May 2025

This month’s data release highlights the ongoing high demand across the secondary care sector, alongside record levels of activity being delivered by trusts, with progress being made toward meeting performance targets.

Green shoots of improvement

Despite ongoing pressures, NHS trusts have shown notable improvements in key performance areas. In cancer care, targets for the 28-day faster diagnosis standard and the 62-day treatment pathway were met. A&E performance also improved, marking the strongest April in four years, although it still fell short of national targets. Ambulance services demonstrated further progress, with category 2 response times meeting the 30-minute national recovery target for the second consecutive month. Category 1 response times were the fastest recorded since May 2021, though they remained above the seven-minute standard. 

Demand and activity 

Demand across the NHS remains exceptionally high. In urgent and emergency care, A&E attendances and ambulance incidents were higher than any other April on record. Mental health services continue to face growing pressure, with March recording the second highest number of new referrals. An increasing number of children and young people (CYP) waiting for initial contact and rising numbers of open referrals underscores the growing need for mental health support for CYP. Our briefing, Mental health: shifting the focus, explores challenges facing the mental health sector and highlights how trusts are adapting and innovating in response.

Trusts have responded to elevated demand with increased activity across several areas. In planned care, both cancer and diagnostic activity increased compared to last year. Mental health data showed an increase in contact figures. For example, over the past year, more CYP accessed mental health services than ever before, reflecting both the scale of need and the commitment of trusts to expand access. 

Ongoing challenges

But challenges remain in ensuring timely and sufficient support for those in need.  Signs of stretched capacity are evident throughout secondary care. Discharge delays have increased compared to last year, and key indicators of patient flow—such as 12-hour waits in A&E—remain high. Waiting times also remain a significant challenge across the system. After six months of gradual improvement, the elective waiting list increased again, and the diagnostic waiting list reached a record high despite unprecedented levels of diagnostic activity.

Community services also saw their waiting lists rise for the third consecutive month in March, nearing the peak recorded in August 2024. Long waits for community services have worsened, particularly among CYP. Our recent report, Providers Deliver: putting young people at the heart of care, showcases how trusts are reshaping care models to better meet the needs of CYP. 

Looking ahead 

This month’s data shows that trusts are making headway on key targets to reach the Government's ambitions to improve NHS performance and service delivery. This is against a backdrop of competing financial priorities requiring tough decisions from trust leaders. All eyes are on the Government’s 10-year health plan which will need to give need clarity of direction on ‘what gives’ when operational targets cannot be reconciled with financial imperatives.  

Case study 

Super Saturday in surgery to tackle waiting lists

The team at King’s College Hospital discuss new strategies to reduce waiting lists.

The neurosurgical team at King’s College Hospital is trialling a new way of working to reduce the time neck and spinal injury patients are waiting for routine surgery. 

Recently, the team carried out eight procedures in one day compared to an average of 2.5 cases on a standard single list, using high intensity theatre (HIT) lists. HIT lists, which are carried out on Saturdays, focus on one type of procedure at a time, allowing for streamlined preparation and maximising the number of patients being treated in one day. 

During a HIT list, there are increased numbers of anaesthetic, surgical and theatre staff to ensure patients are prepped and ready for their procedure, reducing the amount of non-operating time for the surgeon. Two operating theatres along with three multi-disciplinary teams work to enable the surgeon to go between cases, allowing more cases to be carried out in the same time period.

Mr Gordan Grahovac, Consultant Neurosurgeon at King’s College Hospital, who has been operating during a HIT list, said: “Careful planning to select the most suitable patients, coupled with streamlined processes, is key to the success of HIT lists. 

“We are currently looking at all areas of the patient’s journey, seeing what works well, and where we need to make changes to safely improve efficiency. This allows us, as surgeons, to spend more time operating and less time carrying out non-operative tasks. 

“As well as refining hospital processes, we are also looking at patient education and how we can support those undergoing surgery to make a swift post-operative recovery.

“At King’s, we have an Enhanced Recovery Team working with patients to ensure they are as fit and healthy as possible before surgery – supporting them to eat well and exercise, as well as give up or reduce smoking and alcohol consumption – and mobilise quickly after surgery. 

“Research has shown that the earlier a person gets out of bed and starts walking, eating and drinking after having an operation, the shorter their recovery time will be.”

The HIT list procedures carried out were Anterior Cervical Discectomy and Fusion (ACDF) surgery on patients experiencing pressure on the spinal cord or nerves causing pain, tingling, numbness, or weakness in the upper limbs, and laminectomies to treat compressed nerves in the lower spine, resulting from a range of conditions including slipped discs, sciatica and spinal injuries. 

Of the eight patients operated on, six were well enough to be discharged the following day, and the remaining two the day after. 

Dr Anneliese Rigby, Clinical Director for Theatres and Anaesthetics at King's College Hospital NHS Foundation Trust, added: "It is a combined team effort to run our Super Saturdays successfully, but this initiative allows our staff to dedicate their day to delivering the right care to carefully selected patients and reducing unnecessary delays. As a result, we are able to treat approximately three times as many cases, bringing down waiting times.

“We are now putting plans in place to run this initiative each month, helping make sure our patients receive the treatment they need as efficiently as possible.”