Minimum waits deliberately delay NHS care in England

Nearly half of England’s Integrated Care Boards (ICBs) are using minimum waiting times for elective procedures, meaning some patients who could potentially receive treatment sooner are deliberately made to wait. Data obtained by The BMJ show that 17 of 36 ICBs have introduced minimum waits or similar policies of between 12 and 16 weeks.

The measures affect procedures including hip and knee surgery and cataract treatment. Health boards say the policies can help manage demand, capacity and budgets, but medical organisations have raised concerns about their impact on patients.

Minimum waits across England

The BMJ sent Freedom of Information requests to all 36 ICBs, which plan health services for their local populations. Of the 35 that responded, 17 confirmed some form of minimum waiting policy, while another 17 said they did not use one. NHS North East London was unable to confirm its position. Shropshire, Telford and Wrekin and West Yorkshire have introduced minimum waits of 16 weeks for all routine procedures. South East London uses a 16-week minimum for cataract treatment.

Other regions use what they describe as “planning assumptions”. In Humber and North Yorkshire, NHS and independent providers plan on patients waiting an average of 16 weeks. North East and North Cumbria uses a similar assumption of 15 weeks for elective procedures. Several ICBs have introduced 14-week waits covering all elective procedures, while others apply them to particular specialties or providers, including orthopaedics, ophthalmology, cataract treatment and independent surgical providers delivering NHS care.

Concerns about patient impact

The Royal College of Surgeons of England (RCS) expressed concern about the scale of the policies. President Tim Lane acknowledged the financial and capacity pressures facing the NHS but warned that minimum waits can result in patients who are clinically ready for treatment having to wait longer.

For patients, the consequences can include prolonged pain, reduced mobility and anxiety, as well as difficulties working or carrying out everyday activities. Lane also warned that a patient’s condition could deteriorate while waiting, potentially changing their clinical needs. The Royal College of General Practitioners (RCGP) questioned the justification for blanket minimum waits. Its president, Victoria Tzortziou Brown, argued that patients should not face unnecessary delays when they could otherwise receive treatment sooner, particularly while the NHS is seeking to reduce waiting times.

Blanket 16-week policies have also raised concerns because they leave relatively little margin before the 18-week referral-to-treatment standard set out in the NHS Constitution. That national target has not been met since February 2016.

Balancing budgets and access

The debate highlights the tension between reducing waiting times and managing limited healthcare resources. Some ICBs told The BMJ that minimum waits help them use financial resources effectively and provide treatment fairly across their populations. Sally Gainsbury, senior policy analyst at the Nuffield Trust, said limiting activity through minimum waiting periods can be a rational and equitable way of spreading a fixed budget across a population. However, she questioned whether there is sufficient clarity about how such policies can be implemented fairly.

An NHS spokesperson said commissioned waiting policies can help make the best use of services, staff and budgets, while patients continue to be treated according to clinical need. The NHS also said organisations should not commission waiting periods that risk breaching the NHS Constitution’s 18-week maximum for elective treatment.

The findings nevertheless raise a fundamental question about waiting-list management: whether patients should be required to wait when clinical capacity could allow them to receive treatment earlier. For ICBs, balancing financial sustainability with timely access to care is becoming an increasingly visible part of managing elective services.

App access EHR

Back in 2024, the NHS planned to give patients full access to their medical records through the NHS App. Users will be able to view information including communications with doctors, test results and laboratory reports. The initiative is part of a ten-year strategy to digitalise healthcare and develop a universal electronic health record.

Several challenges remainend. Patient records are still stored locally by GPs and hospitals, while not all healthcare organisations are connected to the NHS App. There were also concerns about privacy and data protection. The UK government said it is fully committed to safeguarding confidential medical information. By expanding digital access to health data, the government aims to give patients and healthcare professionals easier access to relevant information while helping to keep healthcare accessible, affordable and of high quality.