Attendances to accident and emergency departments have fallen over the course of the past year, according to NHS England data.

Between October and December attendances dropped to 5,289,000, down from 5,351,000 in the same period the previous year − a fall of 1.2 per cent.

The number of patients presenting at major consultant led A&Es decreased further, by 2.1 per cent to 3,473,000.

Performance against the target to treat, admit or discharge 95 per cent of patients within four hours has dropped slightly, by 0.1 percentage points to 95.6 per cent over the quarter.

However, admissions to major A&E departments increased by just over 2 per cent to 959,000 year on year.

The Foundation Trust Network’s head of analysis Sivakumar Anandaciva said the key to A&E performance was admissions rather than attendances because “whole system working” was required to ensure a flow of patients through the department.

He added: “You can get the same number or even fewer admissions, but if the case mix or acuity of those admissions changes then that affects four hour performance. For example, more complex comorbid cases means more complex care and slower throughput through the emergency department and hospital.”

An analysis of the 10 trusts performing worst against the four hour target shows that admissions decreased slightly compared to the same period last year, from 81,701 to 81,351.

The 10 best performing trusts against the target have also seen admissions ease slightly, with a drop of just over 3,500 since last year from 66,075 to 62,522.

Overall performance for the bottom 10 trusts has worsened by an average of three percentage points against the four hour target compared to last year, from 93 per cent to 90 per cent.

The top 10 performing trusts against the four hour target have seen their performance rise by an average of 1.9 percentage points, to 97.9 per cent.

Since the last week of December the number of trusts failing to hit the waiting time target has more than doubled.

Several chief executives of trusts that were recipients of part of the £400m funding made available to support A&Es this winter felt they were not allocated enough money to tackle the problem of increased emergency admissions and a lack of beds. Clinical commissioning groups were given the money to distribute in community, as well as acute, settings.

One chief executive at a poorly performing trust said: “Our CCG got the money and by the time any filtered through to us it was a lot less than the original amount allocated. It hasn’t been enough to make a big difference to our emergency department.”

Mr Anandaciva said the fund had “not created a stable or regular income or subsidy for providers and furthermore it has not been allocated equitably”.

He added: “The funding has been allocated to those perceived to be most at risk of failing their targets but that doesn’t mean that the small number of at most risk systems have received enough funding to be sustainable or meet their targets, nor does it mean that those trusts that have not yet received additional funding will be able to financially cope this winter.”