These are some of the factors in the rise in A&E wating times:

  • STAFFING AND WARD SPACE

DR James Price denied there was a shortage of staff and space at the John Radcliffe Hospital in Oxford.

Shadow Health Secretary Andy Burnham , pictured, said Government cuts had led to “many hospitals operating below recommended staffing levels”.

But Dr Price said: “Our hospitals and our emergency departments in particular are equipped in terms of space, equipment and staffing to manage whatever clinical scenarios and activities levels occur.

“When A&E departments struggle is when they become very congested, when patients who have been seen and treated by emergency department staff cannot be moved to beds beyond the emergency department.

“The whole system is looking at what happened this winter and what changes must be put in place to make sure it does not happen again.”

Oxford University Hospitals NHS Trust employs 11,000 people, the majority based at the JR.

Dr Price said nationally there were problems recruiting new staff – with some having to bring in Army personnel to cover – but the “excellent links” with Oxford University and Oxford Brookes meant this was not the case in Oxfordshire.

Dr Price said the John Radcliffe had also reduced its use of locum staff “significantly” over the last year.

  • NHS CHANGES

Shadow Health Secretary Andy Burnham said changes to the NHS have had been a “distraction” to sorting out A&E waiting times.

In April, Primary Care Trusts were disbanded and new GP-led Clinical Commissioning Groups were brought in across the country.

The CCGs aim to give clinicians the power to purchase health and social care services in their local areas.

Dr James Price said the GP-led system had not been a distraction in Oxfordshire and said they were the “most efficient and effective deployment” of NHS cash.

He said: “That has to be the correct approach and we have confidence that the clinically-led CCG, working with other clinically-led organisations, will mean that Oxfordshire health services are in good shape for the forthcoming winter.

  • 111

Problems with the NHS’s new non-emergency number 111 have been blamed nationally for increasing A&E waiting times.

The number was brought in to Oxfordshire in October 2012 to replace NHS Direct and GP out-of-hours numbers and was meant to make it easier for patients to seek advice and treatment.

But it has been criticised nationally – where it was rolled out on April 1 – for being understaffed, not having medically trained staff manning phones and being overly cautious.

Dr Stephen Richards said Oxfordshire’s 111 system, run by South Central Ambulance Service, had been “one of the best in the country”.

He said: “Whilst others have fallen over, we have worked closely with them to build the service. It is currently putting more people towards A&E, but not in vast numbers. There was an increase in A&E way before the introduction of 111.

“We would currently acknowledge a one per cent increase [at Oxfordshire’s A&E departments] probably due to 111 services.”

“We will be working with 111 services to see if we can improve that.”

He said the system had been “built to avoid risk”.

  • GOVERNMENT CUTS

Shadow Health Secretary Andy Burnham blamed “severe cuts” to frontline services and “deep cuts” to council budgets for poor A&E waiting times.

He said many NHS trusts were operating below recommended staffing levels and cuts to council social care budgets meant patients could not be discharged from hospital beds.

But asked if the cuts had impacted on A&E waiting times in Oxfordshire, Dr James Price said: “No.”

Asked if they could in the future he said: “No.”

He added: “The budget for our emergency departments have grown to reflect the needs placed upon them and we have developed our systems and our staff to work even more effectively and cost-effectively, recognising that caring should be delivered outside acute hospitals and closer to home by GPs and community health and social teams.

“The country and the National Health and social care services are in a period where we have to deliver the best patient experience and best quality of care within constrained finances. There is no argument with that.”

He could not provide figures for the A&E budget.

Last year it was announced that Oxford University Hospitals NHS Trust had to make £160m of savings over four years as part of £20bn of Government cuts to the NHS.

And last month it was revealed that the trust missed 10 out of the 11 monthly targets it was set for reducing the number of delayed transfers of care.

The issue – dubbed bed-blocking – happens when patients are clinically well enough to be discharged, but are kept in hospital beds because social care arrangements are not in place.

  • GP OUT-OF-HOURS SERVICE

Health Secretary Jeremy Hunt has blamed the extra pressure on A&E departments on Labour’s “disastrous” changes to GP contracts in 2004.

He said 90 per cent of GPs had opted out of providing out-of-hours care and, since the change, four million more people were using A&E services.

Dr Stephen Richards said: “What we are looking at is improving the already good out-of-hours service and improving the knowledge of the population about how to use and access them.

“It is about us working together to get the message out that if you want to see a GP they are there right through, seven days a week, and they have the capacity to see the vast majority of people at out-of-hours centres.”

He added: “Quite a lot of these people would be better and quicker seen either using GPs out-of-hours services, minor injuries units and first aid units.”

Oxford GP Dr Catharine Benson, said: “It would have been disastrous if it was left as it was because the workload was unsustainable.

“I think there is a change in the way people think. People have this perception that you cannot contact a doctor out-of-hours, but that is not how it is.”

  • AGEING POPULATION

Perhaps the biggest factor facing the future of health and social care services in Oxfordshire is the ageing population.

A report by Dr Jonathan McWilliam, the county’s health director, last year said the number of people over 85 in parts of Oxfordshire will have almost trebled from last year to 2031.

In West Oxfordshire it was predicted to rise by 180 per cent by 2031, in Cherwell and South Oxfordshire by 150 per cent and in the Vale of White Horse by 135 per cent.

In Oxford City, the number was expected to increase by 50 per cent.

In his report, Dr McWilliam warned that demand for care for older people was predicted to exceed supply within the next 10 years.