More than six million people were on the elective care waiting list in January 2025, and the PAC says progress has now stalled.
Its findings show that:
- 192,000 patients were waiting more than a year for treatment by July 2025, a milestone NHSE had committed to eliminating by March.
- 22% of patients waited over six weeks for diagnostic tests, far above the 5% target and the 1% operational standard.
- Only 59% of patients received treatment within the 18-week statutory limit, well short of the 92% target.
- Plans to cut follow-up outpatient appointments by 25% achieved just 0.1% between June 2022 and July 2023.
The PAC concluded that these failures were partly driven by flawed planning and weak oversight, with billions approved by government without clear expectations for delivery or measurable improvements for patients.
NHSE spent £2.2bn on diagnostic transformation and £1.04bn on surgical hubs, yet a shortfall of 3.6 million diagnostic tests meant targets were missed. The committee noted NHSE tracked only the number of hubs built, not their actual impact on elective care activity.
The report also criticised the lack of a credible strategy to reduce outpatient backlogs. With 80% of elective pathways ending in outpatients, the committee said NHSE failed to secure clinician buy-in or present a workable plan.
Concerns Over HS2-Style Failures in New NHS Reforms
The PAC warned that major reforms by the Department of Health and Social Care (DHSC) and NHSE including 50% cuts to local health boards and NHSE’s planned absorption into DHSC risk repeating the mismanagement seen in HS2 and the New Hospital Programme.
These structural changes, the report says, are being introduced without secured funding or impact assessments, potentially destabilising services and staff at a time of extreme pressure.
The committee has demanded confirmation that DHSC will stop announcing unfunded commitments, and publish the expected costs of redundancies and organisational restructuring.
Digital Solutions “Not a Cure-All”
The PAC questioned the government’s heavy reliance on digital tools to fix waiting times, warning that legacy IT systems, poor integration, and digital exclusion could leave some patients behind.
It has asked DHSC and NHSE to outline how they will address long-standing digital weaknesses and ensure new systems benefit all patient groups.
Clive Betts MP: Billions Spent With Little Improvement
PAC Deputy Chair, Clive Betts MP, said the findings confirm that investment has not been matched by improvements:
“Every unnecessary day a patient spends on an NHS waiting list increases anxiety, and for the undiagnosed, increases risk.”
He added:
“Our report shows that billions have been poured into the system without the requisite focus on improving outcomes for patients.”
Betts also warned that new surgical hubs and diagnostic centres will remain “superficially impressive” unless they deliver productivity gains.
Drawing parallels with national infrastructure failures, he said:
“We are now seeing chilling echoes of HS2 and the New Hospital Programme. Big promises without delivery plans can only end one way.”
