Next month’s Budget must turn NHS waiting-list ambition into action, says Adam Binns, CEO of One Health Group

With the Chancellor’s Budget now just weeks away, there will be no shortage of competing demands on the public finances. Social care has once again moved up the political agenda, underlining the scale of the challenge facing the wider health and care system. Defence, welfare and immigration will also command attention, while the cost of servicing the national debt continues to constrain the Government’s room for manoeuvre. Against that backdrop, I am not expecting the NHS to receive a blank cheque. I do think the Budget needs to answer a simple question, though: what is the plan to get NHS waiting lists falling again?

For those of us supporting the NHS through the provision of elective healthcare services to NHS patients, free at the point of delivery, this significant question is becoming increasingly difficult to ignore. The NHS waiting list has risen again - in August the overall list grew by around 42,000 to 7.37 million, while performance against the 18-week target dipped from 65.4% to 65.2%. The NHS has committed the NHS to achieving 70% within 18 weeks by March 2027, less than six months away. The direction of travel therefore needs to change significantly and promptly for that target to remain credible and achievable.

My overriding concern is that we have heard relatively little about the NHS in the run-up to this Budget, compared with some of the other major pressures facing Government. Elective care risks becoming the part of the NHS conversation that is promised attention but receives neither the certainty nor funding required to make a meaningful difference.

The renewed focus on social care highlights why the NHS cannot be viewed in isolation from the wider health and care system. Andy Burnham’s announcement of plans for a National Care Service has brought the need for a long-term, sustainable approach to care back into the spotlight. While reforming social care is a distinct challenge, the availability of appropriate care and support outside hospital can have a direct bearing on NHS capacity, including the ability to discharge patients safely and free up beds for others who need treatment. These pressures are not a substitute for addressing elective waiting lists, but they reinforce the need for a properly funded, unified approach to health and care. The Budget must address the immediate challenge of increasing treatment capacity while providing a credible longer-term framework for the wider system.

When the Chancellor announces the Budget, the first thing I would want to establish is whether any NHS announcement represents genuinely additional funding, or simply a restatement, repackaging or reallocation of money already announced. For healthcare providers, that distinction is critical. Announcing another pot of money is one thing; creating the financial certainty that allows NHS systems to commission the additional activity required to make a meaningful difference to the waiting list is another.

There is a particularly strong case for this when it comes to elective care. The Government cannot sustainably reduce waiting lists simply by asking the existing NHS estate and workforce to do more of the same. The NHS itself has an important role to play, but there is significant capacity across the wider healthcare system that can be mobilised now. The Government recognised this in its January 2025 partnership with the independent sector, which identified expanding capacity and increasing patient choice as key elements of tackling waiting lists. The Budget is an opportunity to turn that principle into a practical commissioning model.

What I would like to see is a significant additional commitment to elective activity, backed by properly ring-fenced funding for waiting-list reduction. There is a precedent in the form of dedicated elective recovery funding (ERF) deployed in previous years; recreating a clear funding stream for elective recovery would give NHS systems and providers much greater confidence to plan.

The word ‘plan’ is important. One of the biggest frustrations for healthcare businesses is the continued short-term nature of NHS commissioning. If an NHS system wants to use additional capacity to treat patients, providers need to know that activity will be commissioned and funded for long enough to justify recruiting staff, investing in equipment and expanding facilities. A 12-month assurance is not the basis on which you build sustainable healthcare capacity. Multi-year funding and multi-year NHS contracts should become standard rather than exceptional.

There is also a broader question about how we use the capacity that already exists. The instinct in parts of the system can sometimes be to outsource less, and deliver more activity ‘in-house’ within existing NHS infrastructure and assume that this will save money. I struggle to see how that works when NHS productivity remains under such pressure with current activity, without more being expected. Moving activity from one provider to another does not, in itself, create greater productivity, particularly when resources are already at capacity. What matters is how quickly, efficiently and effectively patients can be treated.

The independent sector should therefore be seen not as a substitute for the NHS, but as part of the NHS’s available capacity and wider infrastructure?. If clinically appropriate NHS-funded treatment can be delivered safely and efficiently by an independent provider, patients should not have to wait longer simply because that capacity sits outside the NHS estate. If Government wants independent providers to invest in that capacity, it needs to give them the confidence to do so through longer-term funding and contracts.

The other issue that deserves more attention is the price paid for NHS care. The NHS Payment Scheme or ‘Tariff’ is effectively the price list governing how the NHS, and independent providers, are paid for individual activities within NHS-funded secondary care. Yet independent healthcare providers are operating in an environment of high inflation where labour, National Insurance, energy, estates and other costs have increased significantly, some due to government interventions to raise taxes?. A meaningful improvement in NHS tariff is therefore not simply a benefit to providers. If Government wants additional elective capacity, the payment system must make delivering that capacity economically viable.

The same logic applies to employment costs. Further increases in National Insurance or the National Living Wage would put additional pressure on independent healthcare providers, which do not have the same mechanism as the NHS for absorbing those increases through Government offset funding. I would therefore be cautious about increasing the tax and employment-cost burden on businesses at precisely the point when Government is asking them to invest in additional capacity. Businesses also need a stable tax environment if they are expected to invest and grow.

Ultimately, this is about being disciplined about what actually delivers value. If the Government wants to reduce a waiting list of more than seven million, the focus needs to be on increasing activity, productivity and capacity, while delivering a good return on taxpayers’ and patients’ investment in the system,. What matters is a  genuine and tangible reduction in the number of people waiting for treatment, rather than progress achieved by moving activity around the system, administrative changes or changes to how the waiting list is measured.

There is an economic argument for getting this right too. Many people waiting for treatment are employees waiting to return to work, parents struggling with day-to-day life and businesses carrying the cost of sickness absence and lost productivity. Reducing waiting times is therefore not simply an NHS priority; it is an economic objective fundamental to improving workforce participation, productivity and delivering the much needed UK economic growth the Government aspires to.

The Budget is an opportunity to give the NHS something it has too often lacked: certainty. Certainty over funding for additional elective activity. Certainty that independent providers will remain  an integral part of expanding NHS capacity. Certainty through longer term contracts that give providers the confidence to invest in additional capacity. Certainty that the price paid for care reflects the true  cost of delivering high quality treatment.

If the Government can provide that certainty, the healthcare sector can do what it does best: invest, expand capacity and get patients treated. Combined with a sustainable, joined-up approach to health and social care, that would help deliver something that matters well beyond Whitehall: shorter waiting times, greater patient choice and a healthier, more productive economy.