Sarah Woolnough
Chief Executive – The King’s FundAssessing the Government’s reform agenda 18 months on, Sarah Woolnough, Chief Executive of the King’s Fund, examines whether falling waiting lists signal genuine recovery in the NHS or mask deeper structural pressures that must be addressed to deliver the ambitions of the 10 Year Plan for Health.
When the new Government came into power in 2024, a new chapter for the NHS was at the heart of its plans: a commitment to ‘fix’ a broken system through reform. Lord Darzi’s investigation detailed an NHS that had struggled under the weight of years of inadequate investment, inefficient systems, and an ageing population. It was a health service that did not fare well when compared with those of other European countries. Eighteen months on, the government has succeeded in bringing down NHS waiting lists in some areas, but it is important to dig beneath the surface to understand progress and ongoing challenges.
Early Gains, Modest Impact
A drop in the number of people waiting for NHS care is encouraging and will make a real difference to those waiting for treatment, however, progress is relatively slow. The overall hospital waiting list in England stood at 7.6 million in July 2024 and has fallen to 7.3 million – roughly a 4 per cent drop.
And while the number of treatments provided to patients each month is increasing – and the waiting list has decreased overall[1] – this reduction has been due in part to factors other than better or increased medical care, namely, “unreported removals” or “list cleansing” – a process by which patients are taken off the waiting list due to a particular treatment no longer being clinically appropriate for a patient, or the patient declining treatment or missing their appointment after referral, or to correct administrative errors[A1] .
There are obviously many factors that contribute to a long waiting list, including a growing population, which leads to more demand, and workforce shortages in some specialities and roles, which limits the capacity to deliver treatment. Another significant factor in recent years was, of course, the COVID-19 pandemic: the waiting list was already high beforehand, but it grew dramatically in the wake of the pandemic, due to the number of NHS services that were paused.
Inequality and Regional Variation
Throughout England, the picture is also variable across different demographic groups – whether socio-economic or age-related: people living in the most deprived areas of England are more likely to be waiting longer for elective care than those in the most advantaged areas.[2] And a larger proportion of those aged over 65 experience shorter waiting times, of less than 18 weeks, than both younger adults and people under the age of 18. This variation is also reflected in the proportion of people experiencing very long waits.[3]
The limited progress with respect to elective surgery waiting times is also being mirrored in other key areas. The 2025/26 NHS guidance set the target of seeing 78 per cent of A&E patients within four hours by March this year, but, as of last month, just 72 per cent of patients were being seen within that time. Therefore, the feasibility of the four-hour waiting target by March 2027 being 82 per cent – as set out in the medium-term planning guidance – looks ambitious.
There are other challenges, such as the major restructure underway across the service, with the merger of NHS England and DHSC and significant changes to the makeup of Integrated Health Systems and other regional and local bodies taking time and attention. There is also the wellbeing and morale of the NHS’s workforce to consider. Recent research by The King’s Fund has shown that many feel exhausted and under-valued. They are not just overwhelmed, they are firefighting. Without serious consideration of this and the importance of compassionate, humane leadership to improve working conditions and culture within the NHS, the system risks underperforming.[4]
Beyond Waiting Lists – the Real Long-term Prize
Reducing the waiting lists is certainly important (not least to those who have waited many months or even years for treatment) – and the government is right to set targets – but the real prize for the long term lies elsewhere. This is set out in the 10 Year Plan for Health: to build a health and care system that works to prevent illness in the first place, to create a system that facilitates care beyond hospitals and moves more of it into the community, and one that empowers citizens and patients to take more control over their health.
A better primary and community care system – such as easier access to GP and other health professional appointments, prompt referrals to diagnostic tests, and better joined-up care pathways between service-providers – will be vital to improve health outcomes.
Additionally, the Government needs to address the significant challenges facing the social care sector, and people’s ability to access the quality care they require. The danger is that progress in NHS performance is hampered by a lack of join-up with, or provision of, social care. The example of an older person being admitted to hospital because they aren’t in receipt of support – for example, with cooking or washing – to stay well at home, is a common one. Similarly, another common problem of staff shortages in the social care sector is in danger of being exacerbated by a tightening of the rules on health and care visas, and risks progress on system improvement in the short term.
Looking to the future, the Government will need to be pragmatic and make some tough, perhaps unpopular, choices. However, MPs can play a huge role in shaping these priorities by focusing on the interventions that can truly deliver on the aims of the 10 Year Plan for Health. The NHS and DHSC alone cannot achieve this; it will require the implementation of a cross-governmental approach, akin to the ‘health mission’, to tackle poor health at its root cause by addressing the issues of poor housing, financial hardship, and unhealthy environments. The Government promised this when it came to power. Real change will only be brought about with greater thinking across departments and systems – not just within them.
This article features in the new edition of ChamberUK. Our parliamentary journal.
[1] From September 2024 to May 2025
[2] In November 2025, of those waiting for treatment in the most deprived areas, just 59.8% had been waiting less than 18 weeks for treatment since being referred, and 2.4% had been waiting over a year, while of those from the most wealthy areas, 61.7% had been waiting less than 18 weeks for treatment and 2.2% had been waiting more than a year. The King’s Fund published a report that examines what local NHS trusts and integrated care boards are doing to address inequalities on waiting lists
[3] 64.1% of people older than 65 are waiting less than 18 weeks in November 2025 – compared with 59.0% of those aged between 19 and 64, and 59.1% of those under the age of 18. 1.9% of those aged over 65 have been waiting over a year since referral compared with 2.5% of 19 to 64-year-olds and 2.2% of those under the age of 18.
[4] Our long read From burnout to belief: reflections on reforming the NHS from within looks at the reasons for low morale amongst NHS staff.