A WORCESTER hospital has missed key targets for emergency and cancer treatment waiting times, stroke care and infection control as NHS bosses predict a troubled year ahead.

NHS leaders spoke of ‘continuing challenges’ and pressures caused by staff shortages at Worcestershire Royal Hospital when they addressed an annual general meeting at the Charles Hastings Education Centre in Worcester on Monday.

The report showed many of the trust’s key performance measures were in the red.

One of the most important targets is the emergency access target for A&E with the trust supposed to treat, admit or discharge at least 95 per cent of emergency patients within four hours of arriving at A&E.

The proportion of patients seen within that four hour window slumped to 81 per cent (2016/17), a further decline from the previous year when the figure was 87.9 per cent.

Only 71.8 per cent of cancer patients in 2016/17 began their treatment within 62 days of referral, well below the 85 per cent minimum requirement.

This is yet another fall from the previous year when the trust managed 81.2 per cent.

Despite the dip in performance trust bosses admit the number of attendances for 2016/17 and the previous year was ‘comparable’, suggesting they have not seen huge increases in demand.

Instead, the decline in A&E performance has been blamed on lack of beds.

In total 400 patients waited more than 12 hours in A&E from the point at which a decision was made to admit them.

The 18 week referral to treatment target has also slumped from 83.51 per cent (2016/17) from 89.2 per cent the previous year. The threshold is 92 per cent.

The trust report blamed high demand and staff shortages and said performance was not likely to improve next year.

At least 80 per cent of stroke patients are supposed to spend at least 90 per cent of their time on a stroke ward so they have the best chance of survival and recovery.

For the last financial year the trust managed this only 54.8 per cent of the time.

Only 18 per cent of stroke patients were admitted via A&E to a stroke ward. The figure is supposed to be over 70 per cent.

In the last financial year there were 41 cases of clostridium difficile against a threshold of 32 and four cases of MRSA against threshold of zero.

Vice chairman of Worcestershire Healthwatch Jo Ringshall who attended the meeting said afterwards: "We are concerned.

"The more timely cancer treatment is started, the more effective it is likely to be.

"A lot of it is down to staffing and rotas and diagnostics as to why people are having to wait longer."

Ms Ringshall also said psychological harm could be caused to those who were waiting for treatment which she described as 'really stressful' for patients and their families.

"She said while it was important to give the permanent executive team time to make the changes there was always a question of 'how long' they needed when patients were affected.

The trust outlined plans for 2017/18 to recruit more staff and manage patient flow more effectively.

This involves working to fill 153 medical vacancies out of 705.

There are 164 nursing vacancies out of a total of 1,837 at the trust.

Using locum and agency staff rather than its own employees to fill the rota drives up costs, further increasing the trust's deficit.

Worcestershire Acute Hospitals NHS Trust has been in special measures since 2015 and was rated inadequate by the health and social care regulator, the Care Quality Commission following unannounced visits by inspectors.

Special measures apply to NHS trusts with serious failures in quality of care and where there are concerns that existing management cannot make the necessary improvements without support.

The expectation is that trusts will exit special measures after re-inspection within the initial 12 month period or following the extension period of six months.

The trust’s chairman, Caragh Merrick, who has been in her position now for a year, said the organisation had faced ‘an unrelenting media spotlight’.

However, she said managers were committed to bringing the trust out of special measures which they were now in a position to do with a permanent executive team.

She said staff continued to do their best for patients, praising their commitment under difficult circumstances.

She added: “We are now in a position to move forward with confidence.”

Chief executive Michelle McKay said: "Every day I receive a letter or email from a very grateful patient whose experience has been excellent within the service."

The trust also faces significant financial challenges, including a deficit of £28.7 million for 2016/17 which met the financial control target.

This is an improvement on the previous year's deficit of £59.9 million as the trust clawed back savings and received extra funding of £16 million.

The deficit next year is expected to be £42.7 million but if the trust can meet certain targets set by the NHS Improvement then it can secure extra funding of around £12.7 million, reducing the figure to £30 million.

Robin Walker, MP for Worcester, said the best option for Worcestershire Acute Hospitals NHS Trust was that it received the support it needed rather than being taken over by another trust.

He said: "If management can turn things around and support staff that is the best outcome of all, really. The one thing we all want is a safe hospital that is functioning well.

"I have been trying to make sure they have the support from Government they need. I think that is there now."

Mr Walker has lobbied for the trust to receive £29 million from the Government. £900,000 is already being spent on improving Worcester's A&E.

As previously reported some of this will go towards 81 extra beds and 141 more parking spaces. The trust aims to have some of these beds available by next winter.