COVER STORY: NHS insourcing: addressing the backlog

According to NHS England’s latest figures, from September 2024, there are 7.6 million RTT (Referral to Treatment) pathways open, representing patients waiting to start treatment.¹ This includes an estimated 6.1 million unique individuals. Worryingly, only 58% of patients on the elective care waiting list are seen within the 18-week target, and nearly 250,000 patients have been waiting for over a year. With 1.7 million new RTT pathways initiated in September alone, the demand for elective care continues to grow at a rapid pace.

These numbers underscore the unprecedented pressures on the NHS and highlight the urgent need for solutions to reduce waiting times and improve access to care. Lord Darzi recently framed the issue succinctly in his report: “It is not a question, therefore, of whether we can afford the NHS. Rather, we cannot afford not to have the NHS, so it is imperative that we turn the situation around.” His report further stressed the need for a multifaceted approach to tackle this crisis, including incentivising NHS staff to work extended hours, leveraging insourcing providers to optimise existing NHS capacity, and outsourcing to private healthcare providers where appropriate.

The importance of elective recovery was reinforced by the Prime Minister in his speech on 5th December 2024, where he reiterated that reducing waiting lists and improving access to non-urgent medical treatments is now a critical priority. At the NHS Confederation’s Achieving the 18-Week Standard for Elective Care event in September 2024, insourcing emerged as a key strategy for addressing the challenges of elective recovery.