Intended for healthcare professionals

Feature Data Briefing

Waiting times compared across the four UK nations

BMJ 2019; 367 doi: (Published 07 November 2019) Cite this as: BMJ 2019;367:l6237
  1. John Appleby, director of research and chief economist
  1. Nuffield Trust, London, UK
  1. john.appleby{at}

Northern Ireland’s target for elective referrals is furthest from being met, finds John Appleby

It can be easy to forget quite how many NHS patients used to wait a long time for hospital care. At the turn of the century more than 48 000 patients in England were still waiting longer than a year to be admitted as an inpatient, and more than 132 000 were still waiting after six months for their first outpatient appointment.1

This June, however, just over 1000 patients had been waiting longer than a year across all outpatient and inpatient pathways in England.2 And much progress has been made in reducing waiting times in other areas: diagnostics, emergency care, and cancer services, for example. The tactics used in the English NHS to try to reduce waiting times—more resources, management and political influence, and in particular targets to which it is held to account3—have largely been mirrored in the other parts of the UK.

All four countries have struggled

Over the past few years all four countries have struggled to maintain previous reductions as more patients wait longer. Despite similar approaches to reducing waiting times, however, they’ve seen big differences.

As at March this year about one in 13 people (4.8 million) in Scotland and England were on an elective waiting list. In Wales the figure was one in seven (about 440 000). But in Northern Ireland the figure was about one in every five (about 390 000) (fig 1).

Fig 1
Fig 1

Proportion of population on waiting list for elective care in March 2019

Waits for some patients in Northern Ireland can be extremely long. At the Western Health and Social Care Trust, for example, patients with an orthopaedic upper limb problem face a potential maximum wait of nearly five and a half years for their first outpatient appointment.4 They then have the prospect of a further four or more years if they need to be admitted for surgery.

Variation in waiting times is reflected in the targets each country has set itself for elective care: by necessity, the worse the waiting times, the less ambitious the target. England and Scotland currently have the toughest targets for elective waiting times in terms of the maximum wait (18 weeks from referral to treatment) and the proportion of patients to which this applies (92% and 90%, respectively).

Targets in Wales and Northern Ireland, with a higher proportion of people on waiting lists, are less stringent. Northern Ireland’s elective care targets are markedly less ambitious than in the rest of the UK, with an aim by next March that 50% of outpatients should wait less than nine weeks and 55% of inpatients should wait less than 13 weeks. In England, in June this year more than 72% of patients waited less than 13 weeks across outpatient and inpatient lists. It’s also notable that no country is currently meeting their targets in aggregate (fig 2).

Fig 2
Fig 2

Proportions of elective care patients meeting waiting time targets

Four hours in A&E

Although elective care targets vary across the UK (and also over time within countries), targets set for waiting times in accident and emergency departments are largely similar, with all four countries including a maximum wait of four hours for 95% of patients. Apart from a handful of months when the target was met in Scotland, since 2015 no country has achieved the maximum four hour wait target, and Wales and Northern Ireland have not met their targets since 2012. Currently, about a third of A&E patients in Northern Ireland wait longer than four hours, and over a fifth do so in Wales (fig 3).

Fig 3
Fig 3

Proportion of A&E patients waiting more than four hours

Demand for secondary care in Northern Ireland is not so markedly higher than in the rest of the UK that it can explain the large differences in waiting times. The setting of a target on its own may do little to tackle long waiting times: whether targets are a good tactic depends on the system’s ability to meet them.5 In turn this depends on basic factors such as money, management, commitment, organisational strategies at the front line, and the productivity of the system in converting its budget into activity. It is the variable mix of all these factors that explains not only the worsening performance all countries have experienced in recent years, but also the persistent differences between them.


  • Data sources for figures: figs 1 and 2—NHS England,2 Department of Health for Northern Ireland,67 National Services Scotland,8 Statistics for Wales9; fig 3—NHS England,10 Department of Health for Northern Ireland,11 National Services Scotland,12 StatsWales13

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Competing interests: I have read and understood the BMJ policy on declaration of interests and have no relevant interests to declare.


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