Domain review
Public Service Capacity
Measures whether the state can deliver core public services.
Public Service Capacity is currently rated Fragile. The domain score is driven primarily by Crown Court outstanding caseload (E&W), NHS referral-to-treatment waiting list (England) and Adult social care requests. Data confidence is high across its component metrics.
Component indicators
Public Service Capacity · Metrics
July 2026
Verified official value from NHS England (RTT incomplete pathways), accessed 2026-10-01.
Evidence file
NHS referral-to-treatment waiting list (England)
Latest reading
July 2026
Scoring breakdown
Source
Consultant-led RTT waiting times
- Update frequency
- Monthly
- Reliability
- high
Provenance
- Provider
- NHS England
- Series ID
- RTT incomplete pathways
- Frequency
- monthly
- Accessed
- 1 October 2026
Known weakness
Covers England only; pathway counting rules have changed over time, and the list excludes patients who have given up seeking treatment.
Notes
Verified official value from NHS England (RTT incomplete pathways), accessed 2026-10-01.
August 2026
Verified official value from NHS England (A&E 4-hour performance (all types)), accessed 2026-10-01.
Evidence file
A&E four-hour performance (England)
Latest reading
August 2026
Scoring breakdown
Source
A&E attendances and emergency admissions
- Update frequency
- Monthly
- Reliability
- high
Provenance
- Provider
- NHS England
- Series ID
- A&E 4-hour performance (all types)
- Frequency
- monthly
- Accessed
- 1 October 2026
Known weakness
England-only; the four-hour target has been paused and reintroduced at different points, and Type 1 (major A&E) performance differs markedly from the blended figure.
Notes
Verified official value from NHS England (A&E 4-hour performance (all types)), accessed 2026-10-01.
July 2026
Verified official value from NHS England (Cancer 62-day standard), accessed 2026-10-01.
Evidence file
Cancer 62-day treatment standard (England)
Latest reading
July 2026
Scoring breakdown
Source
Provenance
- Provider
- NHS England
- Series ID
- Cancer 62-day standard
- Frequency
- monthly
- Accessed
- 1 October 2026
Known weakness
England-only; the 62-day clock can be paused for patient-initiated delays, and pathway complexity means like-for-like comparisons over time require care.
Notes
Verified official value from NHS England (Cancer 62-day standard), accessed 2026-10-01.
August 2026
Verified official value from NHS England (Appointments in General Practice) (GP appointments booked >2 weeks ahead), accessed 2026-10-01.
Evidence file
GP access pressure (England)
Latest reading
August 2026
Scoring breakdown
Source
Appointments in general practice
- Update frequency
- Monthly
- Reliability
- medium
Provenance
- Provider
- NHS England (Appointments in General Practice)
- Series ID
- GP appointments booked >2 weeks ahead
- Frequency
- monthly
- Accessed
- 1 October 2026
Known weakness
GP appointments dataset is still classified as official statistics in development; practice coverage and booking system compatibility vary, affecting completeness. From the 2026/27 contract NHS England requires clinically urgent patients to be coded and seen the same day, which may shift the booking to appointment distribution towards same day as coding compliance improves; the underlying table is unchanged but the same day share is monitored across releases for a behavioural step change.
Notes
Verified official value from NHS England (Appointments in General Practice) (GP appointments booked >2 weeks ahead), accessed 2026-10-01.
August 2026
Verified official value from NHS England (Acute Discharge SitRep) (patients no longer meeting criteria to reside), accessed 2026-10-01.
Evidence file
Delayed hospital discharges (England)
Latest reading
August 2026
Scoring breakdown
Source
Discharge delays situation reports
- Update frequency
- Monthly
- Reliability
- medium
Provenance
- Provider
- NHS England (Acute Discharge SitRep)
- Series ID
- patients no longer meeting criteria to reside
- Frequency
- monthly
- Accessed
- 1 October 2026
Known weakness
Administrative data; the definition of 'delayed discharge' has changed in reporting criteria over time, and reporting compliance varies across trusts.
Notes
Verified official value from NHS England (Acute Discharge SitRep) (patients no longer meeting criteria to reside), accessed 2026-10-01.
End Jun 2026
Verified official value from Ministry of Justice (Crown Court outstanding caseload), accessed 2026-10-01.
Evidence file
Crown Court outstanding caseload (E&W)
Latest reading
End Jun 2026
Scoring breakdown
Source
Criminal court statistics quarterly
- Update frequency
- Quarterly
- Reliability
- high
Provenance
- Provider
- Ministry of Justice
- Series ID
- Crown Court outstanding caseload
- Frequency
- quarterly
- Accessed
- 1 October 2026
Known weakness
Caseload counts reflect court listing practices and capacity rather than purely demand, and case complexity is not captured in simple caseload totals.
Notes
Verified official value from Ministry of Justice (Crown Court outstanding caseload), accessed 2026-10-01.
2024-25
Verified official value from NHS England Digital / DHSC (nhse_ascfr), accessed 2026-07-07.
Evidence file
Adult social care requests
Latest reading
2024-25
Scoring breakdown
Source
Adult Social Care Activity and Finance Report
- Update frequency
- Annual
- Reliability
- high
Provenance
- Provider
- NHS England Digital / DHSC
- Series ID
- nhse_ascfr
- Frequency
- Annual
- Accessed
- 7 July 2026
Known weakness
England; counts requests with a determined outcome (not pure demand), and the 2024-25 switch to Client Level Data breaks comparability with earlier years.
Notes
Verified official value from NHS England Digital / DHSC (nhse_ascfr), accessed 2026-07-07.
2025-26
Verified official value from Skills for Care (skills_for_care), accessed 2026-07-07.
Evidence file
Adult social care vacancies
Latest reading
2025-26
Scoring breakdown
Source
The state of the adult social care sector and workforce in England
- Update frequency
- Annual
- Reliability
- high
Provenance
- Provider
- Skills for Care
- Series ID
- skills_for_care
- Frequency
- Annual
- Accessed
- 7 July 2026
Known weakness
England; a Skills for Care modelled estimate (sector body, not official statistics), and high international recruitment has suppressed recent headline vacancy rates.
Notes
Verified official value from Skills for Care (skills_for_care), accessed 2026-07-07.
Historical values
Metric trends
Historical values
NHS referral-to-treatment waiting list (England)
Latest
7.33million incomplete pathwaysNHS referral-to-treatment waiting list (England) · million incomplete pathways · reported values, not stress scores.
Historical values
A&E four-hour performance (England)
Latest
75% attendances within 4 hours (target 95)A&E four-hour performance (England) · % attendances within 4 hours (target 95) · reported values, not stress scores.
Historical values
Cancer 62-day treatment standard (England)
Latest
71.2% treated within 62 days of referral (target 85)Cancer 62-day treatment standard (England) · % treated within 62 days of referral (target 85) · reported values, not stress scores.
Historical values
GP access pressure (England)
Latest
18.4% appointments more than 14 days after bookingGP access pressure (England) · % appointments more than 14 days after booking · reported values, not stress scores.
Historical values
Delayed hospital discharges (England)
Latest
13.8thousand patients per day not discharged when readyDelayed hospital discharges (England) · thousand patients per day not discharged when ready · reported values, not stress scores.
Historical values
Crown Court outstanding caseload (E&W)
Latest
80.8thousand open casesCrown Court outstanding caseload (E&W) · thousand open cases · reported values, not stress scores.
Historical values
Adult social care requests
Latest
2.02million new requests for adult social care supportAdult social care requests · million new requests for adult social care support · reported values, not stress scores.
Historical values
Adult social care vacancies
Latest
6.2% of adult social care roles vacantAdult social care vacancies · % of adult social care roles vacant · reported values, not stress scores.
Data provenance
Sources for this domain
| Organisation | Dataset | Type | Frequency | Link |
|---|---|---|---|---|
| NHS England | Consultant-led RTT waiting times | Official | Monthly | Source ↗ |
| NHS England | A&E attendances and emergency admissions | Official | Monthly | Source ↗ |
| NHS England | Cancer waiting times | Official | Monthly | Source ↗ |
| NHS England | Appointments in general practice | Official (Development) | Monthly | Source ↗ |
| NHS England | Discharge delays situation reports | Administrative | Monthly | Source ↗ |
| Ministry of Justice | Criminal court statistics quarterly | Official | Quarterly | Source ↗ |
| NHS England Digital | Adult Social Care Activity and Finance Report | Official | Annual | Source ↗ |
| Skills for Care | The state of the adult social care sector and workforce in England | Independent | Annual | Source ↗ |
How the Public Service Capacity domain is scored
The domain score is the median of the 8 component metric stress scores. Using the median reduces sensitivity to a single anomalous metric.
Each metric stress score is calculated as:
metric_stress = clamp((2/3) × level_score + (1/3) × trend_score, 0, 100)The Public Service Capacity domain carries a weight of 12% in the national index. Full methodology: methodology page.
International context · vs OECD
Health spending (% of GDP)
Above-average spending input, which does not by itself indicate better outcomes (cf. UK waiting times).
OECD Health at a Glance 2023 / ONS ↗ · 2022 · context only, not part of the score
Sensitivity analysis
What would move this domain?
The Public Service Capacity domain score is most sensitive to its two highest-stress indicators. Meaningful improvement in either of the following metrics would be the most direct path to improving the domain score:
- 81
Crown Court outstanding caseload (E&W)
Total number of open Crown Court cases awaiting hearing in England and Wales, measuring the depth of the criminal justice backlog.
- 76
NHS referral-to-treatment waiting list (England)
Total number of incomplete referral-to-treatment pathways in England, measuring accumulated unmet demand for elective NHS care.
Related analysis
Deep dives related to Public Service Capacity
Councils in England spend £12.0bn a year on long term care for over 65s and those people pay £3.6bn of it back in charges. Scotland has paid for personal care since 2002, now £260.30 a week in a care home. The workforce, the ageing population, and the triple lock record behind the National Care Service announcement.
How the four hour standard has slipped to 75 per cent, the rise in 12 hour waits, and the worst trusts.
33.9 million appointments in July 2026, 4.3 per cent more than a year earlier, 44.7 per cent seen the same day and 82.0 per cent within two weeks, who delivers them, and the official split between urgent and routine care.
7,278,384 referral to treatment pathways were waiting at the end of May 2026, around 6.2 million individual patients, with 65.6 per cent within 18 weeks against a 92 per cent standard last met in September 2015, and 104,734 waits of more than a year.
How the four hour A&E standard has slipped since 2007, the rise in twelve hour waits, by health board, with St John's in Livingston.
Only 40.2 per cent of adults in England, 18.8 million people, saw an NHS dentist in the two years to June 2026, leaving about 28 million with no NHS dental contact: the collapse in access since the pandemic and the worst dental deserts, from 24.5 per cent in Somerset to 52.5 per cent in South Yorkshire.
A Category 2 ambulance took 29m 49s on average in July 2026 against an 18 minute target: the monthly response times by category, the fastest and slowest services, and the handover bottleneck.
How long children wait for mental health support, the size of the backlog, how it varies by area, and the eating disorder standard that is mostly missed.
728,070 work, study and family visas granted in the year ending March 2026, down 44 per cent from the 2023 peak; 93,525 asylum claims, a 39 per cent grant rate at initial decision and the backlog down 55 per cent to 48,758 people; and UK net migration at 171,000, an ONS measure kept separate throughout.