Poor accident and emergency performance this year has not been caused by GP out of hours provision, increased attendances or a lack of doctors, exclusive analysis shared with HSJ shows.

The research by the former Department of Health national clinical director for urgent and emergency care suggests there has been little change in these factors in recent years.

Matthew Cooke, now an academic and clinical director of Heart of England Foundation Trust, says that instead his research indicates the widespread breaches of the four hour waiting time target were down to increased delays in discharging patients.

This is likely to have affected flow of patients through hospital and resulted in delayed admissions, the analysis suggests.

In the last quarter of 2012-13, January to March, only 91.1 per cent of patients at type 1 A&E units − which deal with serious cases − were treated within four hours, amid widespread media reports of a “crisis”.

Professor Cooke’s analysis found no change in the time of day patients presented to A&E during last winter and spring, compared with past years, suggesting any alterations to out of hours primary care had not had a significant effect.

Similarly, A&E attendances increased by just over 1 per cent in 2012-13, while the number of medics working in emergency departments increased slightly over the same period.

However, hospital data shows that increased waits were predominantly for patients who needed to be admitted.

Professor Cooke told HSJ: “[A&E] is in as bad a position as it was 10 years ago. Then it was people with minor injuries who were waiting to get a bed, now minor injuries are getting through the system relatively quickly but there is a problem with admissions.

“My conclusion is that the problem of discharge from hospitals is becoming the predominant cause [of breaches].”

He said there was also some evidence of admitted patients being more ill than in the past, but that the number of patients over 80 had remained broadly the same over the past six years.

Professor Cooke’s conclusions appear to reflect the views of an HSJ survey of hospital chief executives in July. They said they believed increased acuity - severity of illness - of patients was the biggest cause of A&E performance problems. They also said they faced increasing difficulty discharging patients, a problem often linked to a lack of out of hospital health and community care provision.

Official figures on the number of delayed transfers of care from hospitals to local authority funded services have not shown a large increase over the past year. However, the accuracy of this data has been criticised by the Commons health committee, so it is being reviewed by the Department of Health.

One hospital chief operating officer told HSJ part of the problem could relate to A&E medical staff being less experienced than in the past, therefore being more cautious, admitting more often and being slower to discharge.

Another hospital director, commenting on the A&E analysis, said: “Trusts have spent so long believing it’s about [there being] more patients, out of hours and social care that they’ve lost a grip on managing and reforming internal pathways and local clinical discipline.”

The news comes as figures show recent A&E performance to be worse than at the same period in 2012-13. NHS England data showed a national performance of about 94.4 per cent for type 1 A&Es during the second quarter of this year − below the national 95 per cent target - compared with 95.4 per cent in the same period last year.