CASE notes of patients who have used the Royal Gwent Hospital’s emergency department are being scrutinised in a review of health board assessment processes.

Aneurin Bevan University Health Board is working with the Welsh Government and NHS Wales’ Delivery Support Unit on the case note review.

A health board report highlights the main challenge facing the service as “the ability to link the range of planned improvements to the delivery of sustained performance improvement against the national four-hour and 12-hour targets”.

There have been improvements in patient discharges from hospital and in the flow of patients through the hospital system - but there has been no corresponding improvement in performance against the aforementioned targets.

A minimum 95 per cent of patients attending emergency units should be dealt with inside four hours, but health boards across Wales regularly fail to meet this by some considerable distance.

The latest figures, for March, show that at the Royal Gwent, just two thirds of patients (66.6 per cent) were dealt with inside four hours. This was one of four hospitals in Wales where performance dipped below 70 per cent.

At Nevill Hall, the emergency department dealt with 87.4 per cent of patients inside four hours, the second best performance in Wales in March, but still well below the target.

The performance at Nevill Hall showed a marked improvement on that for Mach last year (78.4 per cent), but at the Royal Gwent, performance was slightly down on that for March 16 (67.1 per cent).

Patient attendances for each month were similar at the Royal Gwent but there was an eight per cent fall at Nevill Hall this year.

The report states that “the health board’s urgent care system continues to experience high demand for acute care” with one of the consequences being delays for patients.

Another stubborn problem is waits of longer than 12 hours, which were slightly up in Gwent emergency units for the first quarter of this year, at 1,911.