My Medical Gateway News

The NHS waiting list may be falling, but does that mean fewer patients are waiting for treatment? Official figures show the NHS backlog has reduced since Labour took office, yet millions of patients remain untreated, diagnostic delays persist and growing numbers are turning to private healthcare or treatment abroad. This article examines the reality behind NHS waiting list statistics and asks whether the UK’s healthcare crisis is genuinely improving or simply becoming less visible in the official numbers.

When Sir Keir Starmer told Prime Minister’s Questions on 10 June that Labour had cut the NHS waiting list, the claim was politically useful and, in a narrow sense, correct.

Official NHS England figures show that the elective waiting list fell from around 7.6 million treatment pathways when Labour entered office in July 2024 to around 7.4 million by April 2025, a reduction of roughly a quarter of a million pathways. After years of relentless growth, the headline number is finally moving in the right direction.

But that statistic alone tells us surprisingly little about the true scale of unmet healthcare demand. A falling waiting list is not necessarily the same thing as a shrinking healthcare crisis. The real question is not whether the waiting list has fallen but whether the number of people waiting for care has fallen, and on that measure the evidence is far less convincing.

The NHS waiting list measures treatment pathways that have successfully entered the Referral to Treatment system. It is an administrative count rather than a complete measure of healthcare need. 

At My Medical Gateway, we have long argued that the widely quoted NHS waiting list of around 7.2 million treatment pathways understates the true scale of the problem. When hidden demand, delayed referrals and patients who have yet to enter treatment pathways are taken into account, the true figure is likely to be closer to 9 million people requiring care.

One of the most striking pieces of evidence emerged last year when analysis revealed that around three million patients on NHS waiting lists had received no care whatsoever since being referred by their GP. There was no specialist consultation, no diagnostic investigation and no treatment plan. Around one million of those patients had already exceeded the NHS’s 18-week target despite having had no meaningful contact with secondary care services.

These patients are officially counted as being “on the waiting list” but, in practical terms, many remain stuck at the very beginning of the treatment process. That fact alone should make policymakers cautious about drawing sweeping conclusions from changes in headline waiting-list statistics.

The government’s argument assumes that a reduction in waiting-list pathways reflects a reduction in unmet demand, but that assumption deserves scrutiny because not every patient who leaves the NHS waiting list has necessarily received NHS treatment.

To start with, increasing numbers of patients are finding alternatives. Private healthcare activity has grown substantially across the UK since the pandemic as patients seek to bypass lengthy delays for procedures such as hip replacements, knee replacements, cataract surgery and diagnostics. Orthopaedics in particular has seen significant growth in self-pay treatment as patients decide that waiting months or years for surgery is simply not acceptable. The result is that a growing share of healthcare demand is now being absorbed by private providers rather than the NHS. That may reduce pressure on waiting lists, but it does not necessarily mean NHS capacity has improved.

At the same time, ONS data reports that more than 520,000 Britons travelled overseas for medical treatment during 2025, seeking faster access and lower costs in destinations across Europe and beyond. Every patient who funds a knee replacement privately or travels abroad for treatment reduces pressure on NHS waiting lists, but their departure does not necessarily indicate that NHS capacity has improved. It may simply indicate that patients have found a way to escape the queue.

A waiting list can fall because demand is being met but it can also fall because demand is being diverted elsewhere. The headline number cannot tell us which explanation is responsible. 

Beyond the official waiting list sits what might be called the NHS’s hidden backlog. Healthwatch England and other organisations have repeatedly documented failures within NHS referral pathways. Referrals are lost, administrative errors occur and patients are incorrectly informed that they are waiting when no referral has been processed. There is a pattern of communication failure between GP practices, hospitals and NHS administrative systems.

The result is a substantial number of patients who believe they are progressing through the NHS when, in reality, they may not be in any queue at all. Given that the NHS processes around 15 million referrals annually, even relatively small failure rates translate into very large numbers of affected patients who do not appear in ministerial announcements. Yet their healthcare needs remain entirely real.

Before Covid, many health economists predicted that NHS waiting lists would eventually exceed 10 million as deferred demand returned to the healthcare system, but that surge never fully materialised. One explanation is that some patients may no longer require treatment while many others have moved into private healthcare or sought treatment overseas.  But what is the answer is less reassuring?  Could many be struggling to access primary care or simply have stopped pursuing treatment altogether after years of delay and frustration. Their absence from official waiting-list statistics does not mean their need for healthcare has disappeared.

This matters because the most important question is not whether the waiting list has fallen, it is whether the number of people requiring treatment has fallen. There is little evidence that it has.

The productivity picture raises further questions. Since the pandemic, NHS funding has increased from around £150 billion to £205.1 billion annually. The NHS also employs more than 1.5 million people.  It is the biggest employer in the country and it now has the highest workforce in its history. Yet NHS productivity remains between 5% and 11% below pre-pandemic levels, while independent reviews such as Lord Darzi’s have found that consultants are conducting fewer outpatient appointments and surgeons are performing fewer operations than before Covid.

The issue is not a lack of commitment from NHS staff. Most analyses point towards deeper structural challenges including ageing hospital estates, outdated and insufficient technology, poor patient flow, social care bottlenecks, rising patient complexity, workforce fatigue and administrative burden.

Nevertheless, the conclusion remains uncomfortable. The NHS is receiving substantially more money than before the pandemic while delivering less activity per clinician. That reality makes it difficult to argue that a falling waiting list alone demonstrates a fully functioning recovery.

To be fair to the government, greater use of independent-sector capacity has helped reduce waiting lists and increase treatment activity. These are genuine achievements. However, they should not be confused with a recovery in NHS capacity itself. The more the NHS relies on external providers to deliver care, the more it risks masking underlying weaknesses rather than resolving them. A waiting list may fall, but dependence on outsourced treatment continues to grow.

There is also a longer-term question. Independent providers now undertake more than a quarter of NHS-funded hip and knee replacements and almost half of NHS-funded cataract surgery. These are precisely the routine procedures on which surgical training depends. While private providers have expanded training placements in recent years, medical organisations continue to warn that the growing transfer of NHS-funded activity outside traditional teaching environments risks weakening the training pipeline on which the future NHS workforce depends.

The official waiting list remains above seven million treatment pathways. The true number of people requiring care is likely to be closer to 9 million. Millions of patients on the waiting list have still received no meaningful care since referral. Diagnostic backlogs remain severe. Referral failures continue to affect patients. Productivity remains below pre-pandemic levels despite record levels of spending. Most importantly, nobody can say with confidence how many patients remain outside the system altogether.

That is why the political debate is asking the wrong question. Politicians focus on whether the waiting list is rising or falling. Patients ask something much simpler. Can I get diagnosed? Can I get treated? Can I get better?  For the millions of people still waiting for care, those are the questions that matter.