The Progress and the Challenge
In May 2026, the NHS achieved a significant milestone: 65.3% of patients were treated within 18 weeks, meeting the national interim target. This represents genuine progress – a 5.5 percentage point improvement from March 2025 and the first time the target has been met since November 2021.
However, the Health Foundation's detailed analysis reveals an important truth: recent gains may reflect short-term sprint efforts that will be difficult to sustain over the long term. The acceleration in performance during the final quarter of the financial year – driven by additional evening and weekend clinics – demonstrates what intensive effort can achieve. But it also raises a critical question: how can trusts maintain this momentum without exhausting their clinical and operational teams?
Understanding the Variation
The national figures mask significant variation. Across integrated care boards, the percentage of waits within 18 weeks ranges from 53% to 74%. At trust level, just over 4 in 10 acute trusts did not achieve the target of both a minimum of 60% of waits within 18 weeks and a 5 percentage point improvement from November 2024.
This variation is not random. It reflects differences in baseline capacity, workforce availability, case complexity and local demand. Some trusts have successfully embedded sustainable improvements; others have relied more heavily on sprint activity. For NHS leaders, this variation underscores a critical insight: there is no one-size-fits-all solution to elective recovery. Trusts must
understand their own context and build strategies tailored to their
specific challenges.
The Long-Term Challenge
The government's commitment is clear: restore the 18-week standard for 92% of patients by 2029. This is ambitious and necessary. However, the Health Foundation's analysis suggests that reaching 92% will require more than sprint efforts. It will require sustained investment in capacity, workforce and infrastructure; productivity improvements that enhance efficiency without compromising quality or staff wellbeing; equitable recovery across all trusts, not just those with existing capacity advantages; and resilience that protects services from unexpected pressures or workforce challenges.
Building Sustainable Capacity
For many trusts, the path to sustainable elective recovery involves a strategic blend of approaches: workforce development – investing in training, apprenticeships and career development to grow the permanent diagnostic, clinical and nursing workforce. Process improvement – embedding lean principles, optimising patient pathways and reducing waste to enhance productivity. Technology investment – deploying digital tools to improve scheduling, reduce cancellations and enhance
patient communication. Strategic partnerships – collaborating with other trusts, independent providers and insourcing partners to share capacity and expertise. Flexible staffing – using strategic insourcing to bridge capacity gaps, support surge demand and protect permanent staff from burnout.
The Role of Insourcing in Sustainable Recovery
Insourcing solutions sit naturally within this mix. Clinically led insourcing enables trusts to augment capacity flexibly, responding to demand fluctuations without creating permanent overhead. This approach protects staff wellbeing by reducing pressure on permanent teams, supporting retention and morale. It maintains quality by ensuring insourced professionals are integrated into the trust's clinical governance framework. It enables specialisation by allowing permanent
staff to focus on complex cases, training and service development. It supports surge capacity by enabling trusts to respond rapidly to demand spikes or unexpected absences. It builds resilience through a blend of permanent and flexible staffing that can adapt to changing circumstances.
Addressing Inequalities
The Health Foundation's analysis highlights an important concern: variation in elective recovery performance risks deepening health inequalities. Patients in areas with well-resourced trusts may access treatment quickly; those in under-resourced areas may face longer waits.
Addressing this requires targeted support for trusts facing the greatest challenges. This might include additional investment, workforce development support, and access to proven capacity solutions like insourcing. The goal must be equitable recovery – ensuring that all patients, regardless of where they live, can access timely, high-quality care.
Looking Forward
The achievement of the 65% target is encouraging. It demonstrates that elective recovery is possible. However, the journey to 92% by 2029 requires sustained effort, strategic investment and a commitment to building resilient, sustainable capacity.
For NHS leaders and operational managers, the message is clear: sprint efforts have delivered results, but they are not sustainable long-term. The next phase of elective recovery must focus on embedding lasting change – through workforce development, process improvement, technology investment and strategic partnerships.
For trusts seeking to build sustainable capacity, insourcing solutions offer a proven pathway. By working collaboratively with NHS teams, insourcing providers can help trusts augment capacity, protect staff wellbeing and maintain momentum towards the 18-week standard.
The path to full elective recovery is clear. With the right strategy, investment and support, the NHS can deliver lasting change by 2029.