First missed targets of the winter heighten fears that casualty wards will struggle with seasonal workload

Casualty wards in England have missed their waiting times targets for the first time this winter, heightening fears that accident and emergency units may struggle to cope with the seasonal spike in hospital admissions.

Nationwide, 94.8 per cent of patients at all A&Es, minor injury units and urgent care centres were still admitted or treated within four hours in the first week of December, but this was just below government targets of 95 per cent.

At major casualty wards, the figure was even lower – 92.2 per cent. The last time so many patients had to wait longer than four hours was in April.

Overall, 3,678 patients waited for between four and 12 hours. Five patients had to wait for more than 12 hours to be treated or admitted.

Although the number of people attending A&E is in fact highest in spring and summer, emergency admissions to hospital through all routes, including GP and social care referrals, peak in the winter months as seasonal illnesses take their toll, particularly among older patients.

This increases bed occupancy on hospital wards, which in turn makes it more difficult for emergency doctors to admit patients from A&E, driving up waiting times for those arriving at A&E for treatment.

Health chiefs said it had been the busiest week of the year so far with 415,400 A&E attendances and 105,800 emergency admissions.

Two thirds of NHS trusts with a major A&E unit missed the four hour target. Nationally, major A&E units have not the target since July.

Dame Barbara Hakin, chief operating officer for NHS England said that while it was “disappointing” patients were waiting longer than they should, A&Es were seeing “many more patients than ever before”.

“Every year we see a dip in the figures for December, with week-on-week variations, which is why we fully assess how local systems are coping with winter pressures over a longer period,” she said.

“We knew this winter would be difficult but it is important to stress the NHS continues to deliver a good service, with 94.8% of people going to hospital for urgent care this week treated, admitted or discharged within four hours. This is thanks to the hard work and dedication of our frontline staff.”

A Department of Health spokesperson said: "There hasn't been an entire December in the past five years where the NHS has not missed its A&E target. But last week, the NHS saw more people in A&E than in the same period in any previous December, and saw more patients — almost 400,000 - within four hours in that period.

"We have always been clear that this could be a difficult winter — and there could be more difficult weeks ahead. But the majority of patients continue to get the excellent care they deserve. That's because of the hard work of staff and we want to thank and support them in that.”