Written question WQ99016

The Welsh Government has not made a specific assessment of the impact of patient removals on reported waiting time and waiting list statistics.

This is because routine published statistics are based on patient pathways, rather than individual patients. Referral to Treatment (RTT) data—published monthly—covers both:

• Open pathways: patients still waiting for treatment

• Closed pathways: pathways that have ended, including where patients are treated or otherwise removed from the waiting list

As activity is measured in pathways rather than people, changes to waiting time performance cannot be directly attributed to “patient removals” in isolation. Further explanation of the difference between pathways and patients is available in the Welsh Government Chief Statistician’s blog. https://digitalanddata.blog.gov.wales/2022/03/22/chief-statisticians-update-explaining-nhs-activity-and-performance-statistics/

Patient removals data

The Welsh Government does not hold centrally collected, routinely published data on the number of individual patients removed from NHS waiting lists without receiving treatment or an appointment, broken down by:

• Local health board

• Reason for removal

• Individual patient counts (as distinct from pathway closures)

As a result, the information requested for the last five years cannot be provided in the format requested.

However, RTT statistics do include information on closed pathways, which encompass all reasons a pathway ends and can be accessed at NHS waiting lists: closed referral to treatment pathways, September 2011 onwards | StatsWales

How patients are removed from waiting lists

Guidance to NHS organisations on managing waiting lists and removing patients is set out in the Planned Care Waiting Times Guidance (April 2025). Planned care waiting times guidance: April 2025

Under this guidance, a pathway may be closed (and therefore removed from RTT waiting list statistics) for a number of legitimate reasons, including:

• Treatment completed

• Patient declines treatment or no longer wishes to proceed

• Clinical decision that treatment is no longer appropriate

• Patient did not attend (DNA) appointments, following appropriate follow-up processes

• Patient uncontactable after reasonable attempts

• Transfer to another provider or pathway

• Administrative corrections, including duplicate pathways or data quality adjustments

The guidance makes clear that removal from a waiting list must:

• Follow consistent, auditable processes

• Be supported by clear documentation

• Involve appropriate patient communication

• Ensure patients are not unfairly disadvantaged or inappropriately removed

Health boards are responsible for applying this guidance locally and ensuring appropriate governance and oversight arrangements are in place.