Waiting list reduction has become a central test of NHS recovery, with particular attention on communities where long waits overlap with high economic inactivity. A recent evaluation highlights progress in 20 English hospital trusts selected for targeted support, showing faster reductions in backlogs alongside gains in productivity. The approach focuses on practical redesign of elective care delivery, using specialist teams to work directly with local services. Alongside wider national measures linked to the government’s elective reform plan, the programme reflects a drive to increase activity, remove inefficiencies and improve access to planned treatment, with an explicit emphasis on helping more people return to work.
Targeted Support in Areas with High Economic Inactivity
Specialist NHS teams were deployed to 20 hospital trusts across England identified as having the highest levels of economic inactivity. The initiative, known as the Further Faster 20 (FF20) programme, aimed to reduce waiting lists while supporting growth. The evaluation found that, over the 12 months from October 2024 to October 2025, waiting lists in FF20 areas fell three times faster than in the rest of the country. The reduction in FF20 areas was 4.2%, compared with 1.4% nationally.
The difference was larger for working-age adults, with waiting lists falling more than five times faster in FF20 areas. The programme is presented as contributing to shorter waits and enabling more people to return to the workforce. The NHS is expected to apply learning from the programme more widely, with an intention to scale approaches beyond the initial 20 trusts and support broader improvement in elective care delivery.
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Operational Redesign to Increase Elective Care Throughput
The FF20 programme focused on changing how planned operations and outpatient appointments are delivered, with teams working alongside local staff to transform processes. One operational method highlighted was the use of high-flow theatre lists, described as enabling “Formula 1 style” surgery through continuous operation of theatres. The aim was to allow surgeons to complete planned procedures more quickly by maintaining momentum and reducing interruptions within theatre workflows.
Outpatient redesign also played a major role. Trusts reduced unnecessary appointments by sending patients “straight to test” rather than requiring multiple clinic visits. This approach was positioned as a way to streamline pathways and reduce delays caused by repeated appointments that do not directly advance diagnosis or treatment planning.
Examples from participating trusts indicate how capacity and productivity improvements were pursued. South Tees created 4,000 additional appointment slots by optimising the operation of outpatient clinics. Bolton reduced wasted slots by 20% through improved capacity management. East Lancashire introduced AI-powered dictation for pre-operative assessments and reported a 14% improvement in nurse productivity. Together, these examples illustrate a focus on increasing throughput using operational planning, clinical pathway redesign and targeted technology adoption.
Elective Reform Plan Links with Wider NHS Productivity Push
The programme is positioned as part of broader progress linked to the government’s elective reform plan, launched in January 2025. That plan set out an ambition to return the NHS to a target where 92% of patients wait no longer than 18 weeks from referral to treatment by the end of the parliament. The FF20 findings were released one year after the plan’s launch, with an emphasis on reform efforts supported by record NHS funding directed towards reducing waiting lists and improving timeliness of care.
Nationally, waiting lists have fallen by more than 225,000 since July 2024, despite 28.4 million referrals. Alongside the FF20 programme, the government and NHS have implemented additional changes across England, including more evening and weekend clinics, new and expanded community diagnostic centres and surgical hubs, millions of extra GP appointments, thousands more frontline staff and smarter technology.
Productivity performance was also highlighted, with 2.7% growth reported between April 2024 and March 2025, followed by a further 2.5% increase in the first five months of the current financial year. This was presented as evidence of sustained delivery above target productivity growth, combining increased capacity with efficiency gains.
The Further Faster 20 programme demonstrates how targeted operational support can accelerate waiting list reductions in selected parts of England, with measurable differences compared to national trends. Reported results include faster backlog reductions, stronger improvements for working-age adults and locally evidenced gains in outpatient capacity and workforce productivity. For healthcare leaders, the evaluation underscores the role of pathway redesign, theatre efficiency and selective technology use in increasing planned care throughput. The direction of travel aligns with wider elective reform goals, combining investment with process change to improve access to treatment and support recovery of NHS performance.
Source: GOV.UK
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