Protecting NHS capacity means rethinking where care happens
The NHS waiting list challenge isn’t only about doing more. It’s about deciding what needs to be done in hospital, and what can be done elsewhere.
Last week’s Health Foundation analysis makes uncomfortable reading. On current trends, it projects that by 2029, 92% of patients could still be waiting as long as 35 weeks for elective treatment, almost twice the government’s 18-week ambition. Rising demand, particularly through GP referrals, is making an already difficult capacity challenge harder.
But one part of the NHS response caught my attention. It argues that the projection doesn’t fully account for changes being made to how healthcare is delivered, including the creation of more services outside hospitals and in people’s neighbourhoods. In just a few short weeks, we’ve heard the same idea from two different directions.
I recently wrote about something Andy Burnham had said about moving more care out of hospitals and closer to people’s homes. At the time, I highlighted that we tend to talk about care at home primarily through the lens of the person receiving it: greater convenience, less travel, less disruption to everyday life.
But there’s another side to that equation: What does care delivered at home give back to the hospital?
Today’s waiting-list analysis makes that question feel even more pressing. If demand continues to grow faster than expected, reducing waiting times can’t only be a conversation about how we enable hospitals to do more. It also needs to be a conversation about what genuinely needs to happen in a hospital in the first place.
Every day across the NHS, some patients travel into hospitals for care that, with the right clinical governance, workforce, technology and support, can safely be delivered at home or closer to home.
- An MS patient receiving an infusion at home isn’t occupying a hospital chair
- A patient taught to self-administer their medicine doesn’t need to return to a clinic simply to receive treatment
- Virtual wards can support earlier discharge or avoid an admission altogether, enabling patients who still need clinical care, such as IV antibiotics, to receive it at home while remaining under the care of their hospital team
- Remote monitoring can help clinicians understand how patients are doing without automatically requiring another hospital visit
For each of those patients, that’s potentially a better experience. But collectively, they do something else too: they protect capacity.
None of this means clinical homecare is the only answer to the elective waiting-list challenge. But when demand is growing faster than expected, we have to look at both sides of the capacity equation: how we increase what hospitals can do, and how we reduce the amount of care we ask them to do unnecessarily.
From political conversations about shifting care into communities to the NHS response to today’s waiting-list projections, we’re seeing care closer to home move from an ambition in the 10-Year Health Plan to an operational necessity, part of how we protect the capacity of the NHS itself.
Read the Health Foundation’s findings here
Read the NHS England August 2026 RTT release here
