Every acute hospital trust in England is failing to hit Keir Starmer’s key target to treat 92% of patients within 18 weeks, analysis of NHS figures reveals.
The new data exposes the scale of the challenge facing the prime minister this year as he tries to reform the NHS. The most recent waiting list data reveals that in some hospital trusts, more than half of patients are waiting longer than 18 weeks. Out of 124 acute trusts across the country, none are hitting the target, according to analysis of the figures by the Observer.
Starmer set out his “milestones” earlier this month, which included clearing hospital backlogs to meet the NHS standard of 92% of patients waiting no longer than 18 weeks for elective treatments. This standard was last met in September 2015. A 10-year plan to reform the NHS is due to be published in spring.
The most recent figures published for October show the waiting list stood at 7.54m cases, consisting of approximately 6.34 million individual patients waiting for treatment. About 3.1m cases on the list had been waiting more than 18 weeks for treatment and 234,885 had been waiting more than a year for treatment.
Some specialist and community trusts are meeting the target to treat 92% of patients within 18 weeks, including Kent Community Health NHS Foundation Trust, South West Yorkshire Partnership NHS Foundation Trust and the Royal Marsden NHS Foundation Trust.
Acute hospital trusts provide services such as emergency departments and a wide range of typically short-term treatments. Hospital trusts where more than half of patients were waiting more than 18 weeks for treatment in October 2024 include Manchester University NHS foundation trust, Milton Keynes university hospital NHS foundation trust and University hospitals Sussex NHS foundation trust.
An analysis by the NHS Confederation in September reported that by 2028/29 the NHS will need to undertake 50% more elective activity than it is currently achieving to sufficiently clear the backlog on the waiting list to hit the 18-week standard.
It said the government’s promise of an extra 2 million appointments, operations and diagnostics a year addressed only about 15% of the additional capacity required for clearing waiting lists and hitting the 18-week target over the long term, and would need to be accompanied by additional change and reform.
Matthew Taylor, chief executive of the NHS Confederation, the membership organisation for the healthcare system in England, Wales and Northern Ireland, said there was progress in reducing the long waits, but hitting the 18-week standard was a “stretching target”.
He said: “The critical figure is how long people are waiting. Those longest waits have been slowly coming down, and one would expect them to continue to go down.
“We can see the trajectory, but it’s a pretty shallow path, and at the moment it doesn’t take you to meeting the 18-week standard.”
Taylor said more fundamental reforms were required of the NHS to cope with mounting pressures on services. He said the health service faced a “graph of doom”, in which people were getting sick at an earlier age and staying sick for longer.
He added: “The history of the NHS over the last 25 years has been of a series of commitments to shift resources upstream, out of acute into the community, into prevention, all of which have failed to be delivered as a consequence of short-term pressures, which lead to short-term interventions.
“The critical thing we need to do is improve healthy life expectancy and to better manage long-term multiple conditions. If we don’t address the graph of doom not only does the health service become unsustainable, but so does the whole country.”
Chancellor Rachel Reeves announced a £22.6bn cash injection for day-to-day running costs for the NHS plus a £3.1bn increase for the capital investment over two years in the autumn budget.
Lord Crisp, who was chief executive of the NHS in England when a major NHS Plan was announced in 2000 to boost performance with a new package of funding, said he welcomed the focus on community health to prevent hospital admissions and encourage healthier lifestyles.
He said the challenges were greater than two decades ago and the government should consider a summit with employers, food companies, housing providers and other partners on delivering a healthier nation. “The situation is worse than in 2000,” he said. “You won’t reduce waiting lists unless you invest heavily in community care, primary care and social care. You will just knock them down a bit, and then they will rise again.”
An NHS spokesperson said: “Thanks to the hard work of NHS staff embracing the latest technology and introducing innovative measures such as surgical hubs, the latest data from October 2024 shows the waiting list fell by over 160,000 when compared to the previous year.
“Waits of more than two years were virtually eliminated on target by July 2022 while the number of waits longer than a year (234,885) is the lowest since December 2020, and the number of patients waiting longer than 18 weeks (3.1 million) is the lowest since June 2023. We will be working with the government to return to treating 92% of patients within 18 weeks by the end of the parliament.”
A Department of Health and Social Care spokesperson said: “Our plan for change sets an ambitious but achievable milestone as we tackle the inherited NHS backlog. We will deliver an extra two million appointments in our first year – the equivalent of 40,000 more every week.
“We’re already making progress, sending crack teams of top clinicians to hospitals across the country to help make their surgeries more productive, and the extra £26bn we secured for the NHS will pay for new surgical hubs, scanners and beds as we cut waiting times and get the NHS on its feet.”A spokesperson for Manchester University NHS foundation trust said: “We’re committed to achieving our goals to reduce waiting times for elective care and provide the best possible services for patients. We’ve seen some really encouraging success with our elective hubs. Our Trafford Hub alone has performed over 7500 operations in the last twelve months. We will continue to innovate to give patients the care they need, when they need it.”
A spokesperson for Milton Keynes university hospital NHS trust said: “Since May this year, the number of patients waiting the longest has been reduced by more than half. Having now improved the longest waiting times, we will continue to do everything we can to drive down waiting times for all patients.”
A spokesperson from University hospitals Sussex NHS foundation trust said: “We are providing additional clinical capacity as well as making the most of new community diagnostic centres. As a result, our waiting lists have fallen faster than most other trusts in the country by around 30,000 since its peak, which is close to a 20% reduction. We will keep working at this pace to ensure people receive safe, high-quality care.”
