England’s referral-to-treatment (RTT) waiting list shrank a little faster in January than the usual seasonal reduction, meaning there was probably some genuine recovery. But the improvement was much too small for restoring the ’18 weeks’ waiting time standard by March 2029 as the government has pledged.

Analysis produced for Health Service Journal by Dr Rob Findlay, Director of Strategic Solutions at Insource Ltd and founder of Gooroo Ltd

January is the last month in which waiting list reductions are enhanced by seasonal shrinkage. From February to August the seasonality tips into growth.

Even then, seasonality will be no excuse if the waiting list grows in any month – it always needs to shrink significantly. Even when seasonal growth reaches its peak in May, the list will need to shrink by at least 25,000 patient pathways to match the trajectory for ’18 weeks’ recovery.

In the following discussion, all figures come from NHS England. You can look up your trust and its prospects for achieving the waiting time targets here.

The numbers

The waiting list is still falling far too slowly to restore ’18 weeks’ by March 2029. The grey lines in the chart below are seasonally-adjusted, and they always head downwards, showing that even after allowing for seasonality the waiting list must shrink in every single month.

There are occasional suggestions in the media that the waiting list is only falling because more patients are being ‘validated’ rather than diagnosed and treated. Validation involves checking that the waiting list is up to date and accurate, and then correcting or removing the records of patients who are there in error. Although validation should be a routine task, NHS England sometimes ask hospitals to undertake a more intense validation ‘sprint’, and it is these sprints that the media reports refer to.

The chart below shows that removals did increase in April and May 2025 when one such sprint was underway. Different people may see different things in this chart, but I do not think that recent figures show an exceptional level of validation, suggesting that January’s waiting list reduction was genuine.

Unlike the charts above, the charts below are not adjusted for non-reporting NHS trusts.

The waiting list has been reducing year-on-year, but very slowly. (If you are wondering why the ’18 weeks’ zone in the chart below is lower than in the progress chart at the top, the reason is that the progress chart takes account of demand growth up to March 2029, whereas the chart below reflects the position in January 2026.)

Waiting times fell by 0.4 weeks to 40.3 weeks RTT. For those patients who do not yet have a diagnosis and decision to admit, waiting times fell slightly faster from 38.8 to 38.2 weeks; there were just under 6 million such patients, including an estimated 25,860 whose eventual diagnosis will unexpectedly be cancer.

The trajectories in the ‘progress’ chart at the top assume that the shape of the waiting list improves to 2013-16 levels as waiting times come down. So far there is little sign of that. It is even possible that the shape may deteriorate, if the NHS delays tackling its more challenging waiting lists until the later years. Fortunately, there is little sign of that either, although at the extremes it is notable that there are still 1,600 patients waiting over 18 months despite a long-missed target to treat them.

Oral surgery, plastic surgery, and ENT remain the longest-waiting specialties. Of the big surgical specialties, ophthalmology stands out for having shorter waits.

Referral-to-treatment data up to the end of February is due out at 9:30am on Thursday 16th April, a week later than usual because of Easter. It should start to show the impact of the year-end ‘elective sprint’.