‘NHS must halve waiting lists to meet government 18-week target’, new study warns

The research, led by experts from the NHS, the University of Bath, Lancaster University and Durham University, show that between now and 2029, the NHS would need to make around one million additional removals from the waiting list each year – through completed treatment, surgery, or discharge where no further action is required.

It suggests the Labour government has set the NHS in England an ambitious target to restore the 18-week referral-to-treatment (RTT) standard by the end of the current Parliament.

Under the NHS England constitution, 92% of patients should wait no longer than 18 weeks for consultant-led elective treatment. This standard was last met in 2015, and in September 2025, just 61.8% of patients started elective treatment within 18 weeks or less.

According to the study’s modelling, the total elective waiting list must fall by 54.1% to reach the 92% standard. This is equivalent to making more than four million removals from the waiting list by 2029. 

The RCP has been clear that the 18-week milestone will not be reached if the current models of care remain. With the majority of people on NHS waiting lists in England in need of an outpatient appointment rather than an operation, the RCP says reform of planned specialist care is essential to reduce waiting lists. The college’s Prescription for outpatients published earlier this year sets out a roadmap for redesigning outpatient pathways to improve service efficiency and patient outcomes.

The study’s findings reveal significant variation in the scale of effort required to achieve this target. For instance, the East of England faces a particularly steep challenge, needing a 60% reduction in their waiting list.

Surgical specialists such as trauma and orthopaedics need to cut their waiting list the most, with cardiothoracic surgery seeing more harm from long waits. This evidence highlights the areas that will need significantly more support and resources to reduce their waiting lists.

Study author, Dr Richard Wood, said: 'This study underscores the challenge still required to improve waiting times. Since August 2022, numbers awaiting consultant-led elective treatment have remained above 7 million, with 61.8% currently waiting under the 18-week threshold. By our estimates, the waiting list is required to halve to 3.4m in order to restore the 92% 18-week target. The recent news of a 16,000 reduction in the numbers waiting is welcome. The Health Secretary has also suggested that forthcoming cuts to NHS bureaucracy is ‘enough to fund an extra 116,000 hip and knee operations’ each year. However, these numbers fall some way short of the 1 million extra annual waiting list removals that we estimate as being required to restore 92% 18-week performance by the end of the parliament. We await the budget, which we are told will – among other priorities – ‘focus on cutting waiting lists’.’

Dr Hilary Williams, RCP clinical vice president, said: ‘The NHS waiting list is more than just a figure. It represents real people that are likely living in pain and discomfort. This only gets worse as treatment is delayed, often leading to more complex and intensive care needs.

‘This study adds to the growing evidence that people in some regions are waiting significantly longer for elective treatment than others. These regional disparities are unjust and risks contributing to wider health inequalities.’ 

Dr Theresa Barnes, RCP clinical lead for outpatients, said: ‘Meaningful action to reduce the waiting list must prioritise a redesign of outpatient services that enables more efficient use of diagnostic and treatment capacity, such as the use of one stop clinics. For specialties caring for patients with long-term conditions, this will need to be balanced with an ever-growing requirement for follow up and surveillance. This too requires transformation so patients are better supported to self-manage, and clinicians can digitally monitor and deliver data-led risk stratification to reduce the follow-up burden, freeing up capacity for appointments that can remove patients from the list.’