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The man, who was suffering from diarrhoea and vomiting at City Hospital in Birmingham, waited the longest of all patients in a snapshot survey of 180 casualty units in England and Wales by the Association of Community Health Councils (ACHCEW).

He waited 28 hours and 43 minutes for a side room in a ward at the hospital on Monday.

His wait was nine hours less than the record for last year's survey.

In 1998, a 60-year-old man with severe asthma waited 37 hours for a bed at the East Surrey Hospital in Redhill.

Birmingham, which was hit by a diarrhoea and vomiting outbreak, was the clear blackspot in the survey, with three of the top six waits in the country being at two Birmingham hospitals.

City Hospital had the top two longest waits. A spokesperson for the hospital said the results were "misleading" because it had been hit by an infection and had to isolate some patients.

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Greenwich District General Hospital in South London also had two patients in the top six.

Greenwich Healthcare Trust said the hospital was particularly busy with 40 patients requiring admission, compared to a seasonal average of 25.

It said its problems were caused by disorders requiring isolation and bed shortages on wards, but added that both patients in the top six were waiting in pre-admission beds and not on trolleys.

The situation had eased by Tuesday with patients waiting an average of under three hours.

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The survey - the second ACHCEW has done - showed extra cash from the government has reduced some of the problems in casualty departments, with waits down on last year.

Casualty units were asked to supply details of waiting times, the number of patients and brief descriptions of what patients were suffering from.

Longest waits

The six longest waits were at:

• City Hospital in Birmingham where an 84-year-old man with vomiting and diarrhoea waited 28 hours 43 minutes for a side room in a ward;
• City Hospital, Birmingham where a 26-year-old man with Crohn's Disease waited 27 hours and 30 minutes for a side room;
• Greenwich District General Hospital, South London where a 79-year-old woman with infective diarrhoea waited 24 hours and 56 minutes;
• Good Hope Hospital in North Birmingham where a man with chest pains had been waiting for 24 hours and was on a trolley at the time of the survey;
• Kent and Sussex Hospital in Tunbridge Wells, Kent, where a 33-year-old woman with abdominal pains waited 23 hours and 30 minutes for a bed;
• Greenwich District General Hospital where a 64-year-old man with an immune problem waited 23 hours and 19 minutes.

The aim of the surveys is to gain a clear view of the pressures facing casualty departments.

Donna Covey, director of the ACHCEW, said: "The picture is better than last year, but still shows unacceptable waits for some patients in A&E and wide variations across the country.

"Our survey shows that the extra cash the government has put in to ease winter pressures is helping, but there is still an awfully long way to go."

She added that Birmingham hospitals were badly hit by an outbreak of diarrhoea and vomiting at Good Hope Hospital.

The hospital had to stop admitting patients which had a knock-on effect on other casualty units in the area.

Health minister John Denham said the improvement on last year's figures - despite the recent flu outbreak - showed the extra �200m the government had invested to reduce winter pressures and the "tremendous dedication" of staff were having an effect.

But he said some areas were coping less well than others.

The government will be trying to identify best practice around the country.

It is also planning changes to local planning and delivery of services and GP advice lines, as recommended by ACHCEW.

Scotland

A separate survey by the Scottish Association of Health Councils (SAHC) was conducted in Scottish hospitals and revealed "worrying" problems in some of Scotland's biggest hospitals.

Patricia Dawson, director of the SAHC, said: "We have heard concerns being expressed by doctors and by politicians.

"Our survey shows that there are significant problems in some parts of the country but there is no crisis."

The longest recorded delay was six hours 18 minutes at Aberdeen Royal Infirmary where a patient was waiting for psychiatric assessment.

Many of the patients forced to wait long times were elderly.

A 75-year-old patient collapsed after waiting six hours 15 minutes to be admitted at the Falkirk Royal Infirmary.

And an 88-year-old patient at Glasgow's Western Infirmary waiting four hours 10 minutes on a trolley with a broken leg.

Under recently-introduced rules, patients are expected to be assessed within 15 minutes of admission to casualty and are then given a priority category which determines the urgency with which they should be treated.