We’re cutting waiting lists
The Prime Minister recently claimed in a tweet shared by several other ministers that the government is cutting waiting lists in the NHS. This is a general claim that the Conservative party has also made before.
It has also appeared as a logo on other official government announcements.
The NHS records waiting list data in lots of different ways, and it is true that some specific waiting lists, such as the list of patients waiting more than 18 months for treatment, have shortened in recent months.
However, it is not true that the overall size of the most commonly cited NHS waiting list is falling.
On the contrary, the latest figures at the time of Mr Sunak’s tweet showed that the number of cases waiting for NHS consultant-led treatment in England reached a record high of 7.33 million at the end of March 2023. (New figures published after Mr Sunak made his claim now show that the list has grown further to reach 7.42 million at the end of April.)
Speaking on ITV’s This Morning on 25 May, Mr Sunak acknowledged that the overall size of the waiting list may not start to fall until next year when he said it “should be coming down” by spring 2024.
Full Fact asked Downing Street and the Conservative Party about the evidence for Mr Sunak’s claim and did not receive a response. The Department of Health and Social Care did not offer a full explanation for the claim either, but it has confirmed the overall size of the NHS waiting list continues to rise, and says there has been some success in tackling the list of patients who have been waiting longest.
A similar point appears in some background text in the images attached to Mr Sunak’s tweet, where one line says: “We’ve cut 18 month waiting lists by over 90% since September 2021.”
Politicians must be clear what they mean when making claims using official data to describe public services. Otherwise they risk misleading people about the government’s performance—or, in this case, access to the NHS.
Health policy is devolved, so this article only looks at waiting lists in England, which is the part of the UK health system that the UK government controls.
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What are the waiting lists?
NHS England publishes regular data on what it calls “Consultant-led Referral to Treatment Waiting Times”. This is often called RTT data, and is generally seen as the main measure of its performance in non-emergency care. (For example, it is referred to as “the overall waiting list” in NHS England’s elective recovery plan published last year.)
RTT data counts the number of cases at the end of each month where a patient is waiting to receive some kind of treatment—most often without being admitted to hospital.
Technically, this overall waiting list counts something called “pathways”, not patients. A pathway begins when someone is referred to a consultant, and it ends when their treatment begins, or when the decision is made that they won’t be treated, or if they don’t respond when contacted. As a result, some people may be on more than one pathway at a time, if they are waiting for treatment for two or more conditions.
In a sense there is one RTT waiting list: the total number of cases where someone is waiting for this kind of treatment.
However, because the data shows how long each person has been waiting, it can also be split into several more specific lists: the number where the wait has been less than 18 weeks, the number with a wait of more than 18 weeks, the number waiting more than 52 weeks… and so on.
According to the NHS Constitution, “patients have the right to start non-emergency consultant-led treatment within 18 weeks of referral”. It also sets out an expected standard that “more than 92% of patients on incomplete pathways should have been waiting no more than 18 weeks from referral”.
In practice, NHS England has not met this target since the mid-2010s, and has generally fallen further and further behind in recent years.
What the government promised
A pledge that “NHS waiting lists will fall and people will get the care they need more quickly” was announced bv Mr Sunak in January.
It followed a similar pledge made in the elective recovery plan in February 2022 by Boris Johnson with Sajid Javid, who were Prime Minister and health secretary at the time. That plan said it would “address backlogs built up during the Covid pandemic and tackle long waits for care”.
It also mentioned several specific targets, including to:
- Eliminate waits of more than two years by July 2022
- Eliminate waits of more than 18 months by April 2023
- Eliminate waits of more than a year by March 2025
The first two of these targets have been narrowly missed. At the end of July 2022, an estimated 2,890 cases had been waiting more than two years. At the end of March 2023, 10,737 involved waits of more than 18 months, and this rose slightly to 11,477 at the end of April.
Both these waiting lists had fallen substantially since the targets were announced, however. And waits of over a year have also started to fall in recent months.
In this sense, it is true that some specific “waiting lists” have fallen since Mr Sunak became Prime Minister. However, the overall number of cases where someone is waiting for consultant-led treatment has risen to a record high.
From the outset, the elective recovery plan acknowledged that the future of waiting times was uncertain, in part because it was hard to know how much of the drop in demand for healthcare during the pandemic might lead to higher demand in future.
Describing the plan at the time, NHS England said: “The overall size of the waiting list is likely to increase, at least in the short term. If around half the ‘missing demand’ from the Covid-19 pandemic returns over the next three years, particularly if this is earlier in the period, then we would expect the waiting list will be reducing by around March 2024.”
What about other waiting lists?
NHS England publishes the RTT data by type of treatment and provider, so it is also possible to look at waiting lists in specific areas of the country, and by specific treatment functions.
And there are other kinds of waiting lists, including transplant waiting lists and a variety of different measures of waiting times for cancer treatment, and for diagnostics.
To take just one example, the number of cases on the diagnostic waiting list was about 1.63 million at the end of March 2023, the highest on record, before falling back to 1.56 million at the end of April.