England’s NHS could still be falling far short of Labour’s 18-week treatment pledge by the end of this parliament, according to new analysis from the Health Foundation.
The Health Foundation’s modelling suggests that, if recent trends continue, 92 per cent of incomplete NHS referral-to-treatment pathways could involve waits of up to 34.9 weeks by July 2029, compared with the 18-week constitutional standard.
The constitutional standard says at least 92 per cent of patients should begin treatment within 18 weeks of a referral for non-urgent hospital care. The modelled figure is the threshold within which 92 per cent of incomplete pathways fall, not the average wait an individual patient can expect. On the think tank’s modelling, the target would be missed “by a considerable margin”.
Sir Keir Starmer made restoring the 18-week standard a central promise of his NHS agenda when Labour took office in July 2024. NHS England’s referral-to-treatment figures show that the 92nd-percentile waiting time for incomplete referral-to-treatment pathways stood at 44.6 weeks that month. By July 2026, it had fallen to 38.4 weeks. The constitutional 18-week standard had not been met for about a decade.
The waiting list, counted in incomplete referral-to-treatment pathways, stood at 7.62 million when Labour took office, a near-record high. It had fallen to 7.33 million by July this year, and the Health Foundation expects it to reach about 7.11 million by July 2029. Long waits have fallen fastest: the number of patients waiting more than 52 weeks has more than halved, from over 290,000 to about 111,400.
The NHS did pass an interim milestone this year, treating 65 per cent of patients within 18 weeks by March 2026. Wes Streeting, then health secretary, claimed victory at the time. He left the Department of Health and Social Care in May and is now Defence Secretary. The Health Foundation’s earlier analysis of the milestone warned that the gains in the months before March may have reflected a sprint of extra evening and weekend clinics that would be difficult to sustain. Progress has since stalled, and the authors of the new report said this raised questions about whether the improvements were sustainable.
In September 2025, the Health Foundation projected that the 92 per cent waiting-time threshold would stand at 20.3 weeks by July 2029, narrowly missing Labour’s pledge. Its latest modelling puts that figure at 34.9 weeks under a continuation of recent trends, a substantial deterioration in the outlook over the past year.
A major factor is rising demand. Referrals rose from 20.77 million in the year to July 2024 to 21.73 million in the year to July 2026, and their growth rate doubled, from 1.5 per cent in Labour’s first year to 3.0 per cent in its second. The Health Foundation says the rise appears to be driven largely by GP referrals, though it is still working to establish why. More patients are also leaving the list, because they have been treated, seen privately or died, but removals have been growing at only about 2.2 per cent a year and now outstrip referrals by a much smaller margin, slowing the overall progress.
Dr Francesca Cavallaro, a senior analytical manager at the Health Foundation, said the rise in referrals meant the NHS was “having to run faster just to stand still”, and that the prospects of meeting the Government’s pledge were “receding”.
The report also says industrial action by resident doctors, across three periods in 2025 and again in April 2026, may have impeded elective activity. It is presented as one contributing factor among several. The arithmetic of the pledge is stark in any case: if referrals keep growing at 3.0 per cent a year, removals from the list would need to grow by more than 4.5 per cent annually, roughly double their current rate.
The commitment was made under Sir Keir Starmer, but the Health Foundation says it remains unclear whether Prime Minister Andy Burnham’s Government will give the 18-week target the same priority. Other pledges, social care among them, compete for the same budget.
Dr Cavallaro said: “Andy Burnham’s Government have yet to set out whether they will give the 18-week target the same priority as it had under Keir Starmer, but our analysis shows the pledge is becoming increasingly hard to deliver.”
“While the Government should not give up on bringing down waiting times when millions of people are still waiting too long for treatment, setting a more realistic target would enable the NHS to continue to make progress on elective care and to focus more on improving other key aspects of care that are also important to the public.”
An NHS spokesman said the service was “back to delivering its targets” and had met its commitment to treating 65 per cent of patients within 18 weeks in March this year, despite a significant increase in demand. He said the report did not take account of changes to how health services are delivered, such as creating many more services outside hospitals in people’s neighbourhoods, and added: “While we acknowledge it will be challenging, we remain on course to deliver our commitments by the end of the parliament.”
A Department of Health and Social Care spokesman said: “This Government has made cutting NHS waiting times a central priority, and we are determined to keep pushing towards our 92 per cent target, so more patients can get the treatment they need, when they need it. Already, almost 300,000 fewer people are waiting for treatment now than in July 2024, and more patients are being seen within 18 weeks than at this point last year, but we know there is more work to do in order to maintain that progress.”
Great British PAC reaction
Claire Bullivant, chief executive of Great British PAC, said:
“Labour promised to get NHS waiting times down to 18 weeks. Now independent analysis suggests the waiting-time threshold could still be almost 35 weeks by 2029. That raises serious questions about Labour’s flagship NHS promise.
“And even the headline waiting-list figures deserve closer scrutiny. We now know that patients have been removed from waiting lists through administrative exercises without necessarily receiving treatment. Labour must be completely transparent about how much of its claimed progress comes from patients actually being treated, and how much comes from removing names from a database. Patients need operations, not statistical improvements.
“And we must not forget the financial legacy of previous Labour governments, which have contributed to the mess we are in today. Never forget, it was Tony Blair’s administration that enthusiastically embraced PFI hospital deals, leaving NHS trusts facing enormous long-term financial commitments, with billions of pounds still to be paid. Those decisions continue to have consequences for the money available to run our health service today. I know of some NHS trusts that have to spend over half their annual budgets servicing these historic PFI commitments. That is an extraordinary financial burden, and one that raises serious questions about the decisions made by previous Labour governments.
“Labour needs to learn some serious lessons about economics, accountability and management. Patients need operations, not political spin. Taxpayers need value for money, not another generation of expensive financial commitments.
“Andy Burnham’s Government must explain how it intends to meet its promises, distinguish genuine improvements in patient care from administrative changes, and protect frontline services from the burden of historic financial commitments.
“The British public deserves an NHS that delivers treatment, transparent figures and responsible financial management. You cannot cure patients with press releases, you cannot pay hospital bills with political slogans, and you certainly cannot rebuild public confidence by simply taking names off a waiting list.”
