The worst case was in London, where one 71-year-old woman was kept waiting on a trolley for 41 hours before receiving treatment.

The Casualty Watch 2000 programme was carried out by volunteers from the Association of Community Health Councils of England and Wales (ACHCEW).

The longest waits

41 hours - 71-year-old woman, Harrow, London 25 hours - 46-year-old woman, Redbridge, London 21 hours - 44-year-old man, Brighton 19 hours - 80-year-old , Burton, Staffs 19 hours, 59-year-old, Hillingdon, London 17 hours - overdose victim, Manchester 17 hours - 60-year-old, Merseyside Working with colleagues in Scotland and Northern Ireland, they visited 240 casualty units at 1630 GMT on Monday. The Department of Health's own guidelines say that no-one should be left on a trolley for more than four hours. Its spokesman said: "We welcome the Casualty Watch survey - but it's important to stress that many of these figures are questionable." In particular, he said there were concerns that some of those counted were in hospital beds based in A&E, such as observation wards. However, Donna Covey, ACHCEW's director, described the findings as "shocking and distressing". She said: "They show that people are right to be alarmed about the state of the health service. "Despite the extra money the government invested in A&E following last year's survey, people are still facing unacceptably long waits even by the Department of Health's own standards." The 41-hour wait was found at Northwick Park Hospital in Harrow, north west London - the longest wait found in 1999 was 39 hours. At the same hospital, a 69-year-old man with a heart problem was found to have been waiting more than 30 hours for admission. In all, four patients were waiting a total of 124 hours. However, the worst performing hospital overall was King George Hospital in Redbridge, east London, where six patients were kept waiting for a combined total of 164 hours. Among them was a woman suffering from abdominal pain and vomiting, kept waiting because there were no free beds for 25 hours, despite the fact that she needed surgery. Winter pressures Elsewhere, a man with a facial injury was still waiting for a bed 21 hours after arriving at the Royal Sussex Hospital in Brighton. A shortage of beds has been blamed And a 73-year-old with a heart condition waited more than 18 hours at Hillingdon Hospital in west London. The Casualty Watch checks are traditionally carried out at the end of January, when winter pressures on A&E departments generally are at their worst. Last year's report was equally critical of waiting times. However, the outbreak of virulent flu which caused problems last month is now beginning to ease. The government is investing millions in the refurbishment of A&E units around the country. However, critics say it is the overall number of available beds and staff which creates the problem.