A61Delivery risk: RedGate: pending
Cut treatment waits and improve patients’ health
Existing action A61, assessed at the same scope.
Provisional single-reviewer assessment; not an approved business case.
- Who and where
- Patients waiting for planned hospital treatment in England, starting with trauma and orthopaedics (840,967 pathways, 60.9% within 18 weeks in July 2026) and specialties with the lowest 18-week shares. (from the action record) Jurisdiction: England.
- Result so far
- Range if completed: 13.0–22.0 out of 30 (equal weights; not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co))
- Funded now (baseline)
- Baseline: the Elective Reform Plan (65% within 18 weeks by March 2026, met narrowly at 65.3%; 92% by March 2029), the planning framework’s 70% by March 2027, surgical hubs and £2.0bn of elective capital in 2026–27. Choosing specialties by binding constraint and adding capacity beyond funded plans is a UK Facts proposal, not government policy. (from the action record)
- The change assessed (marginal)
- Marginal change not yet defined
- Domain home: NHS
- In the national plan: Wellbeing list
What the evidence supports—and the next decision
The waiting list is a stock of pathways; reducing it is not a specified treatment intervention and can conceal changes in access.
AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.
- Define the change
- Choose a specialty and bottleneck, with eligible patients and a funded workforce plan. Compare diagnostics, treatment capacity and pathway redesign.
- Test whether it works
- Wait distribution, completed treatment, clinical outcomes and unmet referrals; retain emergency and community-service balancing measures.
- Establish the cost
- Staff, diagnostics, theatre time, capital, maintenance and follow-up, including the opportunity cost of moving staff from another service.
- Protect against harm
- Do not improve the metric by rejecting or administratively removing patients without appropriate care.
Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.
Full assessment of Cut treatment waits and improve patients’ health: ten criteria, scenarios, delivery, costs and monitoring
The ten criteria (0–3)
Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.
Scale and severity (Sc)3 of 3 — Severe harm across a broad population
Reviewer’s reason: Provisional problem-importance judgement from linked site pages; not the scale of achievable benefit.
Increment beyond baseline (Ad)Not yet assessed
Reviewer’s reason: Map diagnostic, theatre, staffing and discharge constraints; select a specialty/locality; demonstrate addition beyond funded plans. A missing rating requires a defined marginal change.
Confidence in the proposed action (Ev)2 of 3 — Relevant evaluated evidence with limitations
Reviewer’s reason: Hub evidence concerns activity; the artifact notes no total activity gain. The proposed increment and effect on waits are unresolved.
Expected incremental benefit (Bn)Not yet assessed
Reviewer’s reason: Unknown unless a reasonably defined target-population benefit can be judged; no bonus merely for spanning domains.
Residual harms (Hm)1 of 3 — Material harm/unresolved mitigation
Reviewer’s reason: Binding workforce capacity; displacement of urgent or other elective care.
Incremental affordability (Co)Not yet assessed
Reviewer’s reason: Capital, staff, diagnostics, maintenance, displaced activity and recurring running costs.
Delivery capacity (Ca)1 of 3 — Binding scarce resource
Reviewer’s reason: Map diagnostic, theatre, staffing and discharge constraints; select a specialty/locality; demonstrate addition beyond funded plans.
Distribution (Fa)2 of 3 — Mixed or broadly neutral with safeguards
Reviewer’s reason: Provisional distribution judgement for the stated target; verify who pays, who gains and excluded groups.
Meaningful first outcome (Ti)2 of 3 — More than one and up to three years
Reviewer’s reason: First meaningful outcome, not announcement: Patient waits and health outcomes, not hub throughput alone.
Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step
Reviewer’s reason: NHS commissioners/providers; nation-specific systems; Identify marginal bottleneck and appraise
Four weightings
Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.
- Equal weights: Range if completed: 13.0–22.0 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
- Evidence doubled: Range if completed: 13.6–21.8 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
- Scale doubled: Range if completed: 14.5–22.7 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
- Cost ignored (the funding gate still applies): Range if completed: 14.4–21.1 out of 30. Not yet assessed: increment beyond baseline (Ad), expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.
Delivery risk and gate
Delivery risk shown: RedReview’s claim: Red. Best the recorded evidence allows: Red.
Review’s reason: Binding workforce capacity; displacement of urgent or other elective care.
Why it is not Green yet
- Delivery obstacle: Binding workforce capacity; displacement of urgent or other elective care..
- Scope (population, place and increment) not verified against the delivery baseline.
- No verified owner with the powers in place.
- Delivery capacity not verified.
- Lifetime incremental costs not complete.
- No credible funding (a committed allocation for the scope).
- Safeguards not specified.
- Monitoring lacks a metric, a data source or a baseline.
Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.
Gate: Pending — appraisal incomplete (review label: “Pending: incomplete appraisal”).
Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).
The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.
Cost and funding
Lifetime costing: Not established. Review: “Full incremental costing not established in reviewed material”.
Still to cost: Capital, staff, diagnostics, maintenance, displaced activity and recurring running costs.
Funding status: not identified.
Owner, powers and capacity
Proposed owner: NHS commissioners/providers; nation-specific systems (proposed, unverified).
Powers: needs a decision or allocation. Capacity: binding constraint.
Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).
- England:
- NHS England, integrated care boards and NHS trusts (action record)
- Scotland:
- not assessed
- Wales:
- not assessed
- Northern Ireland:
- not assessed
Scotland, Wales and Northern Ireland run separate systems with different waiting standards; not assessed.
Dependencies, safeguards and risks
Depends on: None recorded.
Safeguards
None specified yet.
Risks and residual harms: Binding workforce capacity; displacement of urgent or other elective care.
Monitoring and measured results
Metric: Patient waits and health outcomes, not hub throughput alone.
Data source: Not yet named. Baseline: Not yet established.
Measures already on the domain page
- Waiting pathways within 18 weeks: latest 65.2% (August 2026); baseline 92.3% (September 2015 (last month the standard was met)) (England).
- Patients waiting six weeks or more for a diagnostic test: latest 24.7% (August 2026); baseline not published (England).
A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.
Evidence for the outcome
Outcome: Patient waits and health outcomes, not hub throughput alone.
Hub evidence concerns activity; the artifact notes no total activity gain. The proposed increment and effect on waits are unresolved.
SWOT points it addresses
- 65.2% of waiting pathways were within 18 weeks, against the 92% standard, last met in September 2015 on the figures including estimates for missing trusts (February 2016 on reported figures). (NHS)
- 24.7% of patients were waiting six weeks or more for a diagnostic test in August 2026, against a 2026/27 target of at most 14%. In the separately dated July 2026 specialty breakdown, trauma and orthopaedics had the largest treatment list (840,967 pathways), with 60.9% within 18 weeks. (NHS)
Review record
Assessment status: Provisional single-reviewer assessment; not an approved business case.
Reviewer: Original assessment author (name not supplied). Reviewed: 6 October 2026.
Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.
First 90 days (review): Produce a signed scope and current-delivery baseline; Map diagnostic, theatre, staffing and discharge constraints; select a specialty/locality; demonstrate addition beyond funded plans. Obtain incremental costs and an accountable decision before expansion.
Decision route: Identify marginal bottleneck and appraise
An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.