NHS England’s performance to date has not demonstrated that it can secure the clinical engagement that will be necessary to transform waiting lists. Clinical engagement has worked best when there been close working between national and local clinical leaders, and specific and expert support between peers. The diagnostic transformation programme and the surgical transformation programme benefitted from clinical leadership and the support of relevant Royal Colleges. NHS England recognises that this is central to securing change and acknowledged that it still has to work out how it can get better clinical engagement, particularly for the outpatients programme. While NHS England has now set new incentives and priorities, the scale of engagement necessary to achieve full clinical support for the outpatients programme remains a significant challenge. Some progress has been demonstrated by NHS England through other outpatients programmes such as the Further Faster 20 programme to reduce long-term economic inactivity, although formal evaluation of the programme by NHS England and the Department has not yet been completed. 4 recommendation The Department should set out what it plans to do differently to secure clinical engagement on the outpatients transformation programme to improve waiting times.