Plan of elective care reform in England

On January 6, 2025, NHS England and the Department of Health and Social Care released a plan to reform elective care.

Elective care encompasses a wide range of planned, non-emergency services, including tests, scans, outpatient appointments, surgeries, and cancer treatments. The constitutional standard mandates that 92% of patients should wait no longer than 18 weeks from referral to treatment. However, waiting lists have grown over the past decade. The government's Plan for Change commits to restoring this standard by March 2029.

To meet this commitment, NHS England has proposed a set of reforms with specific actions required from different stakeholders (NHS England, Integrated Care Boards, and healthcare providers). The summary of the action plan is provided below.

Empowering patients by giving them more choice and control and establishing expected standards for making their experience of planned NHS care as smooth, supportive, and convenient as possible.

Reforming delivery by working more productively, consistently – and in many cases differently – to deliver more elective care. This will include:

• Expand capacity: Launch 17 new or expanded surgical hubs by June 2025;
• Improve diagnostic pathways: Extend the minimum operating hours for Community Diagnostic Centers (CDCs) to 12 hours a day, 7 days a week, offering same-day tests, expanded test ranges, direct referrals, and 10 straight-to-test pathways by March 2026;
• Enhance early diagnosis: Invest in up to 13 DEXA scanners to boost bone density scanning capacity;
• Leverage the independent sector: Publish a new Partnership Agreement—the first in 25 years—to reduce waiting lists.

Delivering care in the right place to make sure patients receive their care from skilled healthcare professionals in the right setting. This will include:

• Ensure both primary and secondary care are funded to deliver Advice and Guidance (A&G) services;
• Transform care pathways by shifting activity to the community, starting with five priority specialties: ENT, gastroenterology, respiratory, urology, and cardiology;
• Expand remote monitoring for long-term conditions where clinically appropriate.

Aligning finance, performance oversight, and delivery standards with clear responsibilities and incentives for reform, robust and regular oversight of performance, and clear expectations for how elective care will be delivered at a local level. Financial reform will comprise the following key changes to the way some elective care is paid for starting from April 2025 (after consultation on the 2025/26 NHS Payment Scheme): 

• Increase the price paid by the NHS for some ENT and gynecology procedures with the largest waiting lists. This will ensure all providers are fairly reimbursed. This is one example of how NHSE will review relevant tariffs throughout the duration of this plan to ensure they reflect the priorities and incentivize the most productive activity;
• Introducing best practice tariffs to shift procedures from day-case to outpatient settings, starting with six procedures and expanding to 30 clinical areas by 2026/27;
• Identify how to better link payment more closely to activity that directly ends a patient’s wait for their care;
• Developing and testing tariffs for innovative approaches, including A&G, validation, and remote monitoring, for widespread adoption by 2026/27.

See the full details here.

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