NHS Activity and Performance Summary: August and September 2025
Report summarising data on activity and performance in the Welsh NHS for August and September 2025.
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In this page
Introduction
A monthly summary of NHS Wales activity and performance. Long term trends are explored in our annual reports, Trends in NHS urgent and emergency care activity and Trends in NHS planned care activity.
Data are provided by Digital Health and Care Wales (DHCW) and Welsh Ambulance Services University NHS Trust (WAST). Data for each topic area are also available in more detail on StatsWales.
Main points
Emergency services (September)
On 1 July a new ambulance response model was implemented, and two new response categories were introduced to replace the previous Red category. The new categories are Purple: Arrest, for cardiac and respiratory arrests, and Red: Emergency, for major trauma and other incidents where patients are at significant risk of cardiac or respiratory arrest if they do not receive a rapid response.
In September there were 771 purple calls to the ambulance service, around 2.3% of all calls, and 4,443 red calls, around 13.1% of all calls.
For patients in cardiac arrest for whom resuscitation was attempted, 23.7% had a return of spontaneous circulation (ROSC) at the time of arrival to hospital.
The median response times for purple and red calls were 7 minutes 15 seconds and 8 minutes 36 seconds respectively.
In September there were just under 93,900 attendances to all emergency departments, an average of 3,129 attendances per day; this was 10 attendances more per day on average than in the previous month.
Performance against the four-hour target worsened while performance against the twelve-hour target improved compared with the previous month.
The average time spent in emergency departments was more than the previous month at 2 hours and 47 minutes.
Treatment waiting lists (August)
There were just under 790,600 referral to treatment (RTT) patient pathways waiting to start treatment, a decrease of around 2,500 since July. 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 chief statistician’s blog.
Management information suggests there were about 613,700 individual patients on treatment waiting lists.
The proportion of pathways waiting less than 26 weeks decreased to 55.9% in August. The number of pathways waiting longer than 36 weeks increased to just over 266,700.
Just over 8,700 pathways were waiting more than two years, 87.6% lower than the peak but an increase of 698 (8.7%) from the previous month. The average time patients had been waiting for treatment at the end of August was 0.6 weeks longer than the previous month at 21.7 weeks.
Provisional data for September indicate a decrease in total pathways waiting and a decrease in pathways waiting more than two years.
There were just over 71,700 pathways waiting longer than one year for their first outpatient appointment, a decrease from the previous month, and 30.2% less than the peak in August 2022.
Diagnostics and therapies (August)
Diagnostics patient pathways waiting decreased to just under 123,400 in August. The number waiting longer than eight weeks (the target maximum wait) increased to just under 46,700.
For therapies, pathways waiting decreased to just over 58,100 and the number waiting longer than fourteen weeks (the target maximum wait) increased to just over 4,800.
Cancer services (August)
1,828 people started their first definitive treatment in August, 473 fewer than the previous month. The number of patients informed they did not have cancer decreased to 13,524. Performance improved against the 62 day target in August, increasing to 61.8%.
Ambulance calls
Until July 2025, 999 ambulance calls were categorised as red (immediately life-threatening), amber (serious but not life-threatening) or green (non-urgent).
On 1 July a new response model was implemented, and two new response categories were introduced to replace the previous red category. The new categories are purple: Arrest, for cardiac and respiratory arrests, and red: Emergency, for major trauma and other incidents where patients are at significant risk of cardiac or respiratory arrest if they do not receive a rapid response.
Non purple or red calls are currently still managed as amber or green, however work is ongoing to establish new categories reflecting the different types of less urgent calls. These will be added to the performance framework later.
Data up to June 2025 based on the previous response model will remain available on StatsWales, however they are not comparable with the new measures. A wider range of quality indicators will be published by the NHS Wales Joint Commissioning Committee. This Chief Statistician’s update provides more information on the background to the new ambulance performance measures.
| Call category | Measure [Note 2] | July 2025 | August 2025 | September 2025 |
|---|---|---|---|---|
| Purple: cardiac and respiratory arrest | Number of calls | 814 | 802 | 771 |
| Return Of Spontaneous Circulation (ROSC) rate | 21.4% | 27.4% | 23.7% | |
| Average (median) time to identify cardiac arrest | 2:21 minutes | 2:24 minutes | 2:09 minutes | |
| Average (median) time to commence CPR instruction | 4:06 minutes | 4:17 minutes | 4:05 minutes | |
| Average (median) time for defibrillator arrival | 5:35 minutes | 4:36 minutes | 4:57 minutes | |
| Average (median) response time (ambulance or other resource). Target 6-8 minutes. | 7:35 minutes | 7:15 minutes | 7:15 minutes | |
| 90th percentile response time (ambulance or other resource). Target within 20 minutes. | 17:47 minutes | 17:49 minutes | 16:35 minutes | |
| Red: emergency (e.g. major trauma or patient at risk of cardiac or respiratory arrest | Number of calls | 4,449 | 4,380 | 4,443 |
| Average (median) response time (ambulance or other resource). Target 6-8 minutes. | 8:47 minutes | 9:15 minutes | 8:36 minutes | |
| 90th percentile response time (ambulance or other resource). Target within 20 minutes. | 20:45 minutes | 22:20 minutes | 21:54 minutes |
Description of figure 1: ambulance performance measures for the new purple and red response categories in July, August, and September.
Source: Welsh Ambulance Services University NHS Trust
[Note 1]: The new model was implemented at around 10am on 1 July 2025. As such, a small number of incidents, those occurring between 12am and 10am on 1 July, are not covered in these data.
[Note 2]: Detailed definitions for the measures are provided in the accompanying quality report.
Ambulance activity and performance measures, on StatsWales
In September, 771 purple calls were received by the Welsh ambulance service (around 2.3% of all calls) and 4,443 red calls were received (around 13.1% of all calls).
For patients in cardiac arrest for whom resuscitation was attempted, 23.7% had a return of spontaneous circulation (ROSC) at the time of arrival to hospital.
The median response time for purple calls was 7 minutes 15 seconds and the 90th percentile (the point at which 90% of responses were quicker and 10% were slower) was 16 minutes 35 seconds.
For red calls, the median and 90th percentile response times were 8 minutes 36 seconds and 21 minutes 54 seconds respectively.
For both purple and red calls the median and 90th percentile response time targets are 6-8 minutes and 20 minutes respectively.
Figures are also provided for the median times to identify cardiac arrest, to commence instructions to begin CPR and for a defibrillator to arrive. Clinical outcome measures for red calls may be developed as part of future work.
Emergency departments
Activity
Figure 2: average attendances in emergency departments, and admissions to hospital resulting from attendances at major emergency departments per day, by month [Note 1]
Description of figure 2: a line chart showing a generally increasing trend in attendances to emergency departments.
Source: Emergency department data set, DHCW
Emergency departments: attendances by age and sex, April 2016 onwards, 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 September there were just under 93,900 attendances to all emergency departments, an average of 3,129 attendances per day; this was 10 attendances more per day on average than in the previous month.
Just under 15,500 patients were admitted to hospital following attendance at major emergency departments. This was 1.8% higher than the previous month.
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 3: percentage of patients admitted, transferred or discharged within 4 hours at emergency departments, by month
Description of figure 3: a line chart showing the percentage of patients admitted, transferred or discharged within 4 hours at emergency departments has been relatively stable in recent years, between 60 and 70%.
Source: Emergency department data set, DHCW
In September, 65.5% of patients spent less than 4 hours in emergency departments from arrival until admission, transfer or discharge. This was lower than the previous month and remains relatively low by historical standards.
The median waiting time was 2 hours and 47 minutes, up 2 minutes from the previous month. Waiting times vary by age, time of day and day of the week, with further detail available in the Trends in NHS urgent and emergency care activity report.
Figure 4: patients waiting more than 12 hours to be admitted, transferred or discharged at NHS emergency departments, by month
Description of figure 4: a line chart showing the number of patients waiting longer than 12 hours to be admitted, transferred or discharged at emergency departments has been relatively stable recently, at around 10,000 patients.
Source: Emergency department data set, DHCW
In September, 10,208 patients waited 12 hours or more. This was 229 (2.2%) fewer than in the previous month.
Outpatient appointments
Activity
Figure 5: average daily referrals for first outpatient appointment, by month
Description of figure 5: a line chart showing outpatient referrals, which has been fluctuating with an upwards trend.
Source: Outpatient Referral Dataset, DHCW
Outpatient referrals, April 2012 onwards, on StatsWales
An average of 4,138 referrals for first outpatient appointments were made per day in August. This is a decrease of 18.5% (942 fewer referrals per day on average) compared to July.
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 6: pathways waiting more than a year for their first appointment, by month
Description of figure 6: a line chart showing a changeable trend in the number of patient pathways waiting longer than a year.
Source: Referral to treatment times, DHCW
In August, the number of pathways waiting longer than one year for their first outpatient appointment decreased by 2.0% compared to the previous month to just over 71,700.
Diagnostics and therapies
Activity
Figure 7: patient pathways waiting for diagnostic and therapy services, by month [Note 1]
Description of figure 7: a line chart showing generally upward trends in pathways waiting for diagnostic and therapy services.
Source: Diagnostic and therapy services waiting times, DHCW
Therapy services: pathway waiting times, grouped weeks waiting, October 2009 onwards, on StatsWales
[Note 1]: From April 2024 audiology and weight management pathways were no longer reported in the therapies data.
In August there were just under 123,400 patient pathways waiting for diagnostics, a decrease of 0.2% compared with the previous month.
In August there were just over 58,100 patient pathways waiting for therapies, a decrease of 1.5% compared with 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 8: patient pathways waiting over the target time for diagnostic and therapy services, by month [Note 1]
Description of figure 8: a line chart showing a fluctuating trend in diagnostics pathways waiting longer than 8 weeks and a recent downward trend in therapies pathways waiting longer than 14 weeks.
Source: Diagnostic and therapy services waiting times, DHCW
Therapy services: pathway waiting times, grouped weeks waiting, October 2009 onwards, on StatsWales
[Note 1]: From April 2024 audiology and weight management pathways were no longer reported in the therapies data, meaning they are not directly comparable with data up to March 2024.
In August, just under 46,700 pathways were waiting longer than the target time for diagnostics, an increase of 10.6% compared to July, and the highest figure since January 2024.
There were just over 4,800 therapies pathways waiting longer than the target time, an increase of 11.1%.
The median waiting time for diagnostic tests was 5.7 weeks, 0.7 weeks longer than in July, and for therapy services it was 4.8 weeks, 0.6 weeks longer than in July.
Referral to treatment waiting times
Referral to treatment statistics cover open and closed pathways following referral by a GP or other medical practitioner to hospital for treatment. Open pathways are those that remain on the waiting list for treatment, whereas closed pathways are those removed.
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 statistician’s blog.
Performance
Targets
- No patients waiting longer than two years in most specialties by March 2023, and no patients waiting longer than one year in most specialties by Spring 2025 (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 9: patient pathways waiting to start treatment, by month [Note 1]
Description of figure 9: a line chart showing a long term upward trend in pathways waiting. The number waiting longer than one year is changeable and two year waits have fallen over the last few years.
Source: Referral to treatment times, DHCW
[Note 1]: Figures in the shaded area for the most recent month in this chart are provisional and are subject to change. The official data series ends in the previous month.
In August there were just under 790,600 patient pathways waiting to start treatment, a decrease from July (793,100). Just under 156,200 pathways were waiting more than one year in August, a similar figure to last month. Just over 8,700 were waiting more than two years, 8.7% higher than last month but more than three quarters (87.6%) lower than the peak in March 2022.
These official statistics are published with a lag of around seven weeks from the end of the reference period. However, given the interest in referral to treatment (RTT) waiting lists and the Welsh Government’s commitment to reducing the longest waits, there is public value in making data on this topic available earlier. We are therefore providing provisional estimates for the month ahead.
Provisional data indicate there were around 775,700 total pathways waiting at the end of September, of which 142,200 were waiting more than one year and 6,500 were waiting more than two years. These provisional estimates are subject to change before the official figures for September are released in November.
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, 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 712,300 open pathways on consultant-led pathways in Wales, equivalent to 23 pathways for every 100 people. For England, the figure in August was 13 pathways for every 100 people. These comparisons are explored further in this Chief Statistician’s blog.
The number of patient pathways is not the same as the number of individual patients, because some people have multiple open pathways. Management information suggests there were around 613,700 individual patients on treatment waiting lists in Wales. Estimates for the number of individual patients waiting to start treatment by health board can be found in the NHS waiting lists: estimate of unique patients dataset on StatsWales.
Figure 10: percentage of patient pathways waiting less than 26 weeks, by month
Description of figure 10: a line chart showing the percentage of patient pathways waiting less than 26 weeks has been between 50% and 60% in recent years.
Source: Referral to treatment times, DHCW
Of the just under 790,600 patient pathways waiting to start treatment, by the end of August, 55.9% had been waiting less than 26 weeks. This was lower than the previous month.
Figure 11: patient pathways waiting more than 36 weeks, by month
Description of figure 11: a line chart showing the number of pathways waiting more than 36 weeks has fluctuated in recent years.
Source: Referral to treatment times, DHCW
In August, just over 266,700 patient pathways had been waiting more than 36 weeks. This was around 1,100 higher than in the previous month and represents 33.7% of all pathways waiting to start treatment.
The median time waiting to start treatment in August was 21.7 weeks, 0.6 weeks longer than the previous month.
Figure 12: closed patient pathways, by month
Description of figure 12: a line chart showing an upward trend in the number of patient pathways closed.
Source: Referral to treatment times, DHCW
NHS waiting lists: closed referral to treatment pathways, September 2011 onwards
The number of patient pathways closed in August was just over 110,000, an average of 5,500 per working day. This was anincrease of 36 patient pathways (or 0.7%) closed per working day from the previous month.
Hospital discharge delays
Hospital discharge delays occur when patients who are clinically ready for discharge cannot leave hospital because the necessary ongoing care and support or suitable accommodation is not yet accessible. The figures represent the number of adults who were ready to return home or move on to the next stage of care, that experienced a delay in their transfer of more than 48 hours. The data are a snapshot of delays on a given day each month, meaning they do not tell us the total number of delays over the month.
Figure 13: pathway of care delays, by month
Description of figure 13: a line chart showing the number of delays has seen a downward trend over the last year.
Source: Pathway of Care Delays, DHCW
Delayed hospital discharges: total pathway of care delays and total days delayed, on StatsWales
In September there were just under 1,400 pathway of care delays on the day the data were collected, similar to the figure in August.
Cancer services
Activity
Figure 14: closed suspected cancer pathways in the month, by month and outcome
Description of figure 14: a line chart showing the number of patient pathways informed they do not have cancer, which fluctuates, and the number starting their first definitive treatment, which is relatively stable.
Source: Suspected Cancer Pathway, DHCW
In August, 1,828 pathways started cancer treatment, 473 fewer than in July. 13,524 pathways were closed after patients were informed they did not have cancer, a decrease of 14.3%. There were 15,446 new suspected cancer pathways, a decrease of 3,759 (19.6%) from July. In recent years the number of new pathways opened has been relatively stable.
Performance
Target
At least 75% of patients should start treatment within 62 days (without suspensions) of first being suspected of cancer.
Figure 15: percentage of pathways where the patient started their first definitive treatment within the target time, by month
Description of figure 15: a line chart showing the percentage of patients starting treatment within 62 days of a suspicion of cancer has generally fluctuated between 50% and 65% in recent years, with a slight upward trend.
Source: Suspected Cancer Pathway, DHCW
In August, 61.8% of pathways started their first definitive treatment within 62 days of first being suspected of cancer. This was 0.8 percentage points higher than the previous month.
Focus on local health boards
Local health board performance is covered in the quarterly release NHS performance for Welsh local health boards. For the months this is not produced, summary analyses will be provided in this section.
A range of new ambulance performance metrics were introduced in July 2025. Health board figures are published on StatsWales. However, it is not possible to summarise these in the format of the key measures for the other topics as below.
Of the measures covered in this report; all health boards except Betsi Cadwaladr and Cardiff and Vale have either no pathways waiting longer than two years or less than 1%; Powys currently has less than 1% pathways waiting longer than one year; Swansea Bay and Powys currently have no one-year waits for a first outpatient appointment, while Hywel Dda has less than 1%; Swansea Bay has no therapies pathways waiting over 14 weeks and Cwm Taf Morgannwg has less than 1%.
In emergency departments, Aneurin Bevan had the best 4-hour performance (76.7%) and Betsi Cadwaladr had the worst (56.6%). Cardiff and Vale had the best 12-hour performance (6.7%) and Betsi Cadwaladr had the worst (18.8%).
Betsi Cadwaladr had the highest proportion of RTT pathways waiting longer than one and two years in August (26.0% and 2.7%). Powys had the lowest proportion over one year (less than 1%) and Swansea Bay and Powys both had no pathways waiting longer than two years.
For first outpatient waits over one year, Betsi Cadwaladr had the highest at 26.3% of pathways, while Swansea Bay and Powys both had none.
Cardiff and Vale has the highest proportion of diagnostic breaches over 8 weeks (56.6%) and Aneurin Bevan has the lowest (11.3%).
For therapies, Hywel Dda has the highest proportion over 14 weeks (26.4%), while Swansea Bay and Cwm Taf Morgannwg have the lowest (less than 1%).
For cancer services, Cardiff and Vale had the highest proportion of patients starting treatment within 62 days (68.4%), and Betsi Cadwaladr the lowest (56.5%).
More detailed data is available on StatsWales: Health and Social Care.
Figure 16: local health board performance summary, August and September 2025 [Note 1]
Description of figure 16: a series of charts showing comparative performance for the health boards for selected measures across emergency and planned care in Wales. The key points are summarised in the narrative section above.
Source: Wales Ambulance Services NHS Trust, DHCW
Health and Social Care statistics, on StatsWales
[Note 1]: The percentage axes of these charts are on different scales and care should be taken when looking at the size of differences between health boards.
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
Official statistics status
All official statistics should show the standards of the Code of Practice for Statistic (UK Statistics Authority).
These are accredited official statistics. They were independently reviewed by the Office for Statistics Regulation (OSR) in July 2012. They comply with the standards of trustworthiness, quality, and value in the Code of Practice for Statistics.
It is Welsh Government’s responsibility to maintain compliance with the standards expected of accreditation. If we become concerned about whether these statistics are still meeting the appropriate standards, we will discuss any concerns with OSR promptly. Accreditation can be cancelled or suspended at any point when the highest standards are not maintained, and reinstated when standards are restored.
Accredited official statistics (OSR) are called National Statistics in the Statistics and Registration Service Act 2007.
Statement of compliance with the Code of Practice for Statistics
Our statistical practice is regulated by the OSR OSR sets the standards of trustworthiness, quality and value in the Code of Practice for Statistics that all producers of official statistics should adhere to.
All of our statistics are produced and published in accordance with a number of statements and protocols to enhance trustworthiness, quality and value. These are set out in the Welsh Government’s Statement of Compliance.
These accredited official statistics demonstrate the standards expected around trustworthiness, quality and public value in the following ways.
Trustworthiness
These statistics are compiled from a range of sources derived from administrative data systems in use across the NHS in Wales. Data on the 111 service, 999 ambulance calls and ambulance response times are provided by the Wales Ambulance Services University NHS Trust (WAST), and all other data sources are collected by the Welsh Local Health Boards and provided to Digital Health and Care Wales (DHCW) to enable them to be collated at a national level.
The data collections are overseen by the Welsh Information Standards Board (WISB), which is the custodian of the Information Standards Assurance Process. WISB mandates data collections through the NHS and Local Heath Boards, appraises information standards and provides assurance on matters related to confidentiality and consent.
The published figures are compiled by professional analysts using the latest available data and applying methods using their professional judgement and analytical skillset.
These statistics are pre-announced on the Statistics and Research area of the Welsh Government website. Access to the data during processing is restricted to those involved in the production of the statistics, quality assurance and for operational purposes. Pre-release access is restricted to eligible recipients in line with the Code of Practice (UK Statistics Authority).
Quality
Statistics published by Welsh Government adhere to the Statistical Quality Management Strategy which supplements the Quality pillar of the Code of Practice for Statistics and the European Statistical System principles of quality for statistical outputs.
Data standards and definitions are established by the WISB. Guidance is issued to the data providing organisations and training provided to staff responsible for collecting the data at source. DHCW collates and validates health board level data and queries anomalous and missing data directly with the health boards. Before validated datasets are provided by DHCW to Welsh Government, all data are signed off by health boards. DHCW provides validated datasets to Welsh Government, where analysts process the data to produce the aggregate statistics in the format required for publication. Welsh Government undertakes final validation checks which can be queried with DHCW and the health boards before publication. The statistical release is signed off by senior statisticians before publication.
Value
The purposes of this statistical release and the accompanying data published on StatsWales are: to provide evidence for policy development; to inform the media and wider public about activity and performance in the Welsh NHS; to enable service providers such as Local Health Boards and WAST to monitor their own performance.
Reliable statistics on the volume of activity undertaken in the NHS, the size of waiting lists, ambulance response times and emergency department and cancer waiting times are vital to inform users about the state of NHS services and the performance of the Welsh government and the Local Health Boards. These services have a significant impact on citizens’ lives and these topics feature prominently in media coverage and political discourse.
The information published here also supports the Welsh Government’s long term plan for health and social care: A Healthier Wales.
The timeliness of the data provides the most recent update using reliable data.
You are welcome to contact us directly with any comments about how we meet these standards. Alternatively, you can contact OSR by emailing regulation@statistics.gov.uk or via the OSR website.
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 well-being 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 well-being assessments and local well-being plans.
Next update
20 November 2025
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.
