What the return shows

At the end of June 2026, 1,930,725 people were recorded as waiting for one of the 15 tests in NHS England's monthly diagnostic return. Of these, 449,778 had waited more than six weeks, equivalent to 23.3 per cent. A further view of the same return shows 153,351 people waiting 13 weeks or longer. Providers recorded 2,677,285 diagnostic tests or procedures during the month. These are large national totals, but the list and the activity count answer different questions and should not be subtracted to estimate how many people joined or left the pathway.1, 2

The data were published on 13 August and cover the position and activity in June. The waiting list is a month end snapshot, while activity covers tests completed during the month. A person may enter and leave within June without appearing in the final snapshot, and some people waiting at the end may have been referred recently. Changes also reflect new referrals, cancellations, removals and data quality corrections. The publication is therefore not a simple queue in which one completed test removes one person from a fixed starting total.1, 2

The six week measure has a clear policy meaning. NHS England's medium term planning framework describes an ambition to reduce the proportion waiting more than six weeks to one per cent. The June position was far from that level. However, six weeks is a population performance threshold rather than a clinical deadline that makes every wait on one side safe and every wait on the other harmful. Urgency depends on symptoms, suspected diagnosis, deterioration and the role of the test in the pathway.1, 2

For nursing services, the return is relevant well beyond diagnostic departments. Nurses request or support tests, assess readiness, explain preparation, manage long term conditions while results are pending and respond when symptoms change. Community, outpatient, cancer, surgical and emergency pathways can all be affected. The national percentage establishes scale, but safe action depends on knowing which patients are waiting, what information they received and who remains responsible for review.1, 2

The backlog is not one queue

Non-obstetric ultrasound was the largest waiting list, with 663,279 people at month end. Of those, 132,281 had waited over six weeks, or 19.9 per cent. Magnetic resonance imaging had 398,172 people waiting, including 88,562 beyond six weeks, or 22.2 per cent. Computed tomography had a smaller list of 203,388 and 20,028 over six weeks, equivalent to 9.8 per cent. These modalities differ in capacity, preparation, indications and urgency, so their figures cannot be compared as if they were interchangeable production lines.1, 3

Several smaller services had a higher proportion beyond six weeks. Peripheral neurophysiology recorded 17,797 of 42,175 waits over six weeks, about 42.2 per cent. Urodynamics recorded 4,669 of 10,306, about 45.3 per cent. Audiology assessments recorded 51,499 of 124,899, about 41.2 per cent. The smaller denominators mean fewer people than in ultrasound or MRI, but a high proportion can still represent persistent access difficulty and substantial consequences for a particular patient group.1, 3

Endoscopy also carried long waits. The return records 25,464 of 79,447 colonoscopy waits beyond six weeks and 23,013 of 76,807 gastroscopy waits. Flexible sigmoidoscopy had 7,859 of 24,162 beyond six weeks. These procedures can support cancer and non-cancer pathways, but the aggregate test category does not reveal the referral indication or priority of each patient. It would be wrong to describe all people in the category as suspected cancer patients or to assume that every delay has the same clinical consequence.1, 3

Diagnostic activity offers another view of service scale. Computed tomography recorded 822,454 tests during June, ultrasound 806,637 and MRI 436,291. High activity can coexist with a long waiting list when demand and follow up need remain high. A service may increase output and still see the queue grow. Conversely, a smaller list does not prove sufficient capacity if referrals are constrained or people leave before a test. Activity, demand, waiting time and outcome need to be considered together.1, 3

How the measure is constructed

The monthly diagnostics collection is commonly known as DM01. It covers 15 specified tests and procedures, not every investigation provided by the NHS. The waiting period is measured using defined referral and test dates, with rules for planned activity and exclusions. The full extract includes rows labelled total as well as individual test rows. Adding every row would double count the national position because the totals repeat their components. The figures in this article use the individual test rows and then calculate the England sum.3, 2

A person is counted on a waiting list for a diagnostic test, not necessarily once across the whole system. Someone awaiting more than one reportable test may appear in more than one pathway. The dataset should therefore be described as diagnostic waits or waiting list entries unless the publication specifically establishes unique patients. Precision in this language prevents a national total being mistaken for the number of distinct people affected.3, 2

The return is aggregate. It cannot show the clinical reason for delay, whether a patient declined an offered date, or what support they received while waiting. It also does not directly measure report turnaround after the test, communication of the result or the subsequent treatment interval. A completed scan can still leave a patient waiting for interpretation and action. Services need linked local measures if they want to understand the whole diagnostic journey rather than only access to the procedure.3, 2

Data quality can change over time as providers correct submissions and local systems improve. Comparisons should use the latest published series and note revisions. A sudden movement in one test or provider may reflect reporting as well as service change. Clinical teams can help analysts validate whether the pattern matches changes in equipment, staffing, referral criteria or outsourcing. The aim is not to dismiss inconvenient data, but to identify the most accurate explanation before decisions follow.3, 2

Care continues while the test is pending

A waiting list is not a pause in clinical responsibility. The referring service should tell patients what the test is for, how urgent it is, what preparation is needed and who to contact if their condition changes. Safety netting must be specific enough to act on. A general instruction to seek help if worse is less useful than symptoms, routes and expected response. Responsibility for review should be visible when referrals cross organisations, because an electronic acceptance does not automatically create a safe handover.3, 4

Nurses often hold the practical continuity around a diagnostic pathway. They may adjust medicines, arrange blood tests, assess renal function, provide bowel preparation, check implanted devices, support anxiety or coordinate transport. Delays can make earlier preparation out of date. A new illness, pregnancy, medicine or change in mobility may alter what is safe on the eventual test date. Pre-assessment needs a defined validity period and a route to update information rather than assuming that the condition at referral remains unchanged.3, 4

People with progressive symptoms need active reassessment, not a place held passively in chronological order. Escalation criteria should be agreed with the relevant clinical service and accessible to staff receiving calls. A change in risk may justify reprioritisation, another investigation or urgent assessment. This does not mean every person who contacts a service should bypass others. It means clinical priority must remain capable of changing when the evidence changes, with decisions recorded and communicated.3, 4

Long waits can also affect treatment and daily life before a diagnosis is known. Symptoms may limit work, sleep, nutrition, hearing, continence or mobility. Uncertainty can worsen distress. Nurses cannot remove the backlog through supportive care, but they can identify unmet need, explain what is known and ensure that interim treatment remains appropriate. Services should make clear which team manages symptoms so patients are not repeatedly redirected between the referrer and diagnostic provider.3, 4

What capacity improvement requires

Additional equipment is only one part of diagnostic capacity. A scanner or endoscopy room needs trained staff, maintenance, consumables, decontamination where relevant, reporting and a pathway for abnormal findings. Extending operating hours can increase activity, but only if staffing is sustainable and supporting services are available. Repeated overtime or redeployment may weaken another part of care. Plans should show the complete workforce model and monitor vacancies, fatigue, training and cancellation alongside completed tests.1, 4, 3

Referral quality also matters. Clear clinical questions and complete safety information can prevent delay, duplication and unsuitable booking. Decision support may help, but it should not become an automated barrier that excludes people with atypical or complex need. Feedback to referrers should be timely and educational. If a request is declined or changed, the patient and responsible clinician need to know who will decide the next step. Silent rejection creates risk outside the diagnostic service's visible queue.1, 4, 3

Community diagnostic centres may improve access by adding locations and separating planned testing from acute pressures. Their value should be assessed through equitable uptake, completion, report time and patient outcome, not activity alone. Travel, disability access, caring responsibilities and digital exclusion can make a nominal appointment unavailable. Offering a distant slot may shorten the recorded wait only if the patient can realistically use it. Services should examine declined offers and did not attend events without assuming lack of engagement.1, 4, 3

Productivity work should reduce avoidable friction rather than compress safety. Standard preparation, reliable booking and fewer equipment failures can benefit patients and staff. Shortening cleaning, assessment or recovery below what the procedure requires would not. Nursing input is essential because nurses often see where a theoretical schedule fails in practice. Improvements should be tested with balancing measures such as incidents, unplanned admission, repeat tests, staff absence and patient reported experience.1, 4, 3

Using the June data responsibly

Boards should start with both the total backlog and the test level distribution. Nearly 450,000 waits beyond six weeks is a national access problem, while the variation identifies services that need different responses. A single target can focus attention, but it should not cause lower volume services or the longest waiting patients to disappear behind activity in high volume imaging. Measures for 13 week waits, clinical priority and inequality should remain visible alongside the headline percentage.1, 2, 4

Local review should trace a sample of journeys from referral through preparation, test, report and action. This can expose duplicate requests, failed communication, avoidable cancellations and gaps in safety netting that aggregate returns cannot show. Patient and staff accounts should be included, with records used to verify the sequence. The purpose is to improve the pathway, not assign blame to the last person who touched it. Many delays are produced by interfaces between teams rather than a single error.1, 2, 4

Services should also separate people who are waiting for a first diagnostic answer from those receiving planned surveillance. Both groups matter, but uncertainty and clinical risk can be different. A routine follow up test can become urgent if symptoms change, while a first investigation may reasonably remain lower priority after review. Lists need enough clinical information to support that distinction and a process for refreshing it. A date order alone cannot maintain safe prioritisation over many weeks.1, 2, 4

Cancellation data deserve the same attention as activity. A session lost to equipment failure, insufficient staffing or unavailable preparation can remove many tests at once and create repeat work for booking teams. A patient cancellation may reflect illness, transport or an appointment offered without enough notice. Recording reasons consistently can reveal preventable loss without blaming patients. Rebooking should preserve clinical priority and repeat any preparation or safety checks that have expired since the original date.1, 2, 4

Public reporting should preserve uncertainty. The June figures confirm the number of waits recorded and their duration bands. They do not establish how many patients were harmed, which delay was avoidable or whether an individual referral was prioritised correctly. Those questions need clinical review. It is still reasonable to say that long waits create risk and burden that services must manage. Evidence does not have to answer every causal question before a system takes proportionate protective action.1, 2, 4

For nursing teams, the practical conclusion is that diagnostic delay is part of current care, not a separate administrative queue. Nurses need reliable lists, current preparation information, explicit clinical ownership and routes to escalate deterioration. Capacity plans need the full multidisciplinary workforce and attention to access. The national data show where the pressure sits. Safe local systems determine whether people remain seen, informed and supported while they wait for the test that moves their care forward.1, 2, 4