% annual growth in treatments is necessary, mirroring pre-pandemic growth rates of 2.3%. However, referrals are projected to grow at a lower rate (1.5%), which may still pose a risk of increasing unmet treatment needs.
The government's elective reform plan outlines funding commitments and interim targets, including an additional 40,000 appointments per week within the first year and a target of 65% of patients waiting less than 18 weeks by March 2026. Yet, there's a notable gap between initial commitments and the long-term increases required.
To meet these targets, the plan suggests several reforms. Increased use of GP advice and guidance may help manage referral growth. However, unintended consequences, such as increased demand for scans, could arise. Hence, monitoring referral and treatment trends is crucial.
Historical data shows that with focus and resources, the 18-week standard is achievable. The last Labour government met similar targets under better economic conditions and with more substantial investment. Therefore, improving elective care productivity is critical, but not at the expense of other areas like urgent and primary care.
In response to the report, the NHS Confederation’s Acute Director, Rory Deighton, said:
“This new analysis shows just how difficult it is going to be to achieve the government’s goal of the NHS hitting the 18-week elective care target in this parliament. But it shows that with the right support to boost productivity the goal is achievable.
“NHS leaders welcomed the government’s recent plan as a serious attempt to cut waiting lists in a more sustainable way and will work hard to achieve the planned 65 per cent ambition for next year.
“But, as our analysis with Carnall Farrar last year showed, it is clear that the promised 40,000 extra appointments and operations were only ever a starting point and were not enough on their own to achieve the target. More capacity must be created if the NHS is going to drive down waiting lists, especially if demand carries on growing in line with current trends.
“The upcoming 10 year health strategy and spending review are key opportunities to expand upon how the target will be achieved and what support the NHS will be given. Our members look forward to working with the government to drive down waiting lists going forward.”
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