One million patients waiting too long in A&E, report suggests The health service in England must make efficiency savings of £20bn over four years to keep pace with increasing demand within flat budgets. The report also featured a survey of finance directors in the NHS showing a third said the quality of patient care in their area has worsened during the past year, double the number in the last survey. The report said a quarter of all hospital trusts are now reporting breaches in the A&E target showing that the problem is spreading. So-called trolley waits, where patients are waiting to be admitted to a bed on a ward from A&E are also at their highest rate since 2003/4, the report said. Although there are generally greater pressures on A&E in the winter months, so far this season there has been little flu and the norovirus outbreak has now eased. The report said: "The proportion of patients waiting more than four hours from arrival in A&E to admission, transfer or discharge in the third quarter of 2012/13 (October to December) rose by 21 per cent over the previous year and 38 per cent on the previous quarter. Nevertheless, overall, the NHS remained within target on this waiting times measure - although around a quarter, or 65 trusts recorded breaching the target during this quarter affecting more than 232,000 patients. Professor John Appleby, Chief Economist at The King's Fund said: "This is probably a combination of factors. By relaxing the target, the system will move towards that new relaxed level and is readjusting, plus demand is rising for A&E attendances and if the rest of the hospital is under pressure, and cannot discharge patients as quickly, you get a blockage in A&E. It doesn't take much for things to start to go wrong. The percentages may look small but it is affecting a lot of people now, 232,000 in that quarter so nearing a million if that were repeated year round. Also the numbers of trusts it is affecting is increasing showing it is no longer just a problem for a few trusts. He said financial pressures may mean there have been cutbacks in staffing levels and the European Working Time Directive to cuit junior doctors hours to 48 per week will have had an affect on rotas, meaning hospitals would have to employ more staff to fill the rota, which they may be reluctant to do in the current climate. Prof Appleby added: "The NHS faces unprecedented financial pressures, and there are growing worries that patient care will suffer. For social care, it will be increasingly difficult for councils to make further savings without directly cutting services or affecting quality. Health and care services have coped well until now, but it is clear that many organisations expect things to become much more difficult over the coming year. Health Minister Lord Howe said: "Patients need to be able to rely on prompt, high quality, urgent and emergency care and treatment. We are clear that patients shouldn't face excessive waits for treatment. Where there is extra demand on services, hospitals and staff need to work together to ensure that patients get the care they need. A spokesman for the Department of Health said that centralising specialist A&E services in larger centres meant patients with suspected complex problems may stay in the department for longer while they have investigations carried out but this may avoid the need for admission altogether and so is providing better care.