Intended for healthcare professionals


Labour’s plans to reduce the NHS backlog are ambitious but demanding

BMJ 2024; 385 doi: (Published 06 June 2024) Cite this as: BMJ 2024;385:q1250
  1. Thea Stein, chief executive, Nuffield Trust

Plans proposed by the Labour Party to reduce the NHS waiting list are welcome, but making them a reality would be challenging

The Labour Party has committed1 to clear the backlog of patients in England waiting for more than 18 weeks for NHS treatment within the next five years. Cutting waiting lists is of key importance for the UK public right now, so the party’s pledge is bold but also extremely difficult to make reality. Labour is right, however, to identify that the NHS will need more resources if it is to tackle the backlog.

Currently Labour is not committing to additional money for the NHS apart from the £1.3bn attached to initiatives to clear the backlog. Additionally, the real terms budget for the NHS in England has been growing at a slower pace than the historical average,2 and more slowly than the pre-pandemic national plan3 assumed would be required.

Last time Labour was in government, the dramatic reduction of waiting lists took more like nine years. Elective recovery can’t happen while the rest of the NHS stands still, so if Labour forms the next government, its proposals need to be positioned within wider and sustained policy action. The measures set out so far—funding more appointments, investing in diagnostics, and leaning further on the private sector—would help, but each faces challenges.

More appointments and equipment

Labour intends to introduce an additional 40 000 appointments and operations each week during evenings and weekends. This step aims to increase capacity and reduce waiting times. Labour has earmarked £1.1bn a year to fund overtime and weekend payments for NHS staff. But many staff already work weekends, and often they are too exhausted to do more. This is an untested idea and will rely further on the goodwill of staff to take extra shifts.

Labour proposes introducing high intensity surgical teams, but these will take time to implement. Replicating the much lauded model used in Guy’s and St Thomas’ hospital cannot be assumed.4 Often, the inspirational leadership in the original team and context cannot be replicated, or the required resources and staffing can’t be scaled.

It will take more than additional appointments to go beyond clearing waiting lists and to sustainably meet growing demand on the NHS. It will also require a focus on equity across all populations and specialties—so you don’t just clear lists in one place and specialty while waiting lists continue to grow elsewhere.

The additional diagnostic equipment proposed at a cost of £171m is a good investment in a health service long starved of decent IT and scanners for diagnosis.5 But new equipment needs the right facilities and requires trained staff to run it. Unfortunately, in an NHS that is capital poor and has high staff turnover, neither can be taken for granted.

Private sector utilisation

Labour aims to use spare capacity in the private sector to cover NHS treatment. Leaving aside ideological controversy over this approach, there is a question over how much spare private capacity remains. As Justin Ash, CEO of the largest private sector hospital group Spire Healthcare has said,6 there may not be much capacity left to help the NHS. And with no funding to buy more private care, it is not clear how this could be afforded.

The NHS has, does, and continues to use the private sector to drive down waiting lists, and costs surged to £3.2bn in 2022/23.7 However, the significant increase in patients self-funding their elective care in the private sector risks worsening health inequalities for patients who can afford private care, and those who can’t.

Furthermore, private sector spending does not contribute to longer term reform or transformation in the NHS. Increasing its use risks baking in private sector capacity full time, rather than giving the NHS the resources it needs to cope long term.

Will it work?

Tackling record waiting times will rightly be a battleground issue in the UK election campaigns. It is right to focus relentlessly on this issue: it is highly desirable, and the public and NHS staff want to see the NHS improve.

Some experts think that 40 000 appointments a week could make a substantial difference to waiting lists.8 But this assumes a rising level of general NHS capacity, and it may be optimistic to assume that most of the extra appointments would lead to patients leaving the waiting list. That likely won’t be the case as the UK population grows older and sicker and comorbidities increase.

The last Labour government learnt that you must invest in the whole of the NHS to ensure that elective recovery happens. To achieve it, however, requires a holistic approach, considering systemic factors, significant stakeholder engagement, and a long term sustainability plan, with real shift to community, primary care, and prevention so the NHS isn’t simply bailing out the water while flood levels are rising outside the door. The NHS is a complex system, and it demands complex interventions.


  • Provenance and peer review: commissioned; not externally peer reviewed.

  • Competing interests: none