Waiting times

The waiting list illusion is over.

The illusion that the backlog had been brought under control has lasted barely long enough for the congratulatory speeches to be delivered.

There was a time, not so long ago, when a Wes Streeting ministerial victory lap greeted every NHS waiting list release. A few thousand fewer patients waiting led the media to report that the Government had “turned the corner”. The public was assured that the NHS was finally getting back on its feet.

Curiously, those celebrations have become rather quieter.

The latest NHS England figures tell a story that ministers would prefer not to discuss. The Referral to Treatment waiting list has risen for two consecutive months, from 7.11 million pathways in March to 7.28 million in May 2026.

Around 2.5 million patients are still waiting beyond the 18-week constitutional standard. More than 105,000 have waited over a year, an increase on the previous month. The median wait remains 12.4 weeks, a long way from the pre-pandemic norm of 7.7 weeks.

For much of the past year, critics questioned whether the reported reductions represented genuine improvements in NHS productivity. The number of patients treated simply did not account for the magnitude of the fall. The Nuffield Trust repeatedly pointed out that completed treatments remained below the number of new referrals. If more patients are joining the queue than leaving it through treatment, the queue should grow, not shrink.

However, something else was happening. That something was called “validation”, a wonderfully antiseptic bureaucratic term that conceals a very simple reality: removing patients from waiting lists.

Between April and September last year, NHS England allocated £18.8 million to hospitals for waiting-list validation. Hospitals received around £33 per patient to review and remove individuals from elective waiting lists if deemed clinically appropriate, resulting in about 567,000 removals in six months. For example, the Shrewsbury and Telford Hospital NHS Trust removed 14,148 patients and received over £460,000 in payments.

So what happened to these patients? Because NHS England has not published a detailed breakdown of waiting list removals by reason, we don’t know. Were they kicked off only to rejoin?

One might have expected such a significant intervention to attract rather more public debate. Instead, the reductions in waiting lists were presented as evidence that the Government’s recovery plan was succeeding.

So, the awkward question was never properly answered: if treatment numbers alone could not explain the reductions, how much of the improvement reflected administrative removals rather than expanded clinical capacity?

Now the question answers itself: Despite the validation exercise, hundreds of thousands of additional removals from the waiting list, and months of ministerial optimism, the backlog has started climbing once more.

Worryingly, this is happening in spring. Anyone familiar with NHS operations understands why that matters. Winter is when elective services are cancelled, beds fill with emergency admissions and waiting lists inevitably worsen. Spring and early summer are traditionally the recovery period—the months when hospitals “make hay” by catching up on planned care before the next winter arrives.

If waiting lists are growing now, what exactly happens when winter returns?

The Government’s silence is perhaps understandable. It is difficult to boast of progress when the trend reverses almost immediately after the celebrations.

The earlier press releases proclaiming success have not been matched by equivalent statements explaining why the backlog is rising again. Nor has the reversal attracted anything like the media attention devoted to the earlier reductions. Falling waiting lists made headlines; apparently, rising waiting lists are less newsworthy.

Meanwhile, industrial relations with consultants have broken down, threatening further disruption to elective services. Leadership at the Department of Health has changed; yet again, just as the NHS enters another year carrying one of the largest elective backlogs in its history.

The uncomfortable truth is that the NHS has ceased to define success by restoring timely care. Instead, expectations have quietly been lowered. An 18-week maximum wait was once a constitutional standard. Today, the median patient waits over 12 weeks before treatment even begins; millions wait longer than the legal standard; and more than 100,000 people have spent over a year in the queue.

Perhaps the greatest achievement has not been reducing waiting lists but normalising them: The extraordinary has become ordinary. Delays that would have provoked outrage a decade ago are discussed with bureaucratic detachment, accompanied by colourful dashboards and carefully worded press releases celebrating marginal improvements against catastrophically poor baselines.

Nothing in the latest figures suggests the NHS is on a trajectory back towards normal waiting times. On the contrary, they suggest a system that remains fundamentally incapable of matching demand with capacity, even after extensive waiting-list validation and sustained political attention.

Unless something changes far more fundamental than the composition of the waiting list itself, there is every reason to fear that today’s “temporary” backlog is a permanent feature of the NHS.

This post was written by two old geezers who have never been validated.