NHS activity and performance summary: October and November 2023
Report summarising data on activity and performance in the Welsh NHS for October and November 2023.
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In this page
Introduction
In light of the impact COVID-19 has had on NHS activity and performance levels, the Welsh Government has published its programme for transforming and modernising planned care and reducing waiting lists in Wales. This plan sets out a number of key ambitions to reduce waiting times for people in Wales. We have incorporated performance measures against these ambitions into this statistical release and on StatsWales.
Data provided in this statistical report has been provided by Digital Health and Care Wales (DHCW) unless stated otherwise. Data for each topic area are also available in more detail on our StatsWales website.
Main points
In November, more than 70,500 calls were made to the 111 helpline service, a decrease of around 5,100 calls compared to the previous month. Of these, just over 65,900 calls were answered (93%). There were also over 477,500 hits on the NHS 111 Wales website and over 12,500 completed symptom checks (NHS 111 Wales).
In November there were 4,669 red (life threatening) calls to the ambulance service, 13.8% of all calls. An average of 156 immediately life-threatening calls were made each day, 3 less than in October, but still the third highest on record.
49.5% of red calls received an emergency response within eight minutes. This was 2.3 percentage points higher than in October. Data for red calls are only comparable from May 2019 onwards.
There was an average of 2,836 daily attendances to emergency departments, a decrease compared to the previous month. Performance increased slightly against the four hour target and the twelve hour target. The average (median) time spent in emergency departments decreased by 8 minutes in November compared to the previous month at two hours and forty one minutes.
The pandemic has caused a large increase in patient pathways waiting to start treatment. In October the number increased from just over 761,100 to just under 764,500, the eighth consecutive increase and the highest figure on record. The number of patient pathways is not the same as the number of individual patients, because some people have multiple open pathways. More information is available in the Welsh Government’s Chief Statistician’s blog.
Management information suggests that in October, when there were just under 764,500 open patient pathways, there were about 596,000 individual patients on treatment waiting lists in Wales, the highest figure on record.
The proportion of patient pathways waiting less than 26 weeks increased to 58.6% in October. This has been relatively stable after falling significantly from the levels pre-pandemic. The number of pathways waiting longer than 36 weeks increased in October, to just over 231,900, remaining high in historical context.
About 25,700 pathways were waiting more than two years, 63.5% lower than the peak and continuing to fall month on month. The average (median) time patient pathways had been waiting for treatment at the end of October remained the same as the previous month at 19.9 weeks.
The planned care recovery plan established a target to eliminate two year waits in most specialties by March 2023, with ‘most’ referring to all specialties excluding seven recognised as exceptionally challenging even prior to the pandemic. The target was not met in March and in October there were still a further 13 specialties with pathways waiting more than two years accounting for 3,200 pathways.
Headline measures for open pathways across the UK are not comparable. There are large differences between Wales, Scotland and Northern Ireland statistics, meaning they should not be compared at all. With England, current understanding suggests a broadly comparable number can be produced for Wales by removing some known non-consultant led pathways which are not counted in England. On that basis, there are around 677,000 open pathways on consultant-led pathways in Wales, equivalent to 22 pathways (not patients) for every 100 people. For England, the figure in October was 14 pathways for every 100 people.
Pathways waiting longer than one year for their first outpatient appointment increased to around 52,200, 49.2% less than the peak in August 2022. The planned care recovery target to eliminate these by the end of 2022 was not met.
For diagnostic services, patient pathways waiting increased to just over 120,800 in October the highest on record. The number waiting longer than eight weeks (the target maximum wait) decreased to just over 47,800. For therapies, patient pathways waiting increased to just over 70,600 in October. The number waiting longer than fourteen weeks (the target maximum wait) increased to just under 11,500.
For cancer services, more people started their first definitive treatment in October than the previous month, rising to 1,987, the second highest figure on record. The number of pathways closed following the patient being informed they did not have cancer increased to 14,889, the highest figure on record. Performance increased against the 62 day target in October to 56.2%, compared to 52.9% the previous month.
Unscheduled care
New data relating to unscheduled care are provided for the month of November 2023.
Calls to 111 service
As of 16 March 2022, the non-emergency 111 helpline service has been rolled out across the whole of Wales.
Activity
Figure 1: Calls received and calls answered by the NHS 111 service
Description of Figure 1: A line chart showing the number of calls received by the 111 service has been relatively stable during 2023, with gradual increases in the number of calls answered and calls answered within 60 seconds.
Source: Welsh Ambulance Services NHS Trust
111 service activity in Wales, by date and measure, on StatsWales
In November, a total of 70,586 calls were made to the 111 helpline service, a decrease of around 5,100 calls compared to the previous month. Of these, over 65,900 (93%) calls were answered by the 111 service, an average of just under 2,200 calls per day.
An estimated 4,664 (7%) calls were ended by the caller before being answered. Of these, 1,872 were ended within 60 seconds of the automated messages, suggesting their needs were likely to have been met.
Just under 2,800 calls were abandoned after 60 seconds and these are regarded as callers who were more likely to have still required the service after the messages but were unable to get through or decided not to wait.
Of the calls answered, 1,516 calls indicated that they wished to conduct the call in Welsh.
There were over 477,500 hits on the NHS 111 Wales website and over 12,500 completed symptom checks (NHS 111 Wales) in November.
Emergency calls to the ambulance service
A wider range of ambulance quality indicators are published on the Emergency Ambulance Services Committee (EASC) website and on StatsWales.
Calls to the ambulance service are categorised as red (immediately life-threatening), amber (serious but not life-threatening) or green (non-urgent).
Activity
Figure 2: Average daily emergency ambulance calls, by call type and month [Note 1]
Description of Figure 2: A line chart showing the number of emergency calls received by the Welsh Ambulance Services NHS Trust. An Amber call is the most common call and the number of red calls is showing an upward trend over the years.
Source: Welsh Ambulance Services NHS Trust
Emergency ambulance calls and responses to red calls, by local health board and month, on StatsWales
[Note 1] An update to call handling in May 2019 resulted in a change to red incident volume. It is not possible to directly compare before and after this date. Further details are available in the quality information.
In November, just over 33,700 emergency calls were made to the ambulance service. This was an average of 1,124 calls per day, on average 35 calls per day less than the previous month, and 37 (3.2%) less per day than the same month last year.
An average of 156 red calls were made per day in November, 3 less than the previous month but still the third highest on record.
In November, the proportion of all calls that were immediately life-threatening was 13.8%, up from 13.7% in October, still the second highest on record.
Performance
Target
- 65% of red calls (immediately life-threatening, someone is in imminent danger of death, such as a cardiac arrest) to have a response within 8 minutes.
Figure 3: Percentage of red calls which received an emergency response at the scene within 8 minutes, November 2018 to November 2023 [Note 1]
Description of Figure 3: A line chart showing that performance for emergency response calls has trended downwards over the long-term. Performance remains below the target of 65%.
Source: Welsh Ambulance Services NHS Trust
[Note 1]: An update to call handling in May 2019 resulted in a change to red incident volume. It is not possible to directly compare before and after this date. Further details are available in the quality information.
Figure 4: Percentage of red calls which received an emergency response at the scene within 8 minutes, by Local Health Board, November 2023
Description of Figure 4: A bar chart showing that performance was below the target level for emergency response calls in all Local Health Boards.
Source: Welsh Ambulance Services NHS Trust
In November, 49.5% of emergency responses to immediately life threatening (red) calls arrived within 8 minutes of patient location and chief complaint being established. This was 2.3 percentage points higher than the previous month.
At a Local Health Board level, the highest proportion of red calls responded to within 8 minutes was seen in Aneurin Bevan (53.8%), and the lowest in Cwm Taf Morgannwg (43.0%).
The proportion of red calls responded to within 8 minutes has fallen in recent years from a peak of 80% in 2017, but over the same period there has been a significant increase in the number of red calls received. For example, in the latest twelve months there were around 50,000 red calls, more than twice as many as in 2017 (22,000). The overall increase in demand largely reflects two things; changes in how some calls are handled, as some calls that used to be categorised as amber are now categorised as red; and a large increase in respiratory conditions in the latest winter.
Other than demand, handover delays at hospitals can also affect performance, when ambulance crews are unable to respond to new calls while waiting to handover patients to emergency departments. There has been a significant increase in handover delays in recent years, with nearly five times as many hours lost in the latest twelve months compared with 2017. In November around 20,000 hours were lost due to handover delays. Further data on handover delays can be found on the Emergency Ambulance Services Committee’s (EASC) Ambulance Service Indicators dashboard.
The median response time in the four years prior to the pandemic ranged between 4 minutes 30 seconds and 6 minutes for red calls. In November, the average (median) response time to immediately life-threatening ‘red’ calls was 8 minutes 4 seconds. This was 22 seconds quicker than the previous month, and 14 seconds faster than November 2022.
The majority of calls to the ambulance service are categorised as ‘amber’ calls, for which there is no performance target for call response times. In November, the median response time for amber calls was 1 hour 13 minutes and 26 seconds. This was just over 16 minutes faster than in October but just over 27 minutes quicker than in November 2022.
Emergency department attendances and admissions to hospital
Last month’s release included a Chief Statistician’s Statement regarding recent media coverage of official statistics on emergency department waiting times. Local Health Boards have provided assurance that the data they submit to Digital Health and Care Wales is in line with the guidance. Patients subject to clinical exceptions are therefore included in the emergency department attendances in this report and previous reports.
A wider range of emergency department performance statistics are published on the National Collaborative Commissioning Unit (NCCU) website, as management information.
Activity
Figure 5: Average attendances in emergency departments, and admissions to hospital resulting from attendances at major emergency departments per day, November 2018 to November 2023 [Note 1]
Description of Figure 5: A line chart showing attendances to emergency department, which are generally higher in the summer months than the winter, but otherwise remain relatively stable. There was a decrease in attendances during the COVID-19 pandemic.
Source: Emergency department data set, Digital Health and Care Wales
Number of attendances in NHS Wales emergency departments by age band, sex and site, on StatsWales
[Note 1]: Chart shows number of attendances at both major emergency departments and minor injuries units, and the number of admissions resulting from attending major emergency departments only.
In November there were just under 85,100 attendances to all emergency departments, an average of 2,836 attendances per day; this was 174 attendances less per day on average than in the previous month.
In November, just under 15,100 patients were admitted to the same or a different hospital following attendance at major emergency departments. This was 4.7% lower than the previous month, but5.1% higher than the same month in 2022.
Performance
Targets
- 95% of new patients should spend less than 4 hours in emergency departments from arrival until admission, transfer or discharge.
- No patient waiting more than 12 hours in emergency departments from arrival until admission, transfer or discharge.
Figure 6: Percentage of patients admitted, transferred or discharged within 4 hours at emergency departments, November 2018 to November 2023
Description of Figure 6: A line chart showing the percentage of patients admitted, transferred or discharged within 4 hours at emergency departments fell during the coronavirus pandemic and has largely plateaued since late 2021.
Source: Emergency department data set, Digital Health and Care Wales
Performance against 4 hour target by hospital, on StatsWales
[Note 1]: Until September 2023 attendances at Same Day Emergency Care (SDEC) units were included in emergency department data for Cardiff and Vale. From October these were no longer included, and since they are more likely than other attendances to be relatively short, this may have had the effect of reducing the overall proportion of attendances admitted, transferred or discharged within four hours compared with previous figures.
Figure 7: Percentage of patients admitted, transferred or discharged within 4 hours at emergency departments, by Local Health Board, November 2023 [Note 1]
Description of Figure 7: Bar chart showing performance was below the 4 hour performance target for emergency departments in all Local Health Boards.
Source: Emergency department data set, Digital Health and Care Wales
Performance against 4 hour target by hospital, on StatsWales
[Note 1]: Powys Teaching health board is excluded from this figure because there are significant differences in the number and type of services provided in Powys compared with other Local Health Boards. Data for Powys is made available in the previous StatsWales link.
In November, 69.5% of patients in all NHS emergency departments spent less than 4 hours in the department from arrival until admission, transfer or discharge. This was 0.8 percentage points higher than the previous month and remains relatively low in historical context.
Swansea Bay health board saw the highest proportion spending less than 4 hours in emergency departments (75.3%), and Cwm Taf Morgannwg saw the lowest (64.6%).
In 2019, the median time patients spent in emergency departments was around 2 hours and 30 minutes. During the early part of the pandemic, as attendances decreased the median time spent in the department decreased, to a low of 1 hours 47 minutes in April 2020. Since then, median times increased and reached a record high of 3 hours and 8 minutes in March 2022. In the latest data for November, the median waiting time was 2 hours and 41 minutes, over 8 minute faster than the previous month.
The median time spent in emergency department varies by age. Prior to the pandemic, children (aged 0 to 4) spent between 1 hour and 30 minutes and 2 hours in emergency departments, while older patients (aged 85 or greater) spent between 3 hours and 30 minutes and 5 hours.
In November, children (aged 0 to 4) spent an average of 2 hours and 8 minutes in emergency departments. Adults aged 85 and over spent an average of 5 hours and 55 minutes in emergency departments.
Figure 8: Patients waiting more than 12 hours to be admitted, transferred or discharged at NHS emergency departments, November 2018 to November 2023
Description of Figure 8: A line chart showing the number of patients waiting longer than 12 hours to be admitted, transferred or discharged at emergency departments, which fell sharply during the initial coronavirus period. Recently there has been a slight fall after a long term upward trend.
Source: Emergency department data set, Digital Health and Care Wales
Performance against the 12 hour target by hospital, on StatsWales
Figure 9: Patients waiting more than 12 hours to be admitted, transferred or discharged at NHS emergency departments, per 100,000 population, by Local Health Board, November 2023 [Note 1]
Description of Figure 9: Bar chart showing in all Local Health Boards there were patients who waited longer than 12 hours.
Source: Emergency department data set, Digital Health and Care Wales
Performance against the 12 hour target by hospital, on StatsWales
[Note 1]: Powys Teaching health board is excluded from this figure because there are significant differences in the number and type of services provided in Powys compared with other Local Health Boards. Data for Powys is made available in the previous StatsWales link.
In November 8,622 patients waited 12 hours or more. This was 1,313 (13.2%) less than in the previous month. Adjusted by population, more patients waited longer than 12 hours in Betsi Cadwalar (426) than in any other Local Health Board. The lowest figure was in Cardiff and Vale (107).
Scheduled care activity
New data relating to unscheduled care are provided for the month of October 2023. Digital Health and Care Wales (DHCW) now publishes a secondary care dashboard which provides data on outpatients appointments, inpatient admissions and daycase activity undertaken in Wales.
Outpatient referrals and appointments
Activity
Figure 10: Average daily referrals for first outpatient appointment, October 2018 to October 2023
Description of Figure 10: A line chart showing outpatient referrals, which has been fluctuating with an upwards trend. Following a big drop in referrals in February 2020 due to the coronavirus pandemic, outpatient referrals have steadily risen back to pre-pandemic levels.
Source: Outpatient Referral Dataset, Digital Health and Care Wales
Referrals by local health board and month, on StatsWales
An average of 4,265 referrals for first outpatient appointments were made per day in October 2023. This is an increase of 2.6% (109 more referrals per day on average) compared to September 2023 and an increase of 7.8% compared to October 2022.
Performance
Targets
- No one waiting for longer than a year for their first outpatient appointment by the end of 2022 (a target established in the planned care recovery plan).
Figure 11: Pathways waiting more than a year for their first appointment, October 2018 to October 2023
Description of Figure 11: A line chart showing the number of patient pathways waiting longer than a year, which rapidly increased during the coronavirus pandemic before halving to around 50,000 pathways where it has since plateaued.
Source: Referral to treatment times, Digital Health and Care Wales
COVID-19 recovery plan, ambitions for referral to treatment waiting times, on StatsWales
Figure 12: Pathways waiting more than a year for their first appointment per 100,000 population, by Local Health Board, October 2023 [Note 1]
Description of Figure 12: A bar chart showing the number of patient pathways waiting longer than a year for a first outpatient appointment, adjusted by population size and was highest in Cwm Taf Morgannwg and lowest in Swansea Bay, where there are now no pathways waiting more than a year for their first appointment.
Source: Referral to treatment times, Digital Health and Care Wales
COVID-19 recovery plan, ambitions for referral to treatment waiting times, on StatsWales
[Note 1]: Powys Teaching health board is excluded from this figure because there are significant differences in the number and type of services provided in Powys compared with other Local Health Boards. Data for Powys is made available in the previous StatsWales link.
In October, the number of pathways waiting longer than one year for their first outpatient appointment increased by 1% compared to the previous month to around 52,200. The planned care recovery plan target was not met, though there has been a fall of 49.2% since the peak in August 2022.
Among the Local Health Boards, the highest number of pathways waiting more than one year per 100,000 of the population was in Cwm Taf Morgannwg (2,897) and the lowest in Swansea Bay, where there are now no pathways waiting more than a year for their first appointment.
Diagnostic and therapy waiting times
Activity
Figure 13: Patient pathways waiting for diagnostic and therapy services, October 2018 to October 2023 [Note 1]
Description of Figure 13: A line chart showing a long term upward trend in patient pathways waiting for diagnostic services, including a sharp increase in the start of the coronavirus pandemic, and the number of patient pathways waiting for therapy services which has also seen a long term upward trend.
Source: Diagnostic and therapy services waiting times, Digital Health and Care Wales
Diagnostic and Therapy Services Waiting Times by week, on StatsWales
[Note 1]: The low point in April 2020 for therapies is in part due to Betsi Cadwaladr not submitting data for this month, please see the quality information for more information.
In October there were just over 120,800 patient pathways waiting for diagnostics. This was an increase of 0.4% compared with the previous month and the highest figure on record. There were just over 70,600 patient pathways waiting for therapies, an increase of 0.7% compared to the previous month.
Performance
Targets
- The maximum wait for access to specified diagnostic tests is 8 weeks.
- The maximum wait for access to specified therapy services is 14 weeks.
- The planned care recovery plan established a target date of Spring 2024 to reach these targets.
Figure 14: Patient pathways waiting over the target time for diagnostic and therapy services, October 2018 to October 2023 [Note 1]
Description of Figure 14: Line chart showing a big increase in patient pathways waiting longer than 8 weeks for diagnostic services at the start of the pandemic, before falling throughout 2020 and fluctuating since. The number of patient pathways waiting longer than 14 weeks for therapy services peaked in June 2020 and March 2022 and fluctuating since. Neither diagnostics or therapies are close to pre-pandemic levels.
Source: Diagnostic and therapy services waiting times, Digital Health and Care Wales
Diagnostic and Therapy Services Waiting Times by week, on StatsWales
Figure 15: Patient pathways (per 100k of the population) waiting over the target time for diagnostic tests and therapy services by Local Health Board, October 2023 [Note 1]
Description of Figure 15: Bar charts showing all Local Health Boards have pathways waiting more than the target time for diagnostics and therapies.
Source: Diagnostic and therapy services waiting times, Digital Health and Care Wales
Diagnostic and Therapy Services Waiting Times by week, on StatsWales
[Note 1]: Powys Teaching health board is excluded from this figure because there are significant differences in the number and type of services provided in Powys compared with other Local Health Boards. Data for Powys is made available in the previous StatsWales link.
At the end of October, just over 47,800 patient pathways were waiting longer than the target time for diagnostics. This was a decrease of 6.8% compared to the previous month.
At the end of October there were just under 11,500 patient pathways waiting longer than the target time for therapies. This was an increase of 4.4% compared to the previous month.
The highest number of diagnostic pathways waiting more than the target time per 100,000 population was in Cwm Taf Morgannwg (2,469) and the highest number of therapies was in Hywel Dda (797). The lowest number of diagnostic pathways waiting more than the target time per 100,000 population was in Betsi Cadwaladr (917) and the lowest number of therapies was in Swansea Bay (51).
Median waiting times had been relatively stable for diagnostic tests since 2017 (2.8 weeks on average) and for therapy services since 2018 (3.6 weeks on average). Median waiting times for both services peaked in 2020 (14.3 weeks for diagnostics and 14.9 weeks for therapies).
In October, the median waiting time for diagnostic tests was 5.6 weeks, compared to 6.3 weeks the previous month. The median waiting time for therapy services was 5.0 weeks, compared to 5.8 weeks in the previous month.
Referral to treatment time
Referral to treatment time statistics show monthly data on waiting times for both open and closed pathways following a referral by a GP or other medical practitioner to hospital for treatment in the NHS. Open pathways are those that remain on the waiting list for treatment, whereas closed pathways are those taken off the waiting list.
Activity is measured by patient pathways, which differs to the number of patients. More information on this difference is available in the Welsh Government’s Chief Statisticians blog.
Also published is newly collected management information for the number of individual patients on treatment waiting lists in Wales.
Performance
Targets
- No patients waiting longer than two years in most specialities by March 2023, and no patients waiting longer than one year in most specialities by Spring 2025 (new targets established in the planned care recovery plan).
- 95% of patients waiting less than 26 weeks from referral.
- No patients waiting more than 36 weeks for treatment from referral.
Figure 16: Patient pathways waiting to start treatment, October 2018 to October 2023
Description of Figure 16: Line chart showing that since the coronavirus pandemic the number waiting has increased significantly. The number of patient pathways waiting longer than one year and two years both saw a rise due to the coronavirus pandemic, but numbers are now falling.
Source: Referral to treatment times, Digital Health and Care Wales
Figure 17: Patient pathways waiting to start treatment, per 100,000 population, by Local Health Board, October 2023 (total waiting) [Note 1]
Description of Figure 17: Bar chart showing that, adjusted by population, Aneurin Bevan has the fewest pathways waiting to start treatment and Cardiff and Vale has the most.
Source: Referral to treatment times, Digital Health and Care Wales
[Note 1]: Powys Teaching health board is excluded from this figure because there are significant differences in the number and type of services provided in Powys compared with other Local Health Boards. Data for Powys is made available in the previous StatsWales link.
Figure 18: Patient pathways waiting to start treatment, per 100,000 population, by Local Health Board, October 2023 [Note 1]
Description of Figure 18: Bar charts showing that, adjusted by population, Swansea Bay has the fewest pathways waiting more than one year, Aneurin Bevan has the fewest pathways waiting more than two years. Cwm Taf Morgannwg has the most pathways waiting longer than one year and Betsi Cadwaladr has the most pathways waiting longer than two years.
Source: Referral to treatment times, Digital Health and Care Wales
[Note 1]: Powys Teaching health board is excluded from this figure because there are significant differences in the number and type of services provided in Powys compared with other Local Health Boards. Data for Powys is made available in the previous StatsWales link.
In October there were just under764,500 patient pathways waiting to start treatment. This was an increase of just over 3,350 pathways from September, the highest figure on record and 68.4% higher than May 2020.
Headline measures for open pathways across the UK are not comparable. There are large differences in coverage between Wales, Scotland and Northern Ireland statistics, meaning they should not be compared at all. With England, current understanding suggests a broadly comparable number can be produced for Wales by removing some known non-consultant led pathways which are not counted in England. On that basis, there are around 677,000 open pathways on consultant-led pathways in Wales, equivalent to 22 pathways (not patients) for every 100 people. For England, the figure in October was 14 pathways for every 100 people. These comparisons are explored further in this Chief Statistician’s blog.
Of the total 764,500 pathways about 134,500 were waiting more than one year in September. This number was 0.7% higher than last month. Just under25,700 were waiting more than two years. This number continues to decrease each month and is 63.5% lower than the peak in March 2022.
Adjusted by population, Cardiff and Vale had highest number of pathways waiting (27,834 per 100,000). The most waiting more than one year was in Cwm Taf Morgannwg (5,250) and the most waiting more than two years was in Betsi Cadwaladr(1,191). Aneurin Bevan had the lowest numbers waiting overall (22,866). Swansea Bay had the fewest waiting more than one year (3,518) and the fewest waiting more than two years was also in Aneurin Bevan (635).
The planned care recovery plan established a target to eliminate two year waits in most specialties by March 2023. This is assessed on the basis that ‘most’ refers to all specialties excluding seven recognised as exceptionally challenging, with large numbers waiting even prior to the COVID-19 pandemic. These are Dermatology, General Surgery, Ophthalmology, Urology, Gynaecology, Orthopaedics and Ear, Nose and Throat. The target was not met in March, and in October there were still a further 13 specialties with pathways waiting more than two years accounting for 3,200 pathways, a decrease of 100 compared to last month.
The number of patient pathways is not the same as the number of individual patients, because some people have multiple open pathways.
We do not have official statistics on the number of individual patients waiting to start treatment. However, management information suggests that in October, when the National Statistics (above) reported there were just over 764,500 open patient pathways, there were estimated to be about 596,000 individual patients on treatment waiting lists in Wales. This was an increase of around 2,300 from September and is the highest figure on record.
Unlike the National Statistics elsewhere in this release, which have been independently assessed against the Code of Practice for statistics, this estimate is based on management information. Whilst the principles of the Code of Practice have been applied, quality assurance is not to the level of the National Statistics. Work is ongoing to further understand the strengths and limitations of this data and this will be communicated as we learn more. For these reasons there is greater uncertainty around this estimate than with the other figures in this release. However, the level of public interest in understanding the number of patients in addition to the number of patient pathways adds sufficient value to warrant making this available.
Figure 19: Percentage of patient pathways waiting less than 26 weeks, October 2018 to October 2023
Description of Figure 19: Line chart showing that during the coronavirus pandemic the percentage of patient pathways waiting less than 26 weeks decreased sharply, and performance has since stabilized rising slowly between around 50 to 60%.
Source: Referral to treatment times, Digital Health and Care Wales
Figure 20: Percentage of patient pathways waiting less than 26 weeks, per 100,000 population, by Local Health Board, October 2023 [Note 1]
Description of Figure 20: Bar chart showing performance in all Local Health Boards is lower than the target of 95%.
Source: Referral to treatment times, Digital Health and Care Wales
[Note 1]: Powys Teaching health board is excluded from this figure because there are significant differences in the number and type of services provided in Powys compared with other Local Health Boards. Data for Powys is made available in the previous StatsWales link.
Of the just under 764,500 patient pathways waiting to start treatment, by the end of October, 58.6% had been waiting less than 26 weeks. This was 0.6 percentage points higher than the previous month and 23.3 percentage points lower than March 2020. The highest proportion waiting less than 26 weeks was in Swansea Bay health board (62%) and the lowest was in Cwm Taf Morgannwg (53.9%).
Figure 21: Patient pathways waiting more than 36 weeks, by month and weeks waited, October 2018 to October 2023
Description of Figure 21: Line chart showing the number of patient pathways waiting more than 36 weeks, which increased rapidly during the coronavirus pandemic. Throughout 2022 the number increased, though at a slower rate, but it has since fallen and stabilised, though well above pre-pandemic levels.
Source: Referral to treatment times, Digital Health and Care Wales
Percentage of patient pathways waiting to start treatment within target time by month and grouped weeks, on StatsWales
Figure 22: Patient pathways waiting more than 36 weeks, per 100,000 population, by Local Health Board, October 2023 [Note 1]
Description of Figure 22: Bar chart showing the number of patient pathways waiting more than 36 weeks, adjusted by population size, was highest in Cardiff and Vale and lowest in Swansea Bay.
Source: Referral to treatment times, Digital Health and Care Wales
[Note 1]: Powys Teaching health board is excluded from this figure because there are significant differences in the number and type of services provided in Powys compared with other Local Health Boards. Data for Powys is made available in the previous StatsWales link.
In October, just over 231,900 patient pathways had been waiting more than 36 weeks. This represented 30.3% of all patient pathways waiting to start treatment. This was 3,354 (0.4%) higher than in the previous month and high in historical context. The highest number of pathways waiting more than 36 weeks per 100,000 population was in Cardiff and Vale (8,829), and the lowest was in Swansea Bay (6,353).
The median time waiting to start treatment had generally been around 10 weeks pre pandemic between late 2013 and February 2020. This increased during the pandemic and peaked at a record high of 29 weeks in October 2020. In October, the median waiting time was 19.9 weeks, remaining the same as the previous month.
Figure 23: Closed patient pathways, October 2018 to October 2023 [Note 1]
Description of Figure 23: Line chart showing the number of patient pathways closed, which generally fluctuates. After a big decrease in March 2020 due to the coronavirus pandemic, the number of closed pathways has steadily risen to pre-pandemic levels.
Source: Referral to treatment times, Digital Health and Care Wales
Closed patient pathways by month, local health board and weeks waiting, on StatsWales
[Note 1]: Data revised to now include Cwm Taf Morgannwg health board closed pathways. Up to the July 2022 statistical release, the data series was not available for Cwm Tag Morgannwg. More details are available in the quality information.
The number of patient pathways closed in Octoberwas 115,881. This was an average of 5,267 patient pathways closed per working day. This was an increase of 143 patient pathways (or 2.8%) closed per working day from the previous month.
Cancer services
A number of wider measures from the suspected cancer pathway are produced by Digital Health and Care Wales are published alongside this statistical release.
Activity
Figure 24: Closed suspected cancer pathways in the month, by month and outcome, October 2020 to October 2023 [Note 1]
Description of Figure 24: Line chart showing the number of patient pathways informed they do not have cancer, which fluctuates but generally showing an upwards trend, and the number of patient pathways starting their first definitive treatment, which has been relatively stable since recording began.
Source: Suspected Cancer Pathway, Digital Health and Care Wales (DHCW)
Suspected cancer pathway (closed pathways), on StatsWales
[Note 1]: New suspected cancer pathway data collection was introduced in December 2020.
In October 1,987 pathways where the patient was newly diagnosed with cancer started their first definitive treatment in the month. This was an increase of 16.5% compared to the previous month and the second highest figure on record.
14,889 pathways were closed following the patient being informed they did not have cancer. This is an increase of 6.4% compared to the previous month and the highest figure on record.
In October, 16,535 patient pathways were opened in the month following a new suspicion of cancer. This was an increase of 583 (3.7%) on the previous month and an increase of 6.3% compared to October 2022. In recent years the number of new pathways opened has been changeable from month to month, with no discernible trend.
Performance
Target
- At least 75% of patients should start treatment within 62 days (without suspensions) of first being suspected of cancer. Data published for time periods before December 2020 are not subject to the target.
- The planned care recovery plan established a new target of 80%, to be reached by 2026.
Figure 25: Percentage of pathways where the patient started their first definitive treatment within the target time, October 2020 to October 2023 [Note 1]
Description of Figure 25: Line chart showing the percentage of patient pathways that started their first definitive treatment within 62 days of first being suspected of cancer and the 75% performance target. Performance fluctuates, but there is a general downwards trend in recent years.
Source: Suspected Cancer Pathway, Digital Health and Care Wales (DHCW)
Suspected cancer pathway (closed pathways), on StatsWales
[Note 1]: New suspected cancer pathway data collection was introduced in December 2020, with a performance target of 75%. The planned care recovery plan established a new target of 80%, to be reached by 2026.
Figure 26: Percentage of pathways where the patient started their first definitive treatment within the target time, by Local Health Board, October 2023 [Note 1]
Description of Figure 26: Bar chart showing performance in all Local Health Boards was below the target level of 75%.
Source: Suspected Cancer Pathway, Digital Health and Care Wales (DHCW)
Suspected cancer pathway (closed pathways), on StatsWales
[Note 1]: Powys Teaching health board is excluded from this analysis because there are significant differences in the number and type of services provided in Powys compared with other Local Health Boards. Data for Powys are available on StatsWales.
In October, 56.2% (1,117 out of 1,987) of pathways started their first definitive treatment within 62 days of first being suspected of cancer. This was 3.3 percentage points higher than the previous month and 2.2 percentage points higher than October 2022.
The highest proportion of pathways starting their first definitive treatment within 62 days was in Cardiff and Vale (64.7%) and the lowest was in Hywel Dda (49.8%).
Quality and methodology information
All quality and methodology information in relation to this statistical release can be found in the NHS activity and performance summary: quality report
Well-being of Future Generations Act (WFG)
The Well-being of Future Generations Act 2015 is about improving the social, economic, environmental and cultural wellbeing of Wales. The Act puts in place seven wellbeing goals for Wales. These are for a more equal, prosperous, resilient, healthier and globally responsible Wales, with cohesive communities and a vibrant culture and thriving Welsh language. Under section (10)(1) of the Act, the Welsh Ministers must (a) publish indicators (“national indicators”) that must be applied for the purpose of measuring progress towards the achievement of the wellbeing goals, and (b) lay a copy of the national indicators before Senedd Cymru. Under section 10(8) of the Well-being of Future Generations Act, where the Welsh Ministers revise the national indicators, they must as soon as reasonably practicable (a) publish the indicators as revised and (b) lay a copy of them before the Senedd. These national indicators were laid before the Senedd in 2021. The indicators laid on 14 December 2021 replace the set laid on 16 March 2016.
Information on the indicators, along with narratives for each of the wellbeing goals and associated technical information is available in the Wellbeing of Wales report.
Further information on the Well-being of Future Generations (Wales) Act 2015.
The statistics included in this release could also provide supporting narrative to the national indicators and be used by public services boards in relation to their local wellbeing assessments and local wellbeing plans.
We want your feedback
We welcome any feedback on any aspect of these statistics which can be provided by email to stats.healthinfo@gov.wales.
Next update
18 January 2024
