What does the pledge mean?

Labour’s manifesto pledged to raise the level of NHS activity so that in England there are “an extra two million NHS operations, scans, and appointments every year”. It said this would help to “cut NHS waiting times”. It also expressed this as a pledge for 40,000 more appointments a week, as 40,000 multiplied by the 52 weeks in a year makes about two million.

On 16 February 2025, the government announced that the pledge had been delivered, based on data published the same day by NHS England. Until then, it had not been clear exactly what it meant or how progress on it would be measured because the government hadn’t fully explained what the extra appointments were or how they would be counted.

The way in which the pledge has been described has also changed over time.

When publishing the data with which to measure progress, NHS England described it as a manifesto commitment to deliver “an extra two million NHS operations, scans and appointments”. But the full quote from the Labour manifesto is “an extra two million NHS operations, scans, and appointments every year” [our emphasis]. This is potentially significant for reasons we’ll explain in the section below.

The Labour manifesto also described the pledge as a commitment to deliver 40,000 more appointments each week “during evenings and weekends”. It went on to say it would achieve the pledge “by incentivising staff to carry out additional appointments out of hours”. This appeared to suggest that the intention was to deliver two million extra appointments outside normal working hours, although this was not mentioned in the government’s ‘Plan for Change’ in December.

In declaring the pledge to be met, the government said it was “delivered in part by extra evening and weekend working” [our emphasis]. It therefore sounds as though the extra appointments the government says it has delivered were not only at evenings and at weekends, as appeared to have been originally promised, although we cannot find any data showing when they happened.

Before declaring the pledge delivered in February 2025, the government repeatedly failed to explain how it was actually defined, with neither the Department for Health and Social Care (DHSC) nor NHS England providing answers to our specific questions at the end of last year.

This pledge only refers to the NHS in England, since this is the part of the health service that the UK government directly controls, with the rest devolved to the governments of Wales, Scotland and Northern Ireland.

What progress has been made?

For now, we’re rating this pledge “Appears on track”, because the latest data suggests it is on course to be met, but we can’t yet confirm it has already been achieved, as the government claims.

This is because the data does not show a rise in an annual figure. It shows a rise when comparing the first five months of the current government (July-November 2024) with the same five months in the year before (July-November 2023) under the previous government, known as “the baseline”. A note on the data from NHS England says: “The full baseline period is the 12 months from July 2023 to June 2024. This aligns with the 12 months prior to the Government coming into office. To avoid statistical bias due to seasonality it is important to compare months of the year on a like for like basis. Therefore, until we have data for the 12 months following coming into office, the baseline is restricted to the same months as the period covered by the latest data (July to November). The baseline period will expand as further data become available.”

In other words, the first year of the new government isn’t complete yet, so we can’t know how it compares with the year before.

In the past, as we have said, the government described the promise of two million extra appointments as a rise that would happen “a year”, “every year” or “in its first year”. But when the government announced that the pledge had been delivered, the annual element was missing, as it also was from NHS England’s page on which the supporting data was published. 

In its analysis, NHS England counts the total number for specific types of elective operations, outpatient appointments and diagnostic tests and finds that there were 31,321,884 in the first five months of the new government, compared with 29,122,305 in the same period the year before. This is a rise of about 2.2 million, and on a weekly basis it amounts to about 100,000 more appointments per week during this time.

These numbers therefore appear well on track to meeting the government’s target, but we don’t yet definitively know that the first year of the new government will deliver at least two million more appointments, because it is possible that the data for December 2024 to June 2025 may show fewer appointments happening than the year before. On current trends that may not be likely, but we just can’t know until that data arrives. NHS England says that more data will be published in due course.

Some reporting of the government’s announcement mentioned that the comparator period in 2023 was affected by strikes in the NHS, which would have reduced the level of hospital activity at the time, making subsequent years look higher by comparison.

While it is true that NHS England was affected by strikes in July-November 2023, this doesn’t necessarily make it an unfair comparison, since strikes over pay by government employees are at least to some extent within each government’s control.

There is also the question of whether the pledge, as now defined, was a meaningful promise to begin with.

As we said before the election, hospital activity in general has been rising for a while. The NHS has not regularly published data on the specific measure of hospital activity that the government is using for this pledge, so we don’t know whether the higher numbers in July-November 2024 represent a bigger rise than average.

If we had this data, or a close approximation, it might show that the government’s pledge has only delivered a rise in hospital appointments that is similar to rises seen in previous years.