NHS performance update: progress made, but significant challenges remain

Today’s published NHS performance data shows a modest fall in the overall waiting list to 7.29 million. The lowest level since February 2023, alongside record levels of elective activity in 2025. Over 18 million NHS treatments were delivered last year, and it is right to recognise the scale of effort involved, including a significant contribution from the independent who removed a record 1.6 million people from NHS waiting lists last year.

However, as many of you will have seen from the more detailed analysis of the figures, the position is more complex than the headline suggests and begins to show the impact of ICB restrictions on elective treatment in December, with real concerns about what that means for the NHS meeting its 65% target by March.

Overall performance against the 18-week Referral to Treatment (RTT) standard remains at 61.5%. While this is a marginal improvement year-on-year, it is still some distance from the interim 65% target for March and far below the 92% constitutional standard. The monthly reduction in the waiting list was relatively modest and below the trajectory required to restore performance sustainably over time. Meanwhile, almost 140,000 people are still waiting over 52 weeks for treatment.

With around six weeks remaining in the financial year, (three more monthly data releases to go before the March deadline), there is limited scope for structural change to materially alter the underlying trajectory for 2025/26. The recently announced “sprint” funding may shift activity in the short term, but the broader financial context remains extremely tight. Many ICBs are balancing challenging budgets, and in some areas this is already resulting in activity management measures and reduced elective commissioning across both NHS and independent providers.

For members, this creates understandable concern about short-term volatility and late-year adjustments to contracted activity. It also reinforces a wider strategic issue: if the system is to meet very stretching recovery targets over the coming years, it will require clarity, stability and realistic planning assumptions from the outset of 2026/27.

Independent providers continue to stand ready to support the NHS in reducing waits and restoring performance, and with the sector removing a record 1.6 million people from NHS waiting lists, this contribution will remain vital as the system navigates the next phase of recovery.

Looking ahead, careful consideration will need to be given to how next year’s activity plans are set, funded and managed so that:

• Capacity across the whole system is used effectively and predictably
• Patients are not subject to avoidable cancellations or uncertainty
• Providers have the operational stability needed to invest, recruit and plan
• Progress towards the 18-week standard is realistic, measurable and sustainable

With transparent planning, constructive partnership and early clarity on commissioning intentions, the independent sector can continue to play a consistent and reliable role in supporting NHS recovery. But looking ahead to what will be a bumpy few months, it’s clear the scale of the challenge should not be underestimated, with all parts of the health system needing to work towards a clear goal – improving patient access to care.