Acute sector

Acute hospitals continue to experience high levels of demand, particularly in urgent and emergency care, which saw the busiest April on record for A&E departments.
In planned care, activity increased across all cancer pathways and diagnostics compared to last year, as trusts respond to elevated demand.
Despite ongoing demand pressures, performance has improved in key areas. In cancer care, trusts met the targets for the 28-day faster diagnosis standard and 62-day pathway, and A&E performance was the strongest for April in four years, though still below target levels.
Waiting times remain a challenge across the system, with the elective waiting list increasing after six months of gradual improvements. The diagnostic subset of the waiting list also reached a record high, despite record levels of diagnostic activity, highlighting the sustained levels of demand in the system.
Signs of stretched capacity throughout hospitals continue, with discharge delays higher than last year and measures of patient flow, such as 12 hour waits related to A&E, remaining high.

There were 2.3 million A&E attendances in April, which is more than any other April on record. Nearly three-quarters (74.8%) of patients were seen in four hours, the strongest April performance in four years but trusts continued to fall short of the March 2025 planning guidance aim of 78%.
There were 529,180 emergency admissions in April, lower than a year ago and before the pandemic in 2019.
In April, 44,880 patients waited at least 12 hours from the decision to admit to admission. While this figure has been gradually declining each month since the January peak of 61,500, it remains over 100 times higher than pre-pandemic levels.
137,210 patients waited more than 12 hours from arrival at A&E in April (9.9% of attendances), down from highs of over 176,000 seen in January, but still highlighting that too many patients are facing long delays.

FIGURE 1
Monthly A&E attendances

The proportion of patients remaining in hospital at the end of each day despite no longer meeting the criteria to reside was 56.5% in April, down on last month but higher than last year (53.8%).

After falling for the last six months, the elective waiting list rose slightly to 7.42m treatments in March (18,750 more treatments than last month). This is 1.6% smaller than it was a year ago but is 71% greater than six years ago, before the pandemic.
The number of treatments waiting more than 18 weeks fell by 37,140 to 2.98m treatments, equivalent to 59.8% of all waits. The planning guidance sets out an aim for 65% of treatments to be waiting no longer than 18 weeks by March 2026.
180,240 treatments had been waiting over 52 weeks in March, totalling 2.4% of all waits. Planning guidance aims for waits over a year to make up 1% of all waits by March 2026.

Monthly activity across all three pathways (28-day faster diagnosis standard, 31-day and 62-day) in March was higher than last year – up by around 7% for each pathway.
78.9% of patients with an urgent referral were told they have cancer, or it was excluded within 28 days in March. This is down slightly from last month (80.2%) but exceeds the 28-day FDS target of 77% by March 2025.
With 71.4% of referrals meeting the 62-day standard this month, trusts also achieved the aim of 70% as set out in the planning guidance for March 2025.

FIGURE 2
Percentage of patients seen within 28-day FDS pathway and 62-day pathway standards

In March 2025, nearly 2.5 m diagnostic tests were carried out – the highest March figure on record and an increase of 10.7% on last year.
Despite record levels of activity, demand for diagnostic testing is high and the diagnostic waiting list continues to increase – it totalled above 1.7m treatments for the first time in March. This is nearly 5% higher than last year.
In March 2025, 18.4% of patients waited for longer than six weeks for diagnostic tests, an improvement since last year (21.9%) but some way from the 5% ambition set out in the 24/25 planning guidance for March 2025.