NHS activity and performance summary: February and March 2023
Report summarising data on activity and performance in the Welsh NHS for February and March 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 these measurements of performance 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 is also available in more detail on our StatsWales website.
Main points
In March, 78,383 calls were made to the 111 helpline service, an increase of over 10,000 calls compared to the previous month. Of these, about 61,750 calls were answered (79%). There were also over 388,000 hits on the NHS 111 Wales website and around 13,700 completed symptom checks (NHS 111 Wales).
In March there were 4,003 red (life threatening) calls to the ambulance service, 11.5% of all calls. An average of 129 immediately life-threatening calls were made each day, 3 fewer than in February.
47.5% of red calls received an emergency response within eight minutes. This was 3.5 percentage points lower than in February, 3.6 percentage points lower than in March 2022 and the second lowest on record. Data for red calls are only comparable from May 2019 onwards.
There was an average of 2,879 daily attendances to emergency departments, an increase compared to the previous month. Performance worsened slightly against the four hour and twelve hour targets. The average (median) time spent in emergency departments was similar in March 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 February the number fell, from around 734,000 to around 731,000, a fifth consecutive decrease following consistent increases from April 2020. 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.
New management information suggests that in February, when there were about 731,000 open patient pathways, there were about 574,000 individual patients on treatment waiting lists in Wales. This was the fifth consecutive monthly fall, a decrease of almost 1,700 patients from January.
The proportion of patient pathways waiting less than 26 weeks increased to 56.9% in February. This has been relatively stable for some time after falling significantly from the levels pre-pandemic. The number of pathways waiting longer than 36 weeks decreased for the sixth consecutive month in February, to just over 237,600, the lowest since June 2021 but remaining high in historical context.
About 37,500 pathways were waiting more than two years, 47% lower than the peak and falling for almost a year after a consistent increase throughout 2021. The average (median) time patient pathways had been waiting for treatment at the end of February decreased on the previous month to 20.8 weeks.
The number of pathways waiting longer than one year for their first outpatient appointment decreased to around 63,000. The planned care recovery target has not been met, despite a reduction of 39% from the peak reached in August 2022.
For diagnostic services, the number of patient pathways waiting increased slightly to about 113,600 in February. The number of patient pathways waiting longer than eight weeks (the target maximum wait) decreased to just under 43,000, in February.
For therapies, the number of patient pathways waiting increased to just over 59,000 in February and remains high in historical context. The number waiting longer than fourteen weeks (the target maximum wait) decreased to just over 7,600, falling for almost a year after a consistent increase throughout 2021.
For cancer services, fewer people started their first definitive treatment in February (1,572) than the previous month. The number of pathways closed following the patient being informed they did not have cancer decreased from the previous month to 12,724. Performance increased against the 62 day target in February to 52.5% compared to 50.1% the previous month, which was the lowest on record.
Unscheduled care
New data relating to unscheduled care are provided for the month of March 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.
In March, a total of 78,383 calls were made to the 111 helpline service, an increase of over 10,000 calls compared to the previous month. Of these, about 61,750 (79%) calls were answered by the 111 service in Wales, an average of almost 2,000 calls per day.
An estimated 16,635 (21%) calls were ended by the caller before being answered. Of these, 5,262 were ended within 60 seconds of the automated messages, suggesting their needs were likely to have been met.
Over 11,300 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. This number has fallen back to levels of prior months after a peak in December 2022.
Of the calls answered, 1,199 calls indicated that they wished to conduct the call in Welsh.
There were over 388,000 hits on the NHS 111 Wales website and almost 13,750 completed symptom checks (NHS 111 Wales) in March.
More data is published on StatsWales.
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.
Activity
Figure 1: Average daily emergency ambulance calls, by call type and month, March 2018 to March 2023 [Note 1]
Description of Figure 1: A line chart showing the number of emergency calls received by the Welsh Ambulance Services NHS Trust fell during the COVID-19 pandemic but has since returned to a pre covid level.
Source: Welsh Ambulance Services NHS Trust (WAST)
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 March, almost 35,000 emergency calls were made to the ambulance service. This was an average of 1,127 calls per day, an increase of 74 (7.0%) calls on average per day compared with the previous month, but 130 (10.3%) fewer per day than the same month last year.
Calls to the ambulance service are categorised as red (immediately life-threatening), amber (serious but not life-threatening) or green (non-urgent). An average of 129 red calls were made per day in March, 3 fewer compared with the previous month but still the seventh highest number of daily red calls on record.
In March, the proportion of all calls that were immediately life-threatening was 11.5%, down from 12.5% in February but remaining high in historical context.
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 2: Percentage of red calls which received an emergency response at the scene within 8 minutes, March 2018 to March 2023 [Note 1]
Description of Figure 2: A line chart showing that performance for emergency response calls improved during the initial coronavirus period but has otherwise trended downwards over the long term.
Source: Welsh Ambulance Services NHS Trust (WAST)
[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 March, 47.5% of emergency responses to immediately life threatening (red) calls arrived within 8 minutes of patient location and chief complaint being established. This was 3.5 percentage points lower than the previous month and 3.6 percentage points lower than in March 2022 and the second lowest on record. In recent years the proportion of red calls responded to within 8 minutes has fallen fairly consistently. It is important to note that over the same period there has been a significant increase in the volume of red calls received. In 2022 around 70% more red calls were received than in 2020 and 2019.
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 March, the average (median) response time to immediately life-threatening ‘red’ calls was 8 minutes 24 seconds. This was 30 seconds slower than previous month and 34 seconds slower than March 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 March, the median response time for amber calls was 1 hour 41 minutes and 57 seconds. This was over 41 minutes slower than in February, but over 2 minutes faster than in March 2022.
Emergency department attendances and admissions to hospital
A wider range of emergency department performance statistics are published on the National Collaborative Commissioning Unit (NCCU) website, as management information.
Activity
Figure 3: Average attendances in NHS Wales accident and emergency departments, and admissions to hospital resulting from attendances at major emergency departments per day, March 2018 to March 2023 [Note 1]
Description of Figure 3: 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 due to the COVID-19 pandemic.
Source: Emergency department data set (EDDS), Digital Health and Care Wales (DHCW)
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 March there were about 89,300 attendances to all emergency departments. This was an average of 2,879 emergency department attendances per day; 99 attendances more per day on average than in the previous month and 15 more than March 2022.
In March, over 15,000 patients were admitted to the same or a different hospital following attendance at a major emergency department. This was 11.1% higher than the previous month and 7.3% 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 4: Percentage of patients admitted, transferred or discharged within 4 hours at NHS emergency departments, March 2018 to March 2023
Description of Figure 4: 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 not recovered to pre-pandemic levels.
Source: Emergency department data set (EDDS), Digital Health and Care Wales (DHCW)
Performance against 4 hour target by hospital on StatsWales
In March, 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 2.1 percentage points lower than the previous month, remaining low in historical context.
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 March, the median waiting time was 2 hours and 41 minutes, 4 minutes slower 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 March, children (aged 0 to 4) spent an average of 2 hours and 11 minutes. Adults aged 85 and over spent an average of 5 hours and 44 minutes in emergency departments.
Figure 5: Patients waiting more than 12 hours to be admitted, transferred or discharged at NHS emergency departments February 2018 to February 2023
Description of Figure 5: 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 but has otherwise trended upwards over the long term.
Source: Emergency department data set (EDDS), Digital Health and Care Wales (DHCW)
Performance against the 12 hour target by hospital on StatsWales
In March 10,045 patients waited 12 hours or more. This was 1991 (24.7%) more than in the previous month.
Scheduled care activity
New data relating to unscheduled care are provided for the month of February 2023.
Outpatient referrals and appointments
Activity
Figure 6: Average daily referrals for first outpatient appointment, February 2018 to February 2023
Description of Figure 6: 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 (DHCW)
Referrals by local health board and month on StatsWales
An average of 4,203 referrals for first outpatient appointments were made per day in February 2023. This is an increase of 8.0% (311 more referrals per day on average) compared to January 2022 and 13.8% compared to February 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 7: Pathways waiting more than a year for their first appointment, February 2018 to February 2023
Description of Figure 7: A line chart showing the number of patient pathways waiting longer than a year, which rapidly increased during the coronavirus pandemic but has been coming down in recent months.
Source: Referral to treatment times (RTT), Digital Health and Care Wales (DHCW)
COVID-19 recovery plan, ambitions for referral to treatment waiting times on StatsWales
In February, the number of pathways waiting longer than one year for their first outpatient appointment decreased by 6.8% compared to the previous month to around 63,000, the sixth consecutive monthly fall.
The planned care recovery plan target has not been met, though has fallen by 39% from the peak reached in August 2022.
Diagnostic and therapy waiting times
Activity
Figure 8: Patient pathways waiting for diagnostic and therapy services, February 2018 to February 2023 [Note 1]
Description of Figure 8: A line chart showing a long term upward trend in patients 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 been increasing throughout of 2021, but reached a plateau in recent month.
Source: Diagnostic and Therapy Services (DATS), Digital Health and Care Wales (DHCW)
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.
In February there were around 113,600 patient pathways waiting for diagnostics, an increase of 0.9% compared with the previous month. There were just over 59,000 patient pathways waiting for therapies, an increase of 0.8% compared to the previous month, remaining high in historical context.
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 9: Patient pathways waiting over the target time for diagnostic and therapy services, February 2018 to February 2023 [Note 1]
Description of Figure 9: Line chart showing a big increase in patients waiting longer than 8 weeks for diagnostic services at the start of the coronavirus pandemic. the number of patient pathways waiting has fallen throughout 2020 but has been fluctuating since. The number of patient pathways waiting longer than 14 weeks for therapy services peaked in June 2020 and March 2022, but has been falling since, but neither are close to pre-pandemic levels.
Source: Diagnostic and Therapy Services (DATS), Digital Health and Care Wales (DHCW)
Diagnostic and Therapy Services Waiting Times by week on StatsWales
[Note 1]: Betsi Cadwaladr did not submit data for April 2020, so are not included in the Wales figures for this month.
At the end of February, just under 43,000 patient pathways were waiting longer than the target time for diagnostics. This was a decrease of 10.2% compared to the previous month.
At the end of February there were just over 7,600 patient pathways waiting longer than the target time for therapies. This was a decrease of 4.3% compared to the previous month and a 47.9% fall from the peak in March 2022.
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 February, the median waiting time for diagnostic tests was 5.2 weeks, compared to 6.3 weeks in the previous month. The median waiting time for therapy services was 4.4 weeks, compared to 5.2 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 10: Pathways waiting to start treatment, February 2018 to February 2023
Description of Figure 10: Line chart showing that since the coronavirus pandemic the number waiting has increased significantly but has recently started to fall. The number of patients 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 (RTT), Digital Health and Care Wales (DHCW)
In February there were about 731,000 patient pathways waiting to start treatment. This was the fifth consecutive monthly fall, down 0.4% from over 734,000 in January, high in historical context and 57.8% higher than February 2020. Headline waiting lists statistics are not directly comparable across the four nations of the UK. Waiting lists statistics are not directly comparable across the four nations of the UK (Chief Statistician's blog).
Over 146,700 pathways were waiting more than one year in February. This number has fallen for the sixth consecutive month, after being relatively stable since spring 2021. About 37,500 pathways were waiting more than two years, 47% lower than the peak in March 2022 and falling since.
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, newly collected management information suggests that in February, when the National Statistics (above) reported there were about 731,000 open patient pathways, there were estimated to be about 573,900 individual patients on treatment waiting lists in Wales. This was the fifth consecutive monthly fall, a decrease of almost 1,700 patients from January 2023.
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 newly collected 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 11: Percentage of patient pathways waiting less than 26 weeks, by month and weeks waited, February 2018 to February 2023
Description of Figure 11: Line chart showing that during the coronavirus pandemic the percentage of patients waiting less than 26 weeks decreased sharply, and performance has since stabilized between 50 to 60%.
Source: Referral to treatment times (RTT), Digital Health and Care Wales (DHCW)
Of the about 731,000 patient pathways waiting to start treatment, by the end of February, 56.9% had been waiting less than 26 weeks. This was 1.1 percentage points higher than in the previous month but 27.4 percentage points lower than February 2020.
Figure 12: Patient pathways waiting more than 36 weeks, by month and weeks waited, February 2018 to February 2023
Description of Figure 12: 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 been coming down since mid-2022.
Source: Referral to treatment times (RTT), Digital Health and Care Wales (DHCW)
In February, about 237,000 patient pathways had been waiting more than 36 weeks. This represented 32.4% of all patient pathways waiting to start treatment. This was 7,612 (or 3.1%) fewer than in the previous month, high in historical context, but the lowest since June 2021.
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 February, the median waiting time was 20.8 weeks, which was a decrease from 21.4 weeks in the previous month.
Figure 13: Closed patient pathways, February 2018 to February 2023 [Note 1]
Description of Figure 13: 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 (RTT), Digital Health and Care Wales (DHCW)
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 January was 102,334. This was an average of 5,117 patient pathways closed per working day. This was a decrease of 12 patient pathways (or 0.2%) closed per working day from the previous month.
Cancer services
These statistics were previously labelled as experimental (ONS). Following a review of methods, we removed the experimental label in November 2022, and the Office for Statistics Regulation (OSR) has subsequently agreed that the statistics meet the standards required for designation as National Statistics (OSR).
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 14: Closed suspected cancer pathways in the month, by month and outcome, February 2018 to February 2023 [Note 1]
Description of Figure 14: Line chart showing the number of patients informed they do not have cancer, which fluctuates but generally showing an upwards trend, and the number of patients starting their first definitive treatment, which has been 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 February 1,572 pathways where the patient was newly diagnosed with cancer started their first definitive treatment in the month. This was a decrease of 10.7% compared to the previous month.
12,724 pathways were closed following the patient being informed they did not have cancer. This is a decrease of 5.2% compared to the previous month.
In February, 14,786 patient pathways were opened in the month following a new suspicion of cancer. This was a decrease of 1,117 (7.0%) on the previous month but an increase of 8.0% compared to February 2022.
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 15: Percentage of pathways where the patient started their first definitive treatment within the target time, February 2018 to February 2023 [Note 1]
Description of Figure 15: Line chart showing the percentage of patients that started their first definitive treatment within 62 days of first being suspected of cancer and the 80% 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%. This target was updated to 80% in April 2022 as part of the planned care recovery plan.
In February, 52.5% (825 out of 1,572) of pathways started their first definitive treatment within 62 days of first being suspected of cancer. This was 2.4 percentage points higher than the previous month, which was the lowest on record, but 8.0 percentage points lower than February 2022 and low in historical context.
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 May 2023
