Patients who need emergency medical care are facing unnecessary delays in seeing a doctor, despite government targets to speed up urgent treatment, a review says today.

In the most comprehensive review yet of NHS emergency and urgent care, the Healthcare Commission found significant variations in how patients are treated across England, particularly on evenings and at weekends.

In some hospitals only 40 per cent of patients were seen by a doctor or nurse within an hour of arrival at the accident and emergency department, while others achieved 100 per cent.

The proportion of children with a broken arm or leg who attended A&E and were given pain relief within one hour varied from 20 per cent in some hospitals to 100 per cent elsewhere.

The review, which measured the performance of local ambulance trusts, accident and emergency departments, out-of-hours GP and telephone services and walk-in centres, found that patients were often confused over where to seek help.

Overall, emergency care services were “least well performing” or only “fair” in four out of ten areas, with some patients facing delays in transfers to hospital, which are not covered by existing targets.

A new national target is needed to measure how quickly patients receive care from the moment they call an ambulance to the point of admission to casualty departments, the commission suggests.

This would provide a more accurate assessment of patients’ experience than existing measures, which only cover ambulance response times or stipulate a maximum four-hour waiting time in A&E.

In some A&E departments, for 95 per cent of the time, ambulances are back on the road within 15 minutes of delivering a patient, but in other departments this figure is as low as 10 per cent.

This could reflect delays because of a lack of staff or beds to admit a patient, the commission said.

Its review found on average, that services in rural areas performed better than those in urban areas, such as London.

In total, out of 152 primary care trust areas, a third were ranked “best performing” in urgent and emergency care; 41, or 27 per cent, were better performing; 33, or 22 per cent were fair-performing; and 28, or 18 per cent, were categorised as least well performing. Services in the North East performed best overall, with all of the region’s trusts rated as “best” or “better performing”.

Anna Walker, chief executive of the Healthcare Commission, said there had been improvements in performance on government targets, with 97.9 per cent of A&E patients being treated within the four-hour target in 2007-08, up from 91.2 per cent in 2003-04.

Mike Penning, Conservative MP for Hemel Hempstead, said the Government was “hitting self-imposed targets, but missing the point in providing care. Patient outcomes are being neglected.”

Explore Health

• Expert Advice

• Health Features

• Mental Health

• Alternative Medicine

• Child Health

• Health Club