NHS waiting list figures are misleading the public and patients are paying the price

The government has made tackling NHS waiting lists a defining pledge, and on the surface the numbers appear to be moving in the right direction. But look more closely at how those figures are being assembled and a more troubling picture begins to emerge.

Health Secretary Wes Streeting has pointed to 100,000 more NHS appointments per week compared to the previous administration. That claim is technically accurate, but context matters. Those appointments span treatments, diagnostics, tests and outpatient visits and do not include GP appointments. They also take no account of the natural annual growth in demand, which in a normal year runs at roughly 2.2 million additional appointments across England. Without that context, the headline figure is deceiving.

The ways in which those extra appointments are being delivered also warrant scrutiny. Evening and weekend clinics are being staffed through overtime payments but senior doctors have warned that stretching an already strained workforce is not a sustainable solution.

Surgical hubs, largely focused on orthopaedics, ophthalmology and ENT, are showing some promise, but complex patients who have often waited longest are increasingly being passed over in favour of lower-risk cases to meet efficiency targets. Some senior clinicians describe this as a two-tier system, where political optics risk overriding clinical need.

Then there is the question of what is happening to the waiting list figures themselves. From April 2025, GPs were paid £20 for every case where they sought advice from a hospital consultant rather than referring a patient directly to hospital, with the explicit aim of diverting patients away from the elective waiting lists. £80m was ‘invested’ to support this initiative. Hospital trusts, meanwhile, were paid £33 for every patient removed from a waiting list through a government validation scheme, costing NHS England over £18 million in such payments between April and September 2025 alone. 

The NHS waiting list stood at 7.6 million in July 2024 and had fallen to 7.25 million by January 2026. The government has presented this as progress. However, analysis by the Health Foundation and the Nuffield Trust tells a different story.

Those removed from lists include patients who had died, gone private or simply failed to respond to a text message. Both organisations conclude that without those removals, the waiting list would not have fallen at all and may in fact have risen. That information has not been communicated clearly to the public.

From April 2026 the GP referral diversion scheme became mandatory, written into the core GP contract, with a target of blocking one in four referrals from reaching a specialist at all. The BMA ballot on the mandatory contract returned a 98.9% rejection rate among GPs, yet it was imposed regardless.

The decision on whether a patient proceeds is made remotely, by a clinician who has never examined them. GPs have reported waiting as long as eight months for a response. In at least one documented case, an urgent cancer referral was redirected under this system and the patient's diagnosis was delayed as a result.

Fiona Morrison, Director and Co-founder of TLA Medicolegal, said: "The public is being presented with figures that do not reflect reality. Patients are being removed from waiting lists without any treatment taking place, GPs are being financially incentivised to avoid referring them, and when referrals do go ahead, the decision to accept or reject them is being made remotely by someone who has never seen the patient. This is not administrative tidying, it is a fundamental distortion of how waiting lists work and what they are supposed to tell us.

“At TLA we are seeing a significant and sustained rise in clinical negligence instructions, and the pattern is clear. When access to specialist care is delayed or denied, patients are harmed. The public deserves transparency, not statistics that have been shaped to meet a political target."

TLA Medicolegal has observed a marked rise in clinical negligence instructions in recent years, a trend it expects to continue as the downstream consequences of systemic delay work their way through the healthcare system.