For someone waiting for a hip replacement, the NHS waiting list is not an abstract policy problem. It is the difference between walking to the shops or staying indoors, sleeping through the night or waking in pain, returning to work or putting life on hold.
Across Wales, there are signs that some long waits are finally beginning to move in the right direction. More people are getting through the system for planned operations, tests and appointments. But that is only part of the story. The parts of the NHS people rely on when they are frightened, seriously ill, or waiting for cancer treatment remain under severe pressure.
The recent election in Wales makes this an important moment to take stock of the NHS: what is improving, what is still struggling and what this means for patients. The latest official figures cover March and April 2026, when the previous government’s targets still applied.
The new Plaid Cymru Welsh government has said it will continue reporting against these targets unless they are replaced or revised. Mabon ap Gwynfor, the recently appointed minister for health and care, inherits a service that is both recovering and still under real strain.
The clearest good news is in planned care. In March, just under 666,700 appointments, tests or treatments were waiting to be carried out. That was down by around 21,300 from February and marked the tenth month in a row that the number had fallen. These figures do not represent individual patients. One person may be waiting for more than one appointment, test or treatment. Management information suggests that around 529,100 people were on treatment waiting lists.
The longest waits are also falling. Just under 2,600 treatments had been waiting more than two years, 96.3% lower than the peak in March 2022. The proportion waiting less than 26 weeks rose to 65.9%, the best figure since May 2020. Those waiting more than 36 weeks fell to just over 166,800, the lowest level since August 2020. The median wait was 15.5 weeks, the shortest since April 2020.
These improvements should be recognised as important for wider public health. For patients, planned-care recovery can mean less time living with pain, less uncertainty, fewer cancelled plans, and a better chance of staying in work or caring for family.
Why emergency care still feels broken
Emergency care is where many people judge whether the system is really coping. It is the part of the NHS people encounter at moments of fear: chest pain, falls, breathing difficulties, severe infections or the sudden deterioration of an elderly relative.
In April, Wales recorded just under 95,100 emergency department attendances, an average of 3,168 a day. Only 66% of patients were admitted, transferred or discharged within four hours, against a target of 95%. More than 10,000 patients waited 12 hours or more.
The causes are not simply that too many people are turning up at accident and emergency departments (A&E). Emergency departments depend on the wider hospital and on social care outside hospital. If wards are full, patients cannot move out of A&E. If ambulances cannot hand patients over, they cannot get back on the road. If people who are medically well enough to leave hospital cannot be discharged safely, beds remain occupied.
In April, there were just under 1,300 delayed discharges on the day the data was collected. Together, they accounted for almost 57,500 delayed days for adults who were ready to leave hospital but could not move on.
This explains why the public can hear that waiting lists are improving and still feel that the NHS is stuck. A hip operation may finally be scheduled, while an elderly parent waits all day in an emergency department because there is no bed or care package available.
Cancer care shows the stakes most clearly. The Welsh target is for at least 75% of patients to start their first definitive treatment within 62 days of an urgent suspected cancer referral. In March, performance improved, but only to 60.2%. Delays matter because cancer is exceptionally time-sensitive. Later diagnosis and treatment can mean more advanced disease, more complex treatment and poorer outcomes.
Mental health services show another form of pressure. In March 2026, local support services received 7,568 referrals. Across all ages, 84.9% of assessments were completed within 28 days and 92.7% of treatment began within 28 days of assessment. Secondary mental health services were supporting 17,498 patients at the end of March.
These figures show that headline waiting-list improvements, while important, do not tell the whole story. Demand is rising across different parts of the system, and the pressure is not limited to planned operations.
The workforce
The NHS in Wales has more staff than it used to. At the end of 2025, there were 100,224 full-time equivalent staff directly employed by NHS Wales, up 1.6% in a year and 25.8% since 2018. But more staff does not automatically mean enough capacity.
The same release recorded 5,652 vacancies and an average sickness absence rate of 6.4% across 2025. Anxiety, stress, depression and other psychiatric illnesses accounted for 34.9% of sickness absence.
This points to a workforce under sustained pressure. Recruitment matters, but so do retention, morale and working conditions. Recovery will be difficult if the people delivering care are themselves exhausted.
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Then there is the financial reality. Audit Wales reported that all seven Welsh health boards again breached their statutory duty to break even over the three years to 2024 and 2025. Money alone will not solve every problem. But improving access, supporting staff and redesigning services is difficult when every health board is financially stretched.
The Welsh NHS is moving, but unevenly. For people, the test will not be whether one graph improves. It will be whether the whole journey through care begins to feel safer, faster and more humane.
Dylan Wyn Jones is affiliated with Plaid Cymru.
