What would 2 million more operations, scans and appointments do to the NHS waiting list?

With waiting times in the NHS struggling, one pledge made by Labour ahead of the summer election was that, under their leadership, there would be an extra 2 million NHS operations, scans and appointments every year. Sarah Scobie and Theo Georghiou assess what that would mean for waiting times in the health service.

Chart of the week

Published: 17/10/2024

Among the many headline-grabbing insights from Lord Ara Darzi’s recent report on the NHS was the assessment that “it is unlikely that waiting lists can be cleared and other performance standards restored in one parliamentary term”. In other words, Labour’s pledge to restore performance to the constitutional standard (for 92% of people to be seen within 18 weeks from referral to treatment) by the end of the parliament is not feasible.  

This will not come as news to anyone who has been paying attention to the slow deterioration of NHS waiting times performance. As we showed in our pre-election briefing (in a chart replicated in Darzi’s report), the last time the NHS met all constitutional standards was over eight years ago. It is going to be a long, hard road to get back on track with waiting times in the NHS.  

So, with Labour now having completed over 100 days in government, what of their other big waiting times pledge: that there will be an “extra 2 million NHS operations, scans, and appointments every year; that is 40,000 more appointments every week”. What does that mean in practice? How much difference will it make to the waiting list, and to waiting times for patients?

The short answer is: we don’t know.

Looking just at outpatient appointments, a growth of 2 million is very modest in the context of the volume of outpatient appointments each year, and recent growth from year to year. There were 9 million more attended appointments in the year to March this year than in the previous year (104.6 million compared to 95.6 million).

Another challenge is that the promise covers a combination of activities. As well as outpatient appointments (of which under 80% are attended), there are scans, diagnostic tests and procedures which are carried out for patients who have been admitted to a hospital ward (either as a day case or overnight).

Assessing the impact of additional appointments on waiting times and the waiting list is difficult, because extra appointments don’t translate directly into removing people from the waiting list. During July this year, there were over 9.4 million outpatient appointments attended, but only 1.27 million treatments started for patients who were not admitted to hospital. The criteria that determine when patients come off the list include starting medical treatment, having a therapeutic operation, or agreeing with a specialist that no treatment is needed.

Many people will have more than one appointment – such as for diagnostic tests – before they are taken off the waiting list, or will need further appointments to monitor treatment. Similarly, not all operations are the start of treatment – some are diagnostic tests, or follow-up treatment. The chart below illustrates this by comparing the scale of different planned care events during July this year.

Finally, how the size of the list translates to whether people receive treatment more quickly also depends on how providers prioritise patients and ensure fair access to care. This is based not just on when they were referred, but on how urgent their problem is, and capacity within specific services or for people with specific conditions. There are significant inequalities in planned care between more and less deprived areas that appear to be increasing

Increased capacity will help in the long run – whether the appointments are for assessments, diagnosis or treatment. But the additional capacity promised so far won’t make much headway to get the waiting list down, or to how quickly the NHS meets the target of 92% of patients starting treatment within 18 weeks of referral.

 

Data notes:

Attended outpatient appointments: NHS Digital

Treatment starts and referrals onto the waiting lists obtained from NHS England Referrral to Treatment (RTT) data on clock stops (sum of admitted and non-admitted pathways) and new RTT periods: NHS England.  

Elective admissions with a procedure were extracted from Hospital Episode Statistics Admitted Patient Care data, grouped by month based on month of admission. The data for July 2024 is provisional.

Attended outpatient appointments not starting treatment are estimated from subtracting RTT non-admitted treatment starts from total outpatient attendances. Inpatient diagnostic and follow-up procedures have been estimated from subtracting RTT admitted treatment starts from elective admissions with a procedure.

This work uses data provided by patients and collected by the NHS as part of their care and support. Read more on our website www.nuffieldtrust.org.uk/about/corporate-policies#informationsecurity-and-data. The analysis uses Hospital Episode Statistics (HES) data (year 2024/25). Copyright © 2024, NHS England. Re-used with permission of NHS England. All rights reserved. A data-sharing agreement with NHS England (DARS-NIC-226261-M2T0Q) governed access to and use of HES data for this work.

Suggested citation

Scobie S and Georghiou T (2024) “What would 2 million more operations, scans and appointments do to the NHS waiting list?”, Chart of the week, Nuffield Trust

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