The Government has claimed waiting lists at NHS trusts supported by ‘crack' (FF20) teams fell by three times the rate (4.2%) than non-FF20 trusts (1.4%) and five times faster for working-age adults (4.4% vs 0.8%) in the first year of the programme.
Analysis by The Health Foundation shows waiting lists at FF20 trusts (excluding Sheffield Teaching Hospitals) fell by 5.7% between end-October 2024 and end-October 2025, compared with a fall of 1.3% in non-FF20 trusts, supporting the Government's headline claim.
For every 100 cases on the waiting list by the end of October 2024, FF20 trusts added 257.1 cases over the following 12 months, completed 223.1 pathways and removed 39.7 people for other reasons, resulting in a 5.7% net reduction.
In contrast, for every 100 cases on their waiting lists, non-FF20 trusts added 276.6 patient pathways (19.5 more than FF20 trusts), completed 236.2 pathways (13.1 more than FF20 trusts) and removed 41.7 people (2 more) for other reasons, resulting in a 1.3% net reduction.
As found previously, The Health Foundation said the larger waiting list reduction observed in FF20 trusts was mainly driven by fewer referrals relative to the waiting list, rather than more completed pathways (which were higher in non-FF20 trusts over this period). Unreported removals also played a key role in the waiting list reductions; without these, the waiting list would have increased in both FF20 and non-FF20 trusts.
The first of the two main aims of the FF20 programme is to bring down the elective waiting list by improving productivity.
However, The Health Foundation said it did not appear this was being achieved as completed pathways in FF20 trusts increased by 0.3% compared with the 12 months before – less than the 3.7% reported in non-FF20 trusts.
The second key aim is to bring down waiting lists by reducing avoidable demand. The think-tank found evidence this was happening as referrals at FF20 trusts rose by 1.1% compared with a 2.9% increase elsewhere.
Unreported removals increased by 26.9% in FF20 trusts, while they decreased by 3.5% in non-FF20 trusts.
Unreported removals may include care pathways which are completed but only marked as such a few months later, patients not attending their first appointment, or errors in online data systems.
The analysis supports the claim waiting lists fell faster in FF20 trusts than in non-FF20 trusts between October 2024 and October 2025, however, The Health Foundation could find no evidence this was due to the FF20 programme.
The think-tank found the greater reduction at FF20 trusts was primarily achieved through lower rates of referrals (per case on the waiting list) rather than through higher rates of completed pathways.
There was also a significant increase in unreported removals in FF20 trusts, whereas unreported removals had fallen in other trusts.
The Health Foundation concluded the slower growth in referrals may reflect success in reducing demand for consultant-led care, while more unreported removals may signal more hospital appointments. On the other hand, slower growth in referrals may indicate reduced access to consultant-led care and the faster growth in unreported removals may be the result of data cleaning.
