More than 50,000 people waited four hours or more in A&E at the Heart of England Trust last year, according to NHS England.
The trust’s major A&E department is performing very badly against the NHS national standard for waiting times in A&E.
The NHS target is for 95% of people visiting A&E to be discharged, transferred or admitted to a ward within four hours of arriving.
At the Heart of England Trust that figure was just 76%.
The 2017-18 report shows that the trust’s major A&E department saw the equivalent of 634 people a day last year.
Around 231,200 people went to A&E, up from 225,800 the previous year.
Of these, 54,383 waited for more than four hours, from arriving in A&E to being discharged, transferred or admitted to a ward.
Dr Chris Moulton, vice president of the Royal College of Emergency Medicine, said that the pressure on A&E has “spiralled out of control”.
“If you keep stretching an elastic band, eventually it will snap,” he said. “You don’t ask ‘why did the elastic band snap’ – it snapped because you stretched it.”
He said that A&E departments were struggling to cope with the demands of a growing and ageing population, particularly since a lack of social care beds keeps elderly patients waiting in A&E.
He said that the more “badly stretched and understaffed” departments were, the more difficult it is to recruit junior doctors, creating a “vicious circle” of staff shortages.
Dr Moulton still supports the 95% target, saying that it’s a “good pressure” on emergency departments to keep as few patients waiting as possible.
“Nobody wants to keep patients waiting,” he said. “That’s anathema to any emergency doctor.”
According to Dr Moulton, the solution is simple – more acute hospital beds, increased capacity in social care, and the staff and facilities to keep those beds open.
He said: “It’s not a magic formula. It’s a blindingly obvious solution.”
Independent health charity the King’s Fund said that A&E performance is a “barometer for the overall performance of the health and care system”.
Senior analyst Deborah Ward said: “A&E performance is influenced by activity and pressure in other services, affecting both the number of people going to A&E, and how quickly A&E can treat them.”
She said that the availability of social care services to support people at home, and how quickly wards are able to accept people who need to be admitted, were two key examples.
“Some of the pressure comes from within A&E departments,” she said. “Staff shortages are particularly concerning, and many have a lack of physical space. Some departments see twice as many patients as they were built for.”
“However, it isn’t relentlessly bad news,” she added. “A&E waiting times, whilst longer than we would like, are about average when compared to similar countries, and patient satisfaction is holding up.
“In July 2018, 87% of people said they would recommend the care they received in A&E to their friends and family.”
In England there were 23.8m visits to emergency departments last year, including urgent care centres, minor injury units and walk-in centres as well as major A&Es.
Of these, 88% spent four hours or less in A&E. This figure has been steadily decreasing – the last time the 95% standard was met was in 2013-14.
Commenting on the national figures, an NHS spokesperson said: “Minor injuries have fuelled a significant rise in A&E visits over the last decade.
“Yet against this backdrop, and with pressures increased by the hottest summer on record, hard-working NHS staff saw, treated and discharged or admitted 50,000 more patients within four hours last month than August last year.”