When the Labour government swept into power last year, it did so with a bold promise: to bring England’s National Health Service (NHS) waiting times back in line with a key target that’s eluded policymakers for a decade. The 18-week pledge—where 92% of patients should wait no longer than 18 weeks for routine treatment—was set as a flagship commitment, with Prime Minister Sir Keir Starmer putting his name to the goal of achieving it by the end of the current parliament in 2029. But as the Health Foundation’s latest analysis reveals, the road to redemption may be longer and bumpier than many hoped.
According to the Health Foundation, a leading think-tank, England’s NHS is making progress, but not quite at the pace needed. Their analysis, reported by BBC and other outlets, shows that if current trends continue, waiting times will still hover above 20 weeks by July 2029—falling short of the government’s much-publicized target. While the proportion of patients seen within 18 weeks has crept up from 58.8% in July 2024 to 61.3% in July 2025, and the total waiting list has edged down from 7.6 million to 7.4 million, the numbers aren’t quite where they need to be.
To put it simply, the NHS has been fighting an uphill battle ever since the COVID-19 pandemic forced hospitals to scale back routine care. Waiting lists ballooned, and the backlog became a political and public health crisis. “The government has clearly made progress in reducing waiting times, but on current trends our analysis shows that the NHS would just fall short of meeting the 18-week standard by the end of the parliament,” said Dr Francesca Cavallaro, senior analytical manager at the Health Foundation, as quoted by BBC and The Independent. “The scale of the challenge remains significant and even getting close to meeting the target would be a considerable achievement.”
But why is it so hard to hit this target? For starters, the underlying math is daunting. The Health Foundation’s report points out that referrals to the waiting list increased by 1.5% between August 2024 and July 2025, while removals—patients whose treatment is complete, declined, or otherwise unreported—increased by 2.3%. If these trends hold, the waiting list could shrink to 4.7 million by July 2029, with average waits around 20.3 weeks. To actually hit the 18-week mark, removals would need to increase by 2.5% if referrals keep growing at 1.5%, or even more if referrals accelerate further—a scenario the Health Foundation says “seems likely” given the ageing population.
The pressure to deliver is immense. NHS trusts, those on the front lines, have found themselves “between a rock and a hard place,” especially during the last winter. They’ve had to juggle the urgent demands of emergency care with the relentless push to clear the elective backlog. “Over this past winter, because there was quite a lot of pressure to meet the elective targets, trusts were stuck between managing urgent emergency care performance and trying to maintain progress on reducing the elective backlog,” Dr Cavallaro explained.
While the government has touted its achievements—more than five million extra appointments delivered in a year and a reduction of 220,000 in waiting lists, according to the Department of Health and Social Care (DHSC)—the reality is nuanced. The DHSC points to a 2.7% increase in NHS productivity over the past year, new investments of £26 billion for 2025, the creation of new surgical hubs, and the rollout of modern technology and more evening and weekend scans. “We’ve put the NHS on the road to recovery and are pressing the accelerator,” a DHSC spokesperson said, as reported by the BBC. “Strikes have caused delays to patient appointments. We urge the BMA to work with us, not against us, as we drive down the longest waits from 18 months to 18 weeks and get the NHS back on track.”
But not everyone is convinced the government’s optimism is warranted. Tim Mitchell, president of the Royal College of Surgeons of England, told the BBC and The Independent, “This analysis otherwise confirms what surgeons see every day: the NHS is still struggling to meet demand and, unless surgical capacity expands, the government will almost certainly fall short of its target.” The Health Foundation’s findings echo this, noting that just over a third of NHS trusts are making the necessary progress set out under the government’s waiting time plan published at the start of 2025.
There’s also a risk that the intense focus on the 18-week target could come at the expense of other priorities. Dr Cavallaro and the Health Foundation warn that “placing so much emphasis on the 18-week target risks slower progress on other key issues, such as improving access to GPs, which we know is the public’s top priority for the NHS.” Polling supports this, with many members of the public ranking GP access above even hospital waiting times. The Health Foundation’s report suggests that the political spotlight on elective waits could distract from the broader improvements the health service needs.
Industrial action remains another wildcard. Resident doctor members of the British Medical Association (BMA) are still in dispute with the government, and further strikes could further complicate efforts to reduce waiting times. The DHSC acknowledges that strikes have caused problems and continues to urge the BMA to cooperate in tackling the longest waits.
Despite the doubts and the daunting numbers, there are some glimmers of hope. NHS Providers chief executive Daniel Elkeles struck a cautiously optimistic note, saying, “It’s encouraging to see how steps to bear down on waiting lists, including more community diagnostic centres and surgical hubs, are shifting the dial for patients. But it’s a huge task, and too soon to say if the target for this parliament will be met.”
Meanwhile, the Health Foundation’s analysis comes with a caveat: it’s “too early to draw any firm conclusions” about whether the 18-week pledge will be achieved by 2029. The data is trending in the right direction—albeit slowly—and the government’s investment in technology, workforce, and infrastructure could yet bear fruit. But the challenges are significant and multifaceted: an ageing population, rising demand, the threat of further industrial action, and the need to balance competing priorities across the health service.
For now, the NHS finds itself at a crossroads. Progress has been made, but the finish line remains stubbornly out of reach. The coming years will test not only the government’s resolve but also the health service’s capacity for innovation, collaboration, and resilience. With millions of patients waiting and the public’s expectations high, the outcome of this flagship pledge will shape the political and healthcare landscape for years to come.
