The list has fallen from its record 7.77 million in September 2023 to 7.2 million. But that is still far above 2017 levels, and how long people wait now varies sharply by specialty.
The number of people waiting to start hospital treatment in England — the Referral to Treatment (RTT) waiting list — stood at 3.73 million in March 2017.1 It grew steadily through the following years, then rose sharply once the pandemic disrupted routine referrals, passing 7 million in 2022 and reaching a record 7.77 million in September 2023.2 Since then the list has fallen. By April 2026 it stood at 7.2 million — down 7.3% from the peak, but still 93% above its March 2017 level.1
The list is not evenly spread. Trauma and orthopaedics — covering hip, knee and joint procedures — carries the largest single backlog, at 819,951 people waiting, with 59.0% seen within 18 weeks.1 Ophthalmology has a smaller share within the target window failing but a comparatively better on-time rate; oral surgery, the smallest list of the group shown, has the worst on-time performance of any major specialty.1
A falling waiting list can mean two different things: more patients being treated, or fewer patients entering the count in the first place. NHS England's Neighbourhood Health Framework, published in March 2026, sets a national goal to "divert" at least 25% of referrals away from hospital specialists in at least 10 high-volume specialties by March 2027, using GP "advice and guidance" consultations in place of a formal referral.4 A patient whose case is diverted this way never starts an RTT clock, so does not appear in the waiting-list figures at all.5
This is a live and contested policy, not a settled fact about what has already happened to the data. GP representative bodies have objected that a 25% diversion target function as informal gatekeeping that limits referrals some GPs judge clinically necessary, while NHS England has said there is no national quota forcing individual referrals to be rejected.5 A peer-reviewed model of NHS waiting-list dynamics published in 2025 treats referral volume as one of two forces — alongside treatment capacity — that determine whether the list grows or shrinks, meaning the same falling total is consistent with either story.6 Noodle News cannot say from the published figures alone how much of the recent fall reflects more treatment versus fewer referrals reaching the count; a full answer would need the GP referral-rate series checked directly against the RTT clock-start data.
Waiting lists grew across the OECD after the pandemic, not only in England. A peer-reviewed analysis of waiting times for six common surgical procedures (hip and knee replacement, cataract surgery, prostatectomy, coronary bypass and angioplasty) across OECD countries found that the average wait for patients still on the list rose by 27–31% in the three years after 2019, a statistically significant increase, while the wait actually experienced by patients once treated rose only slightly and not significantly — a pattern the authors attribute to patients staying on the list rather than come forward for treatment during the pandemic, then that backlog working through with a lag.6 Within that comparison, the United Kingdom was named among the small group of countries with the largest increases in list-wait (in the 30–60% range) and the largest falls in surgical volume (25–35%), alongside Hungary and New Zealand — among the more severely affected OECD health systems, not merely an average case.6
On what happens to patients while they wait, the evidence is thinner than the volume data. The King's Fund states plainly that the health impact of long waits "is not regularly captured" in routine NHS statistics.7 Peer-reviewed modelling has linked long elective waits to clinical deterioration, worklessness, and patients leaving the list without treatment ("reneging") rather than being formally counted as harmed; poorer patients are less able to bypass the queue with private treatment, which the same literature flags as a widening-inequality effect rather than a directly measured harm total.6 No official measure converts this into a single comparable figure, so Noodle News is not able to state how many people have been harmed by the wait — only that credible sources agree the true cost is broader than the queue length alone shows.
The RTT count is of pathways, not people: a patient waiting for two unrelated procedures appears twice, so the 7.2 million figure overstates the number of individual patients, which NHS England separately estimates at around 6.1 million.1 Two acute trusts did not submit data for April 2026; the England-level total includes an estimate for them, which mainly affects the volume figure rather than the percentage-within-18-weeks measure.1 The 2017 comparison point uses the published (not missing-data-adjusted) figure, so it is a slight underestimate of the true 2017 total — if anything, this understates how much the list has grown. We have not held the upstream referral process constant: a national push to divert referrals before they reach a formal RTT clock start (see above) means part of any recent fall could reflect fewer referrals entering the count rather than faster treatment of those already in it, and the published data does not let us separate the two effects.4 We have not otherwise attempted to attribute the rise or fall to any single cause (pandemic disruption, staffing, funding, demand); that would need a separate analysis and is not asserted here.