ACCIDENT and emergency units again failed to meet four- hour waiting times targets last month, with close to 850 Gwent patients waiting longer to be dealt with.

Once again, no health board in Wales dealt with 95 per cent or more of its major A&E cases inside four hours as required by the Welsh Government, and this is a level of performance that remains elusive not just on an all- Wales basis, but at an individual health board level.

In November, A&E units at the Royal Gwent and Nevill Hall Hospitals dealt with 9,812 patients.

This was more than 700 fewer than in October, with the average for both months for patients dealt with inside four hours being just over 91 per cent.

But comparisons are difficult, as concentrated bursts of activity within months that overall have lower numbers of patients coming through than others, can result in a 'spike' in longer waits.

The 846 patients who waited longer than four hours in November was the lowest for the two units combined during the April-November period.

Overall monthly figures for health boards also include performance at minor injury units, which tends to be higher, and for November, that overall performance against the four-hour target for Gwent was 92.8 per cent.

A&E continues to be used as a venue of first resort by too many patients whose illness or injury could best be treated elsewhere, for instance at a minor injuries unit, through their GP or self-treated.

Campaigns like Choose Well Wales (choosewellwales.org.uk) continue to provide advice on when and when not to use A&E but around 40 per cent of attendees could best be treated by other means.

There are also increasing numbers of 'major' cases coming into A&E, many by ambulance.

These are mainly elderly and often they come with several underlying health conditions.

The attention and resources required to manage these often causes longer waits for other patients in A&E. Waits of longer than 12 hours in A&E remain a high profile issue, and in November 109 patients in Gwent endured such waits at the Royal Gwent and Nevill Hall.

This is slightly up on October, but much lower than those recorded in most of the summer.