Senior leaders at NHS England believe the health service is likely to come close to achieving a key elective care milestone by March 2026, potentially allowing them to claim success on one of the government’s primary performance objectives for the year. The benchmark centres on increasing the proportion of patients starting treatment within 18 weeks of referral to around 65 per cent, a target set as an interim step toward restoring the NHS constitutional standard.
The 18-week referral-to-treatment (RTT) standard has long been a central performance measure in the NHS. Under the NHS Constitution, 92% of patients should begin treatment within 18 weeks of referral, but the service has struggled to meet this benchmark for more than a decade, with the pandemic significantly worsening waiting times. While the 92% target remains the long-term objective, the government and NHS England introduced the 65% milestone for March 2026 as a more realistic short-term goal while the system works to reduce record waiting lists and rebuild capacity.
Gradual improvement in waiting time performance
Recent data indicates modest progress in elective performance. The proportion of patients starting treatment within 18 weeks reached around 61% by mid-2025, representing an improvement from the pandemic-era low of 56.6% in December 2023. Although the improvement is incremental, NHS leaders believe continued gains through increased activity and operational reforms could bring performance close enough to the 65% target by the end of the financial year to demonstrate meaningful progress.
The NHS has expanded elective activity significantly in recent years, with millions more appointments and diagnostic tests delivered as part of a national effort to tackle the backlog created during COVID-19 disruptions and periods of industrial action. Health policymakers view the interim milestone as an important signal that the system is moving in the right direction, even though it remains far from the constitutional standard.
Waiting list pressures remain significant
Despite improvements in performance metrics, the NHS continues to face a large backlog of patients waiting for planned treatment. The referral-to-treatment waiting list stood at around 7.3 million care pathways in late 2025, highlighting the scale of the challenge facing the health service. Long waits can have significant consequences for patients, with research suggesting that delays often lead to worsening health conditions and reduced quality of life.
Healthcare organisations have warned that capacity constraints, including shortages of theatre space, staff and diagnostic facilities which remain major barriers to faster progress. Surgical workforce surveys have shown that many clinicians believe additional investment in infrastructure will be essential if the NHS is to meet future waiting time targets.
Digital transformation supporting recovery efforts
Alongside workforce and capacity initiatives, digital health technologies are playing an increasingly important role in efforts to reduce waiting times. The NHS has been expanding the use of electronic patient records, population health analytics and data-driven scheduling systems to improve patient flow and prioritise cases more effectively. These tools help clinicians identify patients with the most urgent clinical need while enabling hospitals to coordinate operating theatre capacity more efficiently.
The NHS App has also been expanded to allow patients to view appointment information and receive updates about their care, reducing administrative workloads and improving communication between providers and patients. Health leaders believe these digital tools could become central to long-term efforts to manage elective demand and improve productivity across hospitals. Although reaching the 65% milestone would represent progress, analysts caution that achieving the full 92% 18-week standard remains a major challenge for the NHS. Experts estimate that performance would need to improve by more than 25% points over the next few years to return to constitutional standards.
Achieving that level of improvement will require sustained increases in elective activity, expansion of diagnostic services and significant operational reforms across the health system. The government’s broader NHS reform strategy aims to support this recovery through a combination of workforce expansion, increased use of the independent sector and greater reliance on digital technologies to streamline care pathways.
A key political and healthcare milestone
Elective waiting times have become one of the most visible indicators of NHS performance and a central political issue in the UK’s health policy debate. For ministers and NHS leaders, approaching the 65% milestone by March 2026 would represent a symbolic step in demonstrating that the system is beginning to recover from the unprecedented pressures of the pandemic and subsequent workforce disruptions. However, health experts stress that the real test will come in the years ahead as the NHS attempts to move beyond incremental improvements and restore the 18-week waiting time standard for the majority of patients across England.
