NHS spending fails to cut waiting lists as MPs warn of flawed strategy
The Public Accounts Committee has criticized the government's NHS strategy, highlighting missed recovery targets and concerns regarding proposed structural reforms.
Billions of pounds invested into the NHS to address post-pandemic backlogs have failed to produce meaningful improvements in waiting times, according to a report from the House of Commons Public Accounts Committee (PAC). The findings from the committee suggest that progress in reducing lists has stalled, leaving a key government pledge to restore 18-week waiting time targets by 2029 in significant jeopardy.
The committee, which scrutinizes government spending, characterized the approach taken by the Department of Health and Social Care (DHSC) and NHS England as deeply flawed. Despite an expenditure of £3.24 billion on diagnostic and surgical infrastructure—including surgical hubs and diagnostic centres—the report found that the management of these programmes was characterized by extreme variability and a lack of clear delivery plans.
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"Every unnecessary day that a patient spends on an NHS waiting list is both one of increased anxiety for that person’s unresolved case, and if they are undiagnosed, a steady increasing of risk to their life."
Clive Betts, deputy chair of the PAC
The PAC report highlights a disconnect between financial outlays and patient outcomes. While the government has touted a reduction in backlogs, the committee noted that key recovery targets set under the previous administration were missed by wide margins. Specifically, as of July 2025, 192,000 patients had been waiting longer than a year for treatment. Additionally, diagnostic delays remain persistent, with 22% of patients waiting more than six weeks for tests as of March 2025, far exceeding the 5% target and the 1% operational standard.
A central concern raised by MPs is the government’s move toward a major structural reorganization of the health service. The plan to merge the functions of NHS England into the DHSC, alongside a 50% reduction in headcount across both bodies and local health boards, has been met with skepticism. The committee explicitly likened these changes to the systemic failures observed in infrastructure projects such as High Speed 2 (HS2) and the New Hospital Programme, warning that the reforms are being pursued without adequate impact assessments or guaranteed funding.
Current Waiting List Performance Snapshot
| Metric | Result | Target |
|---|---|---|
| 18-week routine treatment | 59% | 92% |
| 6-week diagnostic test | 22% | 5% |
| 1-year waits | 192k (July 2025) | 0 |
The government maintains that the current challenges are the result of inheriting a dysfunctional system. A DHSC spokesperson argued that the ministry has taken robust action, noting that backlogs have fallen by more than 230,000 and that over 5 million extra appointments have been delivered. the department stated that productivity within the health service has increased by 2.7% compared to the previous year, and that the reduction in administrative staff will allow for the reinvestment of billions into frontline care.
However, external experts echo the committee's concerns regarding the focus of current reforms. Siva Anandaciva of the King’s Fund suggested that the government's fixation on raw waiting list numbers might overshadow essential preventative measures. Other policy analysts, including Dr. Hugh Alderwick of the Health Foundation, cautioned that top-down restructuring frequently causes widespread disruption and risks distracting leadership from immediate service improvements. Rachel Power, chief executive of the Patients Association, added that the findings align with the reality long experienced by service users, describing the current situation as akin to "chasing a mirage."
The uncertainty surrounding these reforms extends to the financial strategy for staff redundancies. It is understood that the Treasury has not provided new funding for the departure of approximately 18,000 administrative and managerial staff. Instead, the NHS is expected to overspend its current budget in the short term to cover the costs, with the intention of recouping the expenditure in future years. The PAC has questioned the prudence of such maneuvers, stating they lack the safeguards necessary to ensure value for taxpayer money.
Looking ahead, the government faces pressure to provide the detailed delivery plans requested by the committee. With the 2029 deadline for the 92% performance target looming, the committee warned that unless the department "gets a grip" on its current programmes, the health service risks further cycles of wasted effort and public disillusionment.
