Two years down, three to go: is progress on waiting times stalling?

In 2024, then Prime Minister Keir Starmer made restoring the 18-week constitutional standard for elective treatment in England by the end of the parliament Labour’s top priority for the NHS. Achieving this is a sizeable challenge given that, when the government came to power in July 2024, the waiting list stood at 7.62 million – a near-record high – and only 58.8% of waits were within 18 weeks. More than 290,000 waits were longer than 52 weeks. 

In September 2025, we assessed the progress made in the first year of the Labour government. Our analysis projected that if referrals to and removals from the waiting list continued growing at the same pace, the government would fall just short of delivering on its headline pledge. By July 2029, the 92^nd percentile waiting time would fall from 44.6 weeks in July 2024 to 20.3 weeks, rather than to 18 weeks as pledged. While narrowly missing the standard, this projection showed that it was possible to make substantial progress by 2029 – as long as removals continued to substantially outpace referrals. 

Our analysis also highlighted that referrals grew more slowly than in pre-pandemic years, and that any future ‘rebound’ in referrals would further reduce the chances of restoring the 18-week standard by July 2029. 

So what does progress look like 2 years into the Labour government and what does this mean for its chances of meeting the headline commitment?

Between July 2024 and July 2025, modest progress was made in bringing down the overall waiting list (falling from 7.62 million to 7.39 million), tackling long waits (reducing from 290,000 to 191,000), and improving the percentage of waits within 18 weeks (increasing from 58.8% to 61.3%). But what progress was made in the year that followed?

An analysis we published earlier this year showed a mixed picture on performance against the interim targets for March 2026 set in the 2025/26 NHS planning guidance. The waiting list dipped below 7.11 million, its lowest level since August 2022. There were around 94,400 waits over 52 weeks: 1.3% of the total, missing the 1% target. The national interim target of 65% of waits within 18 weeks was reached – a level not achieved since November 2021. However, almost 4 in 10 trusts did not achieve their targets of at least 60% of waits within 18 weeks and a 5 percentage-point improvement since November 2024. Unless addressed, this variation poses a challenge for achieving the main 18-week target. 

In the year to July 2026, the waiting list fell by 62,000 from 7.39 million to 7.33 million (Figure 1). Nearly 111,400 waits were longer than 52 weeks; 1.5% of all waits. The proportion of waits falling within 18 weeks improved from 61.3% to 65.4%, and 92% of waits were 38.4 weeks or less, a drop from 41.8 weeks.

Our latest analysis shows that performance faltered between March and July 2026 so that, overall, there was less reduction in waiting list size in the year to July 2026 compared with the previous year, though there was better progress in improving the percentage of waits within 18 weeks. Several factors might have contributed to this, including better targeting of waits longer than 18 weeks, and a more rapid increase in referrals leading to more people experiencing shorter waits – something we explore further below.

To cut the waiting list and make long-term, meaningful improvements to waiting times, removal growth needs to outpace growth in new referrals. 

Here we look at what progress since July 2024 can tell us about whether the 18-week standard is likely to be restored by July 2029. Our findings are not a prediction of what will happen, but a projection if recent trends continue. 

Between the year to July 2024 and the year to July 2026, referrals increased from 20.77 million to 21.73 million, an annualised growth rate of 2.3%. In this time, total removals from the waiting list (‘completed pathways’ plus unreported removals) also increased by 2.3% (from 20.83 million to 21.79 million). 

In the year to July 2025, removals growth outpaced referrals growth by almost one percentage point. However, in the 2 years to July 2026, removals have been growing at the same rate as, rather than outpacing, referrals. It suggests that removals will outnumber referrals by a much smaller margin than we projected at the same time last year, when our analysis suggested there would be almost 1 million more removals than referrals in the year to July 2029. Consequently, our projections for progress towards the target are less optimistic. We project that – if these growth rates continue for the next 3 years – the waiting list will reduce to 7.11 million in July 2029 (from 7.62 million in July 2024) and that 92% of waits will be within 34.9 weeks (Figure 2). If achieved, this would represent some progress compared to the 44.1 weeks seen at the start of the current parliament in July 2024, but it would remain a long way off the 18-week target.

Figure 2 also shows our early 2025 projections for what it would take to meet the target by July 2029. It shows that as of July 2026, performance has fallen behind where it needed to be (with 92% of waits within 38.4 weeks, rather than 37.4 weeks) – and our latest projections suggest this gap is set to widen even faster over the next 3 years. 

While the annualised growth rate considers progress across the whole 2-year period (between July 2024 and July 2026) for the basis of our projections, understanding what has happened within – not just across – those individual years is also informative: 

• Annual removals growth has remained broadly constant across the past 2 years (2.4% and 2.2% respectively). 
• Unreported removals increased slightly (by 0.6%) in year two compared with year one. This was unlike year one when growth in unreported removals (3.9%) seemed to be a key driver of reductions in the waiting list. 
• Referral growth more doubled from 1.5% in the first year to 3.0% in the second year. 

The year-on-year change in referral growth has important implications for likely progress towards the government’s 18-week target, as shown in Figure 3. We projected a range of scenarios based on referral and removal growth rates varying from 1.5% to 4.5% each year until July 2029. These scenarios are helpful to highlight the impact of changing referral growth on waiting times in the future, and to identify what removal growth might be needed to meet the target for a given referral growth. Notably:

• If referral and removal growth averages out around 2.5% per year over the next 3 years – a similar rate as observed across the past 2 years – we project 92% of waits will be within around 35 weeks by July 2029 (see highlighted cell in Figure 3). If this referral growth continues, the removal growth would need to be between 4.0% and 4.5% each year until July 2029 to reach the 18-week target. 
• However, if referrals carry on growing at the past year’s rate of 3.0% per year for the next 3 years (overtaking the growth in removals) we project 92% of waits would last up to around 39 weeks, longer than in the projection above. Under this higher referral growth scenario, growth in removals would need to be above 4.5% to restore the 18-week target by the end of the current parliament.

Overall, referral growth in the next 3 years will be a key determinant of how close the NHS will get to achieving the target – yet how fast referrals will rise remains a key unknown. Figure 3 shows that achieving 92% of waits within 18 weeks would require removals growth to exceed referrals growth by 1.5–2 percentage points (ie 4–4.5% growth in removals for a 2.5% growth in referrals) over the next 3 years.

Progress in removals has been shaped by several policies that will affect future trajectories for the waiting list and waiting times.  

Elective sprints

NHS England launched a sprint in January 2026 to drive better elective performance in pursuit of the March 2026 interim target. It awarded up to £120m primarily to increase outpatient activity, where around 80% of pathways end. Given the sharp uptick in performance following the sprint’s launch and in the run-up to March 2026, it seems likely that this initiative proved crucial in helping to reach the interim target of 65% of waits within 18 weeks. There are, however, questions about the sustainability of the pace of change driven by sprint efforts like this, with the waiting list increasing by more than 222,000 (3%) and long waits by almost 17,000 (18%) between the end of the sprint in March and July 2026.

Waiting list validation

Validation activities focus on reducing waiting lists through a range of tools designed to identify patients who can be removed from these lists. The lack of transparency around reasons why ‘unreported removals’ leave the waiting list has raised some concerns about these validation efforts. Ultimately, reducing waiting lists and waiting times depends on the ability of the NHS to treat patients more quickly. The extent of progress made in the past 12 months – with completed pathways growing by only 500,000 – raises questions over whether the NHS is achieving sufficient long-term growth in elective care activity to meet the 2029 target. 

Wider factors

Several other developments may be contributing to the stagnant growth in removals. Industrial action by resident doctors across three periods in 2025 and in April 2026 may have impeded elective care activity. Recent analysis from the Institute for Fiscal Studies draws a possible link between NHS budgets being more strictly adhered to in 2025/26 and slower activity growth (across all forms of hospital activity) – given the slower projected future growth in NHS spending, the possible impacts on elective activity warrant further attention.

We highlighted above that in the year to July 2026, referrals grew at double the rate of the previous 12-month period (3.0% vs 1.5%) and overtook the growth in removals – supporting our previous argument that the lower level of referrals seen in the year to July 2025 was unlikely to continue. 

Referrals are growing faster than both before the COVID-19 pandemic and in 2023/24. Faster growth in referrals means the NHS will need to scale up activity more quickly, increasing removals to keep pace, to continue progressing towards the 18-week target. Understanding the drivers of referral growth is useful to anticipate how much activity growth will be needed in the coming years. 

The increase in referrals was not driven by outlier integrated care boards (ICBs) or specialties (although there was substantial variation across ICBs – from a 7% decrease in referrals in Essex to a 9% increase in Cornwall and the Isles of Scilly). The largest referrals increase across specialties was seen in elderly medicine (+8%).

Referrals by GPs seem to be primarily driving this growth (531,000 more referrals in the year to July 2026 compared with the previous year) rather than referrals by consultants (132,000 fewer) or other sources (23,000 fewer). It is unclear why referrals by GPs have increased so quickly in the past year. Improvements in access to GP appointments, highlighted in the most recent General Practice Patient Survey, and reductions in waiting times may both be encouraging people to seek help from GPs. This could mean that the government’s efforts to improve primary care access are, inadvertently, limiting progress on elective care. In addition, Advice & Guidance (A&G) services, which allow GPs to request advice from a consultant before making a referral, have been scaled up in recent years. Pre-referral requests have increased by around 15–20% annually for the past few years, representing an additional 693,000 requests in the year to July 2026 – although it is unclear how A&G has affected referrals by GPs.

Our projections indicate that, despite the NHS achieving its interim target for March 2026, restoring the 18-week standard by 2029 will be very challenging. The next milestone will be March 2027, the deadline for an interim NHS target of achieving 70% of waits within 18 weeks, with individual trusts facing more ambitious targets than in 2026. Moreover, inequalities in waiting times persist across ICBs, deprivation areas and by ethnicity – raising questions about how equitable the elective care recovery is. 

Understanding why referrals have grown so quickly in the past 12 months is important to help understand whether this may continue and what this may mean for future demands on elective care services. The introduction of a Single Point of Access – expected to be rolled out from 1 October 2026 – is intended to streamline triage for referrals and could help relieve pressure on elective care services. But concerns have recently been raised about associated risks if pathways are “poorly designed or inadequately monitored”.  

To make progress towards meeting the 18-week target by the end of the parliament, many more patients need to be treated, more quickly. Additional funding and efforts by staff across trusts led to less than 500,000 more completed pathways in the past 12 months than in the previous year, not enough to outpace the growth in referrals. 

Improving productivity could also play a role. As our NHS Productivity Commission has shown, increased funding and staff numbers since the COVID-19 pandemic have not translated into corresponding gains in patient care. This is a complex problem in need of thoughtful solutions, but there is room to improve productivity in elective care, for example by reducing unnecessary appointments and repeated tests, which have contributed to the rising average number of appointments needed before a patient leaves the waiting list. 

The government has announced several policies which aren’t accounted for in our projections, as they were rolled out towards the end of our data period. For example, protected budgets for reducing waiting lists for the financial year 2026/27 may help drive a sharper growth in the volume of removals. Additional funding for community diagnostic centres announced in April 2026 may not yet be contributing to additional capacity to reduce waiting times for diagnostic tests.

Prime Minister Andy Burnham’s government has not yet indicated whether restoring the 18-week standard will assume the same priority as it did under the Starmer administration. Either way, the prospects of meeting the target are receding. While the government should not give up on bringing down waiting times when millions of people are still waiting too long for treatment, setting a more realistic target would enable the NHS to continue to make progress on elective care and to focus more on improving other key aspects of care that are also important to the public.