Imagine being told to sprint faster while carrying a heavier load, on a track that’s falling apart under your feet. That’s what NHS trusts are facing with the latest elective care targets. The government’s Elective Reform Plan promises a five-percentage point improvement in 18-week waiting times by next March, with ambitious goals to reach a 65% benchmark by 2026. It sounds impressive—until you realise the track conditions haven’t changed, and the load keeps getting heavier.

The NHS is already delivering 18% more elective activity than pre-COVID levels, but waiting lists are barely budging. Why? Because this isn’t about running faster. It’s about running smarter.

When I read headlines like this: “Every trust given individual elective waiting time target,” my immediate reaction is twofold. First, my pen lingers over my, new “Well that wasn’t obvious was it! bingo card” . Then, I sigh. Because once again, the government is offering targets without the tools to achieve them.

The Reality Behind the Numbers

The waiting list crisis is a symptom of deeper structural issues. Targets might look good on a spreadsheet, but they’re meaningless without addressing the root problems:

• A Mismatch Between Capacity and Demand: More patients need care than the system can handle.
• Crumbling Infrastructure: Diagnostic hubs and treatment centers remain underfunded and overstretched.
• Chronic Workforce Shortages: Staff burnout and attrition make it impossible to sustain current activity levels, let alone increase them.

Yes, trusts will push to meet these new metrics, but at what cost? We’re already seeing the consequences of a system chasing performance over purpose:

• Clinician Burnout: Overworked staff facing impossible demands.
• Missed Patient Needs: Prioritising “quick wins” over complex cases to hit numbers.
• Operational Chaos: Short-notice cancellations and wasted resources as trusts scramble to meet unrealistic benchmarks.
• Unwanted Headlines: It feels like there is a daily news churn of shocking NHS incompetencies and tragedies.

These targets aren’t a roadmap to recovery—they’re a distraction from real solutions.

The Missing Links: What Does Real Progress Look Like?

The plan does include measures like expanding community diagnostic hubs and remote monitoring, but it overlooks critical areas:

1. Fix the Capacity-Demand Mismatch

Targets assume the NHS can simply “do more,” but without more staff, beds, and resources, that’s wishful thinking. Real progress means:

• Investing in workforce planning to align resources with patient demand.
• Expanding diagnostic capacity to prevent bottlenecks.
• Using predictive analytics to anticipate surges and allocate staff dynamically.

2. Rethink “Productivity”

True productivity isn’t about doing more with less; it’s about doing better with what we have. That means:

• Reducing failure demand—the repeat appointments, errors, and delays caused by poor coordination.
• Streamlining patient pathways to cut delays and ensure timely, safe care.

3. Empower Staff with Real-Time Tools

Frontline teams need actionable insights to manage demand dynamically. Predictive analytics and real-time dashboards could transform how trusts allocate resources, adapt to surges, and plan for recovery. But these tools need to be integrated with processes and supported by training—not just dropped into already overwhelmed systems.

4. Support Complex Cases, Not Just the Easy Wins

Targets must prioritise care quality, not just volume. That means addressing the longest waiters and complex cases, even if it’s harder to measure success in a press release.

The Patient Impact: Targets vs. Reality

Let’s talk about the patients who fall through the cracks of this “numbers game.” A trust might meet its percentage improvement on paper, but what about the individual still waiting over a year for surgery? What about the child whose care pathway is delayed because quick-turnaround cases are prioritised instead?

Forcing trusts to play a zero-sum game with limited resources means that someone, somewhere, always loses. That’s not recovery. That’s regression.

What’s Missing from the Plan?

The Elective Reform Plan introduces welcome ideas like reducing cancellations and expanding diagnostic hubs, but it fails to:

• Address Workforce Well-Being: Burnout and moral injury are rampant. Staff need flexibility, support, and manageable workloads if they’re expected to deliver change.
• Invest in Holistic Solutions: Tackling waiting lists requires systemic reform, not isolated targets. Better coordination between primary, secondary, and social care is critical.
• Focus on Equity: Regional disparities mean some trusts face far greater challenges. Universal targets ignore the specific needs of underserved communities.

The Path Forward: Stop Chasing Numbers, Start Building Solutions

The government must rethink its approach. Instead of dangling new targets in front of trusts already stretched to breaking point, let’s focus on systemic reform:

1. Invest in Infrastructure: Expand diagnostic and treatment capacity to prevent bottlenecks.
2. Address Workforce Shortages: Retain existing staff with better support and flexibility while recruiting new talent.
3. Focus on Patients, Not Percentages: Reframe success around meaningful outcomes—faster diagnosis, safer care, and reduced waiting times across the board.

This isn’t about rejecting ambition; it’s about aligning ambition with reality. Targets should inspire action, not desperation. Without the right tools, resources, and support, this plan risks becoming yet another footnote in the long history of NHS crises.

The Bottom Line: Fix the Foundations

The NHS doesn’t need more pressure—it needs a plan that works. One that prioritises patients over politics and progress over performance metrics.

Better workforce planning, real-time management information, and smarter systems will allow the NHS to pivot quickly in times of change, deploying resources where they’re needed most. But more than that, it requires a commitment to seeing productivity not as a target to hit, but as a path to better care.

So, let’s ask the real question: How do we build a system that supports the NHS to deliver the care patients need, not just hit the numbers ministers want? The answer isn’t in chasing metrics—it’s in fixing the foundations. It is about building a long term future where the metrics are positive patient outcomes and improved workforce wellbeing. One thing I will agree with Starmer on is we need a positive approach, we need to lose the naysayers…It can be done! But only together, only if well thought through and only with the right plan.