Billions spent to tackle NHS waiting lists but service recovery targets still missed, PAC finds

- PAC finds £3.24bn in funding to bring down waiting times was poured into programmes which were then managed with extreme variability

- Warning that govt's planned NHS reforms are replicating poor practices seen on HS2

NHS England (NHSE) has failed to meet its post-COVID recovery goals to shorten patient waiting lists. In a new report on reducing NHS waiting times for planned (or elective) care, the Public Accounts Committee (PAC) finds that despite NHSE spending £3.24bn on transforming diagnostic and surgical services, it has now missed its recovery targets by significant margins, with too many people still waiting too long for tests and treatment.

At January 2025, over 6m people were waiting for elective care, and progress in reducing waiting times appears to have stalled:

-  Nearly 192k patients were waiting over a year for care by July 2025 – a length of wait which should been eliminated by March.

- For diagnostic tests, 22% of patients were on a waiting list for more than six weeks - against a target of 5% by March 2025, and an operational standard of 1%.

- When it comes to treatment, only 59% of patients were treated within the statutory standard of 18 weeks, against a target of 92%.

- Plans to reduce follow-up outpatient appointments by 25% (compared to '19-'20) by March '23 saw NHSE achieve only 0.1% fewer appointments between June '22 and July '23.

The PAC's report finds that these failures were driven in part by NHSE's and the government's flawed approach to improving its own services. Billions of pounds in spending were approved by government without sufficient focus on what exactly its funding would deliver and without any focus on outcomes for patients.

Diagnostic transformation received £2.2bn, and £1.04bn went to surgical transformation, at a time of scarcity for capital funding. A shortfall of 3.6m tests led to the missed diagnostics target; for new surgical hubs, only the number of newly delivered hubs was tracked, with NHSE unable to say what contribution they actually made to total elective activity. Plans to free up more outpatient appointments could have made the most difference as the vast majority (80%) of elective care pathways end through an outpatients appointment; but NHSE had no credible plan to achieve this, failing to secure meaningful engagement from clinicians to do so.

The report recommends NHSE and govt should focus reporting on patient outcomes to ensure that funding delivers its intended outcomes, set out plans to reach the 1% operational standard for six week waits for diagnostic tests, and learn the lessons from the failure of the outpatients programme.

The PAC is further concerned that major reforms announced by the Department for Health and Social Care (DHSC) and NHSE are replicating poor practices seen on the HS2 and New Hospital Programmes, and will lead to wasted effort. Structural changes are being made to the healthcare system without secured funding in place to pay for the changes, or impact assessments carried out. The PAC is warning these changes, especially the planned cuts to local health boards, could have a significant negative impact on patients and on the workforce through the level of uncertainty they create. The report seeks confirmation from DHSC that it will not announce unfunded commitments, and set out the likely costs of planned redundancies and the absorption of NHSE into DHSC.

The PAC is not confident that DHSC is being realistic about the immense effort needed to bring down waiting times, with digital solutions risking being treated as a ‘cure-all'. Digital integration is a key weakness for the NHS and the report seeks DHSC and NHSE's plans to address legacy IT. The PAC remains sceptical that digital change can satisfactorily reach all patients as there is likely to always be a part of the population who find digital technology and tools too difficult to use. 

Clive Betts MP, Deputy Chair of the Public Accounts Committee, said: “Every unnecessary day that a patient spends on an NHS waiting list is both one of increased anxiety for that person's unresolved case, and if they are undiagnosed, a steady increasing of risk to their life. Every penny of funding spent to put the NHS back on a pre-pandemic footing must be precisely targeted, or the system itself becomes an obstacle to proper care. Unfortunately, our report establishes that billions have been poured into the system over the past few years without the requisite focus on making sure that money does what it was intended for – improving outcomes for patients. The rollout of shiny new surgical hubs and diagnostic centres will only be superficially impressive if they are not used in the most productive way.

“Alarmingly, in the government's approach to the absorption of NHSE and 50% cuts to local health boards, we are now seeing chilling echoes of past failures on HS2 and the New Hospital Programme. Our Committee has long established that large unfunded commitments, without plans for delivery, while good at generating headlines, can only end one way. We hope the government can provide reassurance as part of this inquiry that it can come forward with the underpinning detail that can marry its ambitions to reality.”

PAC report conclusions and recommendations 

Too many people are still waiting too long for diagnostic tests and treatment, and the pace of change to meet recovery targets is too slow. The March 2025 elective and diagnostic targets for post-pandemic recovery were missed. By July 2025, patients on nearly 192,000 elective care pathways were waiting over one year for care. These long waits should have been eliminated by March 2025. At the same time 22% of patients on the diagnostic waiting list had been waiting for more than six weeks against a recovery target of 5% by March 2025 and an operational standard of 1%. Progress in reducing waiting times appears to have stalled, with the total elective care waiting list standing at 7.4 million clinical pathways. Patients on 59% of pathways were treated within the statutory standard of 18-weeks against a target of 92%. Despite the importance of reducing waiting times for diagnostic tests, NHS England did not include a target in its 2025-26 operational planning guidance. These long waits and persistent backlogs present risks to patients in terms of delayed diagnosis and treatment as well as clinical risks from overdue follow-ups in outpatients. New data published by NHS England in September 2025 also shows that waiting times are longer in more deprived areas.

Recommendation 1. NHS England and the Department for Health and Social Care should:

1. a) set out their plans to reach the 1% operational standard for six week waits for diagnostic tests.
2. b) set out the actions they have taken to monitor and address risks associated with long waits and on disparities in waits between groups of patients.

NHS England's plans to transform outpatient services were not credible, even though it had already acknowledged that more efficient outpatient services would make a material difference to the waiting list. The outpatients transformation had aimed to free up capacity in outpatients services and NHS England had set a target to reduce follow-up outpatient appointments by 25% (compared to 2019-20 levels) by March 2023. The programme achieved a 0.1% reduction of appointments against this target between June 2022 and July 2023. NHS England has dropped this target. NHS England did not secure meaningful clinical engagement on the programme, despite the more successful programmes having benefitted from clinical support. These failures happened despite NHS England telling the previous Committee in 2022 that improvements to outpatients services had the most potential to free up clinical time.

Recommendation 2. NHS England should set out what it has learned from the failure of the outpatients programme and use this to inform its plans for the future of the programme. These plans should include, at a minimum, the setting of meaningful targets for which it has clinical support, ensuring it has senior clinical leadership in place to secure clinical engagement, and strong governance and reporting arrangements.

NHS England's approach to transformational change was deeply flawed in both monitoring of progress and the delivery of intended outcomes. NHS England's diagnostic transformation programme displayed positive features of programme management and achieved planned increases in numbers of diagnostic tests. The planned number of Community Care Centres were also delivered on time. However, the programme did not deliver the intended outcomes of reducing waiting times. Internal NHS England analysis found that there was a shortfall of 3.6 million tests. This led to the recovery target of 5% of waits for diagnostic tests being no more than six weeks being missed, with 22% of patients waiting over six weeks. These flaws have been compounded by NHS England and the Department not setting up the surgical and outpatients transformation programmes effectively enough to measure their impacts and benefits. Ultimately, the Department has approved billions of pounds of spending without sufficient focus on what exactly these programmes will deliver.

Recommendation 3. The Department of Health and Social Care and NHS England should:

1. a) Set up data collections or processes for tracking costs and benefits as early as possible when setting up new services or transforming existing services including the recent extension of specialist telephone advice to GPs.
2. b) Focus reporting on the achievement of policy aims (expected outcomes for patients) to ensure that the capital funding provided delivers intended outcomes.

We are not confident that the Department is being realistic about the immense effort needed to reduce NHS elective care waiting times, and see a significant risk that digital solutions are being treated as a 'cure-all' as the 10 Year Plan is being implemented. While NHS England and the Department for Health and Social Care have outlined an ambitious programme for future change, the current picture of performance for transformation is poor. The integration and sharing of digital records across the NHS is a key weakness and the NHS lacks some of the basics in IT connectivity, with General Practitioners, hospital trusts and consultants still working on different systems. With technology moving quickly, the timing and funding of digital change remains uncertain. At the same time, we are sceptical that digital change can satisfactorily reach all patients as there is likely to always be a part of the population who find digital technology and tools too difficult to use. 

Recommendation 4. NHSE and the Department should set out:

• how the elective care transformation programmes are practically affected by the 'analogue to digital' shift in the 10 Year Plan;
• how it will solve the problem of legacy IT equipment and ensure that the IT systems used in different parts of the NHS are properly connected; and
• whether the 10 Year Plan itself has sufficient funding to deliver the digital transformation required by the plan.

NHS England's performance to date has not demonstrated that it can secure the clinical engagement that will be necessary to transform waiting lists. Clinical engagement has worked best when there been close working between national and local clinical leaders, and specific and expert support between peers. The diagnostic transformation programme and the surgical transformation programme benefitted from clinical leadership and the support of relevant Royal Colleges. NHS England recognises that this is central to securing change and acknowledged that it still has to work out how it can get better clinical engagement, particularly for the outpatients programme. While NHS England has now set new incentives and priorities, the scale of engagement necessary to achieve full clinical support for the outpatients programme remains a significant challenge. Some progress has been demonstrated by NHS England through other outpatients programmes such as the Further Faster 20 programme to reduce long-term economic inactivity, although formal evaluation of the programme by NHS England and the Department has not yet been completed.

Recommendation 5. The Department should set out what it plans to do differently to secure clinical engagement on the outpatients transformation programme to improve waiting times.

We are concerned that the Department for Health and Social Care and NHS England are still announcing major reforms without either delivery plans or secured funding. We do not accept that it is prudent to make a major change, such as the structural changes that are being made to Integrated Care Boards (ICBs) and NHS England without ensuring there is funding in place to pay for the changes, and without conducting an impact assessment or taking other steps to safeguard value for money. These changes, especially the planned cuts to ICBs, could have a significant negative impact on patients and on the healthcare workforce through the level of uncertainty they create, and because they may limit the ability of NHS organisations to plan for the future. We are concerned that these poor practices, previously seen with the New Hospitals Programme and the High Speed 2 programme are being replicated here and will lead to wasted effort.

Recommendation 6. The Department should

• confirm to us that it will not announce unfunded commitments;
• set out the likely costs, with associated funding, together with an impact assessment, for the ICB redundancies and the absorption of NHS England; and
• set out how organisational changes at local level relate to, and are properly linked with, other partner organisations such as local authorities.