What does the pledge mean?

The Labour manifesto committed the government to cutting NHS waiting times, in part by funding special out-of-hours shifts, which it hopes will add an extra 40,000 hospital appointments a week, amounting to about two million a year. (This is another pledge we’re tracking.)

Although there are many types of “waiting time”, and many ways to measure them, the manifesto made a specific promise before the election to “return to meeting NHS performance standards”.

It said: “That means patients should expect to wait no longer than 18 weeks from referral for consultant-led treatment of non-urgent health conditions. This standard was achieved with the last Labour government and will be again under the next.”

In its “Plan for Change” document, published on 5 December 2024, the government made the pledge clearer, saying: “This Parliament, our health milestone is to end hospital backlogs by delivering our ambitious milestone of meeting the NHS standard that 92% of patients should wait no longer than 18 weeks from referral to start consultant-led treatment of non-urgent health conditions.” This restates an existing requirement in the NHS Constitution. A footnote links to NHS England’s referral-to-treatment (RTT) waiting times, where the data is published.

Technically, this data actually records the proportion of “incomplete pathways” (i.e. ongoing cases) that involve waits of 18 weeks or more, not the proportion of individual patients who have this experience. The number of patients and the number of cases are always different, because some patients are awaiting treatment for more than one thing. We’ve written about this confusion many times before. 

In reality, as the chart below shows, NHS England has not reached this level of performance for many years, and it is still far away from doing so.

The target only refers to the NHS in England, which 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. 

In its Elective Reform Plan, published on 6 January 2025, NHS England gave more detail on the timeframe for this pledge, saying: “We will meet the 18-week standard by March 2029. By March 2026 the percentage of patients waiting less than 18 weeks for elective treatment will be 65% nationally. Every trust will need to deliver a minimum 5 percentage point improvement by March 2026. We then expect sufficient increases annually (exact figures to be confirmed in the planning guidance) to reach 92% in 2029.” 

What progress has been made?

This pledge currently looks very far away from being met, but we’ve rated it “In progress” because it’s early in the parliament. 

According to the latest figures, there were about 6.3 million people awaiting treatment, in about 7.5 million cases, at the end of November 2024. Just under 60% of those cases involved waits of less than 18 weeks so far. This figure has been roughly stable for about the past two years, but the government must raise it to 92% by March 2029 in order to deliver its commitment.

At this stage, we can’t yet know whether the measures announced so far to help tackle waiting times—including funding for more appointments and capital investment in equipment and buildings—will be enough to achieve this on their own. As we wrote in an article shortly before the election, the pledge to add two million appointments a year amounts to a very small rise in the overall number.

NHS Confederation analysis looking at both the current waiting list and expected demand in the coming years suggests that these proposed appointments will not be enough to deliver this pledge. Its report says: “Based on current levels of growth in the need for care and how care is currently delivered, this means that by 2028/29 the NHS will need to do 50% more elective activity than it is currently doing to clear the wait list and sustain achievement of 18-week performance. 

“Without being accompanied by change and reform, the government’s promise of an extra two million appointments, operations and diagnostics a year addresses about 15% of the additional requirement.”

In its manifesto, Labour did describe the extra appointments as “a first step” to delivering this pledge.

The Elective Reform Plan also announced a number of measures intended to deliver the 18-week standard by March 2029.