The recent heatwave has driven a demand on the NHS services in Wales, according to the latest figures.
For the third month in a row, the total numbers waiting for treatment by the NHS in Wales have risen, though two-year-waits have dropped slightly.
There were just under 698,400 patient pathways, which represent a patient’s journey through NHS services, in June – an increase of about 8,700.
It is estimated the figures include 547,500 individual patients, as many are on more than one waiting list.
Darren Hughes, director of the Welsh NHS Confederation, said the hot weather had contributed “to record demand”.
The latest NHS performance figures show emergency departments in Wales had record levels of attendances in July, with an average of 3,357 a day.
While waiting times in A&E improved slightly on the previous month, both four and 12-hour waits remain some way off their targets.
Hughes said the recent hot weather had “taken its toll on the NHS”, and had placed staff “under considerable strain as many worked in high temperatures”.
“July saw the highest number of emergency department attendances on record for Wales, a deeply concerning milestone more often associated with the pressures of winter,” he said.
“Hot weather increases demand and contributes to incidents such as falls through dehydration, dizziness, low blood pressure, fatigue and reduced mobility.”
But despite record demand, he said that emergency department performance had improved, with better four-hour and 12-hour targets and average waiting times had fallen to two hours 57 minutes.
Cancer services also showed improvement against key targets, despite a 17% rise in the number of patients being referred for suspected cancer.
The proportion starting treatment within 62-days rose in June to 59.2% – the figures have hovered between 50-65% in recent years.
June also saw a rise in hospital outpatient referrals.
The numbers have increased fairly steadily in recent years – but the latest figures show an average of more than 5,000 referrals made a day across Wales – a 13.4% rise on the previous month.