NHS England (NHSE) has failed to meet its post-COVID recovery goals to shorten patient waiting lists, according to a new report from the Public Accounts Committee (PAC). The £3.24bn investment by NHSE on transforming diagnostic and surgical services has not led to the desired improvement in waiting times, and the NHS has now missed its recovery targets by significant margins.
In January 2025, over six million people were waiting for elective care, and the PAC has found that progress in reducing waiting times appears to have stalled:
• Nearly 192k patients were waiting over a year for care by July 2025 – a length of wait which should been eliminated by March
• For diagnostic tests, 22% of patients were on a waiting list for more than six weeks – against a target of 5% by March 2025, and an operational standard of 1%
• When it comes to treatment, only 59% of patients were treated within the statutory standard of 18 weeks, against a target of 92%
• Plans to reduce follow-up outpatient appointments by 25% (compared to 2019-2020) by March 2023 saw NHSE achieve only 0.1% fewer appointments between June 2022 and July 2023.
Lack of focus on patient outcomes
The PAC’s report finds that these failures were driven in part by NHSE’s and the Government’s flawed approach to improving its own services. Billions of pounds in spending were approved by government without sufficient focus on what exactly its funding would deliver and without any focus on outcomes for patients.
Diagnostic transformation received £2.2bn, and £1.04bn went to surgical transformation, at a time of scarcity for capital funding. A shortfall of 3.6m tests led to the missed diagnostics target; for new surgical hubs, only the number of newly delivered hubs was tracked, with NHSE unable to say what contribution they actually made to total elective activity.
Plans to free up more outpatient appointments could have made the most difference as the vast majority (80%) of elective care pathways end through an outpatient’s appointment; but NHSE had no credible plan to achieve this, failing to secure meaningful engagement from clinicians to do so.
The report recommends NHSE and government should focus reporting on patient outcomes to ensure that funding delivers its intended outcomes, set out plans to reach the 1% operational standard for six week waits for diagnostic tests, and learn the lessons from the failure of the outpatients’ programme.
Repeating mistakes
The PAC is further concerned that major reforms announced by the Department for Health and Social Care (DHSC) and NHSE are replicating poor practices seen on the HS2 and New Hospital Programmes, and will lead to wasted effort.
Structural changes are being made to the healthcare system without secured funding in place to pay for the changes, or impact assessments carried out. The PAC is warning these changes, especially the planned cuts to local health boards, could have a significant negative impact on patients and on the workforce through the level of uncertainty they create.
The report seeks confirmation from DHSC that it will not announce unfunded commitments and sets out the likely costs of planned redundancies and the absorption of NHSE into DHSC.
The report is also critical of the approach to digital transformation. The PAC is not confident that DHSC is being realistic about the immense effort needed to bring down waiting times, with digital solutions risking being treated as a ‘cure-all’. Digital integration is a key weakness for the NHS and the report seeks DHSC and NHSE’s plans to address legacy IT.
The PAC also remains sceptical that digital change can satisfactorily reach all patients as there is likely to always be a part of the population who find digital technology and tools too difficult to use.
Clive Betts MP, Deputy Chair of the Public Accounts Committee, says: "Every penny of funding spent to put the NHS back on a pre-pandemic footing must be precisely targeted, or the system itself becomes an obstacle to proper care.
"Unfortunately, our report establishes that billions have been poured into the system over the past few years without the requisite focus on making sure that money does what it was intended for – improving outcomes for patients.
"The rollout of shiny new surgical hubs and diagnostic centres will only be superficially impressive if they are not used in the most productive way.
“Alarmingly, in the Government’s approach to the absorption of NHSE and 50% cuts to local health boards, we are now seeing chilling echoes of past failures on HS2 and the New Hospital Programme.
"Our Committee has long established that large unfunded commitments, without plans for delivery, while good at generating headlines, can only end one way. We hope the Government can provide reassurance as part of this inquiry that it can come forward with the underpinning detail that can marry its ambitions to reality.”
Rachel Power, Chief Executive of the Patients Association says: “It is deeply troubling that both the PAC, and the Institute for Government (IfG), found an absence of credible delivery plans behind major reforms and digital transformation, and the IfG’s assessment went as far as to describe the Government’s decision to abolish NHS England as ‘rushed and chaotic’. When Parliament's fiscal scrutiny committee and the UK's respected think tank on government effectiveness both reach the same conclusion on the lack of clarity on a delivery plan, this is concerning for everyone. We have been consistently told that the end to unreasonable waiting times is on the horizon and yet, despite some progress, it feels like chasing a mirage.”
