Treatment waiting times

In 2010, the NHS Constitution was updated to include a patient right, stating that people with a referral from a GP should start their treatment within 18 weeks. This was initially introduced as three national targets in 2008. Since June 2015, the target that at least 92% of people should spend less than 18 weeks waiting for treatment has been the sole measure of waiting time performance.

What's happening to the proportion of people being treated within 18 weeks?

The proportion of people being treated within 18 weeks has been consistently high since the introduction of the various 18 week targets. These targets were that 90% of admitted people and 95% of non-admitted people should be treated within 18 weeks. For 'incomplete pathways', where patients have been referred but treatment has not yet started, the target was 92%.
In August 2014, a 'managed breach' of admitted and non-admitted targets was introduced which allowed hospitals to miss these targets without consequence. This managed breach lasted until December 2015 and corresponds to the dip in performance we observe at that time. After this breach it was decided in June 2015 to permanently abolish the admitted and non-admitted targets and that the incomplete target would become the sole measure to monitor treatment waiting times performance.
New operational performance trajectories for NHS providers were introduced in place of the 92% target in July 2016 (Strengthening Financial Performance & Accountability in 2016/17, NHS England).

The 92% target was breached for the first time in December 2015 with only 91.8% of people spending less than 18 weeks on the waiting list for treatment. It was breached again in March 2016 and has not been met since.

Updated November 2016

How many people are waiting for treatment?

As those still waiting for treatment (incomplete pathway) has become the sole measure of treatment waiting times it is important to look at the number of people joining the list and waiting for treatment. In mid-2007, the waiting list was large, with over 4 million people waiting for treatment. This was reduced drastically to fewer than 2.5 million by winter 2009 (data not shown). Since then, we see a clear seasonal trend with the list being longer over the summer months and shorter in the winter. Beyond these seasonal changes we see an overall upwards trend in the waiting list. Since April 2015 there have been more than 3 million people waiting for treatment in every month. In September 2016, there were 3.7 million people waiting for treatment.

Update November 2016

What's happening to people waiting the longest for treatment (over 52 weeks)?

The proportion of people waiting the longest (more than 52 weeks) has been consistently small (under 0.3%) since April 2009 for admitted and non-admitted patients (data not shown). The proportion of patients with an incomplete pathway waiting over 52 weeks has been falling steadily and has been below 0.2% since October 2012. Although this is a small proportion, in terms of the number of people this has been increasing in the past few months, from 475 in March 2015 to 1,181 in September 2016.

Updated November 2016

How have referral to treatment times changed in the short term?

The longer-term trend for the median wait time from referral to treatment (RTT) for all pathways has increased since 2008 (data not shown). As well as the long-term trend, waiting times show small fluctuations from month to month. In particular, we see an annual pattern with peaks in the median wait time in December to February each year which are due to people waiting for treatment over the winter. On the graph a line has been added to show the underlying trend. This trend in median wait times from referral to decision to treat for admitted people has increased slightly by 0.5 weeks between December 2013 and December 2015; non-admitted pathways have increased by 0.4 weeks and incomplete pathways have increased by 0.4 weeks in the same time periods. 

About this data

Once there has been a decision from a consultant that a patient needs treatment, and they have been referred to a hospital, they are on the waiting list and the clock starts on their treatment waiting time. Their treatment pathway, or time on the waiting list, can end in one of two ways:

- 'Admitted': if a patient is admitted to hospital for treatment, the pathway clock stops once they have been admitted either as a day case or inpatient.

- 'Non-admitted': if a patient receives treatment that does not require an admission or is not treated, the clock stops when they receive treatment or when there is a decision that no treatment is needed.

Data for 'incomplete pathways' show patients who have been referred but have not yet started their treatment. These data give an indication of the number of people on the waiting list for treatment each month.

Since October 2015, there is no provision to report pauses or suspensions in RTT waiting time clocks in monthly RTT returns to NHS England under any circumstances.

For further guidance on referral to treatment waiting times, please see the NHS England website


You should include estimates for RTT non-reporters, especially for the Incomplete Pathways. NHS England now do so in their annual RTT reports. Including such estimates, shows the waiting list at over 3.2M.

George Donald (not verified)
(changed )

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