One year on, have ‘crack teams’ cut NHS waiting lists?
About 7 mins
In October 2024, ‘crack teams of top clinicians’ were deployed to 20 hospitals in England in areas with the highest numbers of people off work sick. These teams aimed to support trusts to bring down the elective waiting list by improving productivity and reducing avoidable demand for elective care, in areas with high numbers of people out of work.
In March 2025, the government announced that, in the first 4 months of the programme, waiting lists had fallen twice as fast in Further Faster 20 (FF20) trusts compared with all other trusts not participating in the scheme. Our analysis supported this claim but found similar sized, or larger, reductions in waiting list size were relatively common among other trusts in England, despite the average being lower. We also found that the greater reduction in FF20 trusts was primarily due to a drop in referrals onto the waiting list, rather than increases in the number of cases treated (completed pathways).
Now, at the start of 2026, the government has claimed that during the programme’s first year waiting lists fell by 4.2% in FF20 trusts, three times faster than the 1.4% fall in non-FF20 trusts, and that for working-age adults this fall was five times faster (4.4% vs 0.8%). These claims are based on an evaluation report published by NHS England.
We examine these claims and look at what might be driving any differences in waiting list reductions between trusts involved in the programme and those that are not.
We used England-wide, trust-level data on consultant-led referral-to-treatment (RTT) waits published monthly by NHS England, for hospitals defined as ‘NHS Trusts’ by the Organisational Data Service. These are the accredited official statistics on waiting times. NHS England’s analysis uses data from the Waiting List Minimum Dataset, which is not available publicly. Unlike this dataset, the RTT dataset does not provide breakdowns for working-age adults, so we can look only at the overall changes in the waiting list. Our analysis omits one of the FF20 trusts (Sheffield Teaching Hospitals NHS Foundation Trust), which has not submitted RTT data since June 2025.
How much did waiting lists fall in FF20 trusts and elsewhere?
We found that waiting lists at FF20 trusts (excluding Sheffield Teaching Hospitals) fell by 5.7% between end-October 2024 and end-October 2025, compared with a fall of 1.3% in non-FF20 trusts (Figure 1). The discrepancy with NHS England’s findings is likely due to differences between datasets. Our analysis therefore supports the headline claim.
What explains the difference between FF20 and other trusts?
Each month, patients are added to the waiting list (new RTT periods) through new referrals. Patients on the waiting list are removed mostly because they have started treatment or because treatment is not needed (completed pathways). But there are also removals which occur for other reasons. We refer to these as unreported removals.
The net sum of additions and removals is the change in the waiting list each month.
Figure 1 shows that for every 100 cases on the waiting list by the end of October 2024, FF20 trusts added 257.1 cases over the following 12 months, completed 223.1 pathways and removed 39.7 people for other reasons. This results in a net reduction of 5.7%.
In contrast, for every 100 cases on their waiting lists, non-FF20 trusts added 276.6 patient pathways (19.5 more than FF20 trusts), completed the pathways of 236.2 (13.1 more than FF20 trusts) and removed 41.7 people (2 more) for other reasons. This results in a net reduction of 1.3%.
As we found previously, the larger waiting list reduction observed in FF20 trusts was mainly driven by fewer referrals relative to the waiting list, rather than more completed pathways (which were higher in non-FF20 trusts over this period). Unreported removals have also played a key role in the waiting list reductions; without these, the waiting list would have increased in both FF20 and non-FF20 trusts.
Figure 1
Figure 2 shows the percentage change in the waiting list between October 2024 and October 2025 across hospitals in England, with the FF20 hospitals highlighted in red. The difference between the reduction in the waiting list in FF20 trusts and non-FF20 trusts was 4.3 percentage points. It is unlikely that this difference is a result of chance.1 It is possible that the characteristics of the trusts participating in the programme influenced the results. However, without further analysis, it is not possible to determined how much of the difference is due to the FF20 programme itself and how much is due to the characteristics of the trusts participating in it.
Figure 2
What effect does the FF20 programme appear to be having?
One of the aims of the FF20 programme is to increase productivity and capacity in trusts. If this aim is achieved, we would expect to see treatment volumes, and therefore completed pathways, growing more in FF20 trusts.
It does not appear this aim is being achieved. Figure 3 shows that completed pathways in FF20 trusts increased by 0.3% compared with the 12 months before – less than the 3.7% reported in non-FF20 trusts. This issue was not considered in the NHS England evaluation; further insight into this would improve understanding of the programme’s impact.
Another aim of the scheme is to bring down the waiting list by reducing avoidable demand. There are indications this may be happening in FF20 trusts, as referrals are growing more slowly than elsewhere. Compared with the 12 months before the period analysed, referrals were up by 1.1% in FF20 trusts versus an increase of 2.9% elsewhere.
Unreported removals increased by 26.9% in FF20 trusts, while they decreased by 3.5% in non-FF20 trusts. Unreported removals may include care pathways which are completed but only marked as such a few months later, patients not attending their first appointment, or errors in online data systems. Data are not published on the reasons for unreported removals, so it is unclear which of these categories are driving the increase in unreported removals in FF20 trusts.
Figure 3
Is there enough evidence to show the Further Faster 20 programme has worked?
Our analysis supports the claim that waiting lists fell faster in FF20 trusts than in non-FF20 trusts between October 2024 and October 2025. However, it does not provide evidence that this can be attributed to the FF20 programme: one year on, we still lack the information needed to understand clearly what effects the programme has had.
Our analysis shows that the greater reduction at FF20 trusts has primarily been achieved through lower rates of referrals (per case on the waiting list) rather than through higher rates of completed pathways, which are higher in non-FF20 trusts. There has also been a significant increase in unreported removals in FF20 trusts, whereas unreported removals have fallen in the other trusts.
The lack of detailed data on referrals and unreported removals makes it challenging to interpret changes in FF20 trusts. The slower growth in referrals may reflect success in reducing demand for consultant-led care, while more unreported removals may signal more hospital appointments. On the other hand, slower growth in referrals may indicate reduced access to consultant-led care, and the faster growth in unreported removals may be the result of data cleaning.
This is not to undermine the work to reduce the waiting list in the FF20 trusts, or the work of the teams of clinicians deployed to support this. However, understanding more about the reasons for the changes seen at FF20 trusts, including the role of the programme, is important to enable other trusts to learn from these efforts and help them cut their elective care waiting lists. To do this, more robust evaluation of interventions like the FF20 programme is needed before conclusions are drawn about whether they have succeeded.
1. If 19 trusts were picked at random, we calculate that there would be roughly a 1 in 20 chance of observing a difference of this magnitude, or greater, compared with other trusts in England.