Four out of ten NHS patients are waiting too long for treatment.
The latest data from NHS England shows only 59.8% of patients starting treatment within the recommended 18 weeks – against a target of 92%. The NHS hasn't met the 92% target since 2015 – and as of November 2024, nearly 222,000 patients had been waiting over a year for treatment.
This isn't just missing a target. It's a system-wide crisis that demands fresh thinking about how we deliver healthcare.
The latest data from NHS England shows only 59.8% of patients starting treatment within the recommended 18 weeks – against a target of 92%. The NHS hasn't met the 92% target since 2015 – and as of November 2024, nearly 222,000 patients had been waiting over a year for treatment.
Understanding the RTT Target Reality
The Referral to Treatment standard exists for good reason. When someone needs medical care, 18 weeks from referral to treatment represents the maximum time they should have to wait.
Currently, we're achieving less than 60%. This means that more than 4 out of every 10 patients are waiting longer than they should for care they need.
Why We're Missing the Target So Badly
The gap stems from interconnected system failures: a workforce capacity crisis where you can't treat patients without the right people in place, emergency care stealing resources from planned procedures, administrative bottlenecks creating multiple failure points, and limited physical capacity making it difficult to scale up quickly.
The Cost of Delay
Every week that patients wait beyond the 18-week target has real consequences. For patients: disease progression, increased pain, mental health strain, reduced quality of life. For the NHS: higher treatment costs and more intensive care needed. For society: lost productivity, extended time off work, increased pressure on families.
The number of patients waiting over 52 weeks has surged past 220,000, showing how delay has become the norm, not the exception.
Insourcing: Keeping Control While Scaling Up
For many trusts, insourcing represents the sweet spot between maintaining service quality and rapidly increasing capacity. Unlike traditional outsourcing, insourcing allows trusts to keep clinical governance within the organisation, use existing facilities more intensively, maintain continuity of care, and reinvest savings back into patient services.
Nearly a quarter of elective operations are now being cancelled last-minute and not rescheduled within 28 days. Trusts need ways to scale internal capacity – fast and flexibly.
The Path Forward
The 59.8% RTT performance we're seeing today doesn't have to be permanent. The gap between current performance and the 92% target is significant, but it's not insurmountable with the right tools and approach.
The Institute for Fiscal Studies has said the NHS would need to increase planned care by nearly 5% each year to hit the 92% target by 2029 – a tough ask without smarter workforce strategies.
The future of RTT improvement lies in hybrid approaches that combine permanent staff, collaborative workforce platforms, and smart technology to create more flexible, responsive healthcare systems.
