NHS authorities have paid providers £33 per patient to remove thousands of names from waiting lists, a strategy that critics say conflates administrative housekeeping with genuine clinical progress. The scheme, part of what is known inside the health service as a “validation sprint”, has seen hospitals receive incentive payments for each patient they remove after a review — even when those individuals remain in significant need of treatment.
The payments form a central plank of the government’s efforts to show it is reducing backlogs and meeting waiting‑time targets. But patient advocates and politicians have warned that lifting the cap on these bonuses creates a “perverse incentive” for trusts to prioritise list‑clearing over patient care. The initial budget for the programme was £30 million, but it reportedly overspent by £2.5 million.
Data obtained from NHS sources shows three trusts each received more than £1 million in the past year from these validation exercises. The Princess Alexandra Hospital Trust in Essex was paid nearly £1.2 million. Across 130 trusts, the average payment stood at £250,000, with 17 trusts receiving at least £500,000. Since the validation sprint began in April 2025, the level of so‑called “unreported removals” has risen by 13 %.
Under the scheme, hospitals are paid for each “clock stop” over a locally determined baseline, contributing towards the target of treating 65 % of elective patients within 18 weeks by March 2026. The result is a waiting list that appears to be falling: it stood at 7.39 million in April 2025 and dropped to 7.25 million by January 2026, a reduction of more than 370,000 since June 2024. Yet the list remains “stubbornly high” at 7.43 million as of February 2026. Only 59.7 % of patients began treatment within the 18‑week target in April 2025, against a government ambition of 92 %, and 190,068 patient pathways had been waiting more than a year.
The government has also leaned heavily on the independent sector to absorb demand. In the past year, private providers delivered 6.15 million appointments, tests and operations for NHS patients — an increase of nearly 500,000 on the previous year, accounting for about 10 % of all elective activity. By April, private hospitals were performing the equivalent of 2,859 NHS procedures per working day, a rise of more than 60 % compared with April 2019. Almost one in five NHS operations in England now takes place in a private hospital or clinic. However, independent‑sector activity has declined by 12 % since its peak in July 2025, coinciding with financial pressure on NHS budgets. A survey of almost 2,600 people in England found that 16 % had used the private sector in the previous year.
Immigration and the NHS workforce
While the government celebrates a record fall in net migration, the NHS and care sectors are grappling with acute staff shortages that can only be filled by overseas workers. In the year ending March 2023, nearly 100,000 overseas health and care workers came to the UK, making up the majority of Skilled Worker visa entrants. Without them, the service would face even greater gaps — yet changes to immigration rules are now threatening this pipeline.
Recent policy changes include higher visa fees and a longer qualifying period for indefinite leave to remain (ILR). Research suggests that up to 50,000 migrant nursing staff could leave the UK if the extended ILR waiting period is implemented. Without ILR, migrant workers face restrictions on changing jobs and may be unable to access state support. The Royal College of Nursing has warned that anti‑immigrant government policies risk driving out thousands of nurses and doctors the NHS relies on.
The loss of overseas students — another consequence of the immigration crackdown — is also hitting university finances. In the 2023/24 academic year, nearly a fifth of UK universities’ total income came from non‑EU students, who generate an estimated £41.9 billion for the economy each year. Government policies aimed at curbing immigration have reduced international student numbers, and a planned levy on their fees could worsen the financial position of many institutions.
Privatisation concerns persist
The growing role of the private sector inside the NHS is not limited to waiting‑list initiatives. Outsourcing of NHS services to for‑profit companies has increased steadily: between 2013 and 2020, it rose to more than 6 % of total expenditure for regional health boards, and in 2021 the NHS spent £13.8 billion on private healthcare services. Studies suggest this trend is linked to higher rates of treatable mortality, with an estimated 557 additional avoidable deaths in England between 2013 and 2020 potentially connected to greater privatisation.
Private Finance Initiative (PFI) schemes, introduced to fund hospital construction, continue to burden trusts with high costs. Between 2004 and 2021, 99 NHS PFI companies made £1.9 billion in pre‑tax profits and paid out £1.07 billion in dividends. NHS trusts are obliged to meet PFI payments regardless of their financial position, and there are concerns that any revival of such schemes could repeat past failures.
Andy Burnham, the Mayor of Greater Manchester, has called for the nationalisation of water companies but has not questioned the ongoing outsourcing, privatisation and PFI plans within the NHS. He has historically placed restrictions on private‑sector involvement in the health service and has advocated for devolved health and social care, yet his approach may be evolving. Wes Streeting, until his resignation as Health Secretary in May 2026, championed the use of private providers to cut waiting lists and outlined a 10‑year plan to shift care from hospitals to communities. Critics argue his record lacked detailed implementation and focused on headlines rather than substantive change.
The question of how long the NHS can survive under a Burnham‑Streeting government remains unanswered by either politician.