What does the pledge mean?

Labour’s manifesto pledged to raise the level of NHS activity so that in England there are “an extra two million NHS operations, scans, and appointments every year”. It said this would help to “cut NHS waiting times”. It also expressed this as a pledge for 40,000 more appointments a week, as 40,000 multiplied by the 52 weeks in a year makes about two million.

In February 2025, the government announced that the pledge had been delivered, based on data published the same day by NHS England, which has since been updated monthly. Until then, it had not been clear exactly what it meant or how progress on it would be measured because the government hadn’t fully explained what the extra appointments were or how they would be counted.

But historic data, which Full Fact had to obtain with a Freedom of Information request, shows that the rise delivered so far is smaller than it was the year before—raising questions about how meaningful the pledge was in the first place.

The way in which the pledge has been described has also changed over time.

When publishing the data with which to measure progress, NHS England described it as a manifesto commitment to deliver “an extra two million NHS operations, scans and appointments”. But the full quote from the Labour manifesto is “an extra two million NHS operations, scans, and appointments every year” [our emphasis]. This is potentially significant for reasons we’ll explain in the section below.

The Labour manifesto also described the pledge as a commitment to deliver 40,000 more appointments each week “during evenings and weekends”. It went on to say it would achieve the pledge “by incentivising staff to carry out additional appointments out of hours”. This appeared to suggest that the intention was to deliver two million extra appointments outside normal working hours, although this was not mentioned in the government’s ‘Plan for Change’ in December.

In declaring the pledge to be met, the government said it was “delivered in part by extra evening and weekend working” [our emphasis]. It therefore sounds as though the extra appointments the government says it has delivered were not only during evenings and weekends, as appeared to have been originally promised, although we cannot find any data showing when they happened.

Before declaring the pledge delivered in February 2025, the government repeatedly failed to explain how it was actually defined, with neither the Department for Health and Social Care (DHSC) nor NHS England providing answers to our specific questions at the end of 2024.

This pledge only refers to the NHS in England, since this is the part of the health service that the UK government directly controls, with the rest devolved to the governments of Wales, Scotland and Northern Ireland.

What progress has been made?

For now, we’re rating this pledge “Achieved”. The latest data shows that between July 2024 and March 2025 there have been around 108,000 more appointments per week, which suggests that Labour have far exceeded the target. It’s worth noting though that we don’t yet have a full year’s data and there remains some confusion over exactly how the pledge was framed and how it should be measured.

In the past, as we have said, the government described the promise of two million extra appointments as a rise that would happen “a year”, “every year” or “in its first year”. But when the government announced that the pledge had been delivered, the annual element was missing, as it also was from NHS England’s page on which the supporting data was published.

In its analysis, NHS England counts the total number for specific types of elective operations, outpatient appointments and diagnostic tests and finds that there were 56,249,899 in the first nine months of the new government, compared with 52,085,178 in the same period the year before (once the data has been standardised to the same number of working days).

This means there has been a rise in the number of appointments of about 4.2 million, which amounts to about 108,000 more appointments per week during this time.

This weekly rate is well above the 40,000 per week figure set out in Labour’s manifesto pledge, suggesting it has been achieved, and the Institute of Fiscal Studies has also told us it considers the promise to have been “fulfilled”. However we will continue to monitor the data for the rest of Labour’s first year.

Some reporting of the government’s announcement in February mentioned that the comparator period in 2023 was affected by strikes in the NHS, which would have reduced the level of hospital activity at the time, making subsequent years look higher by comparison.

While it is true that NHS England was affected by strikes in the baseline period, this doesn’t necessarily make it an unfair comparison, since strikes over pay by government employees are at least to some extent within each government’s control.

As we said earlier, there is also the question of whether the pledge, as now defined, was a meaningful promise to begin with.

Although in February NHS England published the data that allowed a comparison of Labour’s first months in office with the same months the year before, it didn’t publish the same data going further back. This made it impossible to know how significant the rise recorded under Labour really was, until we obtained the historic data from NHS England.

This data (see chart above) shows that the number of appointments being counted towards this pledge had been rising steadily for several years, since roughly the beginning of 2021. This isn’t surprising, since the population has been growing and ageing, and government health spending and the NHS workforce have been rising during that time.

In this context, Labour’s pledge to raise the number of these appointments by two million in a year appears very modest. Indeed, if it achieved a rise of two million in its first year in office, it would be by far the smallest rise since the pandemic.

While the number of these appointments did rise by 4.2 million between July 2024 and March 2025 compared to the same period the previous year, when standardised for the number of working days per month, they also rose by five million in the same period the year before.