Hospital productivity in the English NHS has, according
to official estimates, been outperforming the government's target
of 2%, with NHS England figures suggesting that
productivity grew by 2.7% in 2024–25 and 2.4% in the first
quarter of 2025–26. One might expect this to have led to improved
hospital performance. Yet the NHS has made limited
progress on its headline target of cutting elective waiting
times. The overall waiting list fell from 7.5 million to
just 7.4 million between March 2024 and March 2025, and has not
fallen meaningfully further since then. The percentage of
patients waiting less than 18 weeks for treatment changed from
57.2% in March 2024 to 59.8% in March 2025 and 61.8% in September
2025, still far from the NHS constitutional standard of 92%.
In new analysis, IFS researchers find that this divergence
between productivity and waiting list performance cannot be
explained by changes to NHS funding, growth in referrals to the
waiting list or increases in emergency hospital activity.
Instead, it is driven by patients on average receiving
more hospital appointments and operations before leaving the
waiting list. In 2024–25, the number of outpatient
appointments grew by 9.4%, while the number of completed waiting
list pathways grew by only 4.0%. It is not clear what drove this
difference, though it seems unlikely to have been driven
primarily by changes to patient need. If the number of
completed waiting list pathways had instead grown in line with
hospital activity, the waiting list would have been around 1
million cases lower by now.
Olly Harvey-Rich, a Research Economist at IFS and an
author of the comment, said:
‘It is of course good news that hospital productivity has been
rising. But so far, this has not resulted in materially lower
waiting times for patients. That's not because lots more patients
are joining the waiting list, but instead because the average
patient is having more appointments and operations before being
discharged. For a government that has set so much stock in its
ambitions to cut NHS waiting times, understanding – and
potentially reversing – this trend will be of crucial importance.
Ultimately, the NHS needs to ensure that the right activity is
being delivered for patients to complete their pathways, rather
than simply delivering more activity.'
ENDS
Notes to Editor
Why isn't hospital productivity growth bringing down the
waiting list more quickly? is an IFS briefing by Olly
Harvey-Rich and Max Warner.
