NHS waiting time targets explained

The table below summarises the main NHS waiting time standards currently in use across England.

These targets are referenced in the NHS Constitution and related operational planning guidance. They apply to NHS-funded care in England, and performance is monitored through regular national reporting. However, while they are commitments the NHS aims to meet, they function as operational standards rather than directly enforceable legal rights. There is no mechanism for a patient to compel treatment within a specific timeframe.

The RTT standard — often referred to as the NHS 18-week rule — states that patients referred by a GP for consultant-led treatment should normally start treatment within 18 weeks of the referral date. This applies to most non-urgent specialist services across hospitals and outpatient clinics.

The 18-week clock begins when the GP sends the referral and continues until treatment starts, the patient is discharged, or the patient declines treatment. Delays can occur at multiple points in the pathway, from triage and first appointment through to diagnostic tests and the start of treatment.

The NHS has specific cancer waiting time targets designed to ensure early diagnosis and prompt treatment. These apply when a patient is referred urgently with suspected cancer by their GP.

Patients urgently referred by their GP with suspected cancer should be seen by a specialist within two weeks of the referral. This is often called a "two-week wait" or "urgent suspected cancer" referral and is one of the most well-known cancer targets from a patient perspective. It represents the first milestone in the cancer pathway and ensures patients are assessed quickly when there is a clinical suspicion of cancer.

Patients referred urgently for suspected cancer should receive a definitive diagnosis — or have cancer ruled out — within 28 days of the referral. This standard was introduced to reduce the uncertainty patients face while waiting for test results and to ensure diagnostic pathways are completed quickly.

Once a decision to treat has been made, patients should start their first treatment within 31 days. This applies to all cancer treatments, including surgery, chemotherapy, and radiotherapy. The target ensures that once a treatment plan is agreed, there is no unnecessary delay in starting care.

Patients who have been urgently referred by their GP through the two-week wait (suspected cancer) pathway should begin treatment within 62 days of the original referral. This target specifically applies to patients on the urgent suspected cancer pathway — not to all GP referrals where cancer happens to be diagnosed later. A patient referred routinely who is subsequently found to have cancer would follow a different treatment pathway. The 62-day target covers the full journey from the initial urgent GP referral through diagnosis to the start of treatment, and is one of the most closely monitored cancer standards.

Together, these cancer waiting time targets aim to reduce delays at every stage of the cancer pathway and ensure patients move from suspicion to treatment as quickly as possible.

The NHS four-hour A&E target states that patients attending an emergency department should normally be:

within four hours of arrival. This A&E target is designed to reduce overcrowding in emergency departments and ensure patients receive timely emergency care. Performance against this standard has been under significant pressure in recent years due to rising demand, capacity constraints, and challenges with patient flow through hospitals.

Alongside the four-hour target, NHS England also monitors additional A&E performance metrics, including the percentage of patients waiting over 12 hours in A&E from arrival. These longer-wait measures provide a fuller picture of emergency department pressures and help identify where patients are experiencing the most significant delays.

The NHS monitors waiting times for diagnostic tests separately from the main RTT pathway. The target is that patients should usually wait no longer than six weeks for key diagnostic investigations, including:

Delays in diagnostic testing can affect how quickly treatment decisions are made, as many conditions require test results before a treatment plan can be agreed. Diagnostic delays can also extend the overall RTT pathway.

NHS ambulance services in England operate under a set of national response time targets, categorised by the severity of the call:

Actual ambulance response times vary by region and demand. These targets have been under pressure in recent years, with response times in some areas exceeding the national standards, particularly for Category 2 and Category 3 calls.

Mental health services use different access targets from the standard RTT pathway. Key standards include:

Patients should start treatment within:

Treatment should begin within two weeks of referral for patients experiencing a first episode of psychosis.

Waiting times for mental health services vary significantly across England. For some services, patients can self-refer directly without needing a GP appointment, which may offer a faster route to support.

Waiting times for Children and Young People's Mental Health Services (CYPMHS, formerly known as CAMHS) are also a significant concern. Unlike adult talking therapies, there is no single national waiting time target for CYPMHS in the same way. Waiting times vary widely across England, and in some areas children and young people can wait many months before being seen. Parents and carers should contact their local CYPMHS service or GP for current timescales in their area.

The diagram below illustrates the typical stages of an NHS referral-to-treatment pathway. Waiting times can occur at several points along this journey.

The 18-week RTT target covers the full journey from GP referral to the start of treatment. Other targets — such as cancer and diagnostic standards — apply to specific stages within this pathway.

NHS England publishes monthly performance data showing how hospitals and trusts are performing against national waiting time standards. Hospitals report their waiting time statistics regularly, and this data is used to track performance, identify pressure points, and allocate resources.

Performance data is published publicly and covers RTT waiting lists, cancer pathway completion rates, A&E attendance and wait times, and diagnostic test volumes. This transparency helps patients, clinicians, and policymakers understand where the system is under the most pressure.

Patients can access NHS performance statistics directly through the NHS England website, where monthly data is published for individual hospitals and trusts. This can be useful for checking how your local hospital or trust is performing against the main waiting time standards, and for comparing performance across providers in your area.

Demand for NHS services has increased significantly in recent years. Millions of patients are currently waiting for treatment across England, and a substantial proportion have been waiting longer than the relevant target timescales.

Factors contributing to extended waiting times include increased referral volumes, workforce shortages — particularly in specialist and consultant roles — the post-pandemic backlog, and limited capacity in certain regions or for specific conditions. These pressures affect performance across most major NHS targets, from RTT and cancer pathways to A&E and diagnostics.

If your waiting time is approaching or exceeding the relevant NHS target, there are practical steps you can take at different stages:

Contact the hospital or clinic managing your referral to confirm your position on the waiting list and check there are no issues with the referral itself. Referrals can occasionally be lost, misdirected, or require additional information before being processed.

Formally raise this with the provider managing your care and ask for an updated timeline. You can reference the relevant NHS waiting time standard and ask whether any steps can be taken to expedite your appointment or treatment.

Escalate through the Patient Advice and Liaison Service (PALS) at your hospital or contact your local Integrated Care Board (ICB) to raise concerns. PALS can help resolve issues informally, while the ICB is responsible for commissioning services and ensuring targets are met.

Ask your GP about alternative providers that may have shorter waits, explore Right to Choose options which allow patients in England to select their provider for a first outpatient appointment, or consider private care if appropriate and affordable.

This guide draws on publicly available NHS information.

Sources referenced include: