Can the NHS really hit the 18-week waiting time target? And how can pharma, med tech and device companies help?
The Health Foundation recently published this report on the Government’s plan for 18-week NHS waiting times and whether or not that’s a realistic target.
The 18-week target is enshrined in the NHS Constitution and the idea is that 92 per cent of patients requiring elective care start treatment within 18 weeks of referral.
Given where we are with the NHS – record backlogs and criticism of the new Government for not having a plan to improve things – this is a timely report because it drills down into whether the goal is achievable, especially given the current pressures on the NHS.
It offers some recommendations for navigating the obviously complex challenges in delivering on the 18-week target and there are some great opportunities presented to pharmaceutical, medical technology and device companies.
Delays are at record levels – and they’re fuelling their own fire
Waiting lists have never been as high as they are now. Officially, 59 per cent of patients are treated within 18 weeks of referral, well short of the 92 per cent target.
More than 234,000 patients have been on a waiting list for treatment for more than a year, a stark indicator of the scale of the challenges the NHS is facing up to.
Delays impact patient outcomes – they result in an increased number of people repeatedly going back into General Practice to try and speed up their appointment, a situation the GP cannot help with.
Delays also increase the burden on emergency services because people have heart attacks and strokes while they’re waiting. Their long-term conditions worsen, they’ll have exacerbations that put them in hospital and that really erodes public confidence in the healthcare system.
The Health Foundation highlights the factors that are causing the problems:
- Workforce shortages. They’ve got too much work and not enough people to meet the demand. So where is the innovation that’s going to help try and change those outcomes for patients and the NHS?
- Increase in patient demand. A lot of this is due to the ageing population. We all want to grow old! But can we grow old with reasonably healthy lifestyles please, rather than with rising rates of chronic illness.
- Growing backlogs in elective procedures. The report mentions the pandemic as a factor here but commentators like myself know the backlogs were rising before the pandemic hit. There’s no doubt the pandemic made it worse but it isn’t the only contributory factor. There’s an urgent need to address the elective backlogs but the sheer scale of the task raises serious questions on the feasibility of achieving an 18-week target within the proposed timeline.
What’s on the Government’s list of priorities?
To hit the 18-week target by March 2029, the Government plans to:
- Expand elective care capacity with 40,000 extra weekly appointments.
- Reduce unnecessary referrals by streamlining the pathway, ensuring only essential cases reach specialists.
- Boost productivity by implementing digital solutions and more efficient workflows.
- Cut unnecessary follow-ups to free up outpatient capacity. The plan emphasises collaboration between NHS hospital trusts, integrated care boards (ICB) and private providers to optimise resource allocation, minimise care pathway bottlenecks and get patients through the system much more smoothly.
Changes in Advice and Guidance (A&G) are also on the horizon, allowing GPs to seek consultant input without a full referral – something I’ll cover in more detail soon. Clients in my online learning programme are already working on that.
Any recovery will require a bigger workforce
Is the 18-week target achievable? The Health Foundation is cautiously optimistic but highlights major hurdles, especially treatment volume and workforce shortages.
To meet the target, the NHS must treat 2.4% more patients annually, delivering 2.6 million extra treatments by 2029. While that rate of growth is not unprecedented, it does require a sustained increase in capacity and efficiency.
The biggest barrier? Staffing. Without addressing workforce shortages, increasing activity simply isn’t possible. Fixing this means recruitment drives but also sustained measures to retain existing staff by improving job satisfaction.
Funding is another issue. The report emphasises the importance of capital investment in facilities, equipment and technology. The NHS faces a £2–3 billion overspend by March, making large-scale infrastructure investments difficult.
Finally, integrated care systems (ICBs) must coordinate better to balance elective care with urgent and emergency demand. Without joined-up planning, progress will stall.
Read my blog on how industry can help GPs struggling with their workload here
Four key areas of focus pharma, med tech and device companies need to chime with
There are four big recommendations in this report:
- Boosting productivity. One of the big things Lord Darzi’s report talked about was adopting robotic surgery and this report talks about that alongside remote diagnostics and tracking patients in real time to speed up early and correct diagnosis and reduce hospital admissions
- Supporting the workforce. Investment in training, retention and wellbeing is critical to tackle burnout and staffing shortages, ensuring long-term productivity.
- Balancing priorities. Elective care can’t be fixed in isolation – primary care, mental health, and emergency services must also be strengthened to create a sustainable system.
- Industry collaboration. This is not the first report to recognise there’s an opportunity for collaboration with private healthcare providers to deliver NHS services. The NHS is actively looking for partnerships with pharma, med tech, and device companies to introduce innovations that improve patient outcomes, ease NHS workloads, and expand capacity. Digital solutions and outcome-driven models will always get a hearing.
Industry’s digital solutions have a golden opportunity
The challenges outlined in the report create some fertile ground for pharma, med tech and device companies to play a role in supporting the NHS. Medical devices which provide more advanced solutions and enhance the efficiency of elective procedures, surgical tools that are minimally invasive and AI diagnostic equipment can all reduce procedure times and improve patient outcomes.
I’m seeing lots of digital health solutions in the field. I’m working with one now in mental health where the early indications are showing significant improvements in patient outcomes, therefore reducing workload and burden.
Telehealth applications, patient management systems, things that help streamline care pathways, anything that empowers the patient to manage their own condition more effectively, reduce unnecessary appointments, referrals, admissions and keep them at home is going to be welcome.
And clearly – with the Government planning to increase activity within the private sector – companies can work with the NHS to co-develop solutions that optimise resource allocation and improve patient outcomes.
You might even be part of the provision. We’ve got lots of home care services but could you offer services in secondary care? Can you offer the NHS pharmacists, teams or nurses that could actually take on some of the activity?
Big opportunities for pharma to upskill the workforce
There are opportunities in training and education with the workforce. Industry has brilliant educational packages to help train, educate and upskill healthcare teams in new technologies, pathways or drug treatments.
Industry could enhance early adoption of innovative solutions that helps support the workforce and facilitates staff development as well. Lots of people within the NHS want to develop and progress – so help them do that, become a real value-added partner, that’s a big opportunity for industry.
Every single NHS customer I interviewed as part of my ‘Sell Better To The NHS’ programme said data, tools and analytics provided by industry were absolutely welcome and wanted.
Providing tools for data collection and analysis helps healthcare providers identify bottlenecks in the pathway and help them optimise delivery. If we can generate real world evidence through those tools that help them inform policy decisions, improve patient outcomes and reduce workload, there is good opportunity in there.
Linking back to Lord Darzi, investing in preventative care aligns with the NHS’s long term strategy and will be front and centre of the new 10-year plan, due for publication in May or June this year. Pharma in particular can help develop things like public health campaigns and new therapies that support chronic conditions before they escalate.
For all the opportunities – beware of the challenges
While there are lots of opportunities, there’s also challenges to be navigated when it comes to industry engaging the NHS. I always highlight regulatory compliance – if we’re going to engage the NHS, we’ve got to adhere to regulatory and procurement frameworks and processes.
Companies need to be certain their solutions meet safety, efficacy and cost-effectiveness rules – and I think nowadays you’ve also got to demonstrate value. The NHS has a bad habit of talking about value and then just says: “But could you not just cut the price?”
In this resource-constrained environment, industry must quickly demonstrate how products and services deliver real, tangible benefits, improve patient outcomes, reduce workloads and save on costs.
A collaborative approach is essential
The fragmented nature of NHS decision-making, with ICBs, individual trusts and General Practice all having autonomy, means the companies need to adopt tailored engagement strategies for different stakeholders and then bring them all together.
We’ve talked before about targeting the management side of the hospital trust. Winning the clinical argument is one thing but you’ve got to get the managers working with you to get to the point where you can collectively engage the ICB to get the programme activated.
The Health Foundation report highlights the complexities of hitting that 18-week target. It’s an ambitious goal but it’s not unattainable if the NHS can address the workforce challenges.
For pharma, med tech and device companies, there is an opportunity to align your offerings with NHS priorities and play a major role in helping the NHS deliver on its target.
The next few years are going to be really interesting. There’s going to have to be bold thinking, real collaboration and sustained investment to make it happen. But with the right strategies, the NHS and its partners could deliver the outcome they’re looking for and meet the needs of all of us as patients.
Scott McKenzie helps pharmaceutical, medical technology and device firms get their products and services in front of the right NHS decision-makers. In 2023 alone, he helped land 53 new NHS projects. His 12-month mentorship programme – revamped and expanded for 2025 – offers tools, NHS customer insights and direct decision-maker introductions to get your projects over the line. Find out more here.