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This article sets out key themes from our work, and challenges facing the new Welsh Government, NHS Wales, and local authorities. It includes updated data analysis.

What is NHS urgent and emergency care?

Urgent and emergency care services treat patients with serious conditions that need immediate care. The system is complex, with many organisations involved.

When services do not work well, blockages occur. If patients cannot leave hospital on time, fewer beds are available and emergency departments get overcrowded. People attending because they cannot access other services adds to the problem. Ambulance crews also face delays handing over patients.

Questions for the Welsh Government, the NHS, and local authorities

Urgent and emergency care is under constant pressure. This increases patient safety risks and drives higher costs.

Despite new policies and extra funding that encourage better joined-up working, many problems remain. Staff and leaders across the system told us that something must change.

We have set out six questions for the Welsh Government, NHS Wales, and local authorities to consider:

• How will services be planned and managed as a whole system, with clear accountability for improving patient flow?
• What action will be taken to increase the use of services designed to prevent unnecessary emergency department attendances, including improved access to primary care?
• What will be done differently to reduce discharge delays at pace, given slow progress over many years?
• How will workforce shortages be tackled across health and social care, with joined-up planning?
• How will increased spending be focused to deliver lasting improvements, and how will its impact be measured?
• How will data sharing across organisations be improved to manage risk and to better understand patient journeys and how the system is working?

Our findings

Ambulance handover delays are putting patients at risk and increasing pressure on the whole system

Between April 2024 and March 2026, only one in five patients arriving at hospital by emergency ambulance were handed over within 15 minutes. The target is 100%.

In July 2025, the Welsh Government introduced a temporary 45-minute handover target. However, waits are still too long. The average wait in March 2026 was 1 hour 38 minutes, although some improvements elsewhere were balanced by a big increase in the average wait at Morriston Hospital in Swansea and three North Wales hospitals.

Handover delays mean ambulances cannot respond quickly to other urgent calls. Response time targets are still not being met in some of the most serious categories, including ‘Emergency (Red)’.

The number of hours lost due to delays is also still too high. Lost hours are when ambulance crews are not available to respond to new calls. The ambulance service plans for 6,000 lost hours a month but has not seen levels that low in the past five years (Chart 1).

Source: Analysis of NHS Wales Joint Commissioning Committee data

A UK review by the Association of Ambulance Chief Executives in 2021 found that the risk of moderate to severe or permanent harm to patients increases with longer handover delays. For patients waiting over four hours, the risk increases to 70%. In 2025-26, 15,084 of 151,707 patients waited over four hours.

Waits in emergency departments are still too long

Emergency department attendances have returned to high levels after a sharp fall due to the COVID-19 pandemic (Chart 2). There was an average of 94,398 attendances a month between April and December 2025 compared with 90,918 between April and December 2019.

Source: Analysis of Welsh Government data for major and minor units

Note: We have highlighted the duration of the pandemic in the presented data. This is based on the official dates announced by the World Health Organization.

During our work, we heard that more people are now attending emergency departments with complex conditions, such as dementia, which require more support from a wider range of staff.

Meanwhile, waiting times in major emergency departments are still high. Between April 2025 and March 2026, just over half of patients were seen within four hours, against a target of 95%. While 85% of patients were seen within 12 hours against a target of 100%.

Again, performance varies across health boards and hospital sites, but none are meeting the national targets.

In March 2026 alone, 10,905 patients waited more than 12 hours. The Royal College of Emergency Medicine has estimated that 965 deaths in Wales during 2025 were linked to waits of over 12 hours.

Despite extra funding, new services are underused

In recent years, the Welsh Government has provided extra funding and introduced new policies to support urgent and emergency care. This includes:

• £100 million through the Six Goals for Urgent and Emergency Care programme (2021-22 to 2025-26).
• £143 million through the Regional Integration Fund to develop home from hospital schemes (2022-23 to 2025-26).
• £12 million of Further Faster funding to increase community provision (2023-24).
• £19 million of 50-Day Challenge funding to ease winter pressures and help people leave hospital (2024-25).

This funding has supported new services, which aim to reduce pressure on emergency departments. This includes clinical teams that direct patients to the right service, same-day emergency care centres, and urgent primary care centres. It also includes services to identify, assess, and support older people who are frail.

These services sit alongside others, such as the minor ailments scheme in pharmacies. However, limited staff and patient awareness of these services and limited access mean they are still underused.

Overall, most new initiatives focus on single services rather than the whole system. It is also often unclear if they will continue after short-term funding ends.

Access to dental and GP services is also an issue. The average number of daily GP appointments provided for urgent or acute needs fell from 28,260 in April 2023 to 21,864 in December 2025. During our work, we also found that dental problems were the single biggest reason for people calling the NHS 111 service, accounting for around one in 25 calls. In some areas, the rate is much higher.

Delays in discharging patients from hospital still lead to hundreds of thousands of lost bed days each year

Hospital discharge delays happen when patients are ready to leave but the care, support, or accommodation they need is not in place. A patient is classed as delayed if they stay in hospital for over 48 hours after they are ready to leave.

Patients in hospital longer than needed can develop greater care needs and require more support from community services after discharge.

Discharge delays have been falling slowly since April 2023. However, in March 2026 just under 1,400 patients waited more than 48 hours (Chart 3).

Source: Analysis of Welsh Government data

In 2025-26, delays beyond 48 hours led to just under 345,000 lost bed days. This cost about £172 million. If health boards and local authorities reduce delays by just 15%, this could release £26 million of resources.

Problems with discharge delays are not new, but progress has been slow. We found that health boards had addressed only a quarter of the discharge planning recommendations we had made in 2017-18.

Workforce issues across health and social care are a big part of delayed discharges

Vacancies and sickness absence reduce capacity in key areas such as nursing, social services, therapies, and home care. This leads to greater reliance on temporary staff and can create gaps in community and home care provision.

In both adult social services and nursing, sickness absence has increased slightly since April 2023 from an already high level. Rates tend to peak in winter (Chart 4).

Source: Analysis of Welsh Government data

The vacancy rate in adult social services and registered nursing improved between April 2023 and December 2025, but is still high in adult social services:

• Adult social services vacancies fell from 10.5% to 8.3%.
• Registered nursing vacancies fell from 8.4% to 3.0%.

During our work, all local authorities reported recruitment difficulties.

Waiting for a social care assessment, a joint health and social care assessment, or a new home care package have been among the top five reasons for delay each month since April 2023. Waiting for a nursing care assessment was also a main reason most months. Together, these accounted for just under two-fifths of delays between April 2023 and March 2026.

The provision of home care packages has, however, improved. The number of people waiting for home care, whether in hospital or not, fell from 1,300 in April 2023 to just under 500 in March 2026.

Data is not being shared effectively across the system to support decision-making

Poor data sharing at the patient level can lead to missed warning signs, unsafe discharges, repeated assessments, medication errors and missed safeguarding concerns. Patients with complex needs are most at risk, as they often move between services.

Poor data sharing also limits how organisations manage current, and predict future, demand. Data is not yet being linked, trusted, or used consistently.

Meanwhile, measures focus on single parts of the system, such as emergency departments, discharge delays, or social care. This can lead teams to focus on their own performance, without seeing the wider impact.

We also found that organisations were finding it difficult to use data to show the impact of new services on the wider system.