Every trust given individual elective waiting time target

The target is set out in the long awaited ”Elective Reform Plan” launched by the prime minister today. The five percentage point target, is part of a wider commitment to have 65 per cent of elective patients treated within 18 weeks by March 2026 – as HSJ exclusively revealed on Friday.

It is not clear what the baseline for the increase is, but the plan implies it is December 2024.

The elective reform plan sets out a series of strategies which are intended to help the NHS meet the 18-week statutory standard’s 92 per cent benchmark by March 2029. The plan also proposes significant reform of the NHS financing, as well as a range of other measures (See more here: Major pricing shake-up for elective care announced).

By April 2025, NHS England will establish a maximum acceptable number of short notice cancellations due to clinical reasons for each system. “Providers will be required to review their current level of cancellations and ensure these are reported”, states the plan.

By March 2026, the minimum opening times for community diagnostic centres will be 12 hours per day, seven days a week and the range of tests they carry out will have been increased. 

By the same deadline, patient initiated follow ups pathways are to be “offered as standard in all appropriate pathways”. But the plan also reveals a previous target for at least 5 per cent of all outpatient appointments to be on PIFU pathways has been pushed back until March 2029.

The plan says expanding remote monitoring across all long-term conditions where clinically appropriate will help “remove up to 500,000 lower value follow-up appointments per year from 2026-27 onwards”.

The plan also reveals that NHSE will this month establish a group to set out “clear expectations for administrative practice and operational management in the delivery of elective care” by September 2025.

It adds: “Providers will be expected to consistently meet these delivery standards. We will also provide a suite of metrics that will demonstrate operational grip and monitor these on a regular basis to provide confidence in how elective care is being delivered.”

Target may be ‘too ambitious’

Meeting the 65 per cent benchmark by next March would require trusts to cut the overall waiting list, which stands at 7.5 million by around 450,000 cases, officials said. Trusts are currently delivering just 59 per cent against the 18-week statutory standard.

However, as revealed by HSJ in December, NHS leaders have only committed to doing around the same level of elective activity in 2025-26 as they are doing now – around 18 per cent more than pre-covid levels.

While the waiting list has been falling it has only done so modestly, from 7.7 million cases in October 2023 to 7.5 million a year later, according to the most recent data.

Senior NHS sources told HSJ it was unclear that delivering current activity levels would be sufficient to delivering the 450,000 reduction in the waiting list required to hit the 65 per cent benchmark. Wating list expert Rob Findlay also told HSJ the target may “be too ambitious”.

Currently around a third of the 155 trusts which report RTT data are meeting the 65 per cent benchmark with performance varying widely, the latest data shows.

The plan does not set a target for when the NHS will eliminate long waiters, those waiting more than a year. This is despite the last elective recovery plan, published in 2022, focusing on doing this by March 2025. The system will miss this target, with around 235,000 year 52-week breaches on the list at last count.

Much of the document’s contents, such as plans to slash referrals into the acute sector and boost diagnostic and elective hub capacity were pre-announced and widely reported over the weekend , as reported by HSJ on Sunday.

Performance oversight will largely continue to be run through the existing “tiering” system – although the plans say a “new NHS Oversight and Assessment Framework” will be rolled out, which will include the introduction of a new “independent diagnostic process” for struggling trusts.

The plan says: “For providers with longstanding elective performance issues we will use an independent diagnostic process to understand and analyse the root causes and provide mandatory intensive support, including through NHS IMPACT, GIRFT and embedded managers and clinicians where appropriate.”

“Conversely, through the new NHS Oversight and Assessment Framework we will also identify high performing ICBs and providers that could benefit from additional freedoms.”