Despite efforts to improve efficiency, hospitals within the National Health Service (NHS) are struggling to significantly reduce patient waiting lists, according to a recent analysis. While the number of outpatient appointments has seen a substantial increase, the corresponding rise in the number of patients completing their treatment pathways has been considerably lower.
Specifically, outpatient appointments grew by 9.4% in the 2024/25 period. However, the number of patients who actually finished their treatment only increased by 4%. This disparity suggests that patients are requiring more appointments and procedures before being discharged, ultimately hindering progress in tackling the backlog of cases.
The analysis indicates that if the number of patients completing treatment had increased at the same rate as non-urgent hospital activity, the NHS waiting list could be approximately one million cases shorter than it currently is.
Factors Contributing to the Issue
The report dismisses the possibility that a change in the severity of patients’ illnesses is responsible for the increased number of appointments. Instead, it points to an NHS England incentive scheme that tied some funding for trusts to activity levels rather than the successful completion of treatments. This may have inadvertently incentivized hospitals to prioritize the volume of appointments over the efficient resolution of patient cases.
Expert Commentary
An expert stated that while the increase in hospital productivity is positive, it has not translated into a noticeable reduction in waiting times for patients. The issue is not necessarily an increase in patients joining the waiting list, but rather that each patient requires more interventions before being discharged. Addressing this trend is crucial for the government to achieve its goals of reducing NHS waiting times. The focus should be on ensuring that patients receive the appropriate care to complete their treatment pathways efficiently, rather than simply increasing the volume of activity.
NHS England’s Perspective
NHS England reports a productivity increase of 2.7% in 2024/25 and 2.4% in the first quarter of 2025/26, exceeding the government’s target of 2%. However, the analysis suggests that progress in reducing waiting times for pre-planned care has been slow or even regressive over the past 18 months.
It’s important to note that NHS productivity metrics combine elective and emergency care. Strong performance in one area can mask weaker performance in another. However, the analysis indicated that emergency care activity grew at a relatively slow pace in 2024/25.
Waiting Time Statistics
The percentage of patients waiting less than 18 weeks for treatment has seen some improvement, rising from 57.2% in March 2024 to 59.8% in March 2025 and further to 61.8% in September 2025. However, this is still significantly below the NHS constitutional standard of 92%. The government aims to reduce waiting times to 18 weeks for the majority of patients by the end of Parliament in 2029.
The Rise of Robotic Surgery and the Need for Standards
The NHS is increasingly turning to robotic-assisted surgery to help reduce waiting lists. Projections estimate that 500,000 procedures will be supported by robotics annually by 2035, a significant increase from 70,000 in 2023/24.
However, surgeons have cautioned that the rapid adoption of robotic technology must be accompanied by rigorous standards for training and governance. The Royal College of Surgeons of England (RCS England) has issued new guidance urging NHS trusts to strengthen training and governance in this area.
Currently, there is no national protocol or minimum requirement for robotic training for surgeons, whether experienced or in residency. RCS England’s guidance calls for the establishment of such a minimum, with training incorporating online modules, virtual reality simulations, and supervised experience with robotics-trained surgeons.
The college emphasizes its commitment to supporting the training of future surgeons in robotic surgery and recommends a structured curriculum of core skills for using the technology across all stages of surgical training.
Expert Opinion on Robotic Surgery
A consultant colorectal surgeon and council lead for the future of surgery, robotics, and digital surgery at RCS England, stated that while robotic-assisted surgery offers significant patient benefits and the potential to reduce waiting lists, its rapid implementation necessitates rigorous standards.
Updated guidance from RCS England outlines the steps NHS trusts need to take to strengthen the training and governance of surgeons performing robotic procedures. This includes simulator training, cases supervised by experienced proctors, and thorough competency checks. As robotic surgery becomes more widespread within the NHS, it is essential that surgical residents receive the same structured training opportunities as consultants.
