NHS achieves second biggest waiting list drop in 15 years

How insourcing solutions from Agile Insourcing support continued progress

The NHS has delivered remarkable progress in tackling waiting lists, with November 2025 recording the biggest monthly drop in 15 years, outside of the early pandemic. This milestone demonstrates what can be achieved through strategic capacity management, seven-day working and clinically led insourcing solutions. 

Despite unprecedented pressure - including 27.8 million A&E attendances during 2025 - NHS trusts across England have shown that innovative workforce models and targeted insourcing services can deliver meaningful reductions in backlog while maintaining patient safety and continuity of care. 

Record progress amid unprecedented demand

In November 2025, the elective waiting list fell by more than 86,000 patients, bringing the total to 7.31 million - a significant step forward one year on from the publication of the Elective Reform Plan. 

This progress was delivered during one of the most challenging winters on record, with:

• An average of 2,725 patients hospitalised with flu each day
• A 57% increase in norovirus cases
• 73.8% of patients seen within the four-hour A&E target, equating to 50,000 more patients treated on time than the previous year

Such achievements highlight not only the dedication of NHS staff, but also the growing importance of flexible insourcing models that allow trusts to increase activity without compromising governance or overstretching permanent teams. 

Innovative capacity models driving success​

The NHS's progress has been driven by:

• Evening and weekend clinics
• Expanded diagnostic capacity
• Surgical hubs
• Streamlined patient pathways, including 'straight to test' models

This approach mirrors the way Agile Insourcing works with NHS Trusts - unlocking underutilised estate, extending operating hours and deploying clinically led insourcing services that integrate seamlessly with existing pathways. ​

How Agile Insourcing supports NHS elective recovery

At Agile Insourcing, we support NHS trusts by providing additional clinical capacity exactly where and when it's needed, helping services maintain momentum against national targets. 

Our fully managed insourcing solutions enable trusts to:

• Increase first outpatient appointments
• Protect continuity of care
• Reduce RTT breaches
• Maintain clinical governance and local oversight

Across our current contracts, we are delivering:

• 3,000 additional first appointments every month
• 50,000 first outpatient appointments delivered last year across larger contracts
• Full onward management of diagnostics, treatment, follow-ups and surgery
• Seven-day services, delivered both on-site and off-site

All services are clinically led, overseen by our Medical Director and specialty-specific clinical leads, ensuring quality, safety and compliance at every stage. ​

Real-world insourcing impact across NHS Trusts

Agile Insourcing has supported NHS elective recovery through targeted weekend and out-of-hours delivery, including:

• Insourcing cardiology and echocardiology at King's College Hospital
• Insourcing pain management services at Barking, Havering and Redbridge
• Breast radiology insourcing in Birmingham
• Insourcing dermatology services at Queen Elizabeth Hospital, King's Lynn
• Dermatology insourcing clinics at Manchester Foundation Trust

These programmes converted spare capacity into productive clinical activity - directly supporting RTT, diagnostic and cancer pathway performance. Our teams work within NHS​ systems and frameworks, ensuring additional capacity complements - rather than replaces - existing clinical teams. 

At Agile Insourcing, we're proud to work by your side, delivering clinically-led insourcing solutions that help the NHS maintain momentum, improve patient access and build long-term resillience. For more information on our services either call 01756 704 754 or email [email protected]

*Source: NHS England, 15 January 2026​