New Government, same problem? Where next for NHS elective recovery

IHPN’s Head of Acute Policy, John Hopgood, looks at the testing position the new Health Secretary finds herself in, and lays out how sustained progress towards the 18-week target will depend on increasing activity, removing barriers to patient choice, and making full use of available independent-sector capacity.

Governments may change, but the NHS waiting list does not reset with them. As Andy Burnham enters Downing Street and Yvette Cooper becomes Health Secretary, the key questions is: what happens next to elective recovery? While there will inevitably be renewed attention on longer-term reform and delivery of the 10 Year Health Plan, the immediate reality is that she inherits a health service still grappling with record demand and millions of patients waiting for treatment.

Reducing waiting times has been one of Labour’s defining tests in government, and remains one of the clearest measures by which the new administration will be judged. With Andy Burnham confirming he will be sticking to Labour’s 2024 manifesto – and the public consistently saying their priority for the health service is to reduce waiting times – we expect to see an ongoing push to ensure the NHS can get back on the road to meeting its 18 week target. Three months ago, there was much fanfare as the NHS confirmed that it had met its first interim target (65% of patients waiting fewer than 18 weeks). But already, through the first two months of 2026/27, progress towards the next interim target – 70% – seems to have stalled.

After an improvement of 2.7 percentage points in March (a jump from 62.6% to 65.3%) – the largest single month change in this metric since the pandemic – compliance fell back to 65.0% in April, before ticking up to 65.6% in May.

Understanding this – both the reason for the late surge to hit 65%, and the relative stall in the two months since – will surely be key to the new Health Secretary’s success – or failure – when it comes to electives. If the government is serious about improving public confidence in the NHS while supporting economic growth by helping people return to work more quickly, sustained progress on elective recovery cannot be allowed to drift.

Clearly – and as has been widely reported – the extensive data validation exercises that the NHS carried out on the waiting list over the past twelve months have played a significant role in ensuring that people who should not be on waiting list are correctly removed. This, in turn, helps with hitting the 18-week target.

But the waiting list remains at more than 7.2 million people. The last time it was below 7 million was July 2022 – pre-Covid (February 2020) it stood at 4.6 million. Validation can only achieve so much against these numbers. Ultimately, the waiting list will only fall sustainably if the NHS consistently treats more patients than are being added to it.

The story on activity, then, remains key for Yvette Cooper.

First the good news – NHS activity was up by 1% in April when compared with April last year.

Then the bad news – to hit the 18-week target, both the next interim aim in March 2027 for 70% of patients to be treated within this timeframe, and the overall goal of 92% by March 2029, that growth in activity needs to be greater, and it needs to be sustained.

May’s data showed an overall decrease in activity compared with the previous year, albeit with a modest growth when adjusted for working days. The UK’s extreme weather through June and July are likely to mean further suppression of activity over the next reporting period.

Amid this, of course, is the ongoing role of the independent sector. As we have reported previously, overall RTT activity delivered by the sector decreased slightly (down 1.4%) in 2025/26 compared with 24/25. This reduction was clearly and directly driven by changes in the contracting model for choice-based services last year, with Activity Management Plans leading to a clear slow-down in the second half of the year.

This year will be the first time we see the full-year impact of those contracting decisions. Through two months, independent sector RTT activity is down 9% when compared with the same months two years ago. Restrictions set out in Indicative Activity Plans suggest that that trend may continue.

And that could be a significant problem for the new Health Secretary. Despite the introduction of minimum waiting times in many areas, waiting times within the independent sector are still, on average, lower than for NHS providers. Compliance with the 18-week wait standard is higher in the independent sector. If the government’s overriding objective remains faster access to treatment, then making full use of all available NHS-funded capacity, regardless of who provides it, will be essential.

It is also clear that demand to be treated within the sector is as high as ever – more people are waiting to be treated by independent providers than at any time in the past five years.

Last week, NHS England wrote to systems to ask them to begin preparing their winter readiness plans. For the NHS, the next pressure point is never far away – and it is the independent sector that is best placed to deliver the additional capacity that NHS systems need to deal with that pressure. Activity data from previous years clearly demonstrates that the sector can do more than it is currently being asked to – potentially as much as an additional 15-20% based on growth in previous years. As the new ministerial team establishes its priorities, there is an opportunity to reset the relationship with the independent sector and ensure existing NHS-funded capacity is used to its full potential, particularly ahead of what is likely to be another challenging winter.

Over the coming weeks, IHPN will be reaching out to the new DHSC team to offer the sector’s support in tackling the waiting list challenge and helping more NHS patients to access treatment as quickly and conveniently as possible. For Yvette Cooper, the challenge is not simply whether the NHS can meet the next elective recovery milestone, but whether it is prepared to use every available lever to do so. Patients waiting for treatment will care far less about who provides their care than how quickly they can receive it.

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.