Research

How NHS RTT 18-week performance varies by Integrated Care Board

Reviewed by PlainNHS · · Source: NHS England RTT statistics

The ICB ranking

Across 266 English providers with 1,000+ incomplete pathways, 65.5% sit within 18 weeks (NHS target 92%). ICB means stretch from GLOUCESTERSHIRE at 73.7% to ESSEX at 56.2% (17.5 percentage points), weighted by each ICB's waiting-list size.

65.5%
Incomplete pathways within 18 weeks (weighted national mean)
73.7%
GLOUCESTERSHIRE, highest ICB mean (n=3 providers)
56.2%
ESSEX, lowest ICB mean (n=8 providers)
17.5 pp
Spread between highest and lowest ICB means

URL slug keeps the historical /research/rtt-performance-by-region path. The commissioning field in NHS England's provider return is the ICB name, not the seven NHS England geographic regions. Providers with fewer than 1,000 incomplete pathways excluded. Vintage September 2026. Registry voice only, not clinical advice.

Top ICBs by within-18-week share

Highest waiting-list-weighted ICB means first. NHS operational target remains 92%.

Highest ICB means Horizontal bar chart of the top 5 items by value (%). Highest ICB means Top 5 1. GLOUCESTERSHIRE 73.7% 2. NORTH EAST AND NOR 73.6% 3. BRISTOL, NORTH SOM 71.9% 4. WEST YORKSHIRE 70.3% 5. BIRMINGHAM AND SOL 69.4% Share of incomplete RTT pathways within 18 weeks(waiting-list-weighted by ICB)

What share gets an ICB into the top five?

An ICB needs a waiting-list-weighted within-18-week share of at least 69.4% to enter this month's top five. The distribution shows how concentrated the current field is, rather than treating every rank gap as equally meaningful.

  1. Below 60%

    1 ICB

  2. 60–64.9%

    13 ICBs

  3. 65–69.9%

    15 ICBs

  4. 70% or more

    4 ICBs

ICB means, highest to lowest

Waiting-list-weighted share within 18 weeks for every ICB with at least three qualifying providers.

GLOUCESTERSHIRE: 73.7%GLOUCESTERSHIRE73.7%NORTH EAST AND NORTH C: 73.6%NORTH EAST AND NORTH C73.6%BRISTOL, NORTH SOMERSE: 71.9%BRISTOL, NORTH SOMERSE71.9%WEST YORKSHIRE: 70.3%WEST YORKSHIRE70.3%BIRMINGHAM AND SOLIHUL: 69.4%BIRMINGHAM AND SOLIHUL69.4%SOUTH YORKSHIRE: 68.2%SOUTH YORKSHIRE68.2%SOUTH EAST LONDON: 68.1%SOUTH EAST LONDON68.1%WEST AND NORTH LONDON: 67.9%WEST AND NORTH LONDON67.9%SOUTH WEST LONDON: 67.9%SOUTH WEST LONDON67.9%THAMES VALLEY: 67.6%THAMES VALLEY67.6%NORTH EAST LONDON: 67.2%NORTH EAST LONDON67.2%NOTTINGHAM AND NOTTING: 66.8%NOTTINGHAM AND NOTTING66.8%
Within-18-week share by ICB (n=266 providers; 7.1m incomplete pathways)

Within-ICB provider spread

Gap between each ICB's highest and lowest provider pct_within_18w. Large spreads mean the ICB mean hides trust-level choice.

GLOUCESTERSHIRE: 12.4 ppGLOUCESTERSHIRE12.4 ppNORTH EAST AND NORTH C: 32 ppNORTH EAST AND NORTH C32 ppBRISTOL, NORTH SOMERSE: 30.7 ppBRISTOL, NORTH SOMERSE30.7 ppWEST YORKSHIRE: 34.5 ppWEST YORKSHIRE34.5 ppBIRMINGHAM AND SOLIHUL: 21.3 ppBIRMINGHAM AND SOLIHUL21.3 ppSOUTH YORKSHIRE: 22.9 ppSOUTH YORKSHIRE22.9 ppSOUTH EAST LONDON: 26.5 ppSOUTH EAST LONDON26.5 ppWEST AND NORTH LONDON: 33.4 ppWEST AND NORTH LONDON33.4 ppSOUTH WEST LONDON: 27.6 ppSOUTH WEST LONDON27.6 ppTHAMES VALLEY: 21.9 ppTHAMES VALLEY21.9 ppNORTH EAST LONDON: 27.9 ppNORTH EAST LONDON27.9 ppNOTTINGHAM AND NOTTING: 11.9 ppNOTTINGHAM AND NOTTING11.9 pp
Max minus min provider within-18 share inside each ICB (percentage points)

A higher ICB mean can still hide a wide trust-level gap

Each point is an ICB. The horizontal axis is its waiting-list-weighted within-18-week share; the vertical axis is the gap between its best and worst qualifying providers. The highlighted BLACK COUNTRY point has the widest provider spread at 65 percentage points.

Lower mean · wider spreadHigher mean · wider spreadLower mean · tighter spreadHigher mean · tighter spread55.3%60.1%65.0%69.8%74.6%0 pp17.0 pp34.1 pp51.1 pp68.2 ppWithin 18 weeks (weighted share)Provider spreadGLOUCESTERSHIRE, Within 18 weeks (weighted share): 73.7% · Provider spread: 12.4 ppNORTH EAST AND NORTH CUMBRIA, Within 18 weeks (weighted share): 73.6% · Provider spread: 32 ppBRISTOL, NORTH SOMERSET AND SOUTH GLOUCESTERSHIRE, Within 18 weeks (weighted share): 71.9% · Provider spread: 30.7 ppWEST YORKSHIRE, Within 18 weeks (weighted share): 70.3% · Provider spread: 34.5 ppBIRMINGHAM AND SOLIHULL, Within 18 weeks (weighted share): 69.4% · Provider spread: 21.3 ppSOUTH YORKSHIRE, Within 18 weeks (weighted share): 68.2% · Provider spread: 22.9 ppSOUTH EAST LONDON, Within 18 weeks (weighted share): 68.1% · Provider spread: 26.5 ppWEST AND NORTH LONDON, Within 18 weeks (weighted share): 67.9% · Provider spread: 33.4 ppSOUTH WEST LONDON, Within 18 weeks (weighted share): 67.9% · Provider spread: 27.6 ppTHAMES VALLEY, Within 18 weeks (weighted share): 67.6% · Provider spread: 21.9 ppNORTH EAST LONDON, Within 18 weeks (weighted share): 67.2% · Provider spread: 27.9 ppNOTTINGHAM AND NOTTINGHAMSHIRE, Within 18 weeks (weighted share): 66.8% · Provider spread: 11.9 ppSTAFFORDSHIRE AND STOKE-ON-TRENT, Within 18 weeks (weighted share): 66.6% · Provider spread: 35 ppSOMERSET, Within 18 weeks (weighted share): 66.5% · Provider spread: 34.8 ppBATH AND NORTH EAST SOMERSET, SWINDON AND WILTSHIRE, Within 18 weeks (weighted share): 66.5% · Provider spread: 23.9 ppCHESHIRE AND MERSEYSIDE, Within 18 weeks (weighted share): 66% · Provider spread: 31.5 ppSHROPSHIRE, TELFORD AND WREKIN, Within 18 weeks (weighted share): 65.7% · Provider spread: 29.3 ppLANCASHIRE AND SOUTH CUMBRIA, Within 18 weeks (weighted share): 65.4% · Provider spread: 47.7 ppDEVON, Within 18 weeks (weighted share): 65.1% · Provider spread: 29.9 ppHAMPSHIRE AND ISLE OF WIGHT, Within 18 weeks (weighted share): 64.4% · Provider spread: 39.9 ppBLACK COUNTRY, Within 18 weeks (weighted share): 64.1% · Provider spread: 65 ppNORTHAMPTONSHIRE, Within 18 weeks (weighted share): 63.7% · Provider spread: 24.4 ppKENT AND MEDWAY, Within 18 weeks (weighted share): 63.4% · Provider spread: 43.8 ppNORFOLK AND SUFFOLK, Within 18 weeks (weighted share): 63.3% · Provider spread: 36.1 ppHEREFORDSHIRE AND WORCESTERSHIRE, Within 18 weeks (weighted share): 63.2% · Provider spread: 1.9 ppCENTRAL EAST, Within 18 weeks (weighted share): 63.2% · Provider spread: 38.6 ppSURREY AND SUSSEX, Within 18 weeks (weighted share): 62.5% · Provider spread: 46.7 ppGREATER MANCHESTER, Within 18 weeks (weighted share): 62.4% · Provider spread: 40.1 ppDERBY AND DERBYSHIRE, Within 18 weeks (weighted share): 62.2% · Provider spread: 36.4 ppCOVENTRY AND WARWICKSHIRE, Within 18 weeks (weighted share): 62.2% · Provider spread: 26.9 ppLINCOLNSHIRE, Within 18 weeks (weighted share): 62.1% · Provider spread: 6.3 ppHUMBER AND NORTH YORKSHIRE, Within 18 weeks (weighted share): 60.8% · Provider spread: 25.7 ppESSEX, Within 18 weeks (weighted share): 56.2% · Provider spread: 34.5 pp
ICB averages versus the variation patients may still see between qualifying trusts. Focus or hover a point for its exact values.

This does not rank clinical quality or predict an individual wait. It is a prompt to compare named trusts when referral choice is available. Compare trusts Browse trust profiles.

Method

From NHS England's monthly consultant-led RTT provider return we take every English provider with at least 1,000 incomplete pathways, group by the commissioning Integrated Care Board named in that return (stored in our region column for historical reasons), and compute a waiting-list-weighted within-18-week share (sum of within_18w divided by sum of total_waiting). ICBs with fewer than three qualifying providers are dropped so a single trust cannot define an ICB mean. Min and max are the extreme provider-level percentages inside each ICB.

This is not a ranking of the seven NHS England geographic regions. Those labels live on the smaller trust profile set; the full provider return keys providers to ICBs. Figures refresh when a new NHS England monthly release is ingested. Descriptive registry analysis only.

Full ranking table

#Integrated Care BoardProvidersWeighted meanMinMax
1 GLOUCESTERSHIRE 3 73.7% 73.5% 85.9%
2 NORTH EAST AND NORTH CUMBRIA 16 73.6% 64% 96%
3 BRISTOL, NORTH SOMERSET AND SOUTH GLOUCESTERSHIRE 6 71.9% 68.9% 99.6%
4 WEST YORKSHIRE 11 70.3% 65.5% 100%
5 BIRMINGHAM AND SOLIHULL 7 69.4% 58.9% 80.2%
6 SOUTH YORKSHIRE 6 68.2% 55.8% 78.7%
7 SOUTH EAST LONDON 6 68.1% 66.6% 93.1%
8 WEST AND NORTH LONDON 17 67.9% 63.2% 96.6%
9 SOUTH WEST LONDON 7 67.9% 64.8% 92.4%
10 THAMES VALLEY 8 67.6% 62.5% 84.4%
11 NORTH EAST LONDON 6 67.2% 57.3% 85.2%
12 NOTTINGHAM AND NOTTINGHAMSHIRE 4 66.8% 64.8% 76.7%
13 STAFFORDSHIRE AND STOKE-ON-TRENT 6 66.6% 57.5% 92.5%
14 SOMERSET 3 66.5% 65.2% 100%
15 BATH AND NORTH EAST SOMERSET, SWINDON AND WILTSHIRE 6 66.5% 56.9% 80.8%
16 CHESHIRE AND MERSEYSIDE 16 66% 60.6% 92.1%
17 SHROPSHIRE, TELFORD AND WREKIN 4 65.7% 53.6% 82.9%
18 LANCASHIRE AND SOUTH CUMBRIA 12 65.4% 42.7% 90.4%
19 DEVON 5 65.1% 55.1% 85%
20 HAMPSHIRE AND ISLE OF WIGHT 8 64.4% 56.4% 96.3%
21 BLACK COUNTRY 6 64.1% 9.8% 74.8%
22 NORTHAMPTONSHIRE 6 63.7% 61.3% 85.7%
23 KENT AND MEDWAY 11 63.4% 56.1% 99.9%
24 NORFOLK AND SUFFOLK 7 63.3% 60.1% 96.2%
25 HEREFORDSHIRE AND WORCESTERSHIRE 3 63.2% 61.9% 63.8%
26 CENTRAL EAST 13 63.2% 54.3% 92.9%
27 SURREY AND SUSSEX 16 62.5% 53.2% 99.9%
28 GREATER MANCHESTER 14 62.4% 57.2% 97.3%
29 DERBY AND DERBYSHIRE 5 62.2% 55.5% 91.9%
30 COVENTRY AND WARWICKSHIRE 4 62.2% 57.9% 84.8%
31 LINCOLNSHIRE 3 62.1% 61.9% 68.2%
32 HUMBER AND NORTH YORKSHIRE 8 60.8% 56.8% 82.5%
33 ESSEX 8 56.2% 49.7% 84.2%

Reading the spread

The headline finding, an overall 65.5% weighted mean against the 92% operational target, matches the national picture NHS England has published through the elective backlog years. The 17.5 percentage-point gap between GLOUCESTERSHIRE and ESSEX is unlikely to be case-mix alone; published reviews from the Nuffield Trust and the King's Fund point to workforce, estate, and elective-recovery investment as geographic differentiators that also show up at ICB scale.

For patients using NHS Choose and Book where clinically permitted, trust-level choice inside an ICB often moves the needle more than crossing ICB boundaries. Use the comparison tool and trust profiles for provider-level waits.

Limitations

Coverage is English providers meeting the 1,000-pathway floor (266 rows , 7.1 million incomplete pathways). ICB means can still be dominated by a few large providers. RTT within-18 share is an operational process metric, not a clinical outcome. No case-mix adjustment is applied.

Source attribution

Important: This page is descriptive statistical analysis. It is not medical advice. Always consult your GP, NHS 111, or the treating NHS Trust for clinical decisions.

Source: NHS England Referral to Treatment (RTT) waiting times · September 2026 ICB labels come from the commissioning region field on NHS England’s provider return, not the seven geographic NHS England regions.

Compiled from official public sources by the publisher.

Spotted a figure that looks wrong? Report a correction.

PlainNHS ICB rankings are rendered directly from NHS England RTT provider returns, no number is typed in by an editor. Waiting-list-weighted ICB means use sum(within_18w) / sum(total_waiting) from the live return. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error on this page. Data current as of September 2026. Figures here are for context and comparison; clinical pathway decisions belong with your GP, NHS 111, or the treating Trust.