NHS funding is growing, but more slowly than a bigger, older population needs — and the waiting list shows it
NHS funding is due to grow by around 3.0% a year in real terms to 2028/29 — below the roughly 3.7% a year the Health Foundation says is needed to keep pace with a population that has grown by 12.2m since 1990 and is ageing. Overall assessment: structurally-pressured — the waiting list has eased from its 2023 peak but remains far above pre-pandemic levels, inside a wider picture that is otherwise flat or worsening across A&E, GP access and capital investment.
Read this first — what else changes the meaning of the headline
- Estimated individual patients
- ~6.23m
Lower than the 7.33m pathways figure because some patients are waiting for more than one treatment — the two numbers answer different questions, not a discrepancy.
- A&E seen within 4 hours
- 74.9%
Against a 95% standard last met in 2013-14 — improved from a 70.8% low in 2022-23, but still far short of standard.
- GP practices lost since 2018
- 1,025
Down from 7,254 (Jan 2018) to 6,229 (Jul 2025) while registered patients rose by 4.9 million over the same period — fewer practices serving more people.
- NHS estate maintenance backlog
- £15.9bn
ERIC-derived estimate, 2024-25 — up from £10.2bn in 2021-22, a growing capital pressure that interacts with the other three measures above.
NHS England ERIC dataset
million pathways: 7.33m · million estimated patients: 6.23m · +1.1m vs million estimated patients
+1.1 vs million estimated patients
⚠ Both figures are for the same month and the same England-wide RTT series — the gap between them is patients waiting for more than one treatment, not a data quality issue.
NHS Elective Waiting List — England (millions of PATHWAYS)
The waiting list roughly tripled from 2.5m pathways in 2010 to a 7.6m peak in 2023 and has edged down since — a decade of demand outpacing capacity, not only a pandemic story.
View data table
| Year | Waiting list (m pathways) |
|---|---|
| 2010 | 2.46 |
| 2011 | 2.42 |
| 2012 | 2.63 |
| 2013 | 2.94 |
| 2014 | 3.17 |
| 2015 | 3.53 |
| 2016 | 3.83 |
| 2017 | 4 |
| 2018 | 4.28 |
| 2019 | 4.57 |
| 2020 | 4.59 |
| 2021 | 6.07 |
| 2022 | 7.2 |
| 2023 | 7.61 |
| 2024 | 7.46 |
| 2025 | 7.29 |
England · Source: NHS England, RTT Overview Timeseries (including estimates for missing trusts) · as of December 2025 (latest month: July 2026, 7.33m pathways / 6.23m patients)
What the facts show
The funding gap
NHS funding has historically needed to grow by around 3.7% a year in real terms to keep pace with demand — a bigger, older population needing more care, plus new treatments and healthcare-specific cost inflation. Independent analysis breaks that down further: the Health Foundation estimates 2.9% a year is needed just to stand still (roughly two-thirds of which is population growth and rising rates of major illness), and 3.8% a year for sustained improvement, in line with the historic average. NHS England’s actual planned growth for 2025/26 to 2028/29 is around 3.0% a year in real terms (2.8% across the whole DHSC health budget, which also covers capital and public health) — below the long-term average needed, though not half of it.
Source: Health Foundation, “How much funding does the NHS need over the next decade?” (June 2024) and “What does the 2025 Spending Review mean for the NHS?” (June 2025) — independent analysis, not an official government figure.
A&E performance against the 95% standard
A&E 4-Hour Performance — England (all A&E types, %)
The 95% NHS standard for A&E has not been met nationally since 2013-14. Performance bottomed at 70.8% in 2022-23 and has recovered slightly to 74.9% — the 2020-21 reading is higher only because attendances fell sharply during the pandemic, not because the system was performing better.
View data table
| Year | % seen within 4 hours (all types) |
|---|---|
| 2010 | 97.4 |
| 2011 | 96.6 |
| 2012 | 95.9 |
| 2013 | 95.7 |
| 2014 | 93.6 |
| 2015 | 91.9 |
| 2016 | 89.1 |
| 2017 | 88.3 |
| 2018 | 88 |
| 2019 | 84.2 |
| 2020 | 86.8 |
| 2021 | 76.7 |
| 2022 | 70.8 |
| 2023 | 72.1 |
| 2024 | 73.9 |
| 2025 | 74.9 |
England · Source: NHS England, A&E Attendances and Emergency Admissions (monthly time series) · as of 2025-26 (latest month: June 2026, 75.0% all types / 61.2% Type 1)
GP access
Between January 2018 and July 2025, England lost 1,025 GP practices (7,254 → 6,229), while registered patients rose from 58.9 million to 63.8 million over the same period. Each full-time-equivalent GP now serves around 2,257 patients on average — up roughly 11% from 2,034 in December 2017.
Capital backlog and infrastructure
Years of under-investment in NHS buildings, IT systems and diagnostic equipment have created an estate maintenance backlog estimated at approximately £15.9bn (2024-25, up from £10.2bn in 2021-22) — outdated infrastructure that reduces efficiency and, in some cases, patient safety.
Source: NHS England, The Health Foundation, OBR, DHSC, RCGP analysis of NHS Digital data, NHS England ERIC.
Pathways, people and pressure: what the headline number doesn't show on its own
The waiting list is the most visible NHS number, but it is one measure among several that move independently and interact with each other.
Pathways are not people
Source: NHS England RTT Overview Timeseries
List length is not the same as waiting time
Source: NHS England RTT Overview Timeseries
The 2020-21 A&E "improvement" is not a normal benchmark
Source: NHS England, A&E Attendances and Emergency Admissions
These pressures interact — none of the four numbers above moves alone
Source: NHS England; DHSC Annual Report and Accounts
A bigger population is part of why demand keeps rising
Source: ONS, Provisional population estimate for the UK: mid-2025
What it means
- What the data directly shows
- The waiting list has fallen from its 2023 peak but remains far above pre-pandemic levels; A&E performance has improved from its 2022-23 low but has not met the 95% standard since 2013-14; GP practice numbers have fallen while registered patients have risen; the capital backlog has grown.
- What can reasonably be inferred
- Overall assessment: STRUCTURALLY-PRESSURED, with one partial recovery (the waiting list easing since 2023) inside a wider picture that is otherwise flat or worsening. Calling the whole system simply 'improving' or simply 'deteriorating' would overstate the consistency of what these four measures actually show — they move in different directions at different speeds.
- What is disputed
- How much of the current pressure is COVID-backlog recovery still working through the system, versus a longer-run structural funding/capacity gap that predates 2020, is disputed among health-policy analysts — the funding-gap figures above (around 3.0% planned real growth vs a 3.7% long-term average, Health Foundation analysis) support the structural reading, but do not on their own settle how much weight each explanation deserves.
- A political judgement, not a finding
- Whether the priority should be waiting-list reduction targets, capital investment, GP workforce expansion, or social-care reform to free up hospital capacity is a political choice about where a constrained budget goes — this data does not rank those options.
- What the evidence cannot establish
- This data cannot establish how long an individual patient in a specific specialty actually waits (only the total list size and the A&E 4-hour proportion), nor precisely how much of the current pressure is COVID-recovery versus pre-existing structural strain.
What people often get wrong
What people often think
“7.33 million people are waiting for NHS treatment.”
What the evidence shows
7.33 million is a PATHWAY count — some patients are waiting for more than one treatment, so they are counted more than once. NHS England's own estimate of individual patients waiting is around 6.23 million, a real but smaller number.
What can change this
Where there are meaningful levers, drivers or constraints on this picture.
Close the real-terms funding gap
Proposed policyNHS funding has needed roughly 3.7% real growth a year on average to keep pace with a bigger, older population and rising treatment costs; planned growth for 2025/26-2028/29 is around 3.0% a year.
- Evidence:
- Health Foundation NHS funding analysis, as cited above.
- Expected effect:
- Would narrow, though not immediately close, the gap between demand and capacity across waiting lists, A&E and GP access simultaneously, since all three draw on the same budget.
- Time horizon:
- Years — funding increases take time to translate into staff, beds and equipment.
- Trade-offs:
- Requires either higher taxation, higher borrowing, or reduced spending elsewhere.
- Unknowns:
- How much of the current pressure would ease versus how much reflects structural workforce and capacity constraints that funding alone does not immediately resolve.
Reduce the capital backlog
Proposed policyA £15.9bn maintenance backlog constrains diagnostic and treatment capacity directly — RAAC-affected buildings and outdated equipment reduce the NHS estate's effective capacity below its nominal size.
- Evidence:
- NHS England ERIC dataset, as cited above.
- Expected effect:
- Would increase effective treatment capacity over time without requiring workforce growth on its own.
- Time horizon:
- Years — capital projects have long lead times.
- Trade-offs:
- Capital and day-to-day (revenue) NHS budgets are separate and not fungible in the short term; a capital increase does not by itself fund more staff.
- Unknowns:
- The exact capacity gain from backlog reduction is not separately quantified in the sources this page draws on.
Address social-care pressure to free hospital capacity
External optionDelayed discharges caused by insufficient social-care capacity reduce the number of hospital beds available for new elective and emergency admissions — a widely-documented interaction this page does not chart directly.
- Evidence:
- Referenced in the "wider picture" section above; not separately charted with a UK Facts registry entry on this page.
- Expected effect:
- Would improve hospital flow and reduce A&E and elective pressure without requiring new NHS capital or staff.
- Time horizon:
- Depends on the specific reform; some measures (e.g. discharge funding) can act within a year, structural social-care reform is longer.
- Trade-offs:
- Social care is separately funded (largely local-authority led) from the NHS, creating a coordination problem across budgets and organisations.
- Unknowns:
- The precise quantified effect on NHS waiting figures of a given social-care reform is not established by the sources this page draws on.
Local comparison
How this plays out locally: Portsmouth GP staffing
Portsmouth has run 20–25% below England on fully-qualified GP staffing for the whole published period. The gap was widest in September 2023 — 32.7 GPs per 100,000 patients against 43.5 nationally — and has recovered only partially since.
Portsmouth: 36.38per 100,000 · England: 45.73per 100,000 · -9.35per 100,000 vs England
-9.35 vs England
⚠ NHS England publishes GP workforce by sub-ICB, not by local authority. Portsmouth's sub-ICB (10R) is coterminous with the city — all 125 of its LSOAs are in Portsmouth — so this is a genuine Portsmouth figure, but it counts registered patients rather than residents.
The waiting-list and A&E figures above are England-wide totals with no comparable Portsmouth-specific breakdown on this site — Portsmouth Hospitals University NHS Trust’s catchment (675,000+ across several local authorities) is not the same population as Portsmouth’s residents, so it is deliberately not shown here as if it were.
▸Detail data and technical notes
RTT waiting list: NHS England Referral to Treatment statistics, England only. England only; 7,328,252 pathways, representing about 6.23 million patients. Figures include estimates for non-reporting trusts (Sheffield Teaching Hospitals, Torbay and South Devon, and University Hospitals Plymouth did not submit July 2026 data) and, newly this month, an estimate for one non-reporting independent-sector provider, Cora Health MSK.
A&E: NHS England A&E Attendances and Emergency Admissions monthly time series. The 95% 4-hour standard applies to all A&E attendance types; Type 1 (major, consultant-led units) is shown separately above because it performs materially worse than the all-types average and is often the figure clinicians themselves refer to.
GP practice and registered-patient figures: RCGP analysis of NHS Digital data, corrected 2026-07-28 after an audit found the page previously labelled the same 7,254/6,229 figures with incorrect calendar years (see this site’s claims register, claim covering GP practice counts, for the full correction history) — the dates shown here (January 2018, July 2025) are the audited, correct ones.
Capital backlog: NHS England ERIC (Estates Returns Information Collection), independently reported (National Health Executive, citing NHS Providers/ERIC-derived figures) at approximately £15.9bn for 2024-25. No single dated primary NHS England publication was matched for the exact figure at time of writing — flagged in this site’s claims register as independently-reported rather than a direct primary-source citation.