NHS Waiting Time Rights

Under the NHS Constitution and NHS England's Referral to Treatment (RTT) rules, patients in England have a legal right to start consultant-led treatment within 18 weeks of their GP (or other clinician) making a referral — unless:

• You choose to wait longer (for example, for a particular surgeon or hospital)
• It is clinically appropriate to wait longer
• You do not attend appointments without telling the provider in advance

The clock starts on the day your referral is received by the provider and stops when treatment starts — or when you first attend a new outpatient appointment if no further treatment is needed. Diagnostic tests and outpatient appointments are included within the 18-week pathway.

If the NHS cannot see you within 18 weeks at your chosen provider, it must offer you a choice of alternative providers that can treat you within the target time. This is sometimes called the "Choice Guarantee."

To exercise this right:

1. Contact the hospital's patient access or booking team to ask when your appointment or treatment is expected.
2. If it will be beyond 18 weeks, ask to be referred to an alternative provider. The NHS e-Referral Service (eRS) can show you which providers have shorter waits.
3. Your GP can also use eRS to make a new referral to a different provider if you request this.
4. Independent sector providers contracted by the NHS can count toward this right — treatment may be available faster at a private hospital operating under an NHS contract.

Cancer patients have additional, more urgent targets:

• Two-week urgent referral: If your GP makes an urgent referral for suspected cancer, you should be seen by a specialist within two weeks.
• 31-day target (decision to treat): Once a decision to treat has been made, first definitive treatment should begin within 31 days.
• 62-day target (referral to treatment): From an urgent GP referral for suspected cancer to first definitive treatment should be no more than 62 days.

These targets are not currently meeting the NHS's own standards in many areas. If you are concerned about cancer waiting times, contact your GP or the hospital's cancer nurse specialist urgently, and contact PALS or NHS England if you feel your care is being delayed.

If you are waiting beyond NHS targets or are concerned about your position on the waiting list:

1. Contact the hospital's patient access team directly to ask about your expected wait and whether you can be seen sooner, including as a cancellation.
2. Ask your GP to chase the referral — they can contact the consultant's secretary or escalate via the referral system.
3. Contact PALS at the hospital for informal support and to flag your concern to management.
4. Make a formal complaint to the trust if your rights are not being upheld — this creates a formal record and the trust must respond within 25 working days.
5. Contact NHS England on 0300 311 22 33 if the trust does not resolve your concern.

Understanding the legal underpinning of waiting time rights can strengthen your position when escalating.

Regulation 45 of the NHS Standing Rules Regulations 2012

The 18-week right is given practical force by Regulation 45 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. This regulation imposes a duty on your Integrated Care Board (ICB): where it considers that treatment is unlikely to start within the maximum waiting time, it must offer the patient at least one alternative provider. This is an enforceable legal obligation — not a target or aspiration.

If your ICB fails to offer you an alternative when your wait is forecast to exceed 18 weeks, you can challenge this failure directly. Contact the ICB's PALS service in writing, citing Regulation 45, and request that they identify an alternative NHS provider — including an Independent Sector Treatment Centre (ISTC) — that can treat you within the 18-week standard. Keep a record of all correspondence.

Integrated Care System Responsibility

NHS Integrated Care Systems (ICSs) comprise the ICB and NHS providers working in partnership. ICSs publish elective care recovery plans and have waiting time improvement targets. If your ICB is consistently failing to meet the standard, this is a system-level issue that can be raised with NHS England. NHS England publishes monthly RTT performance data by provider on its website — you can look up your local trust's position to understand whether your wait is an outlier.

The PHSO as a Final Remedy

If you have gone through the local complaint process (formal complaint to the provider or ICB) and the PHSO is the next stage, you can refer your case once you have received the organisation's final response letter or have waited six months without one. The PHSO can investigate whether the ICB failed to comply with Regulation 45 and whether this caused you injustice or hardship. Remedies available through the PHSO include formal apologies, financial recompense for the impact of the delay, and recommendations for service improvement. If a waiting time failure caused clinical deterioration, you may also have grounds for a clinical negligence claim — seek specialist legal advice.