Midland casualty departments received some of the poorest ratings by patients in a national survey.

Cleanliness, waiting times and overall care were problems raised in the A&E patient survey by independent watchdog The Healthcare Commission.

More than a quarter of patients at most A&Es in the region said it took well over the four-hour government target time to be dealt with – some spending more than 24 hours in casualty.

University Hospital of North Staffordshire NHS Trust was shamed over visiting times with half of patients saying they spent between four and over 24 hours waiting to be well enough to go home or be referred to a ward.

A third of A&E patients reported similar waiting times at Russells Hall Hospital, in Dudley, Mid Staffordshire Hospitals, Shrewsbury and Telford Hospitals and University Hospitals Coventry and Warwickshire.

A University Hospital of North Staffordshire NHS Trust spokeswoman said: “This survey was conducted in the early days of a major move of our emergency departments. There were teething troubles and some patients waited longer to be seen or admitted than staff would like. The trust also has the busiest A&E in the West Midlands, treating 260 to 300 emergency patients each day.”

Liberal Democrat health spokesman Norman Lamb is calling on health secretary Alan Johnson to investigate discrepancies over waiting times with so many patients waiting longer than the four-hour target – despite official figures stating 98 per cent of patients are treated in the target time.

Five Midland trusts – University Hospital Birmingham (UHB), which runs Selly Oak A&E, Dudley Group of Hospitals, Mid Staffordshire Trust, South Warwickshire General Hospitals and Walsall Hospitals Trust – received some of the lowest patient gradings for care.

UHB, Mid Staffordshire, Walsall, South Warwickshire, University Hospital of North Staffordshire Trust and Heart of England Trust, in charge of Good Hope, Heartlands and Solihull A&Es, received the lowest ratings for cleanliness.

UHB, Heart of England and North Staffordshire Trusts have been highlighted in the past year over high rates of superbugs, like MRSA and Clostridium difficile (C.diff).

The Healthcare Commission said the survey in March on 50,000 patients was a snapshot poll on people’s experiences during that day.

Sue James, chief executive for Walsall Manor Hospital, which scored highly on short waiting times, said: “We have worked hard to have a high performing service as far as waiting times in A&E are concerned, now we are concentrating on improving the overall patient experience.

“We have already appointed two new consultants in A&E and have increased the cleaning resources available to the department.”

While a UHB spokeswoman said: “The survey was carried out several months ago and much work has already been undertaken to resolve those issues that are most important to patients like improving the environment in the A&E waiting rooms.”