# health.waiting-time

How long a patient has waited on an NHS England consultant-led
referral-to-treatment (RTT) pathway, the way NHS England counts it: days from
the clock start to the clock stop (or to the measuring date while the patient
is still waiting), the weekly reporting band, and whether the 18-week standard
has been breached.

Patients in England have the right to start consultant-led non-emergency
treatment within a maximum of 18 weeks from referral. 18 weeks is 126 days,
and a patient who has waited exactly 126 days is still within it (they are
reported in the 17-18 week band); 127 days is a breach. `eighteenWeekDate` is
the clock start plus 126 days, the last day on which treatment still meets the
standard.

**Week bands.** RTT returns put each pathway in a weekly time band, ">n-1 to
n weeks", and `weekBand` is that n. The first band, 0-1 weeks, holds eight
days (0 to 7), every later band seven: 8-14 days is band 2, 120-126 days band
18, 127 days band 19. NHS England's last band is "104+ weeks", 729 days and
more; `weekBand` keeps counting above 104 (729 days is 105) so a caller can
still tell long waits apart, and a return should put anything above 104 in the
>104 band. `completedWeeks` is simply whole weeks (days divided by 7, rounded
down), for display. A clock that starts and stops on the same day is a real
pathway of zero days.

**No clock pauses.** Earlier versions of the rules allowed "patient-initiated
clock pauses". NHS England removed them in 2015 with the admitted pathway
standard: "there is no longer any provision to report pauses or suspensions in
RTT waiting time clocks ... under any circumstances". This capability
therefore takes a clock start and an optional clock stop and nothing else,
deliberately. Events that the rules do recognise are the caller's to apply:

- a clock stop (rules 4 and 5: first definitive treatment, a decision not to
  treat, active monitoring, a patient declining treatment, and so on) is the
  `clockStop` date;
- a DNA of the first appointment nullifies the clock (rule 5e, footnote 10),
  and when the patient rebooks a new clock starts (rule 3e), so pass the
  rebooking date as a new `clockStart`;
- other new clock starts (rule 3: a second bilateral procedure, a new
  treatment, the end of active monitoring) are likewise new pathways.

**Errors.** A measuring date before the clock start, a clock stop before the
clock start, and a clock stop after the measuring date (a stop that has not
happened yet) are errors. Dates are ISO `YYYY-MM-DD`, and the measuring date is
always an argument, never the clock.

## Source

NHS England, "Recording and reporting referral to treatment (RTT) waiting
times for consultant-led elective care", version 5.2, February 2025:
section 2.2 reproduces the "Referral to treatment consultant-led waiting times
rules suite" (clock starts, rules 1-3; clock stops, rules 4-5), the
introduction records the removal of clock pauses, and section 10.1.7
"Measuring the length of RTT pathways" defines the time bands.
https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2025/10/Recording-and-reporting-RTT-waiting-times-guidance-v5.2-Feb25.pdf