GWENT'S A&E departments performed less well against four-hour waiting times targets last month, and dealt with 2.4 per cent - or 341 - more patients than during December 2017.

The increase in patients bucks the Wales-wide trend for December 2018, while rising numbers of sicker patients - classed as 'major' cases - are adding to the challenge for frontline staff.

But despite last month's figures, and a difficult January to date, Aneurin Bevan University Health Board's winter plan is "holding up well", though the situation is "vulnerable", board members were told by interim director of operations Claire Birchall.

She described the picture locally and nationally as "very challenging", highlighting an instance yesterday morning when 14 ambulances arrived at the Royal Gwent with patients within 40 minutes.

In December, 76.2 per cent of A&E patients at Nevill Hall, and 63.8 per cent at the Royal Gwent, were dealt with inside four hours. This means 3,371 patients waited longer than four hours. Across Wales, the figure was more than 18,000.

Waits of more than 12 hours in Gwent A&E units last month totalled 468, down from 526 in December 2017.

The target is that a minimum 95 per cent of A&E patients should be dealt with inside four hours.

Mrs Birchall said referrals to emergency departments have increased, and more patients who walk in as 'minor' cases, are found to be sicker and are transferred to 'majors'.

'Major' cases continue to increase - there was a huge 13.8 per cent increase is these last month, compared to December 2017. These tend to be older, frailer patients, often with more than one underlying health problem that can complicate the diagnosis and treatment of the problem they have come to A&E with, and involve more staff and take more time to deal with.

Mrs Birchall said the health board is "having good days and challenging days" in terms of achieving timely handovers of patients from ambulance crews, but that there are less very lengthy delays, due in part to work improve turnaround times at the Royal Gwent and Nevill Hall.

She added that extra money has been invested in nighttime senior middle grade staffing until March, and there have been less long delays in the mornings, and fewer patients in emergency departments.

"It's pleasing that the early signs are that the (winter) plan is delivering," she said.

"And we've had good feedback in terms of patients' experience, and the attitude and caring nature of our staff, even at very challenging times."

'Safety huddles' - where A&E staff gather to discuss issues and situations in departments - are being held for a few minutes every two hours, 24/7, and Mrs Birchall said this and other measures are helping departments recover more quickly from periods of peak demand.

'Minor' case attendances at Gwent A&E units were down seven per cent in December, compared to the same month in 2017, which has been put down in part to people taking in the Choose Well message promoted by the NHS in Wales, and seeking a more appropriate solution to their health problems than simply attending A&E.

Health board chief executive Judith Paget there are many more alternatives to attending A&E, such as minor injuries units, GPs, out-of-hours services, and pharmacies, with the recently promoted common ailments scheme a good example.

"We've worked to promote the Choose Well message, and I think we have got alternatives (to A&E)," said Mrs Paget.

"I think based on understanding and reading comments from people, those initiatives are being well used, and there is good uptake in our communities."