Patients should expect ‘inevitable’ greater waits in accident and emergency departments, two health charities have warned.

The Nuffield Trust and the Health Foundation said that there was a “perfect storm” of factors leading to an increasing in waiting times in emergency departments across England.

The comments come after the latest figures from NHS England show that major A&E departments failed to meet the four hour admission to treatment or transfer target for 52 weeks running.

The charities analysed 41 million A&E attendances from 2010 to 2013 and highlighted a number of contributing factors which could lead to the breaches.

Winter pressures are also associated with higher rates of people waiting for more than four hours, their report stated.

They also found that the number of people in emergency departments has risen as the population has grown and aged.

The report suggested that older people are waiting longer than young adults or children.

People over the age of 75 spend an average of 3.5 hours in A&E compared with 2.5 hours for younger patients, they found.

The authors said that older people have more complex problems, which often require longer periods of care.

Patients with long term conditions are also likely to wait longer to be admitted or discharged, and people with more than one of these conditions are forced to wait even longer, they said.

Those who are on the register of a GP surgery with good patient feedback were less likely to attend emergency units.

“We may have reached the limit of what we can deliver with our current A&E capacity,” said Ian Blunt, the report author and Nuffield Trust senior research analyst.

“Prolonged poor performance on the four hour target will not be popular with the public or politicians and will mean exposing patients to the worse outcomes that are associated with longer waits.

“But without either new money to invest in A&E or new ways to divert people to other parts of the NHS, rising waits may be inevitable. A lot now rides on NHS England’s urgent and emergency care review.

“The NHS has been criticised for not having the information it needs to fully understand what’s going on in A&E. This report provides some of the new evidence we need so that policy makers are able to target limited resources most effectively.

“However, there’s still a lot we don’t know. It is vital that the health service makes better use of linked data to understand how issues like bed availability and staffing levels have an impact on what people experience in A&E.”

Jennifer Dixon, chief executive of the Health Foundation, said: “A&E departments are completely stretched - aggravated by increasing demand for emergency care.

“But the solutions are more complex than simply ‘more investment needed’, even if that were forthcoming. The access and quality of health and social care available to people outside hospital also needs to be very carefully examined. Is it good enough to prevent the need for an A&E visit?

“We also know that hospitals have huge difficulty discharging patients because of a lack of social care. The flow of patients through hospital - to relieve A&E departments and also free up beds - is often disordered and blocked. Only careful attention to all these areas is the solution.”