What is the 18 week rule for NHS?
The NHS’s 18-week rule is a commitment to provide patients with non-urgent, planned hospital treatments – including operations, procedures or medication – within 18 weeks of referral by their GP. The NHS/government target is that 92% of referrals should hit this target. See end of article for latest data.
In other words, 92% of patients should have definitive treatment (or a decision not to treat) within 18 weeks of referral from GP to hospital (e.g. GP to hospital consultant for an operation like a hip replacement).
When the rule applies
The 18-week rule applies to all patients, in all specialties, in every NHS organisation.
When the rule doesn’t apply
The 18-week rule doesn’t apply if:
- The patient chooses to wait longer
- It’s in the patient’s best clinical interest to wait longer
- The patient fails to attend appointments
- The treatment is no longer necessary.
How the NHS meets the rule
The NHS aims to meet the 18-week rule by:
- Balancing the number of people joining and leaving the waitlist
- Reviewing waits longer than 18 weeks to identify unnecessary waits.
What happens if the NHS doesn’t meet the rule?
- Nothing much. That’s the problem
- Neither previous (Conservative) or current (Labour) governments seem to have a plan to sort it out
- It is not just a government problem. The doctors (e.g. through their union, the BMA, colleges etc), seem to want to help. The doctors refuse to change traditional work practices. So operating theatres lie empty on weekends, and Friday afternoons
- If the NHS doesn’t meet the rule, it should take reasonable steps to offer patients alternative hospitals (including private ones).
When the rule was last met (latest data)
- The NHS last met the 18-week rule in September 2015
- Currently 58% of patients hit the NHS target
- In October 2024, the waiting list was still very high at 7.5 million – i,e. about 10% of the population
- Almost 234,900 of these patients have been waiting over a year for treatment
- The current median waiting time for treatment is 14.2 weeks (just over 3 months) – nearly double the pre-COVID median wait of 7.6 weeks in August 2019.
Other resources
This data includes 18 weeks, 4 hour (A&E) and cancer targets.
Latest NHS 18 week data (BMA)
NHS key statistics (House of Commons library)
Key NHS targets
