Twenty-six hospital trusts are responsible for half of the national growth in patients waiting more than four hours in accident and emergency, HSJ analysis reveals.

The 26 organisations (see box, below) saw roughly a quarter of all A&E attendances in the first 50 weeks of 2014-15 but are responsible for half of the year on year increase in breaches of the target to treat or discharge 95 per cent of patients within four hours of attendance.

Critical care nurse

The number of patients who had to wait more than four hours has grown to 1.2m in 2014-15

The NHS in England will now definitely miss the annual 95 per cent target for the first time in a decade.

Analysis of weekly NHS A&E data shows that in the first 50 weeks of 2014-15 93.7 per cent of patients were treated or discharged within for hours, compared with performance of 95.7 per cent in the same period of the previous financial year. Attendances have grown by 2.6 per cent over the same period.

The number of patients who had to wait more than four hours has grown from around 800,000 in 2013-14 to 1.2m in 2014-15, with half the 400,000 increase taking place at 26 hospital trusts.

Some of the organisations, like Barts Health Trust, are large and run multiple A&Es, but others make a contribution to the decline in national performance that is disproportionate to their size.

Colchester Hospital University Foundation Trust and South Devon Healthcare Foundation Trust both have A&E units attended by fewer than 75,000 people, but together contributed 12,327 to the national increase.

Princess Alexandra Hospital Trust in Essex saw 2 per cent fewer attendances in 2014-15 than it did in 2013-14, but saw the number of patients breaching the four hour target more than double to 12,000.

The biggest single contributor to the national growth in breaches was Hull and East Yorkshire Hospitals Trust, which missed the target for 20,400 patients this year, up from 6,000 in 2013-14. This meant its performance against the target fell from 95 per cent to 84 per cent.

A spokeswoman for the trust said: “The trust has been subject to an unprecedented amount of pressure this winter. Whilst the number of attendances at our emergency department has not risen significantly across the year, what we have seen is an increase in the complexity of the cases people are presenting with.

“The emergency department has been undergoing an £8m refurbishment throughout the winter, so staff have been adapting to changes in the physical environment and new ways of working whilst continuing to manage demand. Limited bed capacity and ward restrictions due to winter vomiting bugs have, at times, meant that flow through the emergency department has not always been easy to maintain.

“We are also carrying a number of vacancies within the emergency department, including for consultants, however all of our staff have gone to extraordinary lengths this year to deliver the best possible care for our patients.”

Some trusts managed to buck the downward national trend. Bedford Hospital Trust and Luton and Dunstable University Hospital Foundation Trust both managed to hit the 95 target whilst coping with increases in attendance of 5.5 per cent and 7.5 per cent respectively.

Sarah Pinto-Duschinsky, director of operations and delivery for NHS England, said: “This winter NHS staff in England pulled out all the stops and, compared with last year, provided care for an incredible 190,000 more people coming to A&E and 51,000 more being admitted to hospital as an emergency. These record numbers - up by between 6 per cent and 9 per cent some weeks - mean that although the NHS won’t have met the A&E average 95 per cent target for the full year, staff continued even during this busiest winter ever to treat more than nine in 10 people within four hours.  

“This is not only the best performance in the UK but probably of any major country internationally.”

The 26 trusts responsible for half of the national year-on-year increase in four-hour target breaches

Hull And East Yorkshire Hospitals Trus

Nottingham University Hospitals Trust

Brighton And Sussex University Hospitals Trust

Barts Health Trust

Barking, Havering And Redbridge University Hospitals Trust

Cambridge University Hospitals Foundation Trust

Portsmouth Hospitals Trust

Heart of England Foundation Trust

Medway Foundation Trust

Peterborough and Stamford Hospitals Foundation Trust

York Teaching Hospital Foundation Trust

South Devon Healthcare Foundation Trust

Walsall Healthcare Trust

University Hospitals Coventry and Warwickshire Trust

The Princess Alexandra Hospital Trust

Mid Essex Hospital Services Trust

Royal Cornwall Hospitals Trust

West Hertfordshire Hospitals Trust

Imperial College Healthcare Trust

Pennine Acute Hospitals Trust

Aintree University Hospital Foundation Trust

Norfolk and Norwich University Hospitals Foundation Trust

Colchester Hospital University Foundation Trust

United Lincolnshire Hospitals Trust

East Kent Hospitals University Foundation Trust

Warrington and Halton Hospitals Foundation Trust