Waiting times for hospital treatment

The NHS in England collects and publishes a large amount of information about how quickly patients can access treatment within a range of targets set by government. There are no directly comparable data for other countries outside the UK. The NHS in England is not currently meeting a number of key waiting time targets for urgent and emergency care, cancer services and routine hospital treatment. But rising numbers of people using these services mean that the NHS is responding to more people within target times than ever before.


The NHS did not meet either target for ambulance response times for 999 calls where there is an immediate threat to life in 2016/17. Figure 1 shows that in 2016/17 an emergency response arrived within eight minutes in 68.7% of Red 1 calls and 62.5% of Red 2 calls, both below the expected standard of 75.0%.

Red 1 calls are the most time critical, covering patients with cardiac arrest who are not breathing and do not have a pulse, and other severe conditions such as airway obstruction. This target was met in 2013/14 (75.6%), but performance began to fall in 2014/15 and 75% has only been achieved in three out of the past 36 months.

Red 2 calls are also serious, but less immediately time critical and cover conditions such as stroke and fits. The Red 2 target was achieved in 2012/13 (75.6%), but performance dropped to 74.8% in 2013/14 and has remained below the target throughout the past three years.

A further target is that a fully-equipped ambulance should arrive within 19 minutes where there is an immediate threat to life and an ambulance is needed to transport someone to hospital. The target is to meet this standard in 95.0% of calls, but only 90.4% of calls met this standard in 2016/17. The target was met between 2011/12 and 2013/14, but performance has since deteriorated and the target has not been met for the past three years.

Figure 1: Ambulance response times to Red 1 and 2 calls, England, 2012/13* to 2016/17**

* Data are not available for April or May 2012, so only 10 months of data are included for 2012/13.

**Full 2016/17 data are not available for South Western, Yorkshire and West Midlands ambulances services, so numbers of calls are not directly comparable with previous years.

Source: NHS England, 2017

Figure 1 shows that the total number of ambulance calls where there is an immediate threat to life has grown over time, and the total number of calls that receive an emergency response within eight minutes has increased every year since the Red 1 and 2 targets were first set in 2012/13. The number of calls for 2016/17 excludes calls to the three ambulance services in England not reporting directly comparable data due to participation in trials to improve response times, but data reported by the other eight ambulance services suggest the number of calls continued to grow in 2016/17. The number of 999 calls made to the ambulance service has also grown: 9.8 million calls were made in 2016/17, up by over 1.6 million from 8.2 million in 2011/12. Despite this, the ambulance service has made considerable progress: more people have received help over the phone, fewer have been taken to accident and emergency (A&E) departments and more received an appropriate response first time.

A&E departments

Once in an A&E department, 95.0% of patients should be admitted to a hospital bed, discharged home or transferred to another hospital within four hours of their arrival. The NHS did not achieve the A&E waiting times target in 2016/17: 89.1% of patients who needed emergency treatment waited four hours or less. The most recent year in which the A&E target was met was 2013/14; Figure 2 shows that the percentage of patients waiting four hours or less has fallen in every year since.

Figure 2: A&E waiting times in England, 2003/04 to 2016/17

Source: NHS England, 2017

However, the number of patients visiting A&E departments has grown over time and more were treated in 2016/17 than ever before. Figure 2 shows that 23.4 million people visited A&E departments in England in 2016/17. There has been an average annual increase in the number of people visiting A&E departments of 2.4% over the past decade. And the number of patients treated within target times has remained broadly stable since 2010/11, despite the NHS experiencing considerable pressure from continuing increases in demand for emergency care.

As well as a continued increase in the number of visits to A&E departments and patients needing emergency admission to hospital, there have also been more problems with discharging patients who no longer need a hospital bed (known as delayed discharge). 77,782 patients experienced a delayed discharge in 2016/17, an increase of 29,081 from 48,701 in 2011/12. Nearly 2.3 million hospital bed days (when those beds could have been used by other patients) were lost to delays in 2016/17, up from 1.4 million in 2011/12. A lack of suitable social care capacity has become the fastest growing cause of delays, accounting for over a third of the total in 2016/17.

High levels of bed occupancy have contributed to delays in admitting patients to hospital from A&E departments. More patients experienced excessive delays in A&E departments waiting for a hospital bed (known as trolley waits) in 2016/17 than in any other year since comparable records began in 2004/05. 560,398 patients experienced a trolley wait of more than four hours in 2016/17, up from 108,314 in 2011/12 and from 57,841 in 2006/07. 3,503 experienced a trolley wait of more than 12 hours in 2016/17, up from 123 in 2011/12.

Comparing A&E waiting times with other countries is difficult, with very little reliable information available, but the UK does not appear to be an outlier in this respect. In a recent international survey (see Figure 3), 88.5% of patients from the UK reported waiting less than four hours: a higher percentage than reported by patients in Australia, Canada, Norway, Sweden, Switzerland and the USA, but lower than reported by patients in France, Germany, the Netherlands and New Zealand. The survey was based on small samples and the results should be treated with caution.

Figure 3: The last time you went to the A&E department, how long did you wait before being treated?

Source: Commonwealth Fund, International Health Policy Survey of Adults, 2016

Non-emergency and elective hospital treatment

Patients needing consultant-led treatment are expected to start treatment within 18 weeks of referral by their GP. These are non-urgent cases but can be serious, and the target was designed to make sure that patients got all the tests and investigations they needed in good time.

The NHS did not achieve the 18-week waiting time target for consultant-led treatment in 2016/17. 90.7% of patients who needed routine specialist treatment waited less than 18 weeks from being referred by a GP, slightly lower than the expected standard of 92.0%.

Figure 4: Referral to treatment waiting times for non-emergency and elective care in England, 2012/13 to 2016/17

Source: NHS England, 2017

Figure 4 shows that the current target of 92.0% was achieved from its introduction in 2012/13 to 2014/15, but performance began to fall in 2015/16. There are many reasons for this, but it is likely that increasing demand for emergency care has made it harder for hospitals to keep up with routine treatment, such as planned operations. The amount of routine treatment being carried out by the NHS has grown and is planned to continue growing, but the NHS has acknowledged that this is unlikely to keep pace with demand and the 18-week target is unlikely to be achieved until 2019.

Despite this, most patients continue to wait far less than 18 weeks to start treatment. The median time that patients had waited to start treatment was 6.2 weeks at the end of 2016/17, an increase of around five days from 5.2 weeks at the end of 2011/12. The number of patients waiting more than 52 weeks to start treatment has also increased in recent years, but remains small relative to the total number of patients. At the end of 2016/17, 3.7 million patients were on a waiting list to start treatment – an increase of 1.3 million from 2.4 million in 2011/12 – of which 1,529 (0.04%) had been waiting more than 52 weeks. This remains substantially lower than in the early 2000s when the original 18-week target was first set.

In terms of waiting times for patients referred with suspected cancer, the NHS achieved seven of the eight targets for cancer waiting times from 2011/12 to 2016/17.

Figure 5: Patients starting treatment within 62 days of GP referral for suspected cancer, 2011/12 to 2016/17

Source: NHS England, 2017

However, Figure 5 shows that in 2016/17 the NHS did not achieve the target for the percentage of patients waiting less than 62 days to start treatment after referral by their GP for suspected cancer. 81.8% of patients began treatment within 62 days, compared with an expected standard of 85.0%. This is arguably the most important of the eight targets for cancer waiting times because it covers more patients from referral through diagnosis to the beginning of treatment than the other targets. This target was achieved from 2011/12 to 2013/14, but performance deteriorated in 2014/15 and the target has not been met for the past three years. Figure 5 also shows that the number of patients treated on the 62-day pathway has grown substantially over time.

International comparisons of waiting times are challenging because countries often take different approaches to what and how waits are measured. An analysis of OECD data by Siciliani et al (2013) highlighted that the UK has made considerable progress in reducing waiting times, from having relatively long waits in 1999 to being one of the better performing countries by 2012.

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