The NHS Trust Development Authority is undertaking “urgent work” to investigate the “unexpectedly high” demand for acute services that has seen winter pressures continue into the summer.

A report to its board last week said the work would examine what was behind the apparent surge in demand and support providers in their response.

The board heard trusts had missed all national accident and emergency and ambulance targets and a number of elective care and cancer standards in May.

During that month 93.9 per cent of patients waited less than four hours at A&E departments, missing the 95 per cent target.

Trusts also fell short of a target demanding 90 per cent of admitted patients are treated within 18 weeks of referral, with performance at 88.2 per cent.

Dale Bywater, the TDA’s director of delivery and development for the Midlands and the East, said the pressure on A&E departments had not abated from last winter.

“At this time of year we generally expect some recovery after the winter period,” he said.

“That hasn’t been the case this year; there seems to be an increasing pressure on A&E departments… admissions and attendances are fairly significantly up on this time last year.

“This feels less now like a winter/summer service, [and] much more of a norm that’s facing organisations.”

Mr Bywater said one of the reasons pressure had continued was because of the increasing frailty of patients attending A&E departments.

“You have a quite small change in admissions of the frail elderly but… the impact on longer stays is quite significant,” he said.

One trust that experienced a 1.8 per cent increase in frail elderly admissions saw bed days go up by 14 per cent, Mr Bywater added.

David Flory, chief executive of the TDA, told the meeting this year was different because pressure was felt on multiple fronts.

“This time last year when we discussed service performance, our main focus was on A&E,” he said.

“The difference this year is we’ve got pressures in A&E care caused by the increases in demand… but as you see across the whole spectrum of measures there’s increasing pressure in lots of other areas.”

Providers have received extra funding this year to turn around performance - £400m to support A&Es and £250m to help clear elective treatment backlogs.