Waiting times for accident and emergency patients reached a nine-year high in the fourth quarter of 2012-13, the King’s Fund said today.

The monitoring report from the King’s Fund showed that in the final quarter of 2012-13, 5.9 per cent of patients (313,000 people) waited for four hours or longer in A&E, the highest level since 2004.

It is an increase of more than a third on the previous three months, and of nearly 40 per cent since the same quarter the previous year.

It means that the government’s target that no more than 5 per cent of patients should wait for more than four hours has been broken for the first time since June 2011, when they promised to keep waiting levels low.

HSJ reported on A&E performance on 2 May, revealing that many trusts had breached the target, and that the NHS appeared likely to narrowly miss the four-hour target as a whole during 2012-13.

John Appleby, chief economist at The King’s Fund, said today: “Emergency care acts as a barometer for the NHS. The worryingly high number of patients waiting longer than four hours in the last quarter of 2012-13 is a clear warning sign that the health system is under severe strain.

“The pressures in emergency care will not be relieved by focusing on a single aspect of the problem in isolation - it requires a co-ordinated response across the whole health system.

‘While the NHS is in a healthy financial position overall, efficiencies are becoming harder to deliver as one-off savings such as cuts in management costs start to slow. This is compounded by the need to maintain staffing levels following the shocking failures of care highlighted by the Francis report.

“With staff costs making up the bulk of the NHS budget, this will leave little room for manoeuvre - significant changes to services will be required if the NHS is to meet its target of delivering £20bn in efficiency savings.”

A report to Monitor’s board noted that over 2012-13 foundation trusts overspent on agency and contract staff by £500m, driven particularly by emergency care.

The report noted that while performance had improved in May, 58 per cent of foundation trusts missed the 95 per cent A&E target from January to March.

Nearly 40 per cent of trusts reported that they breached the waiting time target in the last quarter. The King’s Fund also said that the proportion of patients waiting more than four hours before being admitted to hospital from A&E has risen to nearly 7 per cent - again, the highest level since 2004.

The thinktank said the analysis shows the “severe strain on emergency care in early 2013” and that there is a risk the same thing could happen next winter.

However, a spokeswoman for The King’s Fund said: “Despite the pressures in emergency care, other NHS performance measures are continuing to hold up well. Waiting times for referral to treatment in hospital, the number of health care-acquired infections and delays in transferring patients out of hospital all remain stable.”

A survey of NHS finance directors also conducted by The King’s Fund found that the NHS is set to end the 2012-13 period in a healthy financial position, but that the outlook for the following two years is bleak. Most expect the NHS to fail to meet its target of delivering £20 billion in productivity improvements by 2015, The King’s Fund said.