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Data and charts

Waiting times for elective (non-urgent) treatment: referral to treatment (RTT)

Waiting times consistently rank as one of the public’s main concerns with the NHS and have a big impact on patient experience of the service. Here we explore how long patients are waiting for treatment and what impact Covid-19 has had on the numbers.

Meeting the RTT standard

The NHS constitution sets a standard that 92 per cent of people waiting for elective (non-urgent) treatment, for example, cataract surgery or a knee replacement, should wait no longer than 18 weeks from their referral to their first treatment. The standard was last met in September 2015. Since then performance declined steadily, until the Covid-19 pandemic when it deteriorated rapidly.

To meet the referral-to-treatment standard 92 per cent of people on the waiting list need to have been waiting less than 18 weeks, but current performance is significantly below that

The number of long waits

In addition to the 18-week standard, to prevent very long waits for treatment, NHS England introduced a policy in 2013/14 that said no one should wait more than 52 weeks from referral to first treatment. The number of people waiting more than a year was maintained at a low level for a long period of time but has never reached zero. Long waits started to creep up again in 2018, and then climbed significantly during the Covid-19 pandemic. There was a post-Covid-19 peak of 411,000 in October 2022 before the numbers started to fall.

The number of long waits increased significantly during the Covid-19 pandemic, with the numbers of people waiting more than 52 weeks going up significantly

Specialty RTT performance

Over the past four years all specialities have seen a fall in performance, and none are currently meeting the RTT standard. The largest single waiting list is for trauma and orthopaedics, which was more than 800,000 in March 2023. Ear, nose and throat had the highest proportion of waits of more than 18 weeks. The impact of long waiting times on patients is not regularly captured, but can mean patients waiting in pain for longer and the possibility of their condition deteriorating.

All specialities have seen a fall in performance against the referral-to-treatment standard since April 2019

Referrals higher than treatments

In simple terms, the waiting list is growing because people are joining it (being referred) at a faster rate than people are leaving it (being treated). This has led to the elective waiting list growing to its highest level since 2008; it is now with more than seven million1 . There are lots of factors that can contribute to this, for example, a growing population leading to more demand, and workforce shortages in the NHS meaning capacity to deliver treatment is limited.

Since April 2016, the number of people joining the RTT waiting list (referrals) has been higher than the number of people leaving it (treatment) in every month except one

Referrals compared to pre-Covid-19

The Covid-19 pandemic has had a big impact on elective waiting times. To prioritise hospital capacity for Covid-19 and emergency patients the NHS paused elective (non-urgent) treatment in April 2020 meaning waiting times grew quickly. However, during the national lockdowns fewer people were referred for treatment so the overall waiting list remained fairly stable. Despite expectations of a backlog of people seeking treatment, referrals in 2021 and 2022 remained below pre-Covid-19 levels.

Referrals on to the referral-to-treatment waiting list fell due to Covid-19, and did not return to pre-pandemic levels in 2021 or 2022

The King's Fund view

Waiting times consistently rank as one of the public’s main concerns with the NHS and have a big impact on patient experience of the service. The Covid-19 pandemic caused elective waiting times, and the overall size of the waiting list, to grow substantially; with recent warnings that it could take a long time for the waiting list to start falling. However, the NHS was already missing these key waiting time standards before the pandemic started, and the numbers waiting continued to increase after the Covid-19 lockdowns ended.

It will take considerable time and resources to reduce waits for routine NHS care. Building on the collaboration seen during the pandemic, there is an opportunity to think about how services can be provided in more innovative, more efficient ways that reach those most in need, address health inequalities and can sustainably meet the waiting-time standards, for elective care and more widely across the NHS.