What needs to be done to hit the NHS' 18 week target?

“[The government will] get a grip on record waiting lists”. The Prime Minister has reaffirmed the government’s commitment to meeting NHS waiting time targets. In doing so, he has invited voters to judge his government on its success in meeting that goal. The stakes couldn’t be higher – for the politicians, yes, but more importantly for the millions of people currently waiting in uncertainty, pain and distress for NHS treatment.  

Cutting waiting times will not be easy. It will require focused and sustained effort from all parts of the healthcare system. And this includes independent providers who already deliver one in five NHS inpatient procedures. So, what can we expect from the months and years to come if we are to achieve the ambition of returning to NHS constitutional standards? Let’s do the maths.  

The waiting list stands at 7.5 million.  

But, of course, people join and leave the waiting list all the time. People join when they are referred by a GP or other health professional and they leave when their treatment starts or it’s decided that they don’t need treatment – often when a diagnostic test gives the ‘all clear’. It’s important to remember that most of the people on the waiting list are not actually waiting for an operation but for a diagnosis.  

And the simple point is that the NHS needs to ensure that more people leave the waiting list than join it. 

Helpfully, we know two important facts. First, the rate at which people join the waiting list. And at the current level, 90.8m people will join the waiting list between now and the end of the parliament.  

Second, the number of ‘clock stops’ which is the rate at which people leave the waiting list. And at the current rate, 80.7 million people would leave the waiting list between now and the end of the parliament.  

Of course, the aim is not to get the waiting list to zero but to get back to the 18 weeks waiting standard.  

IHPN calculates that to achieve this, the whole system needs to deliver 17 million more ‘clock stops’ than it is currently on track to. 320,000 a month, or a 21% increase on current activity levels.  

This can be done! For example, we know that there is massive variation between the least and the most productive services – so much can be achieved just by spreading best practice around the system. 

But independent providers have a role to play too and, especially in areas like ophthalmology, have shown their ability to quickly ramp up activity levels. We are confident that independent providers are more than ready to increase activity in proportion to the need – with that 21% a realistic benchmark. 

Increasing independent sector activity by 21% would mean approximately 95,000 additional appointments every month. We know from our members that each month around 90,000 appointment slots are made available but not filled by NHS patients. This has to change – including by ensuring that patients are aware of their right to choose an independent provider for NHS treatment. Using all that available capacity would go a long way to setting the NHS on track to deliver improved access. 

The Prime Minister has laid out the challenge. And the next few months are crucial – with an upcoming NHS 10 year plan giving the long-term view and NHS Planning Guidance outlining what can be achieved in 2025/26. We need to start planning now for a big increase in NHS activity levels – both in Trusts and the independent sector. After all, with every week that passes the challenge only gets bigger.