Background
Waiting a long time for treatment can have detrimental effects on patients. It can result in worse prognosis, a need for more complex surgery, increased medication and slower recovery. Long waiting lists are also deeply unpopular with the wider population, and therefore a major concern for politicians and policymakers.
Since March 2010, the NHS Constitution has included a right for patients to start consultant-led treatment for non-urgent conditions within a maximum of 18 weeks of a GP referral. In 2012, it became a statutory requirement that at least 92% of patients should have a referral-to-treatment time of less than 18 weeks. In 2013/14, NHS England set an operational standard to ensure that no-one waits more than 52 weeks for treatment.
Following declining performance over more than a decade, which accelerated during the Covid-19 pandemic, interim targets have been set to improve performance and reduce long waits.
The QualityWatch performance dashboard includes the most recent monthly data on the waiting list, waiting times and targets.
Waiting list for elective treatment
In mid-2007, 4.2 million people were waiting for elective care, which reduced drastically to 2.3 million by February 2009. The number of people on the waiting list for elective treatment then grew steadily for a decade. In February 2020, just before the Covid-19 pandemic, there were over 4.4 million people on the reported waiting list, and together with the estimate for missing data the total number of people waiting for treatment exceeded 4.5 million.
In March 2020, the waiting list decreased: although elective activity fell during the first wave of the pandemic, there was a larger drop in GP referrals, resulting in an overall reduction in the waiting list. The total waiting list briefly reached a low of 3.9 million in May.
From May 2020 the waiting list for elective care increased rapidly, at a faster rate than prior to the pandemic to a peak of 7.75 million people recorded in August 2023. There has since been a slow decline, to 7.12 million in February 2026, in conjunction with a return to the pre-pandemic seasonal trend for the list to grow over the summer and shrink in the winter.
There have been successive recovery plans since the pandemic, initially focusing on reducing long waits for elective treatment – namely, to eliminate waits of over 104 weeks by July 2022, waits of over 78 weeks by April 2023, 65 week waits by March 2024, and 52 week waits by March 2025. The Elective Reform Plan set out a national 18-week elective care target of 65% by March.
Whilst intermittent industrial action across junior doctors, consultants, nurses and other NHS staff may have impacted efforts to reduce the waiting list, continued long waits come from a multitude of factors including growing demand, availability of funding for extra staff, and bed capacity, which in turn is impacted by the level of demand for emergency care.
Fundamentally, there has been a long-standing gap between patients being referred onto the waiting list, and patients starting treatment. The size of the waiting list is also impacted by how data is recorded: our analysis of issues behind the headline waiting list figures can be found here.
Waiting times for elective treatment
The proportion of patients who were either admitted for treatment, still waiting for treatment or a decision had been made that they did not require elective treatment within 18 weeks of a GP referral improved when performance targets were introduced for 90% of admitted patients and 95% of non-admitted patients to start treatment within 18 weeks of referral. For patients still waiting for treatment (the waiting list), the target was set at 92%.
Since June 2015, the admitted and non-admitted targets were abolished and the target for patients still waiting became the sole measure of treatment waiting time performance, set at 92%.
Performance against the 92% waiting list target decreased after it was introduced. The target was first breached in December 2015, when 91.8% of patients waited less than 18 weeks, and continued to decline.
Performance fluctuated at the start of the Covid-19 pandemic, when services were disrupted. Waiting times for treatment then continued to worsen through into 2023. While the figures are no longer getting worse, the NHS is struggling to meet the recovery objective to treat 65% of patients within 18 weeks by March 2026. In February 2026, only 62.5% of patients had been waiting less than 18 weeks to start elective treatment. Further waiting times are longer for patients requiring hospital admission to receive treatment.
Waiting times for elective treatment vary considerably by specialty. In January 2026, no specialty met the target of 92% of patients waiting less than 18 weeks. The specialties with the lowest proportion of patients waiting less than 18 weeks in January 2026 were plastic surgery (55%), oral surgery (54%) and ear, nose and throat (55%). These specialities were similarly positioned the previous year, though have seen some improvement. Conversely, the specialties with the highest proportion of patients waiting less than 18 weeks for the same month were elderly medicine (80%), mental health (80%) and other (unspecified) services (75%).
Innovations and policy change to reduce the waiting list are more effective in some specialties than others. Uptake of advice and guidance, an initiative to reduce new referrals onto the list, is higher in specialties which already have lower waits. Efforts to reduce ongoing outpatient activity to increase capacity for new cases, such as patient initiated follow-up, are also more effective for some patient pathways than others.
Long waits for elective treatment
The number of patients still waiting over 52 weeks for elective treatment after referral fell dramatically between 2007 and 2009 and then remained low until February 2020.
Between March 2020 and March 2021, the number waiting over 52 weeks increased sharply, from 3,097 to 436,127. The number of long waiters has since fallen, but despite efforts to eliminate 52-week waits by March 2025, in February 2026, 120,871 people were still waiting over 52 weeks. As the NHS focuses on reducing the overall size of the waiting list, there has been less focus on very long waits for care in recent guidance.
About this data
Once there has been a decision from a consultant that a patient needs treatment and they have been referred to a hospital, they are on the waiting list and the clock starts on their referral-to-treatment waiting time. There are three different treatment pathways that are measured each month:
- Admitted referral-to-treatment pathways are waiting times for patients whose treatment started during the month and involved admission to hospital.
- Non-admitted referral-to-treatment pathways are waiting times for patients whose wait ended during the month for reasons other than an inpatient or day case admission to hospital for treatment.
- Incomplete referral-to-treatment pathways are waiting times for patients still waiting to start treatment at the end of the month.
Since October 2015, no adjustments have been made to admitted referral-to-treatment pathways for clock pauses, where a patient declined reasonable offers of admission and chose to wait longer.
For further guidance on referral-to-treatment waiting times, please see the NHS England website.