Just two weeks after he was diagnosed with cancer, John Harvey was in a hospital ward on Thursday for a three-hour operation which he hopes will cure him. Harvey, 79, from east London, expected an anxious wait for treatment after being diagnosed with colon cancer but has benefited from a drive to cut waiting times at the London trust where he is being treated. “I thought the wait would be weeks and weeks,” he said. “I was surprised.” Harvey, who was in hospital for an operation to remove part of his colon, and millions of others like him are on the frontline of a key election battleground: the NHS waiting list. Rishi Sunak said in January last year that he would fix the NHS, pledging that “waiting lists will fall and people will get the care they need more quickly”. The waiting list is 330,000 longer than when he made his pledge. Sunak and Labour leader Keir Starmer clashed over the NHS waiting list in the ITV general election debate on Tuesday when the prime minister claimed waiting lists were coming down. Starmer responded: “[They were] 7.2 million when you said you would get them down. They are now 7.5 million, I would like you to explain how they’re coming down.” Shadow health secretary Wes Streeting says a new Labour government will create an additional 40,000 appointments, scans and operations a week in England to cut the waiting list, equivalent to more than 2m extra appointments a year. Yet one key question remains for the millions languishing on the list: will it work? Medical teams at King George hospital, part of the Barking, Havering and Redbridge University hospitals NHS trust, where John Harvey was being treated last week, are already implementing some of the innovative measures which could finally cut the waiting lists. The hospital is in a neighbouring constituency to Streeting’s, and he has highlighted their work as “genuinely groundbreaking and nationally leading”. The goal is to avoid cancellations and ensure that medical resources, from operating theatres to diagnostics equipment, are used effectively. Or, as one director of surgery put it last week, “to sweat the assets”. There is also more weekend working and partnerships with independent providers to ensure faster diagnosis and treatment. Planned operations, known as elective surgery, are routinely cancelled in hospitals across the country because high-dependency beds are unavailable or surgical teams and operating theatres are needed for emergency admissions. The delays cascade down the lists. Thangadorai Amalesh, divisional director of surgery at the Barking, Havering and Redbridge University hospitals NHS trust, said that during the pandemic the medical teams looked at the best ways to avoid cancellations. “We decided to establish what we described as a hospital within a hospital, where we protected King George hospital in our trust as an elective hub,” he said. The new dedicated hub was set up with ringfenced beds, facilities and staff. It meant patients could be admitted without worrying that their operations may be cancelled and surgeons could start operations earlier in the morning, knowing that a high-dependency bed would be available for the patient afterwards. The clinical teams looked at various aspects of their operations, with several projects to increase productivity. It included “bones” weeks to tackle backlogs in orthopaedic patients, with theatres operating 12 hours a day over weekdays and the weekend. “The answer is never bureaucracy but rather to focus on how you remove bottlenecks in the system,” said Amalesh. “We learned a lot of lessons from the pandemic on how to be more flexible.” The standalone elective hub set up at King George hospital during the pandemic was one of the first to be established. There are now about 100 across England, focusing mainly on high-volume, low-complexity surgery. The King George hub was expanded with the opening of a £14m extension including two operating theatres last month. It will allow 100 additional operations a week. The trust cut the number of patients waiting more than a year from 2,430 in March 2021 to 1,783 last March, and officials say they could have got this down to zero had there been no industrial action. Despite this success, the most recent figures show overall waiting lists at the trust are still rising over the year, highlighting the fact that inpatient operations are only a small proportion of the overall waiting list. Matthew Trainer, the trust’s chief executive, said: “This is not going to be a quick fix. It’s a programme of recovery. Nine out of 10 people on the waiting list are not waiting for an inpatient surgical procedure. They are waiting for appointments and diagnostics.” Independent providers are helping to assess patients after GP referrals, and there is a drive by the trust to increase the number of clinics and tests. Trainer said that further initiatives could be introduced nationally to check whether people on the waiting list needed to be on it or whether they could be better treated in the community. He also said there should be greater investment in public health to ensure healthier lifestyles to reduce the burden on the NHS. Kathryn Marszalek, senior analytical manager at the Health Foundation, said that Labour’s pledge of an additional 2m appointments a year should not be seen on its own as a “silver bullet”. “The health system is in desperate need of capital investment, and the industrial action with junior doctors needs to be solved. We can’t rely exclusively on trying to increase activity with one feature, such as weekend working.” Labour plans to cut waiting list times with weekend clinics, using spare capacity in the private sector and doubling the number of scanners to deliver faster diagnoses. It says its plan will cost £1.3bn, paid for by a crackdown on tax avoidance, but it is a small proportion of the annual NHS budget for England of about £165bn. So far the party has given no indication of the amount of money it is prepared to spend on fixing crumbling hospitals or increasing the workforce. Rob Findlay, a specialist in NHS demand and capacity planning at the data management solutions firm Insource, said the NHS undertakes 92m outpatient appointments, tests and operations a year, which includes follow-up appointments. The additional 2m appointments a year promised by Labour represents an increase in activity of only about two per cent. “This extra activity will need to be targeted to bring the waiting times and the waiting list down,” he said. “It will definitely make a difference, but how big a difference is the big unknown.”