A report by the Audit Commission revealed that the number of people waiting more than an hour to see a doctor has increased by 18 per cent over the past two years.
A further concern was that the Government's target of heart attack patients receiving blood-clotting drugs within 30 minutes of arriving at hospital was being realised with only a quarter of patients.
Dr Jonathan Boyce, the director of health and social services at the commission, said that staff could be spread more efficiently within departments. Waiting times vary enormously between casualty departments even when they are similarly busy with the same number of staff. "There are variations between trusts, and it is a question of using staff more efficiently and monitoring performances and setting targets," he said.
In 1995-96, 72 per cent of patients were seen by a doctor within an hour but by last year (1997-98) this had fallen to 67 per cent, despite hospital trusts reporting an 85 per cent increase in doctors in the past two years, particularly consultants and higher junior doctor grades.
However, the report did show some improvements in service, including widespread access to CT scanning, specially qualified doctors in more than half the country's casualty departments and more access to children's nurses. It also showed that more day surgery is being carried out in hospitals in England and Wales for operations including hernias, cataracts and varicose veins.
Up to eight times more patients are being treated in this way, and the number of hospitals with specialist day surgery units has increased from 75 per cent in 1990-91 to 93 per cent.
A spokesman for the Department of Health said: "The Audit Commission has recognised that there are now more staff on the front line in A&E departments and that children's nurses and specialists are more widely available.
"Looking forward, we will be building on progress in A&E with some pounds 250m `winter pressures' money we have just announced. We recognise that more needs to be done. That is why we have just announced an extra pounds 30m to improve and streamline A&E facilities and equipment to help provide a faster, better service."
The department said it was continuing to look at ways to bring down "unacceptable" waiting times. It also said it was trying to improve day case facilities in a few places, and to convince some surgeons of the benefits of day surgery.
n NHS consultants are spending less time treating patients and more hours on paperwork, a survey claimed yesterday.
The study by the Doctors and Dentists Pay Review Bodyrevealed that the amount of administrative work had increased by 73 per cent.
More than half the consultants are working over 50 hours a week for the NHS, with 10 per cent working more than 65 hours, the survey, published in Hospital Doctor, reported.
The average time spent by consultants on management and administrative work has gone up to 9.7 hours a week, from 5.6 hours a week in 1989.Reuse content