Background to the report

Since 2013, the statutory elective care waiting time standard has been that for 92% of elective care pathways, patients should begin treatment within 18 weeks from referral. This was last achieved in September 2015. As at January 2025, around 6.25 million people were waiting for elective care on 7.43 million pathways. Patients waited for up to 18 weeks on 4.37 million pathways (59%) and for more than 18 weeks on 3.06 million pathways.

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In February 2022, NHS England (NHSE) published a plan to recover elective and cancer care over the three years up to March 2025. This plan aimed to reduce waiting times by increasing capacity, prioritising patients waiting the longest and improving information and support for patients. It also included changes to how care is provided through three transformation programmes:

  • Diagnostic transformation including £2.3 billion of capital funding for new diagnostic centres and equipment to move patients through diagnostic services more quickly.
  • Surgical transformation to create surgical hubs to carry out low complexity procedures more efficiently, funded with £1.2 billion of capital from NHSE’s £1.5 billion Targeted Investment Fund.
  • Outpatients transformation to free up capacity by, for example, reducing referrals and follow-up appointments.

We reported on NHSE’s progress with the elective recovery plan in November 2022 and concluded that there were significant threats to recovery, including uncertainty about whether new initiatives would deliver results as quickly as intended.

Scope of the report

In this report, we take a closer look at NHSE’s management of these three transformation programmes, what they have delivered to date and whether NHSE is learning lessons from its experience and applying this learning as it develops its future plans. The report covers:

  • NHSE’s overall progress on elective care recovery
  • NHSE’s progress in delivering its main elective recovery transformation programmes and the outcomes achieved
  • management and oversight of the transformation programmes
  • NHSE’s learning and application of lessons from its elective recovery transformation programmes

Video summary

Ashley McDougall, the report director, summarises our findings.

Conclusions

NHSE has focused its elective transformation activities on diagnostics, surgical and outpatients, aiming to see more patients sooner and to improve the productivity of these services. In the context of an operational environment where challenges have included industrial action, low productivity and high inflation, the transformation programmes have not yet met their goals to support elective recovery.

While diagnostic transformation has demonstrated positive features of programme management, including tracking, clear reporting, and management of costs, outputs and outcomes, the surgical and outpatients programmes require more rigorous oversight from NHSE if they are to deliver the outcomes required.

With the January 2025 plan to reform elective care and reduce waiting lists, the government plans to continue to run the transformation programmes for several more years, including further capital investment in surgical hubs and diagnostic centres. It now has an opportunity to ensure that it learns lessons from its experience in the first phase of the programmes. There are signs that it is doing so in some areas as it makes changes to the outpatients programme, does more to seek buy-in from local NHS systems and clinicians, and re-sets programme governance arrangements.

To achieve its aims on elective reform and secure value for money from the transformation programmes, NHSE will need to better understand the outcomes they are delivering for patients, and assess whether it is focusing its resources in the right areas to improve elective care.

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Publication details

Press release

View press release (24 Mar 2025)

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