More than half of England’s A&E departments fail to meet minimum standards, a Mirror investigation reveals.

It found 106 out of 197 units were either rated “inadequate” or as “requiring improvement” to be good. Our examination of Care Quality Commission reports into every hospital trust paints an alarming picture of A&E wards stretched to breaking point.

It comes as the NHS is expected to be plunged into its worst winter crisis. Inspectors blasted one hospital for the “misdiagnosis or delayed diagnosis of sepsis” – a potentially lethal condition. At another hospital, CQC experts turned up to find 16 ambulances queuing to hand over patients. At a third, a child lay in a resuscitation bay for six hours before being sent to a children’s ward at a nearby hospital.

And an elderly patient suffering a fractured hip waited for over three hours in an ambulance. Staff also failed to follow up a case of a child whose injuries were caused by abuse. Four consultants were working at the unit when 10 were needed.

Overall, nine units were branded “inadequate” while Hull Royal Infirmary, East Yorks, was found to be inadequate in all but one of the areas examined. The Royal College of Emergency Medicine says one in nine A&E patients in England faced 12-hour waits last month.

In Wales, it was nearly one in seven, while in Northern Ireland it was one in six between July and September. Nicola Wise, CQC’s Director of Secondary and Specialist Care, said the regulator called out “poor care” but also escalated concerns where a national solution was needed.

She told the Mirror: “We have repeatedly highlighted the challenges we see facing urgent and emergency care services and the importance of system-wide service collaboration in its delivery. Ultimately, new models for urgent and emergency care are needed so people receive the care they need, where and when they need it.”

The Royal College of Emergency Medicine said the pressures on A&E were made worse by a lack of beds elsewhere in hospitals and by the crisis in adult social care. An NHS spokesman also expressed concerns, adding: “Recent data makes clear the pressure the NHS is under as we head into what is expected to be another challenging winter.”

He said winter preparations began back in July but added: “The NHS has made significant progress on its urgent and emergency care plan with care traffic control centres and additional ambulance capacity in place.” The NHS target of 95% of A&E patients being admitted, transferred or discharged within four hours has not been met since 2015.

The actual number receiving treatment within four hours slumped to just over 50% last winter. Before 2020, a “trolley wait” of longer than 12 hours was unusual. Now, tens of thousands of patients are left in this position every month. A record 54,532 waited more than 12 hours on trolleys last December.

But there are signs this winter could be even worse after the second-highest number was hit last month. Trolley waits are classed as the time between A&E staff deciding a patient needs to be admitted to hospital to when they arrive on a ward.

The Royal College of Emergency Medicine estimates for every 72 patients waiting 8 to 12 hours from their time of arrival there is one patient death. It is estimated that between 300 to 500 excess deaths per week “were associated with long waits for admitted patients” last year. The crisis in A&E is partly blamed on the lack of beds. The Government promised in January that 5,000 new beds would be available in the NHS by this winter but the Royal College of Emergency

Medicine says there has been a further drop of 2,675 beds since then. Year on year, from October 2022 to October 2023, it says there has only been an increase of 84 general and acute beds.

But the Department of Health and Social Care spokesman said: “We are on track to create an additional 5,000 permanent staffed hospital beds this winter and have already rolled out 10,000 hospital at home places, allowing patients to recover from the comfort of familiar surroundings. Our work through the Urgent and Emergency Care Recovery Plan is already cutting both A&E waits and ambulance response times compared to last year as we make progress towards our ambitious targets.”

Tragic stories of A&E patients

Tamara Davis, 31, was admitted to Brighton’s Royal Sussex County Hospital with a severe chest infection after coughing up blood. After 12 hours being treated in a corridor, she was put on a ventilator but died from sepsis and multiple organ failure.

Dr Rob Haigh, chief medical officer at University Hospitals Sussex NHS Foundation Trust, said: “We send our heartfelt condolences to the family of Miss Davis and our thoughts are with them at this difficult time.”

Tamara Davis (left) died in intensive care at the Royal Sussex and her sister Miya (right) has called her treatment 'disgusting' (
Miya Davis / SWNS)

Marie Shenton, 70, died in November last year after a 15-hour wait in an ambulance outside A&E at Torbay Hospital, Devon. Her sister Bridget Haynes, blaimed the wait for her death, adding: “That’s just not right.” The Trust sent “heartfelt condolences” to Marie’s family.

Marie Shenton died after a 15-hour wait in an ambulance outside A&E at Torbay Hospital, Devon

Alzheimer’s sufferer William Owen, 87, broke his pelvis in a fall and died of an apparent lung infection after 17-hour ambulance wait and a 13 more hours outside Glangwili Hospital, in Camarthen. His family think his long, cold wait is linked to the infection he later contracted.

He was then forced to wait in the back of the ambulance, in temperatures as low as 6C, before he could be admitted to Glangwili Hospital, in Camarthen. Mr Owen’s family believes his long wait in the cold may be linked for the fatal lung infection he later contracted.

His son Ed told The Independent: “It’s like a particular part of the NHS is completely broken. There is this ludicrous situation of long waits because there are no beds.”

William Owen died after waiting 17 hours for an ambulance and then spending a further 13 hours outside A&E
Cynthia Jones died after waiting 22 hours for an ambulance (
Family photo / Karen Buckley)

Ninety-year-old Cynthia Jones died after an operation on her broken hip was delayed a day following a 22-hour wait for an ambulance. Cynthia, from Caerphilly, passed away at The Grange University Hospital in Cwmbran, South Wales, hours after the op.

Sylvia Thomas who was left for 24 hours on a trolley in A&E ended up being buried in the outfit she should have been wearing on her daughter's wedding day. Sylvia Thomas was at the Queen's Medical Centre last October when she fell off her trolley and suffered a heart attack shortly afterwards. The 77-year-old died just over two weeks later.

Sylvia Thomas with her daughter Maria Laney (
ITV News)

An investigation by the Nottingham University Hospitals Trust (NUH), which runs the Queen's Medical Centre, said there were "significant staffing gaps" whilst Mrs Thomas was in their care. Dr John Walsh, Deputy Medical Director at Nottingham University Hospitals NHS Trust, said: “I offer my sincere condolences to the family of Mrs Thomas and apologise for the distress caused. Patient safety is our top priority and we have taken action to reduce the risk of patients falling while in our care.”

Blackpool Victoria: Inadequate The hospital and its A&E unit were rated inadequate in January 2022. Inspectors said in the inspection period “18 patients were managed by ambulance crews in the back of ambulances” as there was no room. The Trust said “much improvement work” had been done “which is having a tangible impact on patient experience”.

Hull Royal Infirmary: InadequateThe A&E department was labelled as “inadequate” by inspectors for safety, effectiveness, responsiveness and whether it was “well led.” Under the category “caring,” inspectors said in March it required improvement. Their report said: “We observed no member of staff handwashing before or after patient contact.”

Royal Shrewsbury: Inadequate Its A&E was rated inadequate in November 2021. Inspectors found “a child waited in the resuscitation bay for six hours before transfer” and an elderly patient with a fractured hip “had been on the ambulance for over three hours”. They added it “didn’t have enough substantive nursing support staff to always keep patients safe”.

The York Hospital: Inadequate The hospital’s A&E department was rated inadequate on three measures in June – “safe”, “responsive” and “well led”. Due to building works, “patient arrivals from ambulances were often treated along a corridor”. A spokesman said: “We continue to work with the CQC to address their recommendations.”

Comment by Adrian Boyle

Adrian Boyle is the President of the Royal College of Emergency Medicine

These reports highlight a system strained to its very limit. This is extremely worrying as the weather turns colder and we head into what will likely be a grim winter without the beds, staff and resources that we need.

Existing staff continue to deliver to the best of their ability, putting patients and their care first and doing all they can to mitigate any risks – often this comes at the cost of burnout. The warning signs have been nothing but clear, performance and quality of care have deteriorated year-on-year. Now, 12-hour patient waits in A&Es have become so normalised. This is wrong, no patient should wait 12-hours in A&E - these were never events and now they are daily events.

Last winter was a ‘ground zero’ moment – or should have been. Together with leading health organisations, we highlighted the crisis the health service faced in a joint report, urging that lessons must be learnt from 2022.

A&Es are the canary in the coal mine, they reflect pressures across the whole system. But the solutions lie outside of A&Es, a good starting point would be to actually increase bed numbers in hospitals and fix social care.

To see meaningful change, we need political will and tangible action. More of the same in the form of short-term cash injections, and short-term planning fail to grasp the scale of the crisis and do nothing to tackle it.