NHS waiting lists: what you need to know in 2024

As part of his five pledges in January 2023, the Prime Minister Rishi Sunak promised that “NHS waiting lists will fall, and people will get the care they need more quickly”. So have they? And do they?

Mr Sunak said of his pledges “we will either have achieved them or not” and claimed they involved “no tricks… no ambiguity”. But in fact it wasn’t clear how to judge the promise about waiting lists, because he didn’t specify how quickly the government would achieve it, or exactly what would count as a fall.

It seems safe to assume that he was only talking about waiting lists in England, which is the part of the health service that the UK government controls, and that he meant the “referral to treatment”, or RTT, waiting list specifically.

RTT data records the number of cases and people awaiting planned treatment, which is commonly just called “the waiting list” by politicians and the media, even though the NHS also has many other types of waiting list—including so-called “hidden waiting lists”, for which data isn’t published. The number of cases in the RTT data is always a bit higher than the number of people, because some people need treatment for more than one thing. And in September’s data (published last November), NHS England began to report a specific figure for the number of people waiting for treatment, as well as the number of cases. (Since then we’ve seen frequent confusion about this, including from politicians, journalists and on social media).

As it turned out, Mr Sunak’s ambiguity probably didn’t make a difference, because the number of cases and the number of people on the waiting list rose for most of the year that followed. And in an interview with Piers Morgan in February 2024, he agreed that the government had failed to meet the pledge.

This explainer is part of a series of ‘prebunking’ articles Full Fact is publishing ahead of the next general election, exploring a range of topics which are likely to feature in the campaign. We’ll be updating these articles on a regular basis—this article was last updated on 19 April 2024 and the information in it is correct as of then.

Are people waiting longer?

The size of the waiting list is important, because it gives us an idea of the scale of the backlog, and the workload that the NHS is facing. However, lots of people needing treatment isn’t necessarily a sign of a struggling health service if they are all being seen quickly. From a patient’s point of view, the average time you can expect to wait is probably much more important.

Waiting times were covered by the second half of Mr Sunak’s pledge—that “people will get the care they need more quickly”—and here the picture is slightly more complicated.

In February 2022, before Mr Sunak became Prime Minister, the government set itself various targets to eliminate extremely long waits, and it’s true that there are now many fewer waits beyond 65 weeks, 78 weeks and 104 weeks than there were in 2022. Ministers sometimes talk about NHS performance in these terms.

Extremely long waits are just a small part of the picture, however. They don’t tell us how many cases are treated within 18 weeks, which is considered every patient’s right under the NHS Constitution. Nor do they tell how long people are waiting on average. And the data on this is less encouraging.

Each month, NHS England publishes a figure for the median wait, in weeks, for what it calls “incomplete pathways”—cases where someone has begun their wait for treatment, but has not started to receive it yet. (Because it’s the median, this number shows what you would see if you put every case into a queue in wait-length order, then measured how long the case exactly in the middle had been waiting.)

The median waiting time can fluctuate from month to month, and is somewhat seasonal, because some months of the year are generally busier than others. But overall, the median waiting time has grown much longer over time, and it was slightly longer in February 2024, when Mr Sunak accepted that the pledge had been missed, than in January 2023, when he made it.

Are waits worse for everyone?

The overall figure for the whole of England can be a good way to judge the government’s performance, but it hides the fact that specific people in specific places may have very different experiences.

NHS England data also shows us how many cases are waiting—and how long they’ve been waiting for—in different parts of the country, and for different types of treatment. These show that there have been some areas of improvement even while waiting lists and waiting times got longer overall.

Are strikes or the pandemic to blame?

During his interview in February, Mr Sunak singled out strikes by doctors, nurses and other NHS workers as a cause of lengthening waiting lists. And he has made similar points on other occasions.

These kinds of counterfactual arguments—about what would have happened under different circumstances—are often complex and hard to be sure about. Analysis by the Nuffield Trust and the Health Foundation, two health think tanks, suggests that although strikes did have an effect, waiting lists would probably have grown last year even if they hadn’t happened.

More recent analysis by NHS England itself suggests the same. However it also suggests that in the scenario where no strikes happened, by early 2024 the main RTT waiting list would have returned to around the level of late 2022 and early 2023. 

NHS England also said: “The total effect of [industrial action] on completed pathways may be higher due to other effects of [industrial action] such as the impact on wider financial costs and productivity.”

Separately, in December the deputy prime minister Oliver Dowden claimed that the waiting list numbers were falling before the pandemic, implying that the pandemic was the cause of the rise observed since.

This is not true, at least in terms of the measure Mr Dowden was discussing. While the number of cases awaiting treatment rose more sharply after the first few months of the pandemic, the number had already been rising for years before the pandemic started.

Are these the worst waits in history?

We’ve also seen a number of claims from Labour about how current NHS waiting lists and times compare historically.

For example, at the 2023 Labour party conference shadow health secretary Wes Streeting claimed the last Labour government delivered the shortest waiting times “in history”.

We simply don’t have data about waiting times for the first few decades of the NHS’s history, however, and some of the later data we do have isn’t comparable between governments.

We’ve described how NHS waiting list data has changed over time in an earlier article. But essentially it would be fair to say median waiting times, though they fluctuate from month to month, are about the longest they’ve been since data began to be collected in its current form, in 2007. (This disregards short periods of rapid change when the pandemic started, and at the very beginning of the data series, which we are not able to explain.)

Going further back, you could also say that the old series of inpatient data, which began in 1988, reached roughly the shortest waits ever recorded when the series stopped, in 2009. And waits on this measure certainly shortened substantially during the second half of Labour’s period in government.

Any claims about waiting times throughout the whole history of the NHS, which was founded in 1948, are probably not reliable.

What about the rest of the UK?

We’ve focused throughout this explainer on waiting lists in England, which are what the UK government is responsible for, and which are often the focus of national political debate.

The health services in Wales, Scotland and Northern Ireland also publish regular RTT data, albeit not in the same form as England. For various reasons, this means it isn’t possible to make direct comparisons between the four nations on their headline measures. Some limited comparisons can be drawn between England and Wales, as we explained in a fact check last year, when the then health secretary Steve Barclay claimed people in Wales are more likely to be on a waiting list than those in England.

Overall, we can say waiting lists broadly grew longer in all four nations between the beginning of 2022 and the end of 2023, on the measures that they each use.

Median waits lengthened in Scotland through 2022 and 2023, shortened in Northern Ireland during the same period, and shortened then lengthened in Wales, according to the measures those countries use.

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