CLOSE to 6,500 patients who attended the emergency unit at the Royal Gwent Hospital in the first three months of 2017, waited longer than four hours to be dealt with.

Figures for January, February and March show that equates to a little more than one third of all attendances at what is Wales' third busiest unit.

They also indicate that once again, this has been a very busy winter for the NHS - and this has not been confined to Gwent, with frontline emergency units feeling the strain across Wales.

Last month, 66.6 per cent of patients (4,638 out of 6,966) who attended the Royal Gwent unit were dealt with inside four hours. This was down on the performance for February (67.9 per cent, or 3,997 out of 5,884), but better than that for January (64.9 per cent, or 4,147 out of 6,391).

The emergency unit at Morriston Hospital in Swansea dealt with just 59.5 per cent of its patients inside four hours last month, while those at Wrexham Maelor and Ysbyty Glan Clwyd, near Rhyl, recorded 68.1 per cent and 67.5 per cent respectively.

In contrast last month, the emergency unit at Abergavenny's Nevill Hall Hospital dealt with 87.4 per cent of its patients inside four hours, the second highest of the 13 major units in Wales.

Nevill Hall's has consistently been among the best performing units in Wales, albeit with a smaller patient intake than the Royal Gwent.

The target is for emergency units in Wales to deal with a minimum 95 per cent of patients inside four hours.

This target has never been achieved on a Wales- or even health board-wide basis. Individual units have achieved it, though only sporadically and not for several years.

A continued increase in the numbers of older patients presenting as emergencies, and often with a range of complex conditions to manage, is putting increasing pressure on units.

There is too, the ongoing challenge for unit managers of trying to predict when surges in demand will happen, so shifts can be staffed to deal with them.

And inappropriate attendances - by patients with problems that could better be dealt with by other services, such as their GPs, minor injuries units or NHS Direct - also contribute to longer waiting times.