Report · August 2026

England did not move as one system this year

Across the acute sector, elective waiting times improved almost everywhere, urgent care held flat as a national average while most individual trusts slipped, and diagnostics split the country in two. Here is who moved furthest in each direction, and, where their own board papers say so, what they did about it.

Analysis of nationally published NHS England returns to July 2026, covering referral to treatment, A&E, diagnostics and cancer waiting times. Changes are measured between three month averages a year apart, for acute providers only, after screening for reporting gaps, changes of service scope and cohorts too small to rank. The reasons quoted are the trusts' own words, taken verbatim from their public board papers and linked to the source document.

01The national picture

Averages hide the story. On every measure below, the gap between the trusts moving fastest and those going backwards is far wider than the national shift, which is why a single headline figure tells a chief executive almost nothing about their own position.

Read the spread, not the median. The two measures where the country genuinely diverged are A&E and diagnostics, and in both cases a national headline of roughly no change is the arithmetic result of large improvements at some trusts cancelling out large deteriorations at others. A board comparing itself to the national figure on either measure learns nothing about whether it is winning or losing.

02Who improved, and what they say they did

The interesting question is never who is top of a table. It is what the movers actually changed, and whether that is repeatable somewhere else. For three of the largest improvements this year, the trust's own board papers answer that in their own words.

The pattern across the improvers

Read together, three accounts written independently of each other converge on the same four moves: find the two or three modalities or specialties actually holding the backlog, buy short term external capacity while recruiting substantively behind it, validate the waiting list so the numbers describe real patients, and hold it in the board's line of sight month after month. None of that is a technology purchase, and none of it is quick.

03Where it went backwards

This half of the analysis needs more care than the first, for a straightforward reason. Boards document improvement in detail and rarely document decline, so for the trusts below we have the movement but not, in their own words, the cause. We publish the numbers and decline to speculate about the reasons.

A&E figures exclude one provider whose apparent 28.9 point fall is an artefact of where the baseline sits, and whose cancer return has the partial month problem described in section 05.

04The full movers, by measure

05What we did not publish, and why

A league table is easy. A defensible league table means throwing away most of what the raw data offers. These are the screens applied before any trust was named above, with the specific cases each one caught.

06Why this is hard to do by hand

Every number in this report comes from data any organisation can download. The work is not in obtaining it. It is in knowing that a 40% swing in a denominator means a service was reconfigured, that a zero can mean silence rather than excellence, that a specialist centre's percentages are not comparable with a district general hospital's, and that the reason behind a number usually sits in a PDF on a trust's website rather than in the statistical return.

That is what NHS Performance Intelligence does continuously: it holds the national returns for every trust with the screens above applied, benchmarks each organisation against genuinely comparable peers rather than a national average, and links improvements to what the improving trusts said they did, quoted and sourced.