The National Audit Office predicts that many hospitals will hit government waiting time targets but some could be affected by staff and bed shortages.

The NAO also says that that the full impact of changes such as GPs no longer having to provide emergency cover for their patients, are still to be felt.

Do you think that waiting times in casualty units have improved? What action should be taken to improve the situation? Send us your comments and experiences?

This debate has now closed. Thank you for your comments.

Your comments:

SUGGEST A DEBATE This topic was suggested by Peter McKechnie, UK: A report says A&E waiting times are much reduced, do users of the service agree? Send us your suggestions for Have Your Say debates

I work in an A&E department as a mental health nurse. The government's obsession with waiting times in A&E does not take into consideration the sheer weight of numbers that attend. The NAO has quite rightly highlighted the problem of beds and shortage of staff. Patients are not left in A&E because of a lack of access to diagnostic tests or better planning of admissions and discharges. There are simply not enough beds to admit patients into and if there are no beds then people have to wait! Members of the Government and the Department of Health should come and work a shift in A&E and perhaps they might grasp the realities of day to day work on the front line, iInstead of setting unrealistic and quite frankly pointless targets
Daniel Franey, London

Oh please! Quit with the whining about the NHS and their casualty departments. You may have to wait but you don't have to mortgage your house for treatment. Try coming to America where the waits are often just as long BUT we have to see the bank manager before we go so that we can pay the extortionate bill. This myth that other countries handle their medical services any better needs to end.
Susan, Lansing, USA

A and E departments are just like the rest of the NHS, underfunded, under staffed and run by non-medical managers. Equally patients don't have the option of a GP out of ours now, so A & E departments will find themselves stretched and we will have to wait four or more hours. I work for the NHS and all we ever hear is government targets, waiting times and 'star points'. True patient care is watered down every day in attempts to rush people through. We need more equipment, more nurses and more doctors. Isn't that why we pay so much tax?
Chris Chowns, Portsmouth, Hampshire

The 4 hour target has served to increase inappropriate attendances to A&E departments Dr S Patel, London

I am a Junior Doctor in London. The pressure on A&E departments to move patients out within 4 hours due to links of targets to funding means that huge risks are being taken by hospitals, moving patients before they are adequately treated. When times are all pervading, the quality of care undoubtedly suffers. This comes from professionals who are responsible for providing care. People who are very ill are seen quickly, and, in the most part, always have been. The 4 hour target has served to increase inappropriate attendances to A&E departments, meaning it is the ill who suffer. A young well person who attends with a simple cold, as many do, should not have to be seen within 4 days, let alone 4 hours. In a system such as ours, it is essential that people take some responsibility for their health, rather than running to A&E for trivial complaints. NHS Direct is a largely irrelevant service that has only served to increase costs and hospital attendances and inappropriate ambulance use.
Dr S Patel, London

The waiting times are getting better. Sadly, for whatever reason, people will always whinge at their NHS, where they can walk in off the street and demand to see a doctor for a variety of non-accidents and non-emergencies, at no perceived cost to themselves (the whole world pays taxes, folks), try doing that anywhere else in the world, and see how far you get!
JR, Sheffield, UK

Coming from South Africa, we have to pay for medicare at point of delivery. I would have to almost be dead before I would seek medical attention. Who cares about long A&E waits when you don't have to worry about the cost of treatment!
Jason, London

A few years ago I dislocated my elbow in a fall, after being taken to A+E and seeing the triage nurse within a few minutes, I was taken to a cubicle and waited their for 5 hours only to be told I have bruised my elbow and to go home by a very stressed doctor. Two days later I was back again, sent by my GP, and after waiting another 4 hours (because they had conveniently lost my x-rays for the 1st time) I was told by 2 doctors I had broken it and to go to the facture clinic the next day. The consultant in that clinic decided that I had dislocated but somehow managed to pop it back in my self. I have nurses and a consultant surgeon in my family and you should hear the stories they can tell.
Rachael , Nottingham

I do not believe in A&E approved waiting times from recently experience, I did leave the A&E department to be shift to a room next door which was named the MOB (medical observation bay ) where my husband was still assessed by the A&E team who popped in and out. So it is clearly shifting the patients next door so that the statistic would present a nice and improved result. Brigitte
Brigitte Vandenbossche, St Albans

There ought to be much a stricter admissions policy Thom Boston, London

Yes, the waiting times are coming down - I think there can be little dispute about that - at least, for people who genuinely need treatment. What I think tends to happen is that people anticipate having to wait maybe a day or two to see their GP, and decide to take a short-cut instead and nip up the hospital. Well I'm sorry, but if you're doing that, you deserve to be made to wait! There ought to be much a stricter admissions policy - perhaps nurses could direct people to an NHS Direct phone. This is, after all, what banks do when they've got a rush on! Couple this with a real effort to change society's attitudes to binge drinking, and we'll cut the waiting times massively.
Thom Boston, London

As has been mentioned a few times there are people saying they went home and treated themselves. Tip for next time. call the NHS direct helpline first. they are very good and seem to be overlooked.....
Anon, London

I went to A&E on a Sunday afternoon and it was rammed. I was told there was a 4 hour wait! The people waiting had things such as minor cuts, headache's and one person i spoke to said they still had a hangover from the previous night and wanted to see if it could be cured faster! People must accept some responsibility and apply a bit of common sense and use the A&E appropriately, a large part of the problem would then go away.
Adam, Birmingham, UK

Until people like this stop wasting everybody's time, people with real emergencies will suffer Iain, Poole

Some of the comments here seem to highlight the problem as being time wasters; not the staff, which I agree with. When my wife had her finger crushed by a falling sash window (ouch! It still makes my eyes water thinking about it), whilst awaiting treatment for 3 hours on a Sunday night, tears and blood pouring in almost equal measures, someone came in with a bee sting (no allergic reaction, just a bit sore) and an old gent had called an ambulance because he had twisted his knee a bit. After waiting ten minutes he started abusing the receptionist, asking why he had not been seen (whilst walking to and from his chair to the desk more than a couple of times), then asked for an ambulance to take him home because he didn't want to wait! He was duly informed that there was a Taxi rank outside. Until people like this stop wasting everybody's time, people with real emergencies will suffer.
Iain, Poole

I am an NHS employee and have seen people wait almost three days for treatment in extreme circumstances - a lot of our time is spent dealing with drunks and people with mental health issues maybe they should have weekend and evening clinics instead of seeing them in A & E
Anon, UK

Why not have a 10 pound co-payment if you use the A&E?
D.S. Erickson, San Antonio, Texas

It's easy, close A&E for drunks and other self inflicted and avoidable stupidity mishaps. That way genuine accident and emergency victims can be taken care of.
Phil C, Sheffield, UK

What people need to understand is that A&E is for emergencies Matt B, Derby

I work in a hospital where the 4 hour wait is a huge issue...but it wouldn't be if people didn't turn up for absolutely stupid reasons. What people need to understand is that A&E is for emergencies and, as a result, each person will be assessed as to how important their case is....so how people who have twisted an ankle can complain when they have to wait over 4 hour so as to make way for serious road accidents and spinal injuries is beyond me!!! All these targets do is encourage figure-fiddling and passing on of patients ASAP.
Matt B, Derby

The problem is that most of the time you can't get seen by your GP when you're ill or in pain. A few weeks ago, I had what I knew was tonsillitis (I'm a regular sufferer). I was in severe pain and knew exactly what was wrong with me, but when I called my GP I was told there were no appointments for three days. I was advised to see a pharmacist, but the only advice they could offer was to suck on a throat lozenge. I ended up going to a private clinic and paying �70 to be seen by a doctor and get the antibiotics I needed, but thousands of people either don't have access to that sort of service or can't afford to pay, so A&E must seem like their only option.
Allie, London

You have to wait even longer than before Charles, Crawley

Crawley which is a major town in the south no longer has an A&E thanks to the Labour MP for Crawley who refused to stop its closure. People now have to go to Redhill which is an extra 15 mins drive and then you have to wait even longer than before.
Charles, Crawley

I visited my local A&E department earlier in the year, and I had to wait about 10 minutes to be seen, it then took around 30 minutes to be X-rayed and treated. I'm quite happy with that!
Jamie, Leicester, UK

I was in my local A&E 2 months ago after breaking my ankle. I was in and out within 90 mins and treated well by the mainly foreign staff throughout. Why anyone would go to A&E with a problem they could sort themselves is beyond me. During my visit there was a 40 year old woman waiting to be treated for skinned knees - absolutely ridiculous.
Jan, UK

I had to wait in the A&E for almost 5 hours with no painkillers Michelle, UK

Our waiting times are appalling. I was attacked on my way home from work and ended up being taken to hospital with a suspected broken arm. I had to wait in the A&E for almost 5 hours with no painkillers. And to make it worse, I could see the duty doctor through the door with his feet up talking to a mate on his mobile phone for half an hour. I dread being in a major accident with that sort of doctor on call.
Michelle, UK

My sister once went into A&E when she had dislocated her knee. She arrived at lunchtime and by 8pm the nurses advised my mother to take her home and bring her back the next day as she wouldn't be seen till then anyway! This she did, and came back the following morning and she was finally seen at 1pm!!!
Nicole, London

If you go to A&E for a simple insect bite (my sister is an A&E doctor and has seen this more than once!!) you must expect to have to wait while doctors deal with more important things. If your injury is a real emergency you will be seem immediately. Simple as that. There is talk of renaming the departments 'Emergency' (without the 'Accident') which I think might get the message across more clearly to Joe Public, who can see it as an alternative to a trip to the chemist!
Anna, UK

Let's hope that the forecast overspend of �25 billion of my tax money on the new NHS computer system will help - big chance!
John Davies, Sunbury UK

Accident and emergency services seem to be used by people who do not need urgent treatment Nicola, Middlesbrough

Accident and emergency services seem to be used by people who do not need urgent treatment. People on this website have said they waited in A&E 4 hours then went home and treated themselves. Well why go to A&E in the first place then? Was it that serious? People need to access services appropriately so A&E can respond to really urgent cases.
Nicola, Middlesbrough

The last time I was in casualty in the UK, it was Friday night. I was behind a lot of very drunken people who were abusive to the staff as they had to wait. It didn't occur to them that out of the 20 of us there, only 4 of us were not drunk, and 3 of us had not even been drinking. Tackle this little problem and the waiting times in A&E may just take care of themselves.
David, Berlin, Germany, ex UK

I've been to casualty 3 times in 12 years. Each time I've seen staff physically assaulted by patients. The last time a husband (who'd hospitalised his wife) threatened a nurse with a meat cleaver because she wouldn't let him see his wife (presumably to finish what he'd started). He was overpowered by police using pepper spray...which meant he needed treatment in casualty!!! It's no wonder A&E depts are short staffed. Much of the blame lies with the patients' behaviour, not government funding.
Peter, Nottingham

As an NHS employee I can fully endorse the fact that the NHS is making great strides in general. Having said that we are still wasting money on useless posts like Access Facilitators and Equality & Diversity Officers - just to tick a few boxes and keep everyone happy. This money would be better spent on patient care. Some management seem to have lost that principle.
James, Leeds

I don't believe she would have survived another 3 hours surrounded by aggressive drunks Barbara, Altrincham, Cheshire

A&E certainly does not cater for the elderly. Last year my 93 year old mother had a fall and cut her head. She is in a wheelchair, very frail and has Alzheimers. We arrived at 9pm, at 11pm I asked how much longer we had to wait. We were told that the department was busy, it would be at least another 3 hours. The bleeding had stopped so we took her back home; I don't believe she would have survived another 3 hours surrounded by aggressive drunks.
Barbara, Altrincham, Cheshire

I broke my wrist 18 months ago. I arrived at the A&E at 10am and was seen by a doctor, X-rayed and my wrist plastered by 11.30am. I think my A&E were very quick.
Yvonne, Liverpool

The initial waiting time has been altered, as you are seen by a triage nurse within minutes, but then made to wait for hours on end. What they seem to do is pop in and say hello to you from time to time and then claim you have been "seen", but in my book, my 15 hours on a trolley, was still 15 hours on a trolley, no matter how many cheery "hellos" there were!
Caroline, Bristol, UK

My wife recently visited A&E with suspected appendicitis. As a blood test would take more than 4 hours to come back she was admitted to a surgical ward so the A&E department didn't miss the waiting time target. A crude way of manipulating the figures that also blocks a hospital bed
Steve, Canterbury

I was then placed on a trolley bed in casualty for 4 hours and completely ignored Neil, Birmingham, UK

I was in hospital at the beginning of the year with abdominal pains and although I was seen almost immediately on arrival and ushered through the waiting throngs, I was then placed on a trolley bed in casualty for 4 hours and completely ignored. I then "queued" in the observation room for another hour. It feels like they are moving the queues rather than cutting them, which resembled the queue filtering at theme parks!!
Neil, Birmingham, UK

Unfortunately like all services it is oversubscribed and poorly staffed. Many people visiting A&E could see the doctor which clogs the system up for more serious cases. The NHS generally needs an overhaul but this would take a brain and a brave heart to do it.
Carole, UK

I've only been to casualty once, and it was an awful experience. I cut my hand badly at home and needed stitches. I arrived at 6:00pm on a Saturday. Good I thought, at least I've missed the Saturday night drunks. I was seen by a nurse immediately but had to wait till around 2:00am to actually see a doctor. He was the only SHO on minor casualty on a Saturday night and naturally seemed harassed, but kept disappearing during my treatment and was short tempered with me when I was distressed. The whole experience was depressing, disorganised and clearly understaffed. Simple organisation, such as having enough staff on at busy times would help. Perhaps training up nurses to deal with simple procedures such as stitches could help free up doctors and clear the backlog.
RL, London, UK

Modern medicine can, unfortunately, not offer a cure for crass stupidity Jason Miles, Reading, UK

My wife is a doctor who has suffered massive verbal (and the occasional physical) abuse whilst working in A&E. She says most of the problems occur while she's attending to a critically ill elderly patient or a child, and some drunken yob demands to have a plaster applied to his scratched chin. Modern medicine can, unfortunately, not offer a cure for crass stupidity.
Jason Miles, Reading, UK

I was in A&E recently with clots in my leg, I was seen instantly by someone who could hardly speak English, who decided that I had a pain in my leg. About 4 hours later I saw a doctor who told me I had a clot in my leg, and that I should see the vascular surgeon as soon as possible, and to go home. An appointment was later booked 6 weeks hence. As it still hurt, I rang a doctor friend in Nice who told me to sit with my leg as high as I could, and to take some aspirin every day. It worked a treat. I have just got on to a waiting list (hurrah!), so I should have the day surgery op during the spring (2005). My first appointment was in May 2004.
Steve, UK

Of course we're being told waiting times are getting better just like crime is down, the armed forces are being "rationalised" and public transport is hunky-dory. How grateful we should be to live in Blair's utopia.
Ash M, London

The waiting lists are long where I live, but I appreciate that doctors are overworked and stressed with little resources. If you are unfortunate enough to end up in casualty, it would be nice to be seen almost immediately you go in, but unfortunately this cannot happen.
Anon, Maidstone, UK

Strip out the benches in A&E and replace them with beds. That way you can get your head down for a couple of nights and if you're lucky you'll be seen on the third day!
Patrick V. Staton, Guildford, UK

The debate should be about quality of care and not speed of delivery Paul, London

I got knocked off my bike recently and whilst I was seen very quickly in A&E the quality of the service I received was poor. I was neither checked for concussion although I had injured my head and I wasn't X-rayed. It later transpired I had a broken bone. The debate should be about quality of care and not speed of delivery.
Paul, London

How can I possibly believe this rubbish when a nurse friend of mine tells me that when the inspectors come round to monitor this, the hospital knows in advance to bring on extra staff for that period so everything looks really efficient. Another example of deception to try and meet government targets and as an ex-public servant I'm also aware of how easy it is to bend statistics when necessary.
Sue, Romford

I was lucky yesterday, only had to wait 40 mins for treatment. Three years ago I gave up after waiting for four hours and treated myself. There does appear to be improvement although it undoubtedly depends on the day and time.
Anya, London, UK

I waited 7 hours for a broken finger to be attended to - so I just ended up walking out of the A&E department. I don't blame the hospital or its staff though, it's not their fault. I blame the government who have placed the NHS and its staff under poor working conditions and poor pay.
Chris, Braintree, Essex, UK

My son is asthmatic and sometimes needs treatment at our local casualty department. Waiting time depends entirely on what time of day we arrive. Most people don't attend casualty often enough (thank goodness) to be able to make comparisons. What would be nice is to see all staff can speak English - there's an over-reliance on foreign doctors, whose English is often inadequate.
John, London, UK

I visited the A&E department of my local hospital last year. I was instantly assessed by a nurse and then had to wait for roughly 4 hours to be seen by a doctor. Although this was longer than I expected, I did appreciate that the staff were doing the best they could and that there were more important cases than mine.
James D, Birmingham, UK

On a TV programme last night it was stated that 60% of ambulances called to a scene on a Saturday evening in cities and 7 out of 8 admittances to A&E were drink related. Surely if this was reduced then waiting would be cut dramatically.
Allan, Reading