NHS waiting times remain one of the biggest challenges in Wales, testing the Welsh Government’s ability to meet its own targets. This article looks at what has improved, where progress has stalled, and why backlogs persist from the start of the Senedd term to now.
Where things stood at the start of the Senedd term: the Covid-19 legacy
At the start of the Sixth Senedd in May 2021, NHS Wales was still managing the significant impacts of the Covid-19 pandemic. Hospital activity and ventilator use were declining, but pressures remained in admissions and critical care. Elective procedures had been suspended or significantly reduced during successive waves of Covid-19, resulting in a large backlog of patients waiting for planned treatment, diagnostic tests, or outpatient appointments. Audit Wales described the backlog as “one of the biggest challenges facing the NHS in Wales.”
By April 2022, when the Welsh Government launched its Planned Care Recovery Plan, there were over 707,000 patient pathways waiting for treatment. This included more than 68,000 patient pathways with waits exceeding two years. It’s important to note that ‘patient pathways’ refer to treatments, not individuals —many patients are waiting for multiple procedures, so pathways exceed the number of people affected. This distinction is key when comparing waiting list figures across the UK, as different nations report data differently.
The Planned Care Recovery Plan
The Welsh Government acknowledged the scale of the challenge while expressing cautious optimism. Its £1bn backed Planned Care Recovery Plan set out five key targets:
- By the end of 2022: no one should be waiting longer than a year for their first outpatient appointment.
- By March 2023: no one should be waiting longer than two years for treatment in most specialities.
- By Spring 2024: no one should wait longer than 8 weeks for diagnostic tests and 14 weeks for therapies.
- By Spring 2025: no one should wait longer than a year for treatment in most specialities.
- By 2026: 80% of cancer patients should begin treatment within 62 days of suspicion, with an interim target of 70% by March 2023.
Ministers described these goals ambitious but achievable, supported by additional funding, investment in diagnostic hubs, expanded surgical capacity, and regional treatment centres. The Welsh Government expected measurable progress within the Senedd term, stating “we can and will turn this around”.
What has happened since: overall waiting list trends
Despite these efforts, the total waiting list in Wales has continued to grow since 2022. By May 2025, patient pathways had risen to just over 796,700, falling slightly to 794,500 in June 2025. Provisional data for July indicate around 796,000 patient pathways waiting, including 156,500 waiting more than one year and 8,000 waiting over two years (though these figures are provisional and may change when the official July data are released in September).
In practical terms, roughly one in four people in Wales is waiting for NHS treatment—a record proportion and higher than at any point before the pandemic. This backlog reflects the balance between demand and capacity: while NHS Wales has treated record numbers of patients in some months, demand continues to outpace throughput.
Performance Against Targets
The Senedd’s Health and Social Care Committee has been monitoring performance through termly NHS Waiting Times Monitoring Reports, published regularly since October 2022. Taken together, these reports show that the Welsh Government has not met any of its recovery targets:
- One-year outpatient waits: The target was to eliminate waits longer than one year for a first outpatient appointment by the end of 2022. Yet in June 2025, nearly 73,000 patient pathways were still waiting over a year.
- Two-year waits for treatment: The target was to eliminate two-year waits by March 2023. By June 2025, more than 7,400 patient pathways still had waits of over two years.
- One-year waits for treatment: The target was to eliminate one-year waits by Spring 2025. In June 2025, 157,000 patient pathways experienced waits of more than one year.
- Diagnostics and therapies: The target was for no one to wait longer than eight weeks for diagnostic tests and 14 weeks for therapies by Spring 2024. In June 2025, more than 40,400 patient pathways were waiting longer than 8 weeks for diagnostics, and nearly 4,000 were waiting longer than 14 weeks for therapies.
- Cancer pathway: The target is for 80% of cancer patients to begin treatment within 62 days of suspicion by 2026, with an interim target of 70% by March 2023. The interim target was not met, and performance has since worsened. In June 2025, just 60.2% of patients began treatment within 62 days — far short of both the interim and ultimate targets.
Why Progress Has Been Limited: system pressures
While scrutinising the Welsh Government on NHS waiting times, the Health and Social Care Committee has identified several factors, highlighted by the Welsh Government, Health Boards, and other health and social care stakeholders, that have constrained progress:
- Workforce capacity: Recruitment and retention remain major challenges across specialties. Staffing shortages limit the ability to expand capacity, and much of the investment has gone into stabilising the system, rather than increasing service provision. Additionally, it takes time to train new staff.
- Demand growth: Population ageing, rising chronic disease, and post-pandemic surges in referrals have pushed demand above anticipated levels, so that the inflow to the waiting list has outpaced the outflow. Paradoxically, even as NHS Wales treats more people than ever, the total waiting list continues to grow because new patients are joining faster than they are being treated.
- Infrastructure constraints: Diagnostic and surgical hubs have taken time to establish, and capital funding has been stretched.
- Winter pressures: Recurrent winter pressures and flu/Covid waves in 2022–24 repeatedly diverted capacity away from planned care. Each winter, capacity has been diverted to urgent and emergency care, meaning the backlog grows again.
- System inefficiencies: Differences in performance across health boards, and ongoing reliance on outdated IT and estates, have slowed progress.
The Welsh Government notes that structural differences, including higher baseline illness in Wales, partially explain challenges.
Comparisons with NHS England are complicated by differences in reporting: Wales counts patient pathways (so one patient may appear multiple times), while England reports individual patients. NHS England also has a larger workforce, more hospitals, and greater use of independent sector capacity to outsource NHS-funded treatments, which contributes to more visible reductions in long waits.
Opposition parties argue that the failure to meet recovery targets demonstrates systemic underperformance and weak accountability. Polling consistently shows that the NHS remains the top concern for Welsh voters.
Where things stand as the term ends: patient impact
Long waits can delay diagnosis, prolong pain or disability, worsen conditions, and increase anxiety. For some patients, delayed treatment may lead to poorer health outcomes and more complex interventions later. Cancer patients are particularly vulnerable to delays.
The knock-on effect also impacts other parts of the NHS. Patients waiting for treatment often rely more on primary care, emergency services or social care, compounding wider system pressures.
Progress and outlook
While two-year waits have reduced from 68,000 in 2022 to around 7,400 in mid-2025- a clear improvement – the overall list size and the one-in-four statistic remain politically and publicly salient.
The Welsh Government has pointed to progress in stabilising the waiting list, reducing the longest waits, and ongoing investment in workforce training and structural reforms. However, with less than a year until the next Senedd election, there remains a significant challenge if waiting times are to reach the levels originally promised.
Article by Sarah Hatherley, Senedd Research, Welsh Parliament
