A&E waiting times longer - CQC
Waiting times are getting longer at NHS accident and emergency departments in England, according to a survey of patients by the health regulator.
The Care Quality Commission (CQC) survey showed 33% of people spent more than four hours in A&E - up from 27% in 2008.
Government targets say no more than 5% of patients should breach the four-hour limit.
The CQC spoke to 46,000 patients between January and March 2012.
A third of those surveyed also said they waited more than half an hour before they were seen by a doctor or a nurse, up from 29% in 2008 and 24% in 2004.
David Behan, the chief executive of the CQC, said: "The important issue is that people who need to be treated urgently, do not have to wait, it is disappointing therefore that people have said they have to wait longer to be treated than four years ago.
"People should be seen, diagnosed, treated and admitted or discharged as quickly as possible and this is an issue that trusts need to urgently tackle."
The regulator also said there needed to be improvements in getting people to hospital as 24% of people taken by ambulance had to wait more than 15 minutes to be transferred to A&E.
The Department of Health said a four-hour wait was too "narrow" as it "forced A&E staff to make a broken toe as much of a priority as a patient with potentially life threatening chest pains".
A spokesperson added: "Meeting targets and ticking boxes does not ensure good patient care, and we are putting doctors and nurses in charge of making clinical decisions to ensure that the most sick patients in A&E are the highest priority.
"The latest official figures show that the vast majority of people are waiting just 40 minutes to be seen for the first time and the NHS continues to see 95% or more of patients in four hours or less in A&E."
However, the shadow health secretary Andy Burnham said: "It is becoming clearer by the day - the NHS is struggling and the government is doing nothing about it.
"Contrary to his boasts, David Cameron has cut the NHS and we are now seeing the consequence: ambulances queuing outside A&E; patients left on trolleys for hours on end; and, as we learned this week, hospitals 'full to bursting'."
The chief executive of the NHS Confederation, Mike Farrar, said it was important to acknowledge improvements in areas such as cleanliness.
However he said: "There are a number of issues with these results that are a cause for concern, and highlight the growing pressures that our urgent and emergency services are facing.
"These results reinforce just how essential it is for all parts of the system to work together to deliver seamless care for patients. For example, delays in handing over patients at emergency departments cause extended waits for treatment, are expensive and inefficient for the NHS, and mean people lack confidence in getting the right care in the right place when they need it."
The Patients Association said delays in A&E and in ambulances were worrying.
Its chief executive Katherine Murphy said: "With rising admissions and shrinking budgets urgent action is needed by the government to prevent A&E departments becoming bottlenecks."