What would two million more appointments a year mean for the NHS?

2 July 2024

The Labour party has said that if it wins the next general election it will deliver two million extra NHS appointments a year—equivalent to almost 40,000 a week. 

It says these will be delivered in evenings and weekends, and made possible by paying staff extra to work during these times. Labour describes this as a “first step” towards meeting the target for patients to wait no longer than 18-weeks to start non-emergency treatment. 

In the latest data, for April 2024, there were about 6.33 million people on the waiting list for planned care in England, which is the part of the NHS that the UK government controls.

That equates to about 7.57 million cases which hadn’t started treatment—3.16 million of which involved waits of more than 18 weeks. (There are always more cases than people because some people are waiting for more than one thing.) 

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How many NHS appointments are there? 

To put that two million figure in context, in the latest confirmed data for the year to March 2024 there were 157 million appointments and procedures for inpatient and outpatient secondary care. (This includes appointments not attended, so it gives a sense of NHS England’s capacity.)

So if we assumed the same level of activity in the first year of a Labour government, then added two million more appointments, this would amount to an increase of about 1.3%. 

Obviously you’d expect more appointments to be helpful in treating more people, but in the scheme of things this measure on its own would be quite a small rise. 

For context, in the year to March 2023 there were about 144 million appointments, that means that since then there was an increase of about 8.6% between then and the year to March 2024. 

What about the effect on the waiting list?

The main waiting list we’ve been talking about so far—known as the Referral to Treatment (RTT) waiting list—only counts the number of cases where someone has been referred to a hospital for non-emergency treatment, which hasn’t yet begun. Cases come off the waiting list either when someone begins treatment, or when it’s decided that they don’t need it.

However, a course of treatment usually involves seeing a doctor more than once. In fact, analysis by the Health Foundation, a health think tank, showed there are five appointments for every completed case on the waiting list.

As a result, two million extra appointments doesn’t necessarily mean two million extra cases taken off the waiting list, or anything like it. Instead, if you assume that Labour will add appointments roughly in proportion to the ones already happening, the Health Foundation says you might expect about 400,000 more cases leaving the waiting list than would otherwise be expected. Again, this would obviously mean more people being treated, but it still leaves a huge task to reduce a waiting list that currently stands at 7.6 million. 

There is a lot we don’t know 

Adding two million extra appointments isn’t Labour’s only proposal that might reduce the waiting list. The party’s manifesto also promises to use private hospitals to increase capacity and double the number of scanners to reduce wait times for diagnostics, for example. So it is possible that other policies might help reduce waiting lists in other ways.

We also don’t know exactly how the NHS would perform over the next parliament anyway, as changes in demand and productivity could both make waiting lists better or worse than expected.

Nor do we know how the extra two million appointments will be used, which might make a difference, for instance if they’re targeted specifically at people who have been waiting the longest.

It’s also important to say, as we often do, that the number of people waiting for treatment probably isn’t as important, from a patient’s point of view, as the length of time they can expect to wait. In this respect, the number of people waiting isn’t necessarily the best measure of how well the NHS in England is working anyway.

Full disclosure: The Health Foundation has funded Full Fact's health fact checking since January 2023. We disclose all funding we receive over £5,000 and you can see these figures here. (The page is updated annually.) Full Fact has full editorial independence in determining topics to review for fact checking and the conclusions of our analysis. 

This article was written by a Health Foundation staff member on secondment during the election campaign, and edited by Full Fact staff.

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