Can the government achieve its 18-week elective waiting time target?

It’s a key question facing Wes Streeting and the in-transition Department of Health, and the topic that the Insititute for Fiscal Studies (IFS) recently built a whole study paper around.

But is the IFS’s analysis of the situation the right one, and why is it important that we don’t view waiting lists as equivalent to a simple queue?  

What is the background?

The government has committed to returning to the NHS constitutional standard that at least 92% of patients should wait no longer than 18 weeks for elective (pre-planned) hospital treatment in the NHS in England.  

Currently, this target is far from being met. In February 2025, the latest month we have data for, only 59.2% of people were waiting less than 18 weeks for treatment - way below the standard. The 92% target has not, in fact, been met since September 2015.

What dictates the waiting time?

In its study, the IFS considered the long-held analogy of NHS waiting lists as a queue, with the 18-week target measuring how long people have been waiting in that queue.  

The study reminds us that in order to understand the time spent in a queue, it matters (1) how long the queue is when you join it, (2) how fast the queue is moving, and (3) how waiters are chosen to be seen next.  

It suggests that for elective activity in the NHS, there are three levers which we can pull: (1) reducing the number of people being referred to join the waiting list, (2) increasing the capacity of the NHS to treat more people, and (3) altering the ways that different groups of waiters are prioritised.

The IFS has modelled scenarios and concluded that we need a combination of all three to deliver the standard and, notably, posed the question of whether the NHS (and its patients) are prepared for the prospect of the last of these - namely a change in the principle of first-come-first-served once clinical urgency has been addressed.  

Is this the only way?

While we agree with the general logic of the above, thinking of the 18-week pathway as a queue is too much of an over-simplification.

The three levers outlined in the study are all well and good if you think of NHS services as a single queue with one entry point, with linear movement through the queue and one pre-defined end point, i.e. if you think of it like a queue for a post office.  

But, as we know, elective care pathways aren’t like that in reality. Think of them more like the process of catching a plane, with multiple different queues and factors that can affect your progress, all adding up to one overall journey time.

Continuing with the plane analogy for a minute. Yes, of course, this still depends on how busy each element is. How long is the queue at security when you join? How many passport control gates are staffed? Can you access fast track lanes to speed up certain waits?  But arguably each of these steps is only getting you to the next bottleneck.

When you think about the whole journey as a bigger picture, rather than the queues in isolation, there is another factor that can help: the marginal gains that you can use to move though the journey faster in spite of the above.  

How can this be achieved?

If you can use intelligence about the waiting list to pull patients through the pathway faster, to know what they need next quicker and to remove barriers before they cause a delay, then this can achieve a faster waiting time overall.  

This is something we are looking to resolve with our brand-new software platform, Sigma, which is designed to create smarter, smoother pathways to help achieve a reduction in patient waiting times.  

One of the many things Sigma provides is a single timeline view of an individual’s pathway, bringing everything together to clearly understand progress. Its automated tracking facility provides real-time categorisation of what a patient requires next and prompts the completion of key milestone tasks in a journey to avoid delays. Additionally, its data quality checks quickly highlight errors which could lead to unnecessarily longer wating times.  

Imagine if everyone knew the departure gate of the correct baggage carousel straightaway rather than waiting for it to appear on screens. Imagine if you had the assurance that you were waiting in the right place, for the right thing, every time. Everything would be much smoother, right? There would certainly be much less confusion and waiting around.  

So, while the IFS is not wrong in what it says in its study, we need to focus on the whole journey - and each of its many steps, large and small - if we are to make headway into waiting times.  

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