One year on: is the government on track to meet its waiting times pledge?

After the 2024 election, the new Labour government put hospital waiting lists at the top of its agenda by committing to restoring the 18-week standard for elective treatment in England by the end of the parliament. Here, we look back at what progress has been achieved in Labour’s first year in power and update our waiting list projections to see whether the government is on track to meet its aim.

Tackling the elective backlog was a key manifesto commitment and as a first step Labour pledged to deliver an extra 2 million NHS operations, scans and appointments every year – 40,000 more per week. 

Additional NHS funding in the Autumn Budget 2024 was explicitly linked to cutting waiting list backlogs. In late 2024, the government committed to meeting the NHS constitutional standard of 92% of waits lasting less than 18 weeks for elective care by 2029, making this its top priority on health for this parliament. A new elective care recovery plan was published in January 2025 alongside a set of interim targets for March 2026. The plan featured several policies, including making greater use of the private sector, increasing the use of advice and guidance (A&G), and expanding the number of surgical hubs and community diagnostic centres.

The 18-week standard hasn’t been met for nearly a decade, and the pandemic left a substantial waiting list backlog. Recovering this standard within a 5-year parliament is very ambitious and will be a huge challenge.

The manifesto commitment to deliver 40,000 additional appointments per week has been met and exceeded. However, the extra appointments, scans and operations have not resulted in an equivalent increase in patients completing pathways and being removed from the waiting list. The reason is that patients are only removed from the waiting list upon starting treatment or being discharged from consultant-led care, and some may require multiple appointments and scans to reach this stage. 

This helps to explain why the progress made in improving waiting times during the government’s first year in power has been relatively modest. The percentage of waits within 18 weeks improved from 58.8% in July 2024 to 61.3% in July 2025. Over the same period, the percentage of waits over 52 weeks decreased from 3.8% to 2.6% and the total waiting list decreased by 220,000, from 7.62 million to 7.40 million (Figure 1) – short of the 243,000 fall our previous projections estimated was needed.

Overall, the waiting list is in a slightly better shape than when Labour took office. It is difficult to know how much of this change is attributable to the policies introduced by the new government, especially considering the broadly similar approach taken by the previous administration. It is also unclear how much of this improvement is due to successfully increasing the number of patients treated rather than recent validation exercises to review and correct waiting list data. 

The government has set interim targets that, by March 2026, national performance against the 18-week standard should reach 65% – with every trust expected to deliver a 5-percentage-point improvement – and waits longer than 52 weeks should reduce to below 1% of the total waiting list. NHS England’s Director of Elective Care, Cancer and Diagnostics, Mark Cubbon, recently acknowledged that the NHS has ‘more to do’ to meet interim targets. Our analysis confirms this: 

• The percentage of waits within 18 weeks increased from 59.2% in November 2024 (the baseline in the planning guidance) to 61.3% in July 2025. If this monthly increase is sustained, the percentage within 18 weeks would reach 63.4% in March 2026 – narrowly missing the 65% interim target.
• The other interim targets are set to be missed by wider margins. Overall, only 54 of 144 trusts (38%) are on track to achieve a 5-percentage-point increase by March 2026, meaning around two-thirds are on course to miss this target.
• The proportion of waits longer than 52 weeks decreased from 3.0% (222,000) in November 2024 to 2.6% (192,000) in July 2025. If change continues at the same pace, 2.2% of waits would be over 52 weeks by March 2026 – well above the 1% interim target. 

Our projections ignore seasonal fluctuations in the data, which may affect our estimates.

To reduce the waiting list and deliver the 18-week standard, patients already waiting for elective care need to be removed from the waiting list at a faster rate than new patients are referred onto it. Removals include reported removals (also known as ‘completed pathways’) and unreported removals, which don’t appear directly in the data but can be calculated (Box 1).

Before the pandemic, referrals were growing by 2% per year. If referral rates start to increase faster than the 1.5% seen in the past year without a similar increase in removals from the waiting list, the target will be more difficult to achieve. 

Lower than usual referral growth may be partly explained by the scaling up of advice and guidance (A&G) services, which allow GPs to seek specialist advice without needing to refer the patient onto the waiting list. While the previous government’s elective recovery plan already sought to expand the use of A&G, Labour has gone further by offering GPs a financial incentive of £20 per request to encourage uptake. This may be contributing to referrals growing more slowly than before, as requests for A&G are not counted in the main waiting list statistics. 

Between August 2024 and July 2025, we estimate there were 13.5% (172,000) more ‘pre-referral diversions’ – cases where A&G was sought and a patient was not referred onto the waiting list – than in the previous year (see Technical appendix). Had all diverted patients been referred instead, referrals would have increased from 22.0 million to 22.5 million, suggesting the underlying demand is growing by around 2.2% per year (substantially higher than the 1.5% growth in referrals). 

The large increases in the use of A&G since the pandemic are likely to stabilise over time as the proportion of patients appropriately diverted to A&G reaches a natural ceiling. This could see annual referral growth return to historical rates. 

In the longer term, as waiting times go down, GPs and consultants may also be more likely to refer people with less severe conditions and patients may be less likely to seek care privately, which could also contribute to NHS referrals growing faster in future. 

If referrals continue to grow by 1.5% per year, our analysis suggests removals from the waiting list would need to accelerate to at least 2.5% per year to meet the 18-week target by the end of the parliament. If referrals grow above 1.5% per year, removals will need to grow by more than 2.5% per year.

Faster increases in removals may be challenging to deliver. More unreported removals than usual occurred after a validation exercise in April 2025, and unreported removals grew faster than reported removals in the past year, thereby helping to drive the growth in removals. In addition, the total waiting list has decreased over the past couple of years despite referrals outnumbering reported removals throughout this period. This indicates that unreported removals have played a key role in decreasing the waiting list. 

The reasons for unreported removals are not well understood, which makes it unclear how they are likely to change in future. If unreported removals are primarily due to data glitches, they will likely grow more slowly, while if they mostly represent completed pathways recorded with a delay, then their growth over the past year is a positive signal that activity is increasing.

Whether NHS staff will take further industrial action is another unknown. We estimated previously that industrial action had only limited direct impact on the postponement of operations and appointments. However, the direct impact of additional strikes and the indirect impact on efforts to improve productivity could compromise future growth in removals, taking the government further away from the 18-week target.

Bringing 92% of waits within 20.3 weeks by the end of the parliament (down from 41.8 weeks in July 2025) would represent huge progress from the waiting list peak in the wake of the pandemic – albeit falling short of the 18-week standard. Our analysis assumes that referrals and removals will continue to grow at the same rate as the past year. However, there are several factors that may change recent trends. If referrals increase more quickly in future, or the NHS is unable to maintain the recent growth in removals, this would lead to the standard being missed by a wider margin.

Meeting the target will require renewed work to expand capacity and increase activity, informed by a clear understanding of the most effective interventions. It is also essential to focus on delivering the commitment in the elective recovery plan to an equitable recovery by doing more to address the longer waits faced by people of Asian, Black or mixed backgrounds and those living in more deprived areas. The focus on the 18-week standard could mean slower progress in other areas, such as improving access to general practice and reducing waiting times in A&E. 

The government needs to be able to demonstrate to the public that its efforts are resulting in meaningful progress in improving care. Our latest polling with Ipsos found that only 24% of people correctly identified that the waiting list had decreased in the 12 months since the general election was called.

The progress made in reducing waiting times is promising and is an important step towards ensuring patients can access the care they need in a timely way. However, it will be vital to continuously increase the number of patients removed from the waiting list each year – particularly if referrals grow faster than expected – for the government to meet the 18-week standard before the end of the parliament.