These reports are available on our website and we continue to track health boards’ responses to our recommendations.

This article sets out key themes from our work, and challenges facing the new Welsh Government and the wider NHS. It includes some updated data analysis. Our previous health board reports provide more information about their planned care performance at that time against relevant Welsh Government targets and ambitions.

What is NHS planned care?

Planned care, often called elective care, is non-urgent medical treatment scheduled in advance. This can include outpatient appointments, diagnostic tests, and surgery. It is different to emergency care.

Demand for planned care can exceed NHS capacity, creating a ‘waiting list’.

Before the COVID-19 pandemic patients often waited a long time for treatment. When the pandemic struck, many services stopped and were slow to restart. This resulted in a large increase in long waits.

Questions for the Welsh Government and NHS Wales

Planned care services remain under immense strain. Demand is at record levels and, while the longest waits have fallen, waiting lists remain too high and could take years to recover.

Extra funding has helped, but too much effort is tied up in short term fixes rather than lasting change. The NHS must now move from quick wins to transforming services, so they are more efficient, meet future needs, and deliver value for patients.

We have outlined some questions for the Welsh Government and NHS Wales:

• How can the NHS better plan for the longer term so that services are sustainable – that is, they meet demand, are efficient and affordable, and provide good outcomes?
• Where will funding have the greatest impact, value and outcome for patients?
• How will spending be balanced between investment in population health (one of the key drivers of demand), community services, and hospital services?
• How will the NHS ensure its estate, technology and equipment supports modern planned care services?
• What steps will be taken to tackle waste and inefficiency in planned care services?
• How will success be measured, and in a way that encourages sustainable long-term improvement?
   

Our findings

Despite recent progress there are still too many people waiting, too many long waits, and demand has been growing

Waiting lists were already a problem, but have increased substantially since April 2020

The pandemic led to a big increase in the waiting list. Only very recently has there been a notable reduction in the overall number of waits (Chart 1). The waiting list is still around 50% larger than it was before the pandemic.

Source: Digital Health and Care Wales

From April 2022, health boards substantially reduced their longest waits through large increases in funding and short-term actions

The pandemic led to a sharp rise in long waits for treatment. In April 2022, the Welsh Government launched its programme for transforming and modernising planned care and reducing waiting lists in Wales. It set a target to eliminate two-year waits by March 2023, then extended it to March 2024.

NHS Wales did not meet the original or updated target but has substantially reduced the longest waits (Chart 2). As of February 2026, just over 4,500 people had been waiting over two-years, down from a peak of around 70,400 in March 2022.

Source: Digital Health and Care Wales

This progress has come at a cost. Between 2022-23 and 2024-25, health boards received an extra £547 million to reduce long waits. While health boards increased in house capacity, they spent much of the funding on expensive short term measures. This included contracts with private providers and ‘waiting list initiatives’ such as scheduling additional orthopaedics surgery over the weekend.

A lot more people are still waiting longer than before the pandemic, with big differences depending on where people live and the treatment they are waiting for

Despite the progress made, long waits remain an issue. Before the pandemic, the target was for all patients to start treatment within 36 weeks. In February 2019, around 13,300 pathway waits exceeded 36 weeks. By February 2026, that number had risen to around 185,000 — about 14 times higher.

Since April 2022, the Welsh Government has been measuring performance using waits of one or two years or more. There are big differences in the number of long waits for planned care across health boards. This is the case, even after considering the size of each health board’s population (Chart 3).

Source: Analysis of Digital Health and Care Wales and Office of National Statistics data

There are also big differences in the numbers of long waits across the different clinical services. As of February 2026, orthopaedics, ophthalmology, and general surgery made up just over half of around 106,000 waits of over one year.

If recent trends continue, planned care referrals could rise substantially

Demand for outpatient appointments has been rising (Chart 4). While not all outpatient appointments lead to diagnostic tests and treatment, they give a good indication of changes in overall planned care demand. Continued growth would put more pressure on already stretched services.

Source: Analysis of Digital Health and Care Wales data

Note: A small number of extra specialties were added to the referral categories between 2022 and 2025. This accounts for around 0.5% of the growth in referral demand shown above.

We found that health boards needed to plan for future demand, be more efficient, and better manage the risk of harm to patients while waiting

Health boards lacked robust plans to address expected long term growth in demand

Health boards have, understandably, focused on the immediate challenge affecting and concerning patients – the large waiting list backlog. Performance measures and scrutiny focus on waiting list targets. But this is driving an overly short-term response.

We found that health boards were not doing enough to forecast longer-term growth in demand. Nor did they have clear plans to create the required capacity or transform services to help meet changing demand or reduce it through prevention.

We have raised these concerns before. For example:

• in 2015, we reported that better planning of demand and capacity was needed;
• in 2020, we highlighted the need for a ‘full and frank review of capacity and the sustainability of the planned care system’; and
• in 2022, we called for a realistic assessment of capacity and a longer-term approach for investing in hospitals to ensure they are fit for the future.

Health boards have been trying to drive efficiency, but the picture is mixed

Health boards have received advice from national experts but must do more to improve productivity. Simpler care pathways, digitalisation, and greater use of community-based care could help make services more efficient and improve patient experience.

Too many outpatient appointments are wasted because patients do not attend. In 2024-25, there were around 207,000 missed face to face appointments (7.4% of all appointments). This is a poor use of expensive NHS resources. We estimated that cutting missed appointments by one fifth could save around £6.7 million a year, based on 2024-25 costs. We have seen a small improvement in 2025-26, but there is still more to do.

Cancelled operations are also a problem. In 2024-25, health boards cancelled almost 18,000 operations at short notice, which is around 350 per week. And they do not always maximise their use of available operating theatres.

Health boards could also do more day-case surgery, which is more efficient than inpatient surgery. At the time of our work in 2025, no health board was meeting the good practice target of 85% of all surgery being day-case surgery. Some remain a long way short (Chart 5).

Source: Digital Health and Care Wales

Support for patients while they wait was inconsistent, with some health boards slow to adopt new Welsh Government policy

We found that health boards had not consistently implemented the Welsh Government’s ‘3Ps’ approach, introduced in August 2023. The approach is about promoting health, preventing decline, and preparing patients for treatment.

Some health boards were slow to respond to these new requirements, and most were not clear about how a patient could escalate a concern if they felt their health was deteriorating. Hywel Dda University Health Board moved more quickly to provide support in line with the 3Ps.

Apart from some ophthalmology services, we found limited evidence of structured approaches to tracking actual harm resulting from long waits.