IFS response to Labour Party announcement on NHS waiting lists

The Labour Party has today announced more details on its ambition to tackle the NHS elective backlog, proposing to clear waits over 18 weeks within five years of taking office. There are currently 3.2 million incomplete waiting list pathways longer than 18 weeks, and 310,000 longer than a year. The current government target of 92% of patients being treated within 18 weeks of referral has not been met for almost a decade, and performance has only got worse since the start of the pandemic. Reversing this trend over a five-year period is ambitious, and will be challenging to deliver.

Precisely assessing the feasibility of this target is difficult due to a complex relationship between waiting list size and waiting times. Achieving it will require increasing NHS treatment capacity by enough to treat not only new patients joining the list within 18 weeks but also the more than 3 million people who have already waited over 18 weeks. Previous experience tells us that significant waiting time reductions are possible – with the achievements of the Labour governments in the late 1990s and early 2000s a good example of this – but this time round the fiscal climate will make it much harder to increase health funding rapidly.

Max Warner, a Research Economist at IFS, said:

“Labour’s plan to clear the NHS backlog is a serious sign of ambition: clearing waits of more than 18 weeks within five years would represent a major improvement in NHS performance. Big reductions in waiting times were made by previous Labour governments but these were alongside large increases in health spending – increases of over 7% a year in real terms. The challenging fiscal situation facing the next government will make it incredibly difficult to increase health spending at anywhere near similar rates, and will make achieving this commitment much harder.

“The claim that the NHS waiting list will hit 10 million under a future Conservative government rests on the very strong assumption that future NHS performance will be the same as past NHS performance. In reality, the NHS has substantially increased treatment volumes in the past year, and the waiting list has already started to fall. Even in a world where treatment volumes grow more slowly than set out in the NHS workforce plan, our modelling suggests that the waiting list is likely to fall slowly, or at worst flatline, in the coming years. In other words, whichever party forms the next government, waiting lists are highly unlikely to climb to 10 million.”  

What could happen to waiting lists under a Conservative government?

The Labour Party claims that NHS waiting lists will rise from 7.5 million to 10 million if the Conservative Party wins the next election. This is based on the assumption that waiting lists would continue to grow at the same growth rate as they have since May 2022 – a very strong assumption. 

In the immediate aftermath of the pandemic, there were widespread concerns that the NHS waiting list would skyrocket as patients returned for treatment that they missed during the pandemic, and as the NHS took time to ramp up its elective activity once again. This included a warning by then health secretary Sajid Javid that the waiting list could reach 13 million. However, such a scenario has long looked unlikely given the smaller-than-expected number of patients returning for treatment, and the fact that the NHS has substantially increased treatment volumes from the waiting list in the past two years. In 2022, the NHS treated an average of 1.3 million per month from the waiting list. In 2023, this was 1.4 million per month, an increase of 8%. This increase in treatment volumes in part explains why waiting lists have fallen in recent months. It is very likely that – whichever party is in power – NHS performance will continue to improve, with an increase in treatment volumes much more likely than a fall.

This suggests that, while the NHS waiting list remains very high relative to both pre-pandemic and pre-2010 levels, we are unlikely to see such significant increases in the size of the list. In February, we produced a range of scenarios for what might happen to the NHS waiting list over the coming years. Even in our most pessimistic scenario, where NHS elective activity grows much more slowly than previously planned, the waiting list stabilises below 8 million. It therefore seems very unlikely – though not impossible – that the NHS waiting list would reach 10 million whoever forms the next government. 

Clearing waits over 18 weeks

The Labour Party has now committed to clearing waits over 18 weeks within five years. This is a serious sign of ambition: the current government’s target that 92% of patients should be treated within 18 weeks has not been met since September 2015, while only 84% of patients were treated within 18 weeks on the eve of the pandemic in December 2019. Clearing waits of more than 18 weeks would therefore reverse the decline in NHS waiting time performance that has occurred over the last decade in a shorter time span.

It is difficult to precisely assess the feasibility of the target due to the complexity of the relationship between the size of the waiting list and waiting times. What we can say with confidence is that it would be highly stretching. The challenge stems from the fact that the NHS would need not just to treat new patients within 18 weeks, but also to get through the 3.2 million treatment pathways that have already lasted more than 18 weeks. Doing so would require a large increase in treatment volumes. Labour’s commitment to deliver 40,000 extra appointments, scans and operations each week would, if achieved, represent a small but noticeable increase in activity. But this alone may well not be sufficient to clear 18-week waits. To be sure of whether Labour can achieve this commitment, we would need to see more details on Labour’s overall health spending plans for the next parliament.

Substantial improvements to NHS waiting times were achieved by the last Labour government. For example, from 1997, the New Labour governments almost eliminated waits for inpatient treatment of more than 12 months in around six years and waits of more than 6 months in around eight years. This illustrates that major improvements in waiting times are possible. However, they take a long time. Moreover, these past improvements came when health spending was increasing rapidly: real UK health spending rose by an average of 7.1% per year between 1997–98 and 2005–06. The challenging fiscal situation facing the next government will make it incredibly difficult to increase health spending at anywhere near similar rates, and will make achieving this commitment much harder.