Delays to treatment

Delays to treatment of patients are due to a combination of too few staff, too few beds, and a lack of equipment. The overarching reason for a delay to a patient’s treatment is the chronic underfunding of the NHS over the 14 years of the Conservative government. This has left the NHS with record waiting lists for elective surgery, mental health services, and non-hospital based routine procedures, plus long delays in A&E, and long waits to see a GP.

Performance still bad

The end of the Conservative's period in government saw the NHS with its highest waiting lists. In October 2023, NHS England reported the worst performance on record. The NHS England statistics showed the numbers in the queue for elective treatment had topped 7.75 million - with 8,998 waiting longer than 18 months for treatment.

Within this there was a large and growing number of children waiting for hospital treatment; the number has risen to a record high of 423,500. Of those, 23,396 have been forced to wait over a year for their appointment.

The waiting list covers elective surgery and hospital services. In August 2022, the HSJ revealed that there is also a hidden one million-strong additional waiting list for even more poorly-resourced community health services, among them:

75,000 children waiting to access community paediatric services, “including children needing help with developmental delay, long-term health conditions and additional needs”;
74,300 young people waiting for speech and language therapy.
321,000 adults waiting for musculoskeletal services, mostly physiotherapy;
And 120,000 waiting for podiatry.

The elective care waiting list started to fall in August 2024. In February 2025, the waiting list stood at just over 7.4 million, consisting of around 6.2 million individual patients waiting for treatment in England, some of whom needed more than one procedure. Around 3.02 million of these patients have been waiting over 18 weeks and approximately 194,000 of these patients have been waiting over a year for treatment – a decrease from around 199,000 the previous month. The waiting list is 2.83 million higher than in February 2020, however.

In January 2025, the Labour government published its Elective Reform Plan in an effort to tackle the waiting list inherited by the government so that the NHS once again meets the 18 week standard for planned treatment.

The Elective Reform Plan sets out a whole system approach to hitting the 18-week referral to treatment target by the end of this Parliament. This includes expanded use of Community Diagnostic Centres and increasing the number of surgical hubs.

The government aims to deliver 2 million extra appointments in its first year, equivalent to 40,000 every week.

In April 2025, Wes Streeting was accused of jumping the gun by claiming a flagship elective programme has been “busting through the backlog at twice the speed”.

The scheme being referred to is run by the national Getting It Right First Time (GIRFT) programme and seeks to improve the efficiency of elective care, especially outpatient services. Twenty trusts, known as the FF20, are involved in putting the GIRFT ideas into action. Wes Streeting declared that waiting lists fell “130% faster in areas where the government scheme is in action than the national average” over the four months between October 2024 and January 2025.

However, the authors of the first detailed study of Further Faster scheme, have concluded that “it is too early to draw firm conclusions” about its success, and warn “plans for roll out of such schemes must be based on robust evidence that they work”. Report author Charles Tallack told HSJ that although the 130% claim was correct, there was very little difference in the size of the absolute reduction in waiting lists.

A&E waits

The statistic that makes the headlines more than any other is the wait in A&E: there is a national target that no more than 5% of people should wait more than four hours in A&E. Over the years of Conservative government the percentage of patients that have had to wait longer than 4 hours rose steadily. In September 2023, 28% of people attending A&E spent more than four hours from arrival to admission, transfer or discharge.

More recently, in March 2025, a quarter (25%) of all patients waited longer than 4 hours in A&E, and over 46,000 patients waited more 12 hours for a hospital bed.

Source: Nuffield Trust, March 2025

Waits over 4 hours after the decision to admit reached 133,957 in March 2025; in March 2019 the figure was 59,510 waits.

Source: Nuffield Trust, March 2025

Waiting a long time to be seen in emergency departments is costing lives.

In January 2025, the Office for National Statistics (ONS) published a study that found that for patients who spent 12 hours or more in the department, the risk of post-discharge death was 2.1 times higher than those who spent two hours or less.

For those who spent nine hours in A&E, mortality was 1.9 times higher and 1.6 times for those who spent six hours, and 1.1 times for three hour stays.

The ONS also found the biggest differences in risk of post discharge death after 12 hours in A&E, compared with two hour stays, were among younger people (for patients aged 20 years, for example, the risk of death at 12 hours was 4.6 times higher than at two hours) those in London (2.7 times higher), those who attended A&E with eye problems (7.9 times higher), and those who were not admitted to hospital (2.8 times higher).

In December 2024, the government abandoned a pledge that the NHS would hit the four A&E targets, in favour of focussing the NHS on recovering its elective care performance. NHS England recently advised trusts to focus on keeping patients attending emergency care “safe” while they waited.

In November 2023, HSJ conducted an analysis of the data on long waits in A&E departments and concluded that they have caused around 30,000 ‘excess deaths’ 2022-23, up from 22,175 in 2021-22, and 9,783 related deaths in 2020-21.

The data suggests the rate of excess deaths from 2022-23 continued into 2023-24.

The analysis used a methodology in a peer-reviewed study published in the Emergency Medicine Journal, which found delays to hospital admission for patients of more than five hours from time of arrival at A&E were associated with an increase in all-cause mortality within 30 days.

A paper published in the BMJ in April 2021 found that the risk of death in the month following A&E attendance was 16% higher for those who waited over 12 hours than those seen within four. Based on this paper and additional data, John Burn-Murdoch's analysis in the FT in August 2022 concluded that the collapse of emergency healthcare in England may be costing 500 lives every week due to excess waiting times. For June 2022, Burn-Murdoch's analysis found 2000 excess deaths associated with waiting so long for urgent care or admission.

Successive warnings were given, but ignored, and in August 2022, Emergency medicine consultants were once again warning that NHS England’s latest A&E performance figures mean “we are seeing the sharp demise of the health service.”

The delays was largely due to lack of beds, which in turn has been worsened by delays in discharging people who no longer need hospital care due to the lack of social care and community health services.

A Royal College of Emergency Medicine (RCEM) statement noted that these figures are merely the tip of the iceberg of delays in A&E since the numbers waiting over 12 hours from time of arrival in A&E is many times higher. The RCEM noted that in a sample of hospitals in 2021 it was calculated that these delays were 14 times higher than the official recorded 12-hour waits.

It is therefore likely that the 30,000 figure recorded in July 2022 translates into more than 400,000 patients across England waiting more than 12 hours on trolleys in July from arrival in an Emergency Department to being given a bed on a ward.

Also bear in mind that the figures for delays does not include the additional delays due to ambulances queuing for many hours outside A&E departments to hand over “emergency” patients, and the thousands more who suffer falls or heart attacks and wind up waiting hours on end for ambulances to arrive.

Ambulances miss targets

In December 2023, coroners wrote damning warnings to the government over persistent crises in the NHS after multiple inquests into patient deaths following ambulance delays and insufficient mental health beds.

Three coroners sent prevention of future deaths (PFD) reports to the then Conservative health secretary Victoria Atkins in the wake of six deaths.

One PFD report covered three deaths linked to ambulance delays affecting the South West Ambulance Service (SWASFT), with an eight-hour wait for an ambulance in one case and a 13-hour wait in another even though an ambulance would normally have been expected to arrive within 20 minutes.

Over the winter of 2024/2025 the ambulance trusts struggled to meet response time targets. In November 2024, category 2 performance, which relates to serious but non-life-threatening emergency calls, averaged around an hour across England at some points and ambulance response times for incidents including elderly people falling rose to the highest level in two years in November.

Data for March 2025 shows that delays to ambulances are still occurring, but there has been an improvement with ambulance services hitting a crucial “interim” target for responding to the bulk of emergency calls with marked improvements for the most serious category of incidents.

Six out of 10 English ambulance trusts beat the 30-minute measure in March 2025, with the North East and South Central even coming close to the NHS constitution’s long-standing 18-minute target for category 2, both at about 21 minutes.

Source: Nuffield Trust, March 2025

Behind these figures for ambulance delays are some truly harrowing stories of long waits. In August 2022, BBC Radio Cornwall published photos of a shelter that was built to protect an 87 year old man following a fall. He had to wait 15 hours for an ambulance with seven broken ribs, two fractures to his pelvis and an arm wound.

A Guardian investigation in November 2023 analysed data from NHS England that found that in 2022 almost 8,000 people were harmed and 112 died as a direct result of enduring long waits for an ambulance or surgery.

The fatalities included a man who died of a cardiac arrest after waiting 18 minutes for his 999 call to be answered by the ambulance service and was dead by the time the crew arrived.

They show that patient deaths arising directly from care delays have risen more than fivefold over the last three years, from 21 in 2019 to 112 in 2022. The number of people who came to “severe harm” has also jumped from 96 to 152 during that period.

In November 2024 an elderly lady spent 5 hours on a pavement after falling and breaking her hip waiting for an ambulance.

Mental health - long delays for therapy

Although the prevalence of mental health disorders has risen, increases in investment and capacity in services has not kept pace. Recent data released in April 2025 from the CQC’s annual survey of more than 14,000 people who accessed community mental health service found no improvement in services from the previous year, with people waiting too long for care and a lack of care for those in crisis.

A third of people (33%) waited 3 months or more for their first treatment and 4 in 10 people said they did not receive any support while they waited. The issue with long waits and a lack of support is that patients' get more unwell while waiting, making treatment and recovery processes more difficult and possibly lasting longer.

In the CQC survey 42% of people said their mental health deteriorated while waiting for care. While this is a slight reduction from last year (44% in 2023), this still means nearly half of people reported becoming more unwell while waiting for care. And people who waited longer were more likely to report that their mental health got worse (71% for those who waited more than 6 months).

The CQC noted that this annual survey highlighted persistent gaps in care including people struggling to access care, not feeling involved in their care, and not receiving support when they needed it.

Those accessing Older People’s Mental Health Services (OPMHS), for people aged 65 and older, generally reported more positive experiences. Nearly three quarters (73%) said they always felt listened to by NHS staff. However, almost half (48%) of those accessing OPMHS were not asked if they needed help in accessing care and this figure showed no improvement from the previous year (49% in 2023).

Child and Adolescent Mental Health Services (CAMHS) have been struggling with underfunding and under-capacity for many years. And in the recent survey more young people using CAMHS reported needing support in accessing care than last year (30% in 2024 compared with 22% in 2023). However, the number of young people using CAMHS who reported getting help for their physical needs dropped from last year (26% reported definitely getting support compared with 32% in 2023).

This year a third (33%) of people accessing CAMHS didn’t know who to contact in a crisis; which is a slight decrease from last year (38%). It is very concerning that more than a third (36%) of young people who did access crisis care said they didn’t get the help they needed and in more than a third (36%) of instances no support was given to their family or carers during the crisis. Nevertheless, the majority (87%) of young people using CAMHS felt involved, to some extent, in their care planning.

Three quarters (77%) of all respondents weren’t signposted to help or advice with cost of living, even though this can be a significant driver of mental health issues. More generally, how people accessed care really affected their experiences. Whilst 1 in 10 (10%) reported that they weren’t treated with dignity and respect, people who accessed care on the phone reported a worse experience in accessing services, getting the appropriate support, and having a choice about how their care would be delivered. Workforce issues remain an issue with the vacancy rate across the mental health sector being 9.9%, with over 10,000 empty mental health nursing posts.

The disparity between patients with mental health disorders and physical issues was highlighted in February 2025, by the charity Rethink. It analysed NHS data and found that in December 2024, 16,522 people were still waiting for mental health treatment after 18 months, compared to 2,059 people facing the same delay for elective physical health treatments, such as dermatology, ophthalmology and orthopaedic care. The charity highlights that in recent years "the data has continuously painted a stark picture suggesting those facing the longest waits for mental health care are now waiting nearly two years (658 days), more than twice as long as those needing elective physical health treatment (299 days)."

The charity noted that "despite the government’s commitment to tackling long waits through its Plan for Change – which includes a target for 92% of patients to start treatment within eighteen weeks – this plan does not currently include any commitment to tackling waits for mental health services."

Long waits for care and a lack of government commitment to tackling them and improving mental health services has been the situation for many years.

Back in 2023, data from NHS England analysed by HSJ analysis showed more than 24,000 children and young people waiting almost two years to be seen. With 19,000 adults with a serious mental illness waiting for longer than 18 months for a second contact with community mental health services.

In total, almost 240,000 children and young people were waiting for treatment from community mental health services in August 2023, as well as more than 192,000 adults.

Data released in August 2022 show that the service failed to meet its goal of getting 1.6 million patients into “talking therapy” services, also called IAPT, which are aimed at treating people with mild to moderate depression. Only 1.2 million started sessions last year.

Other targets not met include, access and recovery rates for black and minority ethnic patients in the past year in IAPT and providing services to psychosis patients that meet quality standards.

The waiting list for mental health services was estimated to be 1.8 million in 2023, but in reality much higher as the 1.8 million figure does not include those waiting for inpatient care and other services. In late 2021, the official waiting list stood at 1.6 million people and NHS Providers estimated that there are around eight million people in England that are denied access to mental health services because they do not have severe enough symptoms to get put onto a waiting list.

The eight million figure is based on the known prevalence of mental health conditions and the thresholds dictating who gets access to treatment; NHS England considers it an accurate figure for the number of people who are missing out on care because services are not adequate. So the true figure of people waiting for mental health services is around 10 million.

There are long delays for children needing mental health treatment and support, including the rising number requiring specialist treatment for eating disorders. In August 2022, NHS England published its quarterly data on children and young people with an eating disorder waiting times for the first quarter 2022-23. The findings show that of the 230 children and young people currently on the waiting list for urgent treatment, 44% have been waiting for more than 12 weeks.

An analysis of mothers waiting for mental health care published in September 2023 found a sharp increase in waiting times, with one woman found to have waited 319 days for a first appointment.

Amid rising demand for perinatal mental health services, during the period from August 2022 to March 2023 the numbers of women waiting rose by 40%. Over that same period, the numbers who accessed support also rose, but only by 8%.

In December 2021, the Independent revealed waits for a mental health bed were increasing in London, with 50 patients a week waiting more than 12 hours for a bed, compared with 35 during the same period in 2020. However, sources told the paper that the true length of A&E waits are often hidden, with many waits measured in days. One senior director in London, speaking anonymously with The Independent, said they’d seen a child wait 60 hours for a bed earlier this month, while another emergency care doctor said patients in their A&E were waiting for 18 hours.

Targets missed for cancer treatment

In August 2023, Nuffield Trust's performance tracker found 37% of patients who had their first treatment for cancer following an urgent GP referral waited longer than two months. Although this was the best performance seen since March 2023 it is still very far away from the target of only 15% of patients waiting this long.

The number of patients who waited longer than two months from an urgent GP referral to a first treatment for cancer was 5,940 in August 2023. When the 15% threshold target was last met in December 2015, only 1,704 patients waited more than two months for their first cancer treatment.

The most recent official cancer waiting time figures show how performance has failed to improve over the year.

In August 2022, Figures leaked to the HSJ and shared with BBC’s Newsnight team showed almost a third of a million people (327,000) are on cancer waiting lists in England, almost 40,000 of them waiting for treatment to begin more than 62 days after a GP referral.

Worse still numbers waiting over 104 days have more than doubled in a year, to more than 10,000: in 2018, NHSE said there should be “zero tolerance [of] non-clinically justifiable 104-day delays”.

The BBC report quotes Prof Pat Price from Imperial College London warning that:

“The waits for cancer treatment are the worst they’ve ever been – and they’re getting worse. We have to get on and address this crisis. This is an absolute disaster.”

It has been eight years since services for patients with suspected breast cancer met the target of ensuring 93% receive appointments within two weeks. One month waits for treatment have not been on target since the summer of 2018, and the proportion within target has continued falling despite reduced numbers of patients.

It’s even worse with the 62-day (two month) target, which has not been met since early 2014.

Figures leaked to the HSJ in August 2022 show 10,189 of the 327,395 people on the national cancer waiting list, about 3%, had waited 104 days or more, around double the figure from a year ago, with a further 28,406 having waited between 62 and 103 days as of the end of July.

Delays in primary care inevitable

The Covid pandemic had a massive effect on primary care. GPs were issued instructions to avoid face-to-face in the early months of the pandemic in 2020 and adopt ‘total triage’.

However, despite this instruction, GPs faced a backlash for reducing face-to-face contacts during the pandemic.

Following the relaxation of rules around GP appointments, GPs have worked hard to prove they are available. And in April 2022 the average waiting time for a non-urgent, face-to-face appointment was 10 days, according to Pulse’s latest GP survey, quicker than before the Covid pandemic. From 2016-2019, the average wait for a non-urgent face-to-face appointment stood at 13-15 days. The average waiting time for a remote, non-urgent appointment meanwhile stands at eight days.

GPs say that this is because there is a greater drive to deal with patients on the day, and triage has enabled practices to be able to use remote consultations or see other healthcare staff where appropriate, which allows for shorter waiting times for patients who need face-to-face appointments.

The latest data released in March 2025 showed that 44.2% of GP appointments in March 2025 took place on the same day that they were booked and 30.7% took place over 8 days later (although this delay might be what is wanted, such as regular check-ups).

However, there is a severe shortage of GPs and there is considerable uncertainty over how long GPs will be able to maintain or even improve on these figures for waiting time. See Staffing Shortages.