Tackling the NHS backlog was – and still is – one of the Government’s key six missions Prime Minister Sir Keir Starmer says he has a plan to end it,

But what’s remarkable about this new year’s waiting list announcement is how few levers ministers will have to pull.

Much of this plan is about building on work already underway in England – and there are reasons why these policies have had only a limited impact so far.

More surgical and diagnostic hubs are being promised in the community – building on a network that had already begun to roll out before the pandemic.

They allow more care to be provided outside hospitals and the government would like to see not only more of them, but also longer opening hours. But, of course, the main limiting factor is the availability of staff to deliver treatment – ​​the British Medical Association is pointing to this.

Sir Keir also wants to make it easier for patients to choose where to go for treatment – ​​the idea is to allow them to shop around and go where the waiting list is shortest.

This policy is even older as it was introduced by the Blair government and later supported by the Tories when they were in power. Despite this, only a quarter of patients report that they have been offered a choice. And even if that were to change, the question would remain about how many patients would be willing to travel to get treatment elsewhere.

Another initiative, which has been in the works for more than two decades, is to involve the independent sector to reduce the burden on the NHS. The private sector says it has the capacity to see 30% more NHS patients than currently.

But this policy comes with costs – the private sector adopts only the most straightforward procedures, which could deprive NHS hospitals of vital income as well as vital training opportunities for doctors and nurses.

This does not mean that the backlog will not reduce. It would be surprising if it didn’t begin to decline in the coming months – most forecasts point to this spring as the likely turning point.

But the ultimate goal of getting the NHS back up to the 18-week target by the end of this Parliament still remains a big question.

This would mean that 92% of patients would be seen within 18 weeks – something that has not been achieved since 2015. Currently less than 60%.

The Blair government made major progress in the early 2000s, but this was driven by significant increases in the NHS budget – between 6–7% per year on top of inflation.

An increase on that scale seems highly unlikely given the state of the public finances – although we will have to wait until the spring for the spending review to find out how much budget will be set aside for the NHS in the coming years.

Another concern, being expressed by some, is that by placing so much emphasis on waiting lists there is a risk that other areas may be neglected as health chiefs focus too much of their attention on this.

“The 18-week target should not be used as the sole measure of how the NHS is performing,” says Sarah Woolnough, head of the King’s Fund think tank. “It is equally important for people to understand how long they are waiting for a GP appointment or an ambulance for mental health care and other services.”

In short, any progress made on the waiting list can easily be lost if the wheels turn elsewhere.