More than half of National Health Service (NHS) boards in England are implementing minimum waiting times of up to 16 weeks for non-urgent procedures, a move that critics say deliberately delays care for patients in pain to control costs. The British Medical Journal's investigation, utilizing Freedom of Information requests, found that 17 out of 35 integrated care boards (ICBs) have established these minimum wait periods.
These mandated delays mean that patients may wait for procedures such as hip, knee, and cataract surgeries, even when hospital capacity exists to treat them sooner. The Royal College of Surgeons has expressed concern, stating that unnecessary delays can exacerbate pain, restrict mobility, increase anxiety, and worsen medical conditions. GP leaders echoed these sentiments, describing the waits as difficult to justify and adding pressure to primary care.
Among the health boards enforcing these policies, Shropshire, Telford and Wrekin, and West Yorkshire have set a 16-week minimum wait for all routine procedures. West Yorkshire indicated its target is for 90 percent of patients to wait at least 16 weeks, a policy it stated allows doctors flexibility to prioritize patients at risk of clinical deterioration. Shropshire cited its 16-week minimum as a measure to "promote fairness, reduce variation, and ensure that all patients receive timely and equitable access to elective services."
Other ICBs have introduced similar minimums for specific procedures. For example, some areas have a 16-week minimum for cataract surgery. Birmingham has a 14-week minimum for planned non-urgent elective care unless clinical urgency is demonstrated. Humber and North Yorkshire, and NHS Hereford and Worcestershire, have planning assumptions for average waiting times of 16 weeks and 14 weeks, respectively, for routine planned admitted procedures. Dorset expects independent sector surgical providers to adhere to a 14-week minimum from the date of referral, and Somerset mandates no treatment under 14 weeks unless a patient is a priority or requires urgent tests.
Tim Lane, president of the Royal College of Surgeons, acknowledged the financial and capacity pressures on the NHS but emphasized that clinical need, not postcode, should determine access to treatment. He warned that widespread minimum waits risk creating a "postcode lottery" and are not a substitute for addressing underlying capacity issues, calling for increased investment and improved infrastructure.
Professor Victoria Tzortziou Brown, president of the Royal College of GPs, stated that long waits are frustrating for patients managing pain and symptoms, and that these delays increase the workload for GPs. She stressed that decisions on treatment should be based on clinical needs, and blanket minimum waits for administrative or financial reasons are hard to justify when patients could be treated sooner.
Sally Gainsbury, a senior policy analyst at the Nuffield Trust, suggested that limiting activity with minimum waiting times can be an equitable way to spread budgets, but expressed concern about the lack of clarity on how this is done fairly. An NHS spokesperson stated that while commissioned wait policies help optimize services, staff, and budgets, all patients are seen in order of clinical need. The spokesperson also noted that no organization should commission waits that risk breaching NHS Constitution standards, which set an 18-week maximum wait for elective treatment.