A Cat’s Whisker from the Target? The Data Tells a Tougher Story

IHPN’s Head of Acute Policy, John Hopgood, looks at April’s NHS dataset – covering activity delivered in February – which is all about one thing, is the NHS on track to meet its interim target on 18-week waiters?

With one month of activity still to be counted before the end-of-March deadline, the numbers show that 62.6% of patients have been waiting fewer than 18-weeks, still significantly short of the 65% target. Remarkably, February was the first month since last September where that position actually improved. Meeting the target would now require the single largest monthly improvement since we began tracking the position in March 2024, and which has not been achieved since we came out of the initial Covid spike.

Overall, the data shows a system focused on delivering less complicated activity that results in a quick clock-stop at the expense of more complex procedures. This is played out extremely clearly in the independent sector, where indicative activity plans (IAPs) have allowed ICBs to closely control activity among independent providers.

February admitted activity (i.e. more complex inpatient care) in the sector was at its lowest level for a comparable month since 2022, and down 22% compared with February 2025. Non-admitted activity, meanwhile, while still down on its 2023/24 peaks, was up 8% on the same time last year.

The focus on these less complicated, quicker clock-stops aside, after five consecutive years of growth – with total independent sector activity more than 60% higher in 2025 than it was immediately post-pandemic in 2021 – 2025/26 looks set to see a slight decrease in NHS activity delivered by the sector. This is not unsurprising given the changes in commissioning over the last year, with the much more robust use of contract management by ICBs.

The activity profile clearly shows the reason for this. The chart below shows 2025/26 activity tracking broadly in-line with 2024/25 until September, before falling away from October onwards. October marked the point at which ICBs were able to begin exercising their contract management powers – specifically through issuing Activity Management Plans that could place a hard cap on activity delivered by a provider.

Perhaps more concerning is the clear disparity between independent and NHS providers. Overall share of activity delivered by the independent sector climbed from a pre-pandemic baseline of 7% up to a peak of 10% in late 2024 and early 2025. In February 2026, the sector delivered just 7.5% of NHS elective care – the lowest representative single-month share since February 2020.

Looking more broadly, the role that waiting list validation is playing in the NHS’ attempt to meet this target is well documented – and largely not applicable to the independent sector. What is clear though is that without being able to remove hundreds of thousands of patients from waiting lists across the past twelve months via this method, activity alone would have fallen way short of the waiting times target.

At the time of writing, average waiting times in the independent sector remain significantly lower than those at NHS providers. While case-mix differs, so direct comparisons don’t capture every nuance, on average IS waiters can expect to wait as many as four weeks fewer than patients on a waiting list at an NHS provider.

This proactive shifting of activity away from independent providers, makes little sense – either financially (where independent providers deliver activity exactly to tariff rates, and not on block contracting arrangements as in many trusts), or in terms of patient experience. Patients are seen more quickly within the sector – compliance with the 18-week standard is currently around 75% across all independent providers. This means that the sector can disproportionately contribute to the system meeting the overall target, while often working more productively and to greater efficiency that NHS providers.

It remains to be seen whether NHS England’s waiting list validation exercises allow them to ultimately meet the 65% interim target in March. But what is clear – with activity for 26/27 already underway, and the contracting round as slow as ever – further moves to shift activity out of the independent sector and back to NHS Trusts will make meeting future targets even more challenging.

This blog is part of a data series covering the independent sector contribution to NHS-funded activity. All data is taken from monthly NHS statistical publications, including RTT, SUS and WLMDS – source data is available here.