Overview
At the time of this report, NHS England’s Referral to Treatment (RTT) statistics are published as accredited official statistics.
These statistics measure waiting times for patients across the NHS in England, from consultant‑led referral through to elective treatment. The RTT statistics are published monthly, and are critical for measuring access to care, monitoring performance against the 18‑week target, and informing operational planning, national policy and service improvement.
This review examines whether NHS England’s RTT statistics continue to meet the standards of Trustworthiness, Quality and Value set out in the Code of Practice for Statistics (the Code) following several important developments. It identifies key strengths and opportunities to improve how the statistics are produced, explained and presented.
Why we did this review
The RTT statistics were last formally assessed against the Code in 2009. Since then, there have been substantial changes across the health landscape, the statistical system and increased expectations about the volume, quality and accessibility of data for users and decision-makers.
There have also been recent developments in the visualisation of the RTT statistics, including the introduction of interactive dashboards and spreadsheets that can be filtered by individual hospital trust. These tools have changed how users access, explore and interpret the statistics, with potential implications for understanding performance and trends.
Given these changes and the prominence of RTT statistics in public debate and policy scrutiny, particularly as the key metric for assessing progress against the UK Government’s health mission and the pledge to cut NHS waiting times, it is timely to reassess whether they continue to meet the standards of the Code. This review also considers how NHS England has communicated recent changes to users and how this affects their understanding and use of the statistics.
Our findings are based on desk research, engagement with NHS England and conversations with a small number of expert users.
Findings
NHS England continues to publish the RTT statistics reliably, punctually and in a range of accessible formats, supporting trust in the data and effective use of the statistics by a wide range of users.
The significant work behind the new dashboards demonstrates clear commitment to improving accessibility and insight. However, user feedback indicates that further development is needed before they can be relied upon as a primary source of information for understanding trends or supporting decision‑making.
NHS England’s engagement with users is constructive, but it remains largely reactive and focused on technical audiences, with limited routes for users to offer feedback. This means that the perspectives of wider user groups are not consistently reflected in the development of the statistics and supporting documentation.
Greater clarity is needed on unreported removals, where patients have completed their pathways but do not appear in the published figures. Although NHS England understands this issue internally and undertakes detailed quality assurance of the data it receives, the limited public information does not give users confidence in the scale of unreported removals or how to interpret them, and it is still unclear what action is being taken to reduce them.
Although NHS England provides extensive supporting documentation, users still struggle to find the right guidance and apply definitions consistently. Consolidating this material into a single, clear resource and linking it from key products would greatly improve transparency and support consistent interpretation.
Users need clearer explanation of the UK comparability of the RTT statistics and NHS structural changes to help them understand the limits of comparison and aid in their interpretation of the statistics.
Our judgement
We conclude that the RTT statistics continue to meet the standards set out in the Code of Practice for Statistics. The statistics show strong operational delivery and timeliness, and the new dashboards are a positive step in improving accessibility for users. NHS England has also begun preparing for the updated Code of Practice for Statistics by producing a compliance statement and is committed to taking this forward as part of its alignment with Code 3.0.
However, we have five recommendations that NHS England should address to enhance the trustworthiness, quality and value of these statistics and maintain their accreditation. To ensure the wider analytical community can continue to use the data effectively, it remains important that full downloadable datasets are maintained alongside the dashboards. As NHS England introduces new products and makes changes, users would also benefit from clearer communication about developments, more proactive engagement and greater transparency, particularly around unreported removals.
Based on the findings of this review, we recommend the following:
- NHS England should continue enhancing the RTT dashboards and clearly set out planned improvements through pre‑announcements and a published workplan. This would help users understand how the dashboards are evolving and how they can make best use of the new features.
- NHS England should take a more proactive approach to user engagement by widening participation and embedding clear and visible feedback routes within dashboards and datasets. This would help ensure the RTT statistics meet the needs of all users and support greater transparency and trust.
- NHS England should publish more information to support users understanding of unreported removals. It should also prioritise further analysis into the reasons for pathway closures, and set out actions to reduce unreported removals, with these activities included in a published workplan. This will help users understand the issue and interpret the waiting‑list statistics with greater confidence.
- NHS England should bring guidance, definitions and methods together in a single accessible resource, clearly linked across products, to improve clarity and reproducibility.
- NHS England should make comparability information more visible by publishing a comparability note informed by its collaboration with ONS, linking to relevant material from other UK nations, and maintaining a public log of organisational and series changes to support appropriate interpretation of the RTT statistics.
Next steps
We expect NHS England to publish more information to support users understanding of unreported removals and set out further steps to reduce the scale of unreported removals by April 2026. We also expect a public update on progress against the remaining recommendations by August 2026.
We will remain available to discuss plans with the team and will continue to offer support and guidance as needed.