New modelling shows meeting the NHS 18-week target by the end of
this parliament will likely require historically large increases
in activity alongside reductions in demand and greater
prioritisation of those waiting a long time. Hence, the
government will more likely than not miss this 18-week waiting
time target.
A scenario under which the NHS increases treatments from the
waiting list by 3.5% per year over this parliament would on its
own raise the proportion of patients waiting less than 18 weeks
from 59% today to 74% by mid 2029. Such activity growth would be
considerably faster than the NHS managed in the pre-pandemic
period, and is equivalent to increasing treatments from 18
million in 2024 to 21 million in 2029. This would deliver
a big improvement to 18-week performance, but would still be far
short of the Prime Minister's commitment that the NHS
constitutional standard of at least 92% will be achieved in this
parliament.
This is one of the key findings based on a new simulation model
of NHS waiting times that has been constructed by IFS researchers
with funding from the Economic and Social Research Council. There
is general agreement that the target is ambitious, but limited
understanding of how likely the government is to meet it, or how
it might improve its chances of doing so.
The model shows that achieving the 18-week target by
increasing NHS activity alone would require annual increases in
activity of around 4.9%. For comparison, treatment
volumes grew by 3.8% in 2024, and by an average of 2.4% each year
from 2016 to 2019. We judge sustained annual growth of nearly 5%
to be highly unlikely to be achieved.
But alongside increasing treatment volumes, the
government has two further ways in which it could improve waiting
times:
-
Demand reduction: The NHS plans to reduce the
number of patients joining the waiting list. Combined with our
central assumption of 3.5% treatment volume growth, a plausible
restriction to demand could mean 18-week performance increases
to 82% by mid 2029.
-
Reprioritisation: Prioritising those with
longer waiting times would also improve 18-week performance.
Changes to prioritisation rules and the order in which patients
are treated, combined with our central scenario of 3.5% annual
treatment volume growth, could mean 18-week performance reaches
78% by mid 2029.
If the government does both of the above – deliberately aims to
reduce the number joining the waiting list, and encourages
hospitals to prioritise treating patients who have waited longer
than 18 weeks – we estimate it could reach 86% performance
against the 18-week target by mid 2029. If, in addition to this,
it also increases treatment volumes by 4.5% per year (rather than
3.5%), it could deliver on its 92% 18-week target by the time of
the next election. In other words, our modelling shows
that the government will need to pull several policy levers at
once – and hard – to stand a chance of delivering on its promise
this parliament.
These other policies come with trade-offs. Reducing referrals
risks some patients not getting the care that they need, and
prioritisation of longer waiters comes at the cost of
deprioritising patients who have more recently joined the list
(many of whom may be especially sick and in need of care).
Olly Harvey-Rich, Research Economist at IFS and an author
of the report, said:
‘There is widespread agreement that achieving the 18-week target
within this parliament – reversing nearly a decade of worsening
performance in five years – will be challenging. Our new analysis
quantifies just how challenging. Increasing the number of
patients treated by the NHS – whether by increasing funding or
improving productivity – is highly unlikely on its own to be
enough to meet the target. Meeting the target will likely require
historically large increases in activity and reducing
demand and prioritising reducing long waits. The latter
two routes have potential negative consequences for some groups
of patients. It's by no means impossible, but we judge it
unlikely, that the 18-week target will be met during this
parliament.'
