Jim Mackey’s September 19 circular to local health chiefs claims England’s NHS has been “continuing to improve waiting times in electives, cancer and for emergency care.” Is this true?
It’s a mixed picture. On cancer, there is some good news. Performance on the key 28-day target (“Four Week (28-days) Wait from Urgent Referral to Patient Told they have Cancer, or Cancer is Definitively Excluded”) remains in excess of the 75% target, and has improved since last July, from 76.2% to 76.6%, but fallen fractionally back since April.
Numbers of “Urgent Suspected Cancer Referrals Seen at a First Outpatient Attendance” have increased by a healthy 6% (17,000 per month) since July 2024.
On the 62-day target (“Two Month (62-days) Wait from an Urgent Suspected Cancer or Breast Symptomatic Referral, or Urgent Screening Referral, or Consultant Upgrade to a First Definitive Treatment for Cancer) performance is also better than a year ago – but has declined (from 69.9% to 69.2%) since April, and England’s NHS has for years remained consistently well below the 85% target.
For other elective patients the news is less positive. According to the latest overall monthly (July) waiting list statistics the numbers of elective patients treated within 18 weeks has indeed gone up since July last year, and since April for the current year’s performance – but not by much. The increase in 18-week performance is just 53,474 (1.2%) greater than a year ago.
There has been a substantial reduction in really long waiting times, with 52 week-plus numbers down 96,678 (34%) since July 2024; 65 week-plus down 38,910 (77%) and 78 week (18 month-plus) waits down 1,309 (48%). However since the start of the current financial year there has been a worrying increase in these long waits, with 52 week numbers up almost 1,600 to 192,000; 65 weeks up 2,692 to 11,950 and even the 78 week waits up 68 to 1,429.
And while the total waiting list has declined by 220,000 (3%) since July 2024, again the total has risen back over 7.4 million since April – across the summer months of 2025. Some of this is no doubt due to the five days of industrial action by resident doctors, although this appears to have been less impactful than previous disputes.
It is also worth noting that the median wait for treatment (the time by which half of all patients have had their operation) has reduced in the past year, from 14 weeks in July 2024 to 13.1 weeks.
Also improved is the percentage of operations that are cancelled at short notice, which is lower this July than either 2024 or 2019. However the proportion of operations cancelled and not treated within 28 days has risen massively since the pandemic, from 7.4% in 2019 to 22.3% in 2025, an indication of how massively over-stretched the bed capacity of the NHS has become.
The underlying problem is that what progress has been made has been too slow to show any hope of really reducing the waiting list totals and waiting times: if the last 12 months’ progress continues unchanged, the total would still be at a huge 6.75 million by the time the next election is due in 2029 … and at this rate it could take 86 years to clear the waiting list. This is not the vision the voters were led to expect last July.
Perhaps more worrying is the slow progress on improving the 18-week performance. In the July before the pandemic (2019) 85.8% of treatment was delivered inside the limit (although the numbers of operations were lower, at just 3.75 million in 2019, compared with 4.54 million within 18 weeks in July 2025): in July 2025 just 61.3% of the larger total were done within 18 weeks.
Meanwhile the queues waiting for community health services have increased sharply since April, with an extra 70,000 adults (almost 9%) waiting in July, and a smaller increase in the queues of children and young people.
Emergency care, too, is a different story. Once again it is a capacity problem that has created a big increase in delays in admitting the most seriously ill patients. The most recent monthly figures show a small reduction in numbers of the most serious ‘Type 1’ patients between 2019 and 2024, but a significant 63,713 (4.9%) increase between August 2024 and last month. The least demanding ‘Type 3’ numbers also follow the same pattern.
The total of 1,383,870 attendances to major EDs made last month the busiest August on record. Just 62% (858,328) were seen within the target of four hours – .
The number of 4-hour breaches in August 2024 was more than double the level in 2019, although they did improve slightly (by less than one percent) last month.
Even more dramatic are the numbers of 12-hour plus trolley waits after a decision to admit them – for a bed to become available. These mushroomed from 371 in August 2019, to 28,494 in 2024 and to 35,909 in August – 96 times the 2019 level. In the same month 10 years ago, there were just 28 patients who experienced this wait.
Worrying though it is, this is not the worst aspect of performance, because another table of figures shows the shocking number of patients (122,557) who had been left 12 hours or more from time of arrival to the time they were found a bed during August.
The Royal College of Emergency Medicine, which has consistently highlighted these figures and warned of the severely increased risk to patients who are kept waiting for so long on trolleys in crowded departments and corridors, also points out that this is now happening to one in every 11 patients, with this being the second highest August for these delays since records began in 2010. But these are just averages: some areas are much worse. The figures also show 39 trusts in which more than one in eight patients (12.5%) waited over 12 hours, and five trusts where it was close to or above one in five (Lincolnshire Hospitals, Mid Cheshire Hospitals, Warrington and Halton Teaching Hospitals, Wirral University Teaching Hospital and East Kent Hospitals).
That Sir Jim sees emergency care as a bright spot on the performance map is disturbing. Perhaps a chat with the RCEM would help him get a better grip on what’s really happening, and shift his attention from finding ways to cut jobs and spending to finding ways to ensure hospitals give prompt treatment to patients with the most serious urgent needs.
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