England’s NHS waiting list has tripled since 2012.

Provisional single-reviewer assessments from the 6 October 2026 review; not approved business cases, and not government policy.

• Waiting lists■Delivery RAG: Red

  Funded now

  Baseline: the Elective Reform Plan (65% within 18 weeks by March 2026, met narrowly at 65.3%; 92% by March 2029), the planning framework’s 70% by March 2027, surgical hubs and £2.0bn of elective capital in 2026–27. Choosing specialties by binding constraint and adding capacity beyond funded plans is a UK Facts proposal, not government policy.

  The change assessed

  Not yet defined.

  Range if completed: 13.0–22.0 out of 30 (equal weights; not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co))

• Fix NHS equipment and estate bottlenecks that cancel care■Delivery RAG: Red

  Funded now

  Not yet stated in the record.

  The change assessed

  Select named maintenance/equipment projects with logged downtime and funded staff to use restored capacity.

  Range if completed: 15.0–21.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

Alternatives already on record: 26 options listed under the points in the position today (16 without an action record), and 3 earlier options under other options compared. They have not been scored in the review.

Which quadrant a point sits in is our analytical judgement, not a statistical category. Each point says whether it is a measured fact, our synthesis or a risk.

Provisional single-reviewer assessments from the 6 October 2026 review; not approved business cases, and not government policy.

• A61■Delivery RAG: RedGate: pending

  Waiting lists

  Existing action A61, assessed at the same scope.

  Provisional single-reviewer assessment; not an approved business case.

  Who and where

  Patients waiting for planned hospital treatment in England, starting with trauma and orthopaedics (840,967 pathways, 60.9% within 18 weeks in July 2026) and specialties with the lowest 18-week shares. (from the action record) Jurisdiction: England.

  Result so far

  Range if completed: 13.0–22.0 out of 30 (equal weights; not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co))

  Funded now (baseline)

  Baseline: the Elective Reform Plan (65% within 18 weeks by March 2026, met narrowly at 65.3%; 92% by March 2029), the planning framework’s 70% by March 2027, surgical hubs and £2.0bn of elective capital in 2026–27. Choosing specialties by binding constraint and adding capacity beyond funded plans is a UK Facts proposal, not government policy. (from the action record)

  The change assessed (marginal)

  Marginal change not yet defined

  • Domain home: NHS
  • In the national plan: Wellbeing list

  What the evidence supports—and the next decision

  The waiting list is a stock of pathways; reducing it is not a specified treatment intervention and can conceal changes in access.

  Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

  Define the change

  Choose a specialty and bottleneck, with eligible patients and a funded workforce plan. Compare diagnostics, treatment capacity and pathway redesign.

  Test whether it works

  Wait distribution, completed treatment, clinical outcomes and unmet referrals; retain emergency and community-service balancing measures.

  Establish the cost

  Staff, diagnostics, theatre time, capital, maintenance and follow-up, including the opportunity cost of moving staff from another service.

  Protect against harm

  Do not improve the metric by rejecting or administratively removing patients without appropriate care.

  Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

  Full assessment of Waiting lists: ten criteria, scenarios, delivery, costs and monitoring

  The ten criteria (0–3)

  Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

  1. Scale and severity (Sc)3 of 3 — Severe harm across a broad population

     Reviewer’s reason: Provisional problem-importance judgement from linked site pages; not the scale of achievable benefit.

  2. Increment beyond baseline (Ad)Not yet assessed

     Reviewer’s reason: Map diagnostic, theatre, staffing and discharge constraints; select a specialty/locality; demonstrate addition beyond funded plans. A missing rating requires a defined marginal change.

  3. Confidence in the proposed action (Ev)2 of 3 — Relevant evaluated evidence with limitations

     Reviewer’s reason: Hub evidence concerns activity; the artifact notes no total activity gain. The proposed increment and effect on waits are unresolved.

  4. Expected incremental benefit (Bn)Not yet assessed

     Reviewer’s reason: Unknown unless a reasonably defined target-population benefit can be judged; no bonus merely for spanning domains.

  5. Residual harms (Hm)1 of 3 — Material harm/unresolved mitigation

     Reviewer’s reason: Binding workforce capacity; displacement of urgent or other elective care.

  6. Incremental affordability (Co)Not yet assessed

     Reviewer’s reason: Capital, staff, diagnostics, maintenance, displaced activity and recurring running costs.

  7. Delivery capacity (Ca)1 of 3 — Binding scarce resource

     Reviewer’s reason: Map diagnostic, theatre, staffing and discharge constraints; select a specialty/locality; demonstrate addition beyond funded plans.

  8. Distribution (Fa)2 of 3 — Mixed or broadly neutral with safeguards

     Reviewer’s reason: Provisional distribution judgement for the stated target; verify who pays, who gains and excluded groups.

  9. Meaningful first outcome (Ti)2 of 3 — More than one and up to three years

     Reviewer’s reason: First meaningful outcome, not announcement: Patient waits and health outcomes, not hub throughput alone.

  10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

      Reviewer’s reason: NHS commissioners/providers; nation-specific systems; Identify marginal bottleneck and appraise

  Four weightings

  Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

  • Equal weights: Range if completed: 13.0–22.0 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
  • Evidence doubled: Range if completed: 13.6–21.8 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
  • Scale doubled: Range if completed: 14.5–22.7 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
  • Cost ignored (the funding gate still applies): Range if completed: 14.4–21.1 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.

  Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

  Delivery RAG and gate

  ■Delivery RAG shown: RedReview’s claim: Red. Best the recorded evidence allows: Red.

  Review’s reason: Binding workforce capacity; displacement of urgent or other elective care.

  Why it is not Green yet

  • Delivery obstacle: Binding workforce capacity; displacement of urgent or other elective care..
  • Scope (population, place and increment) not verified against the delivery baseline.
  • No verified owner with the powers in place.
  • Delivery capacity not verified.
  • Lifetime incremental costs not complete.
  • No credible funding (a committed allocation for the scope).
  • Safeguards not specified.
  • Monitoring lacks a metric, a data source or a baseline.

  Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

  Gate: Pending — appraisal incomplete (review label: “Pending: incomplete appraisal”).

  Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

  The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

  Cost and funding

  Lifetime costing: Not established. Review: “Full incremental costing not established in reviewed material”.

  Still to cost: Capital, staff, diagnostics, maintenance, displaced activity and recurring running costs.

  Funding status: not identified.

  Owner, powers and capacity

  Proposed owner: NHS commissioners/providers; nation-specific systems (proposed, unverified).

  Powers: needs a decision or allocation. Capacity: binding constraint.

  Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

  England:

  NHS England, integrated care boards and NHS trusts (action record)

  Scotland:

  not assessed

  Wales:

  not assessed

  Northern Ireland:

  not assessed

  Scotland, Wales and Northern Ireland run separate systems with different waiting standards; not assessed.

  Dependencies, safeguards and risks

  Depends on: None recorded.

  Safeguards

  None specified yet.

  Risks and residual harms: Binding workforce capacity; displacement of urgent or other elective care.

  Monitoring and measured results

  Metric: Patient waits and health outcomes, not hub throughput alone.

  Data source: Not yet named. Baseline: Not yet established.

  Measures already on the domain page

  • Waiting pathways within 18 weeks: latest 65.2% (August 2026); baseline 92.3% (September 2015 (last month the standard was met)) (England).
  • Patients waiting six weeks or more for a diagnostic test: latest 23.1% (443,200) (July 2026); baseline not published (England).

  A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.

  Evidence for the outcome

  Outcome: Patient waits and health outcomes, not hub throughput alone.

  Hub evidence concerns activity; the artifact notes no total activity gain. The proposed increment and effect on waits are unresolved.

  SWOT points it addresses

  • 65.2% of waiting pathways were within 18 weeks, against the 92% standard last met in September 2015.
  • 23.1% of patients (443,200) were waiting six weeks or more for a diagnostic test in July 2026, against a 2026/27 target of at most 14%; trauma and orthopaedics, the largest treatment list (840,967 pathways), had 60.9% within 18 weeks.

  Review record

  Assessment version: working-review-2026-10-06 (A61@working-review-2026-10-06).

  Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

  Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.

  First 90 days (review): Produce a signed scope and current-delivery baseline; Map diagnostic, theatre, staffing and discharge constraints; select a specialty/locality; demonstrate addition beyond funded plans. Obtain incremental costs and an accountable decision before expansion.

  Decision route: Identify marginal bottleneck and appraise

  An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

• A75■Delivery RAG: RedGate: pending

  Fix NHS equipment and estate bottlenecks that cancel care

  Proposed new action A75; sourced research home and appraisal design; scope and funding remain provisional.

  Provisional single-reviewer desk assessment, 6 October 2026.

  Who and where

  Select named maintenance/equipment projects with logged downtime and funded staff to use restored capacity. (from the 6 October review) Jurisdiction: England.

  Result so far

  Range if completed: 15.0–21.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

  Funded now (baseline)

  Funded baseline not yet stated

  The change assessed (marginal)

  Select named maintenance/equipment projects with logged downtime and funded staff to use restored capacity. (from the 6 October review)

  • Domain home: NHS

  What the evidence supports—and the next decision

  The maintenance backlog measures estimated repair needs; it is not a forecast of cancelled care avoided by spending the same sum.

  Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

  Define the change

  Select named equipment or estate failures linked to service downtime, with a funded workforce able to use restored capacity.

  Test whether it works

  Downtime, cancellations, usable sessions and patient outcomes before and after repair, allowing for demand and staffing changes.

  Establish the cost

  Survey, repair or replacement, decanting, maintenance, training and running costs; assess lifecycle alternatives and construction disruption.

  Protect against harm

  Prioritise safety and clinical need; avoid buying capacity that cannot be staffed.

  • NHS England: ERIC 2024/25 →

  Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

  Full assessment of Fix NHS equipment and estate bottlenecks that cancel care: ten criteria, scenarios, delivery, costs and monitoring

  The ten criteria (0–3)

  Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

  1. Scale and severity (Sc)3 of 3 — Severe harm across a broad population

     Reviewer’s reason: Problem scale judged from the linked domain evidence; not a population estimate of those helped.

  2. Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery

     Reviewer’s reason: Select named maintenance/equipment projects with logged downtime and funded staff to use restored capacity. This is a provisional marginal-change judgement, to confirm against commissioned delivery.

  3. Confidence in the proposed action (Ev)1 of 3 — Indirect, mixed, modelled or weak causal support

     Reviewer’s reason: Site records a large backlog; it does not establish a national return per pound of repair.

  4. Expected incremental benefit (Bn)Not yet assessed

     Reviewer’s reason: Unknown: no sufficiently supported magnitude for this exact change.

  5. Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards

     Reviewer’s reason: Capital without operating staff; shifting maintenance from other critical sites.

  6. Incremental affordability (Co)Not yet assessed

     Reviewer’s reason: Unknown: the proposed increment has not been costed and matched to an approved affordable allocation in this review. Existing programme envelopes are not that allocation.

  7. Delivery capacity (Ca)1 of 3 — Binding scarce resource

     Reviewer’s reason: Scheme costs and staff capacity must be established before approving expansion.

  8. Distribution (Fa)2 of 3 — Mixed or broadly neutral with safeguards

     Reviewer’s reason: Distribution assessed against the target group and the burdens described here: Capital without operating staff; shifting maintenance from other critical sites.

  9. Meaningful first outcome (Ti)2 of 3 — More than one and up to three years

     Reviewer’s reason: Timing judgement concerns the first meaningful outcome in: Cancelled lists due to estate/equipment; usable theatre hours and completed care, adjusted for staffing. It does not imply all long-term benefits arrive then.

  10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

      Reviewer’s reason: Prioritise safety-critical work separately; appraise operational fixes using downtime and completed-care data. Owner: NHS trusts and capital commissioners in England.

  Four weightings

  Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

  • Equal weights: Range if completed: 15.0–21.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
  • Evidence doubled: Range if completed: 14.5–20.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
  • Scale doubled: Range if completed: 16.4–21.8 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
  • Cost ignored (the funding gate still applies): Range if completed: 16.7–20.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.

  Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

  Delivery RAG and gate

  ■Delivery RAG shown: RedReview’s claim: Red. Best the recorded evidence allows: Red.

  Review’s reason: Capital without operating staff; shifting maintenance from other critical sites. Scheme costs and staff capacity must be established before approving expansion.

  Why it is not Green yet

  • Delivery obstacle: Capital without operating staff; shifting maintenance from other critical sites. Scheme costs and staff capacity must be established before approving expansion..
  • Scope (population, place and increment) not verified against the delivery baseline.
  • No verified owner with the powers in place.
  • Delivery capacity not verified.
  • Lifetime incremental costs not complete.
  • No credible funding (a committed allocation for the scope).
  • Safeguards not specified.
  • Monitoring lacks a metric, a data source or a baseline.

  Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

  Gate: Pending — appraisal incomplete (review label: “Pending cost, funding, scope and capacity appraisal”).

  Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

  The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

  Cost and funding

  Lifetime costing: Not established.

  Still to cost: Incremental lifetime costs and funding not established. Scheme costs and staff capacity must be established before approving expansion.

  Funding status: not established in review.

  Owner, powers and capacity

  Proposed owner: NHS trusts and capital commissioners in England. (proposed, unverified).

  Powers: needs a decision or allocation. Capacity: binding constraint.

  Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

  England:

  NHS trusts and capital commissioners in England. (review)

  Scotland:

  not assessed

  Wales:

  not assessed

  Northern Ireland:

  not assessed

  Read from the review’s owner and scope text; not verified against the powers held.

  Dependencies, safeguards and risks

  Depends on: Scheme costs and staff capacity must be established before approving expansion.

  Safeguards

  None specified yet.

  Risks and residual harms: Capital without operating staff; shifting maintenance from other critical sites.

  Monitoring and measured results

  Metric: Cancelled lists due to estate/equipment; usable theatre hours and completed care, adjusted for staffing.

  Data source: Not yet named. Baseline: Not yet established.

  Evidence for the outcome

  Outcome: Cancelled lists due to estate/equipment; usable theatre hours and completed care, adjusted for staffing.

  Site records a large backlog; it does not establish a national return per pound of repair.

  SWOT points it addresses

  • NHS trusts estimated £15.9bn to eradicate maintenance backlog in 2024/25. This is a risk-based estimate of work needed to restore the estate, excluding planned maintenance—not a funded programme, annual bill or estimate of the benefit from each repair.

  Review record

  Assessment version: working-review-2026-10-06 (A75@working-review-2026-10-06).

  Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

  Carried from the earlier domain review (C record): must be calibrated jointly with the G/W/E/NG/NW/NE records before any combined comparison.

  Decision route: Prioritise safety-critical work separately; appraise operational fixes using downtime and completed-care data.

  An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

The leading option set out as a decision someone could take: who decides, who benefits, the best evidence, cost and funding, and the main trade-off. The full research record is one click away.

The outcome measures to watch. A baseline is where we start, not a target; where there is no official target we say so.

• Waiting lists

  Judged on: Patient waits and health outcomes, not hub throughput alone.

  Data source: not yet named; baseline: not yet established.

  • Waiting pathways within 18 weeksLatest: 65.2% (August 2026). Baseline: 92.3% (September 2015 (last month the standard was met)). England.
  • Patients waiting six weeks or more for a diagnostic testLatest: 23.1% (443,200) (July 2026). Baseline: not published. England.

  ↑ National plan: Wellbeing list

• Fix NHS equipment and estate bottlenecks that cancel care

  Judged on: Cancelled lists due to estate/equipment; usable theatre hours and completed care, adjusted for staffing.

  Data source: not yet named; baseline: not yet established.

  No measure on this page yet.