Tackling the NHS backlog is one of the government’s key six missions – and now Prime Minister Sir Keir Starmer says he has the plan to end it.

But what’s remarkable from this new year waiting list announcement is just how few levers ministers seem to have to pull.

Much of this plan is about building on work that is already under way in England – and there are reasons why these policies have only had limited impact so far.

More surgical and diagnostic hubs are being promised in the community – this builds on a network that started being rolled out before the pandemic.

They allow more care to be provided outside of hospitals and the government wants to see not just more of them but longer opening hours too. But, of course, the key limiting factor is having the staff available to deliver the treatment – something the British Medical Association is pointing out.

Sir Keir also wants to make it easier for patients to exercise choice over where they go for treatment – the idea is that this allows them to shop around and go where waiting lists are shortest.

This policy dates back even further as it was introduced by the Blair government and subsequently championed by the Tories when they were in power. Despite that only around a quarter of patients report being offered a choice. And even if this was to change, questions remain about how many patients will be prepared to travel to get treatment elsewhere.

Another initiative, which has been pursued for more than two decades, is getting the independent sector to ease the burden on the NHS. The private sector says it has capacity to see 30% more NHS patients than it currently does.

But this policy comes with costs – the private sector tends to only take on the most straightforward procedures, which can deprive NHS hospitals of vital income as well as doctors and nurses of vital training opportunities.

This is not to say that the backlog will not be reduced. It would be a surprise if it did not start to fall in the coming months – most forecasts have pinpointed this spring as the potential turning point.

But the ultimate goal of getting the NHS back to hitting the 18-week target by the end of this parliament still remains a big ask.

That would mean 92% of patients being seen within 18 weeks – something that has not been achieved since 2015. Currently fewer than 60% are.

The Blair government made big strides in the early 2000s, but that was underpinned by significant increases in the NHS budget – between 6-7% a year on top of inflation.

Increases on that scale seem very unlikely given the state of public finances – although we will have to wait until the spring for the spending review to find out what budget will be set aside for the NHS in the coming years.

Another concern, being voiced by some, is that with so much emphasis placed on waiting lists there is a risk other areas may end up neglected as health chiefs focus so much of their attention on this.

“The 18-week target should not be taken as the sole measure of how the NHS is faring,” says Sarah Woolnough, head of the King’s Fund think tank. “Equally important to people are how long they are waiting for a GP appointment or an ambulance, for mental health care and other services.”

In short, any progress that is made on the waiting list could easily get lost if the wheels come off elsewhere.