Watchdog's report says those needing treatment suffer more delays than five years ago despite increased NHS spending

Patients who attend accident and emergency departments are waiting longer than ever to be diagnosed and treated, despite the extra money poured into the NHS, a damning report reveals.

Patients who attend accident and emergency departments are waiting longer than ever to be diagnosed and treated, despite the extra money poured into the NHS, a damning report reveals.

The performance of most casualty units in England and Wales has declined during the past five years, according to the Audit Commission, an independent spending watchdog.

Most A&E departments are seeing fewer patients within one hour of their arrival than in 1998 and 1996, years when the commission also carried out surveys. Patients who need further treatment are waiting longer on trolleys before they are admitted to a ward, the study of more than 200 casualty units showed.

The deterioration in waiting times comes despite a 10 per cent increase in the number of doctors in A&E, more than enough to offset an increase in patients of up to four per cent.

Sir Andrew Foster, the commission's controller, said Alan Milburn, the Secretary of State for Health, should be "troubled" by the report.

"If I had put more money and more doctors into the NHS, I would be troubled by how this has happened. These are not mythical figures. I think they reflect the public's experience of attending A&E departments."

He said hospital chief executives should urgently review their own performance and report to trust boards about how to reduce distressing and potentially dangerous delays.

After harrowing reports of patients being parked on trolleys for 18 hours or more, the Department of Health said that, by 2004, no patient should wait more than four hours from arrival in casualty to admission, transfer or discharge.

Labour has invested £150m in modernising A&E departments since 1997 and, in a pre-emptive strike, Mr Milburn announced another £100m to reduce long trolley waits.

The money will pay for 25,000 operations in private hospitals to release NHS beds, an extra 600 nurses in A&E departments and the introduction of a new "streaming" system where patients are prioritised into four queues, instead of one, so that the most serious are treated first.

More than 15 million people attend A&E departments every year. But the survey shows that, in an average department, just 53 per cent of patients see a doctor within an hour compared with 72 per cent in 1996. Half of all departments admitted 76 per cent of patients within four hours, compared with 89 per cent five years earlier.

Waiting times varied hugely across the country. Small units, which see fewer than 40,000 patients a year, are the quickest, along with rural hospitals.

London had the longest waits, with just 30 per cent of patients seen by a doctor within one hour, compared with 50 per cent of patients in the West Midlands, 68 per cent of patients in North Yorkshire, 69 per cent in the South West and 84 per cent of patients in Wales.

Bill Alexander, author of the report, said: "Performance is getting worse. Waiting times are getting longer and the trend seems to be accelerating."

He said longer waits could be the result of poor management and organisation, as well as the introduction of new working hours for junior doctors.

Money and staffing levels were not necessarily critical because short-staffed units often performed as well as those with good manning levels.

Another concern was the number of heart-attack patients who received clot-busting drugs within half an hour of arriving at an A&E department, a technique that substantially increases their survival chances. Just 33 per cent of departments were hitting the target.

Individual hospitals were not "named and shamed" although that is likely to change next year. Sir Andrew urged people to telephone their local hospitals to ask how they fared.

Donna Covey, director of the Association of Community Health Councils, said the report reflected many of the unacceptable delays found by her own organisation.