NHS waiting lists in England have hit a record high, with 7.5 million people currently waiting for hospital treatment. What does the government have planned to reduce the backlog?

7 minute read

With the NHS rarely out of the news, ever-lengthening waiting times for everything from emergency ambulances to GPs to non-urgent surgery are one of the most complained-about areas of our National Health Service.

Waiting lists have hit a record high and there are currently 7.5 million people waiting for hospital treatment in England. Despite setting a maximum waiting time of 18 weeks, the NHS has not met this target since 2016 and over 3 million people have been waiting more than 18 weeks for treatment — the highest this has ever been.

So, what are the average waiting times in England? Why are waiting times so high? And what is the government doing to tackle NHS waiting times?

How long are NHS waiting lists in England?

Waiting lists for hospital treatment

Waiting lists for hospital treatment fell to just above 2 million between 2008 and 2009 before remaining relatively stable until 2012. From 2012 to 2020, waiting lists gradually increased year on year to just below 5 million. Following a slight drop at the start of the pandemic, waiting lists have since been increasing rapidly, reaching record levels of 7.5 million in 2023.

A&E waiting times

Until 2015, the number of patients spending more than four hours in major A&E remained below 10%. After 2015, this percentage increased with every subsequent winter reaching around 30% in 2020. After a pre-pandemic drop, the percentage of patients waiting for more than four hours for major A&E treatment skyrocketed to a record high of 50.4% in December 2022.

The number of patients waiting for a hospital bed after a decision to admit has spiked exponentially in the last few years. While this was a rare occurrence before 2020, figures from 2021 have risen steeply to record levels of over 50,000.

Waiting times for cancer treatment

The NHS target for cancer treatment states that 85% of patients should receive treatment for cancer within 62 days of an urgent GP referral. This target has not been met since 2014. Since 2018, the percentage of patients receiving cancer treatment within the 62-day limit fell sharply, reaching a record low of just 55% in January 2023.

Ambulance response times

With target ambulance response times set at 18 minutes, the reality of waiting for an ambulance in England has fallen drastically short of this in recent years.

In December 2022, the average response time for a category 2 call (strokes, heart attacks etc.) was one hour and thirty minutes. Response times have improved over the past two years but remain outside the target. Category 1 calls (life-threatening injuries/cardiac arrest) stayed around the target response time of seven minutes between 2019 and 2021, worsened in late 2021 and through 2022 before improving slightly, but still exceeding the target.

Mental health services

According to research released by the Royal College of Psychiatrists in 2022, almost a quarter of mental health patients (23%) waited more than 12 weeks between their initial referral and starting treatment.

43% of patients on this “hidden waiting list” said this delay had caused their mental health to worsen, 78% reported that they were forced to turn to emergency services or a crisis line while waiting for treatment, and a shocking 12% of mental health patients waited over six months for treatment, with 6% waiting for more than a year.

Why are NHS England waiting lists so long?

The bottom line as to why NHS waiting lists are so long is that demand for NHS treatment vastly outstrips the NHS’s capacity to meet that demand.

Due to chronic underfunding and staff shortages, waiting lists before COVID-19 were already lengthy, with 4.43 million people on the waiting list for consultant-led care in February 2020. However, the pandemic created a backlog of patients causing waiting lists to skyrocket.

The backlog

During the pandemic, most non-urgent services were put on hold. In addition, many people worried about over-burdening the NHS, or afraid of catching COVID-19, delayed seeking treatment, creating a backlog, and pushing up waiting times even further.  

This backlog consists of:

• Patients on a waiting list for treatment who would normally have been seen by now 

• Patients who have delayed going to their GP because of worries about burdening the health service or concerns about COVID-19 infection

• Patients who have had procedures cancelled

• Patients who have had referrals delayed or cancelled

• Patients who have had referrals refused due to a lack of capacity

Strikes

In addition to the backlog created by the pandemic, recent strike action by junior doctors has also had an impact on patient waiting times. In August 2023, NHS England stated that “to date, around 778,000 hospital appointments across the NHS have been rescheduled due to strike action.”

What is the government doing to tackle NHS waiting lists?

In March 2024, the government updated its 2023 mandate to NHS England in which it listed cutting NHS waiting lists and recovering performance as its first priority.

The government plans to do this by:

• Continuing to tackle the backlog in elective care by continuing to deliver the NHS delivery plan. This aims to enable the 80% of patients waiting for non-admitted care to be seen more quickly. The government aims that by March 2025, 95% of patients needing a diagnostic test should receive it within 6 weeks. This will be aided by the continued introduction of community diagnostic centres across the country.

• Improving cancer outcomes, including:

  • Improving 1-year and 5-year survival for all cancers

  • The NHS Long-Term Plan aims that 55,000 more people diagnosed with cancer in 2028 will survive for 5 years or more

  • Increasing early diagnosis and aiming to diagnose 75% of cancers at stages 1 and 2 by 2028

  • Continuing to expand diagnostic capacity including through community diagnostic centres, and give priority to people with suspected cancer, so that at least 75% of people referred urgently receive a diagnosis within 28 days

• Building on the existing patient’s right to choose their provider and continue the work of the Elective Recovery Taskforce to allow patients access to all providers of NHS healthcare where providers meet NHS costs and standards. Patients should be offered the choice of a minimum of 5 providers where possible. For those already on the waiting list, from October 2023, NHS England should ensure that the longest waiting patients can request to move to a different provider to receive earlier treatment if they choose and where clinically appropriate.

• Improving A&E and ambulance performance by delivering the urgent and emergency care recovery plan. This plan aims to admit, transfer or discharge 76% of patients within 4 hours by March 2024. The plan also aims to improve ambulance response times for Category 2 incidents to 30 minutes on average between 2023 and 2024.

• An increase in capacity, with 5,000 more beds as part of the permanent bed base for next winter and 800 new ambulances on the road, including specialist mental health ambulances.

• Services in the community will be expanded, increasing the use of urgent community response to help reduce avoidable admissions and the implementation of over 10,000 virtual ward beds by this autumn.

• Ensuring urgent mental health support through NHS 111 is universally accessible.

• Continuing to reduce delayed discharges by improving hospital discharge processes. Working through the Better Care Fund, the NHS, together with local authorities will increase capacity for intermediate care. This will be aided by an additional discharge funding of £600 million from 2023 to 2024 and £1 billion from 2024 to 2025, of which half will be issued via the NHS and half through local authorities

• Improving GP access by delivering the primary care access recovery plan. Patients should be able to access a GP appointment within 2 weeks, and those with urgent needs should be given an appointment on the same or the next day. The plan also includes improving access to GPs with the implementation of digital telephony including call-back services. Care navigation training and support should be provided to all practices that require it. By July 2023, all practices should have received support and been asked to sign up for digital telephony, with 1,000 transitioning before the end of 2023, and all practices having new digital tools available by the end of 2023.

How does Labour plan to cut NHS waiting times?

Unsurprisingly, Labour places the issue of spiralling waiting times squarely at the feet of the current government. But, with an election looming, and a shift to the left looking like a distinct possibility, how would a Labour government solve the problem?

Labour has outlined a mission to “get the NHS back on its feet,” which includes:

A child health action plan

Labour plans to create the healthiest generation of children ever by:

• Cutting waiting lists for children

• Ending the crisis in child mental health

• Transforming NHS dentistry

• Cracking down on smoking and vaping

• Banning junk food advertising to children

• Introducing breakfast clubs for all primary school children

• Protecting children from the growth of infectious diseases

Ending unacceptable waits

Labour plans to drive down waiting times and get patients diagnosed earlier by creating an extra 2 million operations, scans, and appointments in the first year.

Dentistry Rescue Plan

Labour plans to provide 700,000 extra dental appointments each year and introduce a targeted recruitment fund to attract more dentists to the communities that need them most. Labour also plans to reform the NHS dentistry contract so that everyone who needs an NHS dentist can get one.

A Neighbourhood Health Service

Labour plans to bring family doctors, district nurses, care workers, physiotherapists, and mental health specialists together under one roof in Neighbourhood Health Centres.

Technology and early diagnosis

Labour’s Fit For The Future Fund plans to double the number of state-of-the-art CT and MRI scanners to ensure early diagnosis, allow patients access to technology so they can take control of their own medicine, appointments, and health needs via their smartphones, introduce at-home tests for kidney disease, with results sent to your smartphone, and implement the use of AI to diagnose cancer from scans.

Better public health

Includes measures such as banning the promotion of vaping and junk food to young people and supporting an incremental ban on smoking.

Mental health

Labour plans to recruit 8,500 additional mental health staff to drive down waiting lists, and make sure every young person has access to a specialist mental health professional at school. Labour’s Young Futures plan, aims to allow young people in every community open access to mental health hubs providing early intervention through drop-in services.

Conclusion

While long NHS waiting lists are nothing new, the pandemic has served to amplify the problem, creating a backlog that has seen waiting times soar to record levels in recent years.

Add to this the ongoing problems within the health service of chronic underfunding, poor staff recruitment and retention and a dissatisfied workforce, and waiting weeks or months for NHS treatment has become a worrying, and at times dangerous normality for many.

As successive governments try to tackle the complex and deep-rooted issues within the NHS, cutting waiting times remains at the top of the agenda. With an election looming, and both Labour and the Conservatives offering long-term plans to reduce waiting times, it falls to the British public to decide who gets their vote.