Re:View 7 November 2025
Research Manager and Head of Health
It’s been an unusually busy week for NHS observers. The resident doctor’s strike is officially confirmed, after resident doctors rebuffed Wes Streeting’s final offer. The Mayfield Review on economic inactivity landed; the ADHD taskforce published its final report; and worryingly, reports of racism towards NHS staff continue.
Another notable – but characteristically ambiguous – outing for health policy this week was in Chancellor Rachel Reeves’s definitely-very-necessary speech to ‘contextualise’ the upcoming Budget. As surely as the sun rises in the east, the NHS tops the three priorities for public spending: cutting waiting lists, national debt and the cost of living.
Yet herein lies the ambiguity: I never know if Government is really clear on what it means by “waiting lists.” For a start, the entire NHS is characterised by waiting. GP appointments, A&E, and the elective backlog. And technically, waiting lists refer to the lattermost.
NHS policy, by contrast, is targeting everything at once. The elective backlog is the Government’s ‘health mission’ but the proposed ‘three shifts’ have little to do with it. There’s been one elective recovery strategy but a 168-page Ten Year Plan majoring on neighbourhood health.
Government may think of elective recovery as a short-term job, and the plan as a long-term vision. But this framing is flawed. If waiting lists are truly the Government’s priority – whether you agree with this choice or not – they must be the long-term strategy. History tells us that backlog recovery is not a quick fix: in the early 2000s it took closer to a decade to bring waits down, even with unprecedented investment and political focus.
More importantly, overcoming backlogs is not a single-dimension problem. It is a product of workforce, infrastructure, technology, and patient flow – exactly the multidimensional challenge we explored in our Hospital of the Future programme. Treating it as a short-term operational issue misses the structural roots of why waiting lists build up in the first place.
Of course, we have seen impressively cost-effective innovations – such as NHS Online – which will do substantial heavy lifting on the backlog. But a certain lack of clarity on the Government’s overarching goal for the NHS, unfortunately, remains. And not knowing what you mean means not knowing what you fund. And not knowing what you fund risks arriving in 2029 with no material change because the limited funds were not precisely targeted. The NHS is a vast and complex system that has a miraculous ability to swallow up money – clarity is not optional.
Which brings us to the evergreen conclusion: the NHS appears set to receive preferential treatment once again in a fiscal event. As a health policy specialist, I of course welcome additional resource for the NHS. But I also wholeheartedly subscribe to the view that extra resource must be carefully targeted, and must be accompanied by sweeping reforms to ensure each pound generates real value for money – as we have set out in our Hospital of the Future programme.