A snapshot survey of A&E departments highlights lengthy waits for admission in many London hospitals even before the holiday pressures began.

Eight of the longest waits reported are at West Middlesex University Hospital trust, where a patient suffering from a brain tumour is reported to have waited more than 22 hours before being transferred for treatment.

In all eight cases patients waited at least that long before being found a bed or transferred elsewhere.

The survey, by the Greater London Association of Community Health Councils, measured how long patients had been waiting when CHC members arrived on sites on 21 December.

Director Sue Towns is concerned that 'the same hospitals feature again and again' in the monthly surveys.

She adds: 'We have been saying for a long time that there need to be more beds so there is more flexibility in the system.'

West Middlesex spokesman Andrew Butcher agrees 'a basic lack of beds' was the 'key reason' for the long waits.

He says that since the period of pressure surrounding 21 December the trust has opened 18 extra beds, and transferred 10 elective beds for acute work. The HA has already agreed to fund 12 unfunded beds.

But he admits that even with the extra beds, up to 20 patients had to stay in A&E overnight at weekends.

The 'inefficient' layout of the hospital site means ambulances and extra staff are needed when patients are moved from A&E to the wards, he says, looking forward to 2002 when new building work should overcome that problem.

Ms Towns also criticises 'poor accessibility to primary care services' in London as a 'major factor' behind pressure on A&E departments.

'In certain areas of London primary care is so underdeveloped and community health services have been eroded.'