Two in five patients waited too long in a Scottish A&E last week, as the turnaround figures fell to to their lowest level since January.
Public Health Scotland reported just 60.9% of people were seen within the official four-hour target in the seven days to December 10, a sharp drop on 64.9% the previous week.
It was the worst figure since the week ending January 8.
The Scottish Tories said the figures were “atrocious and unacceptable”.
The number and proportion of patients enduring extreme waits also shot up.
The number waiting more than eight hours rose from 2,833 to 3,818,or from 11.9 to 15% of patients, while those waiting more than 12 hours rose from 1,252 to 1,693, or 5.3 to 6.7%.
The target is for 95% of patients to be admitted, transferred or discharged within four hours.
It has not been met nationally since July 2020.
The worst performing health board last week was NHS Forth Valley, with just 46% of patients seen within four hours, then NHS Grampian (52.9%) and NHS Lanarkshire (54.9%).
The deterioration coincided with more people attending A&E, up from 23,716 and 25,387.
December and January are traditionally the busiest months in A&E.
The figures emerged just hours before the Government announces its budget for 2024/25, with SNP finance secretary Shona Robison expected to cut services and raise tax.
Opposition parties linked the A&E numbers to SNP health Secretary Michael Matheson and the row over his £11,000 Holyrood iPad bill, run up on a holiday in Morocco.
He is now being investigated by the Scottish Parliament’s cross-party management body after claiming £3,000 on his expenses towards the bill.
Tory MSP Dr Sandesh Gulhane MSP said: “Scotland’s worsening A&E waiting times are atrocious and unacceptable.
“The number of patients waiting four hours and eight hours to be seen is at its highest since January, which highlights the abject failure of the discredited and distracted health secretary Michael Matheson to get a grip of this ongoing crisis.
“The tragic reality is that these delays lead to needless loss of life.
“Overstretched NHS staff are doing all they can, but they are carrying the can for the dire workforce planning of a succession of SNP health secretaries.
“These figures are simply terrifying for staff and patients alike and there is a real risk that we will see the same scale of crisis we saw in Scotland’s NHS last winter - or even worse.
“The last thing we need in these circumstances is a health secretary focused on personal scandals rather than his crucial day job.”
Scottish Liberal Democrat leader Alex Cole-Hamilton said the waiting times were “disastrous” and the Government’s NHS recovery plan had “failed”.
He said: “NHS staff are working flat-out to give people the care they need, but they simply don’t have the beds, safe staffing and resources they need,” he added.
“They have been sounding the alarm for months but the SNP/Green Government just isn’t listening.
“Scotland needs a Government laser-focused on the day job and that will put the voices of staff first.”
Mr Matheson said: “The heightened winter pressure being felt by our A&E departments is not unique to Scotland, with similar challenges being felt by emergency departments throughout the UK.
“However, I am clear that performance remains below the levels we all wish to see and we continue to work closely with boards to support delivery of sustained improvements.
“As we approach the peak winter period we are ensuring boards have the support they need to deal with increased pressure on services.
“Our winter plan is helping boards maximise capacity to meet demand and our £50 million investment will help support Scottish Ambulance Service recruitment
“To ensure people receive care at home or as close to home as possible, where clinically appropriate, we are providing an additional £12 million to boards to further expand Hospital at Home services.
“Scotland’s core A&Es continue to be best performing in the UK for eight years.”
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