hours. while higher than the performance in northern ireland (60%), the welsh nhs is third in the united kingdom, putting it 7 percent behind nhs england and 8% behind nhs scotland. the nuffield trust have identified welsh underperformance as influenced by the welsh population being older, sicker and having more deprivation than any other uk nation. performance against the target has like all other uk nations in recent years, having declined by 7.5% between may 2018 and september 2019. northern ireland targets in northern ireland are set by the health and social care board and are less demanding than in the rest of the uk. none have been met since 2015, and some for considerably longer. a&e waits when considered using the nhs measure of 4 hours to discharge show that performance in northern ireland has dropped 13% between may 2018 and september 2019. missing the target according to the bma the main reasons for not reaching this target are: not enough inpatient beds delayed discharges delay in accessing specialist opinion not enough nurses not enough middle grade doctors department too small delay in accessing diagnostic services in 2014, research conducted by qualitywatch, a joint programme from the nuffield trust and the health foundation, tracked 41 million visits to a&e departments in england in order to better understand the pressures leading to increased waiting times and breaches of the four-hour target. researchers identified a rise in older patients and related increase in long-term conditions as key factors, alongside extremes of temperature (in both summer and winter) and crowding at peak times. they noted that the majority of pressure was falling on major a&e units, and proposed that rising demand as a result of ageing and population growth may be pushing already stretched emergency departments beyond maximum capacity. in july 2017 the royal college of emergency medicine produced a report saying that the nhs needed at least 5,000 more beds to achieve safe bed occupancy levels and hit the four-hour target. pressure even though exceptions are allowed to the targets, concerns have been raised that the target has put pressure on a&e staff to compromise patient care. a significant proportion (90%) of a&e consultants welcomed the four hour target in a study but felt that 98% was too high a target. england at the same time as the four target was introduced a target that no patient should wait longer than 12 hours before they are admitted to a ward, if that is required, was introduced. in england time was measured from the point a decision to admit is made and not from the moment the patient arrives. between january and march 2012 only 15 patients in england waited more than 12 hours, but in the same months in 2017 1,597 patients breached the target. in january 2018 1,043 patients waited over 12 hours for a bed, the worst figure ever recorded. 272 were at university hospitals of north midlands nhs trust. problems at lancashire care nhs foundation trust led to more than 1,000 cases of patients waiting over 12 hours for admission in 2018–19. this was about a third of all the 12 hour breaches, which were mostly mental health cases - where admission to a ward is not within the control of the trust running the a&e department. a review found that some patients in lancashire were “potentially being held against their will without appropriate legal provision”. some were detained in seclusion rooms for more than a week under section 136 of the mental health act 1983, which only provides that patients can be lawfully detained for 24 hours, with a possible 12-hour extension. in december 2019 trusts in london were told to set up dedicated spaces to care for three mental health patients in every a&e department. in december 2019 there were 2,347 breaches, compared with 284 recorded in december 2018. in february 2022 there were 16,404 breaches and in march 2022 22,506. the nhs standard contract for 2022-23 requires hospitals to count 12-hour waits from time of patients’ arrival in the emergency department to the time they are admitted to a ward. measured in this way february and march 2022 show around one in five admissions through ed waited more than 12 hours from arriving until being admitted to a ward – equating to around 158,000 cases, 22% of attendances. problems were particularly severe for people with mental health problems, with many examples of mental health patients waiting up to three days in emergency departments for a mental health inpatient bed to become available. when time was measured from time of arrival in the department to admission to a ward the figures of people waiting more than 12 hours were about six times greater than the nationally published figures which in july reached 29,317. wales the welsh nhs sets a measure of patients waiting more than 12 hours to be treated, transferred, and discharged by a&e. in january 2019, the welsh nhs has recorded a record 6,882 patients waiting more than 12 hours in a&e, and morriston hospital in swansea represented 15% of all a&e patients waiting more than 12 hours. the welsh nhs confederation responded to the figure by stating its disappointment but acknowledging numbers of patients attending with complex needs were increasing in wales. ambulance response times however improved and hit their target for the first time since october. cancer all across the uk the target is that patients should be treated within 62 days of an urgent referral, but the way this is measured varies. in northern ireland the target has not been met since 2015. the welsh government in 2019 became the first nation in the uk to have a single waiting times target for cancer treatment. in england 93% of patients referred for investigation of breast symptoms, even if cancer is not initially suspected, should be seen by a specialist within two weeks. only 77.5% of patients referred for breast symptoms between april and june 2019 were seen within 2 weeks. only 38% of hospitals met the target in 2019 and 22.5% of people waited longer than two months for their first treatment. in february 2022 10.7% of patients treated waited more than 104 days. planned treatment over four million patients were waiting for non urgent hospital care as of july 2017. the royal college of surgeons together with other medical groups fear patients are waiting longer in anxiety and pain for hospital procedures. the target was that 90% of patients admitted to hospital for treatment and 95% of those not admitted should receive consultant-led care within 18 weeks unless it is clinically appropriate not to do so, or they choose to wait. the proportion of people waiting more than the six week target for diagnostic tests was at its highest since records began in september 2018. by august 2019 less than 49% of hospital services were achieving the target and across england the average wait was around 23 weeks. the clinical commissioning group joint committee for mid and south essex in december 2019 reported that local hospitals were “now working” to a 40-week referral to treatment target. one year wait in december 2017 there were 1,750 patients waiting a year or more, the highest total since august 2012. 242 were at imperial college healthcare nhs trust, 156 at mid essex hospital services nhs trust and 114 at royal cornwall hospitals nhs trust. 11.8% of those waiting for a procedure had waited 18 weeks or more. by march 2018 there were 2,647. the largest numbers were at northern lincolnshire and goole hospitals nhs foundation trust, imperial college healthcare nhs trust, king's college hospital nhs foundation trust, royal cornwall hospitals nhs trust and east kent hospitals university nhs foundation trust. 2,432 patients had waited longer than a year in november 2018. in january 2019 nhs england announced that in future both providers and commissioners would be fined £2,500 for each such patient. in february 2022 299,478 patients had been on the list for over 52 weeks. of those 23,281 had been waiting more than 2 years. in northern ireland more than a third of patients, 94,222 people, had waited more than a year for their first appointment in october 2018. according to the royal college of surgeons in ireland the 52-week target had "not been completely achieved in over 11 years". in wales a year target is not measured but a nine month target is monitored. as of january 2020 25,549 patients (5.5%) had been waiting more than nine months to receive treatment. england 445,360 in england had been waiting six months or more by the end of december 2017 - three times more than in 2013. the president of the royal college of surgeons said it was “completely shameful” that patients were being forced to resort to paying for operations the nhs should provide as these waiting times led to an increase of 53% between 2012 and 2016 in the numbers paying personally for private operations. in july 2021 it was reported that there was a 46% increase in patients waiting more than 104 weeks for treatment, from 2,597 to 3,802 from april to may. there were 5.45 million people waiting for hospital treatment in england in june 2021 with very large differences in the numbers waiting in different areas, with 25 times more patients waiting for heart operations in birmingham and solihull than in west lancashire. wales in wales, as of january 2020 83.5% of patients were waiting less than six months to start hospital treatment. this is the lowest figure since december 2015 and was below the welsh government's 95% target. cancellations between january and march 2018 25,475 operations were cancelled at the last minute for non-clinical reasons by nhs providers - 20% more than the first quarter of 2017, and the highest number since records began in 1994–95. this was 1.3% of all elective activity - the highest proportion recorded since 2004–05. community services the 2019 nhs long term plan proposed a two-hour standard for urgent community response services in england. these include prescribing and reviewing medication, access to physiotherapy and occupational therapy, and help with nutrition and hydration. data has been collected since july 2020 and was first published in june 2022. the 70% two-hour response target was met at an all-england level but there were enormous variations between areas.